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does not guarantee absolute safety, nor should it. Of course, some dangers are too high to be acceptable. So long as consumers are properly informed, however, the presumption has traditionally been in favor of consumer sovereignty and freedom of choice. Yet, even most libertarians will admit that the tobacco market has been characterized by severe market failures, including information asymmetry between producers and users, distorted consumer choice due to information deficits, and product pricing that has not reflected the full social costs of the product’s use (especially the effects on nonsmokers). They acknowledge the legitimacy of interventions aiming to prevent youth smoking, to disseminate accurate information and correct misinformation, and to assure that nonsmokers are protected from involuntary exposure to tobacco smoke if the market does not function properly. The residual issue concerns the legitimacy of interventions that burden smokers’ choices for the purpose of getting them to quit. The overarching task for the nation is to consider thoughtfully how consumer freedom can be respected while also taking into account the unique properties of tobacco and tobacco products. The committee’s major goal here is to set forth a framework for reducing tobacco use, and its associated morbidity and mortality, while being duly respectful of the interests of consumers and the companies that satisfy consumer needs.

THE POLICY CONTEXT

During the first six decades of the 20th century, tobacco use became deeply embedded in the economic and cultural life of the United States and in many parts of the world, sowing the seeds of a massive public health problem. The prevalence of smoking among adults in the United States was 42 percent in 1965. The tide turned in the 1960s as the adverse health effects became known, but the prevalence of smoking among adults was still 21 percent in 2005. Absent a major initiative, the prevalence of smoking among adults is likely to level off in 2025 at about 15 percent (see Chapter 3).

Aggressive policy initiatives were impeded for four decades by the tobacco industry’s political and legal strategy of denying and obscuring the addictive properties of nicotine and the real health effects of tobacco use. All this also was reinforced by widespread popular acceptance of consumer freedom to smoke (characterized by its defenders, somewhat ironically, as the “right to be foolish”). In retrospect, it is surprising and puzzling that strong measures to discourage smoking were regarded as unduly paternalistic even by people who otherwise might have been expected to favor strong consumer protection measures. Laissez-faire more or less prevailed despite the seriousness of the problem.

Until the late 1980s, the operating assumptions of tobacco policy in the United States were rooted in the society’s general preference for individual



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