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problem; this is what is meant by the phrase “ending the tobacco problem” used in the title of this report. While that objective is not likely to be achieved in 20 years, the report aims to set the nation irreversibly on a course for doing so.

The committee also needed to decide what it means to formulate a “blueprint.” One possible approach was for the committee to regard its task as a purely scientific one—simply to offer technical advice to policymakers. Under this approach, the committee would confine itself to the task of evaluating the effectiveness (and perhaps the costs) of various policy tools for reducing smoking, leaving it to policymakers to take individual liberty, justice, and other values into account in deciding which policies to implement. However, such a restrained approach struck the committee as incompatible with the specific, direct, and emphatic nature of the instruction we had been given “to generate a blueprint for the nation in the struggle to reduce tobacco use.” Accordingly, the committee’s recommendations are direct and specific.

The Policy Context

For many years, a policy paradigm emphasizing consumer freedom of choice and decrying unwarranted “paternalism” dominated public opinion and policymaking on tobacco. In retrospect, however, the committee believes that predominant emphasis on consumer choice in public opinion during this period was largely shaped by the tobacco industry’s successful efforts to deny and obscure the addictiveness and health consequences of tobacco use, and on an array of resulting market failures, including information asymmetry between producers and users, distorted consumer choice due to information deficits, and product pricing that did not reflect the full social costs (especially the effects on nonsmokers). As the scientific evidence about addiction and the health effects of tobacco use has grown, and the industry’s deceptive strategies have been exposed in the course of state lawsuits and other tobacco-related litigation, public understanding of tobacco addiction has quickly deepened and the ethical and political context of tobacco policymaking has been transformed.

Consequently, over the past 10–15 years, the operating assumptions of tobacco policy in the United States and elsewhere in the world have fundamentally changed. As shown in Chapters 3 and 5, a widespread popular consensus is now emerging in favor of aggressive policy initiatives, and this shift in popular sentiment has also been accompanied by support across most of the political spectrum.

In this context, it is worth pausing to take note of the ethical foundation for taking strong steps to reduce tobacco use. From a traditional public health perspective, the legitimacy and importance of reducing tobacco use



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