The most important role of the federal government is to provide leadership for the nation in a comprehensive multi-pronged effort to achieve a society free of tobacco-related disease and death. This responsibility requires the setting of goals, together with a visible and emphatic commitment to achieve those goals. As discussed below, this does not mean that the federal government should try to manage or direct state and local initiatives or those of the private sector. The nation does not need a "czar" of tobacco control. However, the federal government must commit itself to the effort and, by its own actions, lead the way. Until now, this has not been the case.
There are important signs of change. The General Services Administration has established a smoke-free policy for federal buildings. The Occupational Safety and Health Administration (OSHA) has initiated a rule-making process that could require smoke-free policies for all workplaces covered by OSHA. The Department of Defense has implemented a smoke-free workplace policy. The Food and Drug Administration has initiated an important discussion regarding the need for regulation of tobacco products. The surgeon general's 1994 report on smoking and health was devoted to children and youths and, upon its release, Surgeon General Elders called for restriction on advertising and promotion of tobacco products.
Since 1964, the surgeon general has provided the most consistent and most authoritative federal voice on tobacco control. The annual reports on smoking and health have documented the health consequences of tobacco use and disseminated new research findings to broad public and scientific audiences, and substantial progress in reducing smoking prevalence has been achieved over the past three decades, since Surgeon General Luther Terry issued the federal government's first comprehensive report on the devastating health toll caused by smoking. However, the surgeon general has no direct-line authority to regulate tobacco products, provide technical assistance to states, monitor public health, conduct research, or provide service. Nor does the surgeon general have the authority to manage or coordinate these activities, which are spread throughout the Public Health Service. In the Committee's view, however, the problem of coordination, which will be addressed below, is separate from the issue of leadership.
Federal leadership requires an unequivocal commitment to tobacco control, and specifically to a youth-centered tobacco control policy, that is acknowledged and vigorously pursued by all agencies of the federal government. This means that the goal of preventing nicotine addiction must be enunciated clearly and that the specific objectives of Healthy People 2000 (and successor documents) should