ORISNAL
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AppRess.

By
C. Everett Koop, M.D.
SURGEON GENERAL
U.S. Pupiic HEALTH SERVICE
AND
Deputy ASSISTANT SECRETARY FOR HEALTH
U.S, DEPARTMENT OF HEALTH AND HUMAN SERVICES

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PRESENTED TO THE PAN AMERICAN HEALTH ORGANIZATION
SUB-REGIONAL MEETING ON NATIONAL SMOKING CONTROL PROGRAMS

Buenos AIRES, ARGENTINA
NovemBer 18, 1985
(GREETINGS TO HOSTS, GUESTS, FRIENDS, ETC.)

IT IS A GREAT PLEASURE AND A DISTINCT PERSONAL PRIVILEGE FOR ME
TO ADDRESS YOU THIS MORNING,

AS THE SURGEON GENERAL OF THE U.S, PUBLIC HEALTH SERVICE. | AM
CONCERNED FOR THE HEALTH AND WELL-BEING OF EVERY ONE OF OUR CITIZENS,
SINCE WE HAVE MORE THAN 235 MILLION CITIZENS, I HAVE TO RECOGNIZE SOME
PRIORITIES IN MY COUNTRY’S PUBLIC HEALTH AGENDA,

AND THE TOP PRIORITY FOR ME -- AS IT HAD BEEN FOR THE FOUR
SURGEONS GENERAL WHO PRECEDED ME -- IS TO REDUCE CIGARETTE SMOKING IN
THE UNITED STATES BECAUSE CIGARETTE SMOKING IS THE SINGLE, GREATEST
KILLER OF OUR PEOPLE,

AND IT IS PREVENTABLE.
HOW LONG HAS THIS BEEN GOING ON?

CIGARETTES HAVE BEEN SMOKED FOR OVER 100 YEARS. IN FACT. THE
CIGARETTE MACHINE WAS INVENTED 100 YEARS AGO, BUT THE LARGE-SCALE
CONSUMPTION OF CIGARETTES 1S A PHENOMENON OF THIS CENTURY. IT EVOLVED
IN OUR SOCIETY DURING -- AND JUST AFTER -- THE FIRST WORLD WAR.
CIGARETTE SMOKING WAS ONE OF THOSE DARING, “SINFUL” THINGS SOME PEOPLE
DID DURING THE DECADE OF THE 1920’s, WHICH HISTORIANS OF THE UNITED
STATES HAVE CALLED “THE ROARING TWENTIES.”

BUT THE GREAT SURGE IN CIGARETTE SMOKING TOOK PLACE DURING THE
SECOND WORLD WAR, WHEN MEN AND WOMEN IN MILITARY SERVICE PAID VERY
LITTLE FOR CIGARETTES...OR PAID NOTHING AT ALL. THOSE YOUNG PEOPLE
BECAME OUR FIRST GENERATION OF “HEAVY SMOKERS,” PEOPLE WHO SMOKED MORE
THAN 30 CIGARETTES A DAY...A PACK AND A HALF OR MORE.
AS THAT GENERATION ENTERED THEIR 50s AND 60s, THEY BEGAN TO SHOW
HIGHER AND HIGHER RATES OF LUNG CANCER AND HEART DISEASE. THE
AMERICAN HEART ASSOCIATION FIRST SOUNDED THIS ALARM IN THE LATE 1950s,

IN 1961 DR, LUTHER L. TERRY WAS APPOINTED U.S. SURGEON GENERAL BY
PRESIDENT KENNEDY, DR. TERRY BROUGHT TOGETHER A NUMBER OF EMINENT
PHYSICIANS AND RESEARCHERS TO REVIEW THE GROWING BODY OF DATA
CONCERNING THE RELATIONSHIP BETWEEN SMOKING AND HEALTH,

IN 1964, DR, TERRY PUBLISHED THE FINDINGS OF THAT COMMITTEE. IT
WAS TITLED SMOKING AND HEALTH: THE REPORT OF THE ADVISORY COMMITTEE 10

THE SURGEON GENERAL.

IT WAS A PROFOUNDLY IMPORTANT EVENT, SINCE IT SET US ON THE TRACK
OF DOCUMENTING, THROUGH CAREFUL EPIDEMIOLOGICAL AND BIOMEDICAL
RESEARCH, THE NATURE AND EXTENT OF THE HEALTH RISKS CAUSED BY THE
SMOKING OF CIGARETTES,
THAT FIRST REPORT IN 1964 WAS FOLLOWED BY 16 OTHERS, ALMOST ONE A
YEAR FOR THE PAST 20 YEARS, IN A MONTH OR SO, I WILL RELEASE THE 18TH
SURGEON GENERAL’S REPORT ON SMOKING AND HEALTH, IT WILL ADDRESS THE
HAZARDS AND THE ECONOMIC IMPACT OF SMOKING AT THE WORKSITE,

ALL THESE REPORTS INDICATE SMOKING WAS -- AND STILL IS -- A GRAVE
THREAT TO INDIVIDUAL AND FAMILY HEALTH.

1 BECAME SURGEON GENERAL IN 1981, I RELEASED THE REPORT FOR THE
FOLLOWING YEAR, THAT 1982 REPORT CLEARLY SHOWED THE LINK BETWEEN
CIGARETTE SMOKING AND CANCER, PARTICULARLY LUNG CANCER. IT IMPLICATED
CIGARETTES IN AS MANY AS 129,000 CANCER DEATHS PER YEAR.

OUR 1983 REPORT WAS ON THE CLOSE RELATIONSHIP BETWEEN SMOKING AND
CARDIOVASCULAR DISEASE. AND THE NUMBERS WERE EVEN LARGER: WE
ESTIMATED THAT CIGARETTE SMOKING WAS DIRECTLY RELATED T0 170,000
CORONARY HEART DISEASE DEATHS EACH YEAR. AGAIN...A SUBSTANTIAL
NUMBER,
THE 1984 SURGEON GENERAL’S REPORT ON SMOKING AND HEALTH
DOCUMENTED THE RELATIONSHIP BETWEEN CIGARETTE SMOKING AND CHRONIC
OBSTRUCTIVE LUNG DISEASE. ONCE AGAIN, WE HAD A GRIM PICTURE OF HIGH
MORBIDITY -- CHRONIC, LONG-TERM SUFFERING -- AMONG CIGARETTE
SMOKERS,

DURING THOSE SAME 20 YEARS, 1964 THROUGH 1984, AS THE EVIDENCE
WAS MOUNTING IN THESE REPORTS ISSUED BY FOUR SURGEONS GENERAL, THE
UNITED STATES REQUIRED THAT ANTI-SMOKING MESSAGES HAVE AS MUCH TIME ON
RADIO AND TELEVISION AS CIGARETTE ADVERTISING HAD. THOSE PUBLIC
SERVICE MESSAGES APPARENTLY HAD AN EFFECT BECAUSE CIGARETTE
CONSUMPTION BEGAN TO LEVEL OFF FOR THE FIRST TIME IN THIS CENTURY,

NEXT, CONGRESS BANNED THE ADVERTISING OF CIGARETTES ALTOGETHER ON
ANY ELECTRONIC MEDIA. THE CONGRESS FURTHER REQUIRED THAT EVERY
PACKAGE OF CIGARETTES AND EVERY SCRAP OF CIGARETTE ADVERTISING CARRY A
WARNING FROM THE SURGEON GENERAL THAT SAID “SMOKING IS DANGEROUS TO
YOUR HEALTH,”
DURING THIS PERIOD, ALSO, CERTAIN OTHER COMMERCIAL INTERESTS IN
OUR SOCIETY BEGAN TO SEE THE VALUE IN THEIR OWN TERMS OF THE ANTI-
SMOKING CAMPAIGN... THE HEALTH AND LIFE INSURANCE PEOPLE, FOR EXAMPLE.
AND SEVERAL AIRLINES AND SOME HOTELS AND RESTAURANTS...A FEW TO BEGIN
WITH, BUT THE LIST CONTINUES TO GROW,

THESE AND OTHER DEVELOPMENTS COMBINED TO EFFECTIVELY EDUCATE THE
PUBLIC ON THE SERIOUSNESS OF THE CIGARETTE ISSUE. I CALL THIS PERIOD
"PHASE 1” OF OUR FIGHT AGAINST SMOKING,

IN “PHASE II” THE NONSMOKER ARRIVED ON THE SCENE. THE NONSMOKER
WAS MERELY IRRITATED AT FIRST, BUT THEN BECAME ANNOYED. AND FINALLY
THE NONSMOKER BECAME MILITANT. THE MORE MILITANT HE OR SHE HAS BEEN,
THE GREATER THE CHANGE THAT HAS OCCURRED IN SOCIAL CUSTOMS AND IN
LOCAL AND STATE LAW,
FOR EXAMPLE, IN 1973, THE STATE OF ARIZONA BECAME THE FIRST STATE
TO PROHIBIT SMOKING IN PUBLIC PLACES, ON COMMERCIAL AIRLINERS IN
ARIZONA AIRSPACE, AND ON BUSES,

IN 1975 THE STATE OF MARYLAND PASSED A LAW THAT SPECIFICALLY
PROTECTS NON-SMOKING PATIENTS FROM THE HARMFUL EFFECTS OF PASSIVE
SMOKING IN ALL HEALTH FACILITIES,

SINCE THEN, MORE THAN 30 OF OUR 50 STATES AND HUNDREDS OF LOCAL
COMMUNITIES HAVE FOLLOWED SUIT, ENACTING ORDINANCES TO PROHIBIT OR
SEVERELY RESTRICT SMOKING IN PLACES LIKE RESTAURANTS, GOVERNMENT
OFFICES, THEATERS, INDOOR SPORTS ARENAS, BUS STATION WAITING ROOMS,
CLINICS, RETAIL STORES, AND SO ON,

WHAT DO THESE LAWS SAY? LET ME GIVE THE SAN FRANCISCO LAW AS AN
EXAMPLE. ON MARCH Ist, 1984, SAN FRANCISCO PUT INTO EFFECT
"PROPOSITION P.” WHICH THE VOTERS OF THAT CITY APPROVED IN AN ELECTION
WATCHED BY THE WHOLE COUNTRY,
"PROPOSITION P” IS A TOUGH LAW, IT SAYS, AMONG OTHER THINGS,
THAT EVERY WORKPLACE AND EVERY PUBLIC GATHERING PLACE MUST SEPARATE
SMOKERS FROM NON-SMOKERS. A COMPLAINT BY A SINGLE NON-SMOKER IS
ENOUGH TO REQUIRE THIS SEPARATION IN ORDER TO PROTECT THE HEALTH AND
WELL-BEING OF THE NON-SMOKER, IN ADDITION, IF THE PEOPLE RESPONSIBLE
FOR A PUBLIC SPACE DO NOT SEPARATE THE SMOKERS AFTER A COMPLAINT HAS
BEEN LODGED, THEY ARE SUBJECT TO HEAVY DAILY FINES,

ANOTHER VERY INTERESTING EXAMPLE OF ANTI-SMOKING LAW IS IN
VIRGINIA, FIRST, VIRGINIA HAD A LAW THAT SAID, IF A PUBLICLY EMPLOYED
FIRE-FIGHTER, POLICE OFFICER, OR DEPUTY SHERIFF IS DISABLED OR DIES
BECAUSE OF HEART DISEASE, RESPIRATORY ILLNESS, OR HIGH BLOOD PRESSURE,
THE STATE WILL ASSUME THAT THE ILLNESS WAS CAUSED BY THE CONDITIONS OF
EMPLOYMENT, THEREFORE, THE STATE AGREES TO BE FULLY LIABLE FOR ALL
COMPENSATION AND PENSION CLAIMS,
HOWEVER, SEVERAL COUNTY GOVERNMENTS IN VIRGINIA HAVE GONE ONE
STEP FURTHER. THEY SAY THAT THOSE SAME CARDIOVASCULAR AND RESPIRATORY
DISEASES ARE ALSO LINKED TO SMOKING, AS THE SURGEON GENERAL’S REPORTS
AND OTHER RESEASRCH HAVE AMPLY DEMONSTRATED OVER THE PAST 20 YEARS.
HENCE, THOSE COUNTY GOVERNMENTS WILL DENY COMPENSATION OR PENSION
CLAIMS MADE BY ANY EMPLOYEES WHO PREMATURELY BRING THOSE CONDITIONS
UPON THEMSELVES BY SMOKING.

AND NOW THOSE SAME COUNTIES DEMAND THAT ALL NEW EMPLOYEES IN
PUBLIC SAFETY SIGN THE FOLLOWING PLEDGE:

"T AGREE NOT TO SMOKE AT ANY TIME, SO LONG AS I AM EMPLOYED BY THE
ABOVE-MENTIONED AGENCIES (THAT IS, POLICE, FIRE, AND SHERIFF'S
OFFICE), WHETHER ON OR OFF DUTY, AND THAT MY FAILURE TO COMPLY
WITH THE ABOVE-MENTIONED CONDITIONS OF EMPLOYMENT SHALL CONSTITUTE
GOOD CAUSE FOR MY EMPLOYER TO TERMINATE MY EMPLOYMENT.”
10

1’D BE HARD-PRESSED TO FIND A BETTER EXAMPLE THAN THIS OF JUST
HOW COMPLETELY THE PUBLIC HAS ACCEPTED -- AND BELIEVES -- THE FACTS
PUBLISHED IN THE 17 REPORTS ON SMOKING AND HEALTH THAT HAVE BEEN
ISSUED BY THE SURGEONS GENERAL OF THE U.S, PUBLIC HEALTH SERVICE SINCE
1964,

TODAY, WE HAVE GOOD REASON TO THANK THE MILITANT NONSMOKER FOR
THE PROGRESS WE ARE MAKING. THE NONSMOKING MILITANT HAS BEEN THE
CENTRAL FIGURE IN WHAT 1 LIKE TO CALL “PHASE II” OF THE FIGHT AGAINST
CIGARETTES,

WE ARE IN “PHASE III” NOW. AT THIS TIME, WE’RE BEGINNING TO
UNDERSTAND WITH MORE SCIENTIFIC PRECISION JUST WHY THE NONSMOKER IS SO
UPSET. DURING THIS PHASE WE HAVE BEGUN TO GENERATE HARD DATA THAT
SPECIFICALLY MEASURES THE DETRIMENTAL HEALTH EFFECTS OF PASSIVE OR SO-
CALLED “SIDE-STREAM” SMOKING,
1]

THE DATA REGARDING THE EFFECTS OF “SIDE-STREAM” SMOKING UPON
CHILDREN HAVE BEEN AROUND FOR SOME TIME, BUT THE EVIDENCE REGARDING
ADULTS WAS MORE SUGGESTIVE... LESS FIRM,

THAT’S CHANGED, HOWEVER. TODAY, WE HAVE GOOD, SOLID INFORMATION
-- AND MORE IS BEING DEVELOPED -- CONCERNING THE EFFECTS OF A SMOKER’S
ENVIRONMENT UPON THE ADULT NONSMOKER OR “PASSIVE SMOKER.”

ONE OF THE MOST SIGNIFICANT PIECES OF INFORMATION OF THIS NATURE
WAS PUBLISHED IN THE SEPTEMBER 27TH, 1984, ISSUE OF THE NEW ENGLAND
JOURNAL OF MEDICINE. IT’S A JAPANESE STUDY THAT MEASURED THE PRESENCE
OF COTININE, A METABOLIC PRODUCT OF NICOTINE, IN THE URINE OF PASSIVE
OR SIDE-STREAM SMOKERS, THE JAPANESE RESEARCH TEAM CONCLUDED THAT IF
YOU ARE A NONSMOKER BUT YOU LIVE WITH SOMEONE WHO SMOKES 2 PACKS A
DAY, YOU WILL BE UNWITTINGLY “SMOKING” 3 CIGARETTES A DAY YOURSELF.

THE EVIDENCE AGAINST CIGARETTES HAS BECOME QUITE FORMIDABLE...SO
MUCH SO THAT THE UNITED STATES CONGRESS PASSED NEW LEGISLATION LAST
YEAR TO MAKE THE LABELS ON CIGARETTES MORE PRECISE AND -- WE WOULD
HOPE -- MORE EFFECTIVE AS DETERRENTS,
12

THE NEW LAW IS CALLED “THE COMPREHENSIVE SMOKING EDUCATION ACT OF
1984,” IT REQUIRES CIGARETTE MANUFACTURERS TO ROTATE FOUR WARNINGS IN
THAT SMALL RECTANGLE THAT HAS CARRIED THE SURGEON GENERAL’S HEALTH
MESSAGE, THE NEW MESSAGES WARN THE PUBLIC...

THAT "... SMOKING CAUSES LUNG CANCER, HEART DISEASE, EMPHYSEMA, AND
MAY COMPLICATE PREGNANCY,”

THAT ",..PREGNANT WOMEN WHO SMOKE RISK FETAL INJURY AND PREMATURE
BIRTH,”

THAT “,..CIGARETTE SMOKE CONTAINS CARBON MONOXIDE.”

AND THAT ",.. QUITTING SMOKING NOW GREATLY REDUCES SERIOUS HEALTH
RISKS,"
13

ALL FOUR WARNINGS BEGAN APPEARING ON CIGARETTE PACKAGES AND IN
CIGARETTE ADVERTISING AS OF OCTOBER 12TH,

THE REQUIREMENT FOR THESE FOUR LABELS WAS A HIGHPOINT IN THIS
"PHASE ITI” PERIOD IN THE HISTORY OF THE DECLINE AND FALL OF THE
CIGARETTE INDUSTRY,

BUT AS GOOD A JOB AS WE HAVE DONE OVER THE PAST 20 YEARS, I CAN
TELL YOU THAT WE ARE STILL FAR FROM SATISFIED WITH THE RESULTS,

THERE ARE STILL 53 MILLION AMERICANS WHO SMOKE, THESE 53 MILLION
PEOPLE...ONE-THIRD OF ALL AMERICANS WHO ARE 14 YEARS OLD OR OLDER...
ARE STILL VICTIMS OF ONE OF THE MOST DESTRUCTIVE SUBSTANCES IN OUR
ENVIRONMENT,

IT IS ALSO ONE OF THE MOST ADDICTIVE: 78 PERCENT OF THOSE WHO
SMOKE WANT TO STOP, BUT THEY CAN’T, CIGARETTES CONTAIN NICOTINE,
WHICH IS ONE OF THE MOST ADDICTIVE DRUGS IN OUR SOCIETY.

HOWEVER, WE DO HAVE REASON TO REMAIN OPTIMISTIC. LAST YEAR, FOR
EXAMPLE, THERE WAS A 7 PERCENT DROP IN THE ANNUAL PER CAPITA CIGARETTE
CONSUMPTION, BRINGING THE FIGURE DOWN TO LESS THAN 3,500 CIGARETTES
PER PERSON. THAT FIGURE HASN’T BEEN THAT LOW SINCE 1949,
14

ALSO, THE NUMBER OF MEN WHO SMOKE CIGARETTES -- AS A PERCENTAGE
OF ALL MEN -- DECLINED FROM 37,9 PERCENT T0 33 PERCENT BETWEEN 1980
AND 1983, AMONG WOMEN, THE DECLINE WAS FROM 29,8 PERCENT TO 29
PERCENT...A SLIGHT CHANGE, THAT’S TRUE, BUT A DECLINE NEVERTHELESS.

IN ADDITION, WE ESTIMATE THAT LAST YEAR 21 PERCENT OF ALL HIGH
SCHOOL SENIORS SMOKED CIGARETTES: 6 YEARS AGO NEARLY 30 PERCENT DID,
THAT ALSO IS A SIZEABLE DROP,

AND JUST RECENTLY THE STATISTICS FOR THE FIRST QUARTER OF 1985
BECAME AVAILABLE. IF THEY HOLD STEADY FOR THE REMAINING THREE
QUARTERS, THEN 1985 WILL BE THE FIRST YEAR IN WHICH FEWER THAN 30
PERCENT OF AMERICAN ADULTS SMOKE CIGARETTES.

I AM VERY GRATIFIED TO SEE THIS KIND OF IMPROVEMENT AND I HOPE IT
WILL CONTINUE,

I MUST CONFESS THAT I DON’T PRETEND TO KNOW ALL THE REASONS WHY
WE ARE MAKING PROGRESS,

MAYBE IT’S THE WEIGHT OF 20 YEARS’ WORTH OF RESEARCH,

MAYBE IT’S THE BUILD-UP OF STATE AND LOCAL ANTI-SMOKING LAWS,
15

MAYBE IT’S THE PRICE OF CIGARETTES, WHICH HAS BEEN CLIMBING TO A
DOLLAR AND MORE A PACK,

MORE THAN LIKELY IT’S NOT ONE BUT RATHER ALL THESE THINGS THAT
HAVE BEEN SLOWING DOWN AND EVEN REVERSING THE TREND OF CIGARETTE
SMOKING IN THE UNITED STATES,

THROUGHOUT THE PAST 20 YEARS WE’VE HAD A GOAL AND THAT GOAL HAS
BEEN TO REDUCE THE CONSUMPTION OF CIGARETTES BY OUR CITIZENS, TODAY,
HOWEVER, I DON’T THINK THAT GOAL IS STRONG ENOUGH,

THERE HAS TO BE MORE PURPOSE TO OUR EFFORTS THAN THAT. I BELIEVE
WE NEED TO ASK OURSELVES WHAT OUR OBJECTIVE IS DOWN THE ROAD, WHAT
KIND OF ACHIEVEMENT DO WE WANT TO CELEBRATE IN THE FUTURE?
lo

TO THAT IMPORTANT QUESTION I HAVE ALREADY PROPOSED AN ANSWER, I
BELIEVE THE ULTIMATE GOAL FOR THE UNITED STATES SHOULD BE...

A SMOKE-FREE SOCIETY BY THE YEAR 2000,

WE HAVE THE SCIENTIFIC BASIS FOR SUCH A GOAL, THAT‘’S CLEAR ENOUGH
FROM THE MOUNTAIN OF SCIENTIFIC DATA WE HAVE BEEN PUBLISHING FOR THE
PAST 20 YEARS,

AND WE HAVE MORE THAN ENOUGH PUBLIC UNDERSTANDING AND SYMPATHY
FOR SUCH A GOAL, THAT SHOULD BE CLEAR ENOUGH BY THE RISING LEVEL OF
MILITANCY AMONG NONSMOKERS,

AND 1 ALSO BELIEVE THAT MANY OF OUR SOCIAL, POLITICAL, AND
ECONOMIC INSTITUTIONS HAVE ALREADY SET THEMSELVES ON THE PATH TOWARD
SUCH A GOAL, EVEN THOUGH THEY MAY NOT YET HAVE EXPRESSED IT QUITE THAT
WAY.
17

I ISSUED MY CALL FOR A “SMOKE-FREE SOCIETY BY THE YEAR 2000” IN
MAY 1934 IN MIAMI,

T SAID THAT THIS IDEA WAS NOT JUST A PUBLIC HEALTH SERVICE
INITIATIVE...NOR WAS IT A SURGEON GENERAL’S PET PROJECT, RATHER, IT
WAS A CALL FROM THE SURGEON GENERAL TO THE PEOPLE OF THE UNITED
STATES,

AND SOQ FAR, THE RESPONSE TO THAT CALL HAS BEEN EXCELLENT, THE
BOARDS OF DIRECTORS OF THE AMERICAN CANCER SOCIETY, THE AMERICAN LUNG
ASSOCIATION, AND THE AMERICAN HEART ASSOCIATION ARE ALL SQUARELY
BEHIND THIS EFFORT,

T HAVE RECEIVED MANY LETTERS FROM HOSPITAL AND CLINIC STAFFS,
TELLING ME THAT THEY ARE MAKING THEIR INSTITUTIONS “SMOKE-FREE.”

PARENT GROUPS AND SCHOOL GROUPS, DOCTORS’ GROUPS AND NURSES’
GROUPS HAVE ALL SENT ME MESSAGES, AFFIRMING THEIR BELIEF IN THE NEED
TO MAKE THE UNITED STATES “SMOKE-FREE.”
18

WHEN I FIRST ISSUED THE CALL LAST YEAR, I DID SO PRIMARILY AS AN
ACT OF FAITH, I THOUGHT IT SHOULD BE DONE AND I HAD FAITH THAT WE
COULD DO IT, SINCE THEN, I AM HAPPY TO REPORT, THE IDEA HAS NOT ONLY
BEEN SWEEPING THROUGH OUR OWN COUNTRY, IT’S BEEN GETTING SERIOUS
CONSIDERATION IN OTHER COUNTRIES, AS WELL...ENGLAND, ISRAEL, AND
SWEDEN, FOR EXAMPLE,

TODAY, I WOULD LIKE TO ENCOURAGE YOU TO ADOPT THAT VERY SAME GOAL
FOR YOUR OWN COUNTRIES. TOGETHER, WE CAN MAKE THIS HEMISPHERE “SMOKE-
FREE SOCIETY BY THE YEAR 2000,”

ACHIEVING SUCH A GOAL WOULD MEAN THE ANNUAL SAVINGS OF HUNDREDS
OF THOUSANDS OF LIVES AND TENS OF BILLIONS OF DOLLARS, THE LIVES
SAVED WOULD BE THE LIVES EACH COUNTRY NEEDS THE MOST: THE LIVES OF ITS
YOUNG PEOPLE AND ITS WORKING ADULTS,
19

THE BILLIONS OF DOLLARS, NOW SPENT ON MEDICAL BILLS FOR THE
TREATMENT OF SMOKING-RELATED ILLNESS, COULD BE MORE WISELY SPENT ON
BETTER HOUSING, BETTER EDUCATION, AND -- YES -- BETTER HEALTH CARE,
T00,

I TOLD YOU ABOUT OUR “PHASES I, II, AND III.” I'D SAY WE ARE NOW
IN "PHASE IV," A PHASE OF HISTORY DURING WHICH OUR SOCIETY BEGINS TO
SCRUB ITSELF CLEAN OF CIGARETTE SMOKE,

THIS IS A LONG AND COMPLEX CAMPAIGN, THE NUMBERS OF PEOPLE
INVOLVED ARE VERY LARGE,,.AS I SAY, SOME 53 MILLION ADULTS IN THE
UNITED STATES STILL SMOKE,

THE SIZE AND INFLUENCE OF THE CIGARETTE INDUSTRY IS ALSO VERY
GREAT. IT IS A $60 BILLION-A-YEAR INDUSTRY, ACCORDING TO ITS OWN
ECONOMISTS, THAT’S ABOUT 2,5 PERCENT OF THE GROSS NATIONAL PRODUCT OF
THE UNITED STATES,
20

BUT THE RESULTS OF SUCH A CAMPAIGN ARE ALSO FORMIDABLE. WE ARE
TALKING ABOUT RESCUING EACH YEAR 340,000 INDIVIDUALS FROM PREMATURE
DEATHS BROUGHT ON BY THE SMOKING OF CIGARETTES,

AND WE ARE TALKING ABOUT AN ANNUAL SMOKING-RELATED MEDICAL BILL
FOR OUR NATION OF CLOSE TO $40 BILLION,

THE PATHWAY TO A SMOKE-FREE SOCIETY MAY HAVE MANY BARRIERS THROWN
ACROSS IT AND IT MAY SEEM TO BE HEADING ONLY UPHILL. BUT WE BELIEVE
IT IS THE PATHWAY EVERY CIVILIZED SOCIETY MUST FOLLOW, IF WE HOPE TO
REDUCE THE NUMBERS OF PREMATURE DEATHS FROM CANCER, HEART DISEASE,
STROKE, AND CHRONIC OBSTRUCTIVE LUNG DISEASE,

IT IS MY HOPE THAT EVERY NATION REPRESENTED AT THIS MEETING WILL
JOIN US ON THAT SAME PATHWAY,..THE ONE LEADING TO A SMOKE-FREE SOCIETY
BY THE YEAR 2000,

THANK YOU,

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