Tobacco Documents Online

I/ii/78 ~~ To: Chief Executives General Counsel FOR YOUR INFORMATION ~AP -) ,Hs ( ~ uJ oO J

b j EMBARGO : " k. ~2,.:', ~.~ ~" 2 . I1' • :4~'~':.'~ i .0 ~ . ~--$" NOT Oa USE BEF0aE DEL1:VEaY - AT 9:30 A.M., ES'T, JANUARY ii, 1978 • ADDRESS BY JOSEPH A. CALIFAN@, JR. SECRETARY OF HEALTH, EDUCATION, AND WELFARE BEFORE THE NATIONAL INTERAGENCY COUNCIL ON SMOKING AND HEALTH SHOREHAM HOTEL WASHINGTON, D. C. January II, 1978 I want to thank you, Dr Terry -- for your remarks, and for =he leadership you have given, over ~he years, =o ~h~ public health effor~ =ha= brings us here ~oday. ... . - .~ , -. ., .. . .,. ~ • . .- . . .-, It gives me great pleasure =o accep~ =he chairmanship of Nationa! Education Week on Smoking. Two and one-half years ago my son Joe, who was then II years old, told me that the best birthday present I could give him would be ~o stop smoking. I se= abou= then to give up cigarettes. And =he best present I could give Joe turned out =o be one of the hardes~ =hings I have ever tried ~o do. Eventually I quiu, on October 21, 1975. Two and one-half years ago, I acted as a father and an individual.

t • ," " . t o- o C - 2 - One year ago, ! became secretary of the cabinet depart- men= responsible for the health of this na~on. It is in that capacity i speak today. I speak as a Secretary who has been studying the scientific evidence of smoking and health for the past year. I do no= bring to this podium the zeal of an ex-smoker who wants to convert the world. .... . . . . . . .....:!.'. . ,., . From my public work in the past year, I do bring the frightening knowledge that cigarette smoking is Public Health Enemy Number One in the United States. From my private experience, ! bring the knowledge that to stop smoking can be the most difficult thing a human being can do. From my personal philosophy, I bring a profound and unyielding belief in freedom, free will and free choice. treasure the nation which provides this to 218 million citizens. J But i recognize that a choice can be free only if it is informed, that a decision can be genuinely voluntary only if i= is based on all the information. =D O0 00

4 l I ! 0 ! I i I i I I l i i ! i l i ) ! ( - 3 - As the chief public health officials of this government, =he Surgeon General and I are determined =o fulfill our responsibility =o provide information co permit American citizens to make a genuinely free choice about smoking and their own health. That is one of the central objectives of =he program we propose today. Fourteen years ago today, Dr. Terry and his colleagues issued the Surgeon General's Report on Smoking~and Healt~ " Sihce 1950, evidence had been accumulating that a wide range • , . . . " of serious diseases was linked t0 Cigarette smoking The i i i I ! i I Surgeon General's Report confirmed that evidence beyond a reasonable scientific doubt. The 1964 report established the causal link between cigarette smoking and lung cancer. It suggested the strong connection between smoking and heart disease. And it connected smoking with other serious, even fatal, health problems such as chronic bronchitis and emphysema. Since then, the evidence linking these killers to smoking has become over-~helming. The Surgeon General's Report has been the basis for a wide range of efforts to reduce the ravages of smoking on GO

/ -// ! I ! J ! ! i .j J | I ! i ! ! I 1 t - 4- the Nation's health. report was published, In the fourteen years since the we Nave made real progress. Smokers in America have become a declining minority. In 1964, more than half the men in America were smokers; today only 39 per- cent smoke. There are today 14 million more ex-smokers in America than there were in 1964. Twenty-eight states have passed laws restricting smoking in public places and in health facilities. The commercial airlines, and many stores, restaurants and public buildings, limit smoking. Many smokers, concerned about the dangers of smoking, have switched Co lower-tar and lower- nicotine brands. O Across the nation, public interest groups have organized to discourage smoking -- and to assert the right of nonsmokers to clean air in offices and public places. O~ 00

f C -3- I J • ~" * i i:<i:: I Since 1966, eve:-/ package of cigare=-es has carried a warning abou= she health dangers ~f smoking; since 197!, broadcast ¢igarec=e advertising has been beamed. • o~r" "'" °~ : ° • . t." • Final!7, =he ec!~.ue==e of smokin~ has changed, slowly bu~ perceptibly. Once the smoker asked, • ' '"Would you likea cigarette?". .Todayche question ": is, "Do you mind i5 i smoke?". .And m~re am.d more Courage Co a/Islet. wi~h a police bun emp. haci=, "Yes, I d= mind." Clear!7, a green deal has been accomplished in ~hese pas~ four~ee~ ~ears. And man7 of Chose accomp, lisb_~encs are =he work of or=aniza=lons like chose represen=ed here today: the ~xnerican Cancer Socie=y, =he America= Hear= Association, the American .L~g ,Mssocia=!on, and man7 ochers. But clearly, much remains co be done. For in spice of :p P all =he encourage=en= we have given them noc =o smoke, =he people of the Un!=ed S=aces are still among the world's heaviest smokers. In 1@76, =hey bought 626 billion cigare==es. $80ZO4411

,i 4 ° . ~,~,,i•~ i i " .•. k ° • . :•.. ,• 4; -6- ~ Oue of ~he mos= alarming dIeve!oDmen~ since !964 has been ~he dramaui¢ increase in smoking by young women be,_-~een 13 and !9 -- ~he percenhage of ~eenage SimS5 wh~ sm=ka has almosu doubled. The d_~er_..c_ in smoking r===-s be~;~en . teenage boys and girls has disappeared; . . likely as boys ~o smoke. girls are now as_ . ,.." And ~he pro-teen si~ua~iom is even more frightening. • T.ma major urban area on =he wesz coas~,•i ou= of 20 childrer is smoking by age !!. Jus~ one year older, ac a~e 12, ~his fiche Skyrockets ~o ! ou=of 5. " • ..... • .... Each year, several hundred million dollars in cigare===_ • adver=ising -- and the powerful habituating efface of ¢~gare==e seeking --are a poten= combination, l'ney add um =o some shocking fac=s abou= disease and dea=h in .America: @ Las= year, smoking was a major factor in 220,000 dea=hs from hear= disease; 78,000 lung cancer dea=hs; and 22,000 deaths from o~her cancers, including cancer of ~he mouth, cancer of =he esophagus, cancer of =he pancreas, cancer of ~he kidney and cancer of ~he bladder, SOZ0441Z

,° ~ ° C ~7I @ A0 per=an= of all ca,.ca= in =ales is car.sad by smoking. • " ' • . , ° " °b:" q @ 85 percent of dea=hs from bronchitis, emphysema and ocher lung disease would no= happen -- if ..e .. people would s=op smoking. These fac=s mean =ha= people who smoke are corral=ring slow-morion suicide. The cost in grief and sadness for =ha families of ~ha rio=ires is beyond ca!cu!a=iou. And the economic cos= is elm=s= beyond belief: each year, according ~o es=ima=es, smoking adds be~-;aen $5 and $7 billion =o heal=h-care cos'~s; =ha cos= of !os= pr~duc=iviry, wages and absen=eeism cause/ by smoking is $!2 =~ $!8 billion. Research since =he !964 Surgeon General's Repor= has proven cha= smoking is even more dangerous ~han we ori==inal!y believed; i~ accounts for even more diseases and disorders O than we realized fourteen 7ears ago:

' o -8- [ ... - . • °.. ° o° .. ":.x . @ • ,. • . ! Women whe ==_ke bir-h control Dills, for ex~-9..!e -- par=icularly women aged 30 and over -- are un ~o 50 ~imes m~re likely to have hear= ~=aoks if ~key s=mke. Recent experiments have sho~-/" ~ha~ babies °-,..° o~-" absorb nicotine before o=r~h with clear effects ou =heir respire=ion and ocher viral signs. ... . .°.. " There is evidence that certain indus=ria! workers • who;smoke, par=icularl7 asbestos and cemen= workers, run dramatically great_r risks of cancer and Other fun== disease because smoking in=erac=s with ocher dangerous substances. So =he evidence of fourteen years: fourteen years o~ lu=ensive biomedical research; four=een years of exp. ensive effor= by the most skilled physicians and exp. er=s in epidemio!og is clear; i= cara-.o= be ignored Smoking rains nea_th. Smoking kills " Vir=ual!y a!l physicians accep~ =his evidence; in no professional group has =he decline in smoking been greater. And vir=ua!l7 all the public accepts this evidence. I know of no parents who want ~heir children to smoke. ~D C~ C~ A~ C~

• 0 , . . . • . • . • ! I I I i I I i ! i I I I i -9- In fact, most smokers accept this evidence: 80 percent agree that smoking is harmful; a majority of current smokers have tried at some time to quit, but =hey have failed -- often, because they are addicted. ! I ! i q ! J Those who ignore these facts are indulging in the most dangerous kind of wishful thinking: they are, quite literally, whistling past the cemetery in their search for a way to . .. .rationalize a. habit that can become a dangerous dependency. .... ..... '. The...fe~,- mostly in =he cigarette industry --.who attempt to refute this overwhelming consensus of the experts are a self-interested minority. Their attempts to deny the overwhelming medical evidence about smoking and health are, in essence, an attack upon science. The fact that Americans are still among the world's heaviest smokers; the fact that disease and death associated with smoking are so widespread and costly; the fact that new evidence implicates smoking in other serious diseases -- all these facts point to one overwhelming conclusion. We must do more, if we are serious about preventive health in America, to end this waste of life. O0

! i - I0 - ( I am today announcing a vigorous new program on smoking and health: a program of public education, regulation, and research -- backed by higher budgets, more energetic efforts, and a renewed commitment from =he government department that is charged with protecting =he nation's health. EDUCATION ' .... The first and most important element of this new program on smoking and health will be a major public information and education effort against smoking. Even the most comprehensive research; even the most convincing body of fact, is useless if not communicated effectively. And, in the last fourteen years, vigorous public information efforts have done the most to encourage people in America to stop smoking -- or not to start. We intend, with the cooperation of dozens of voluntary health agencies and other groups across America, to step up existing-efforts to inform and educate --and to launch some major new initiatives. 0~

i- • I ! I ! i I I i I i• ! ° i .! ! | ! I i I I I | I I I I I ! I f - !I - ( "°i " From 1967 to 1971, broadcast announcements about smoking and health encouraged millions of citizens to quit smoking. But in 1971, cigarette advertising was banned from radio and television, and the number of anti- smoking announcements decreased sharply. BroadcasTers were no longer legally bound, under the fairness doctrine of the Federal Communications Commission, to air them. We strongly believe that the danger of smoking to the public health justifies an increase in the number of broadcast messages on smoking and health. I am therefore writing to the heads of the major broadcast networks, and to the National Association of Broadcasters, asking that they consider, in the interest of the public health, increasing the number of anti-smoking announce- ments they broadcast. CD ~J

• I i • ! t i ! I ! ! L I ! I ! I i. ! I I m ! i I I i i ! ! ! ! I The Department Of Health, Education, and Welfare, in cooperation with the Federal Trade Commission, will petition the Federal Communications Commission to review its policies on public service announcements, so =ha= more such announcements will be-aired ~. thrpughout the entire-~broadcast day. - . • Beyond. thisr we are• taking a number of other informational and educational steps. Because smoking is a habit that leads to dependence, the only sure way to stop smoking is not to. start. We will, therefore, concentrate many of our efforts on prevention among young people of school age. At a meeting this afternoon, I will urge the Chief School Officers of the fifty states to develop comprehensive health-education programs dealing with the dangers of smoking in every school system in the country. O0 O0

-13- 6 I have made the same request in a letter to each one of the Nation's 16,000 school superintendents, and have pledged cooperation and support from HEW and the U.S. Office of Educazion. I ~ ° . The National Institute of Education and the National Institute of Child Health and Human Development will mount the most penetrating program of research ever.undertaken to learn what motivates children and teenagers to smoke or not to smoke. The Public Health Service and the Office of Education will develop a broad 9ublic education and awareness program involving the full range of communications media to motivate teenagers -- and pre-teens -- not to smoke. As part of this public information program, we will develop and disseminate new materials and techniques to help people quit smoking. O0

] t i i t ? f i ! ! ! I ! t i :I t "L ! - 14 - Q Finally, we will target special informa=ion and education efforts at specific high-risk groups: pregnant women, industrial workers in especially dangerous occupational settings, and persons who have health problems that are likely to be Worsened by smoking. An example, which ! am announcing today, concerns the increased risks of smoking for . °- women who use birth-control pills. The on 'O Food and Drug Administration is broadly o~ revising its labeling requirements for such ¢¢ pills. Part of that revision will be a prominent warning that cigarette smoking increases the risk of serious adverse effects on the heart and blood vessels, especially in users who are over 35. Every woman who takes the pill will receive a pamphlet explaining its benefits and risks -- including a prominent warning which says, "Women who use birth-control pills should not smoke." O0

°, , -15- % .. ° • ,. .° ... I am also asking the Commissioner of Food and Drugs systematically to investigate =he interaction of smoking wi~h other therapeutic drugs, so that users who smoke can be made aware of the special dangers they face. Whenever smoking increases the risk to the individual taking the drug, that fact will be prominently labeled. ; • • . . • . . • REGULATION A second .major element of our program is to encourage more vigorous enforcement efforts against smoking -- and to protect the rights of the nan-smoking majority .in public places. O We begin in our own HEW house. We have drafted a new Policy on Smoking in HEW-occupied buildings: as of this morning, it became the official PfEW policy. Thfs new policy bans smoking in conference rooms, classrooms, auditoriums, elevators and shuttle vehicles. Within practical limits, the work areas of smokers and non-smokers Will be separate and physically distinct. In recognition of the rights of individuals who wish to cont'~nue to smoke smoking 0O areas will be established. But the general rule Pf will be "No Smoking -- except in smoking areas.

I i . • ° -16- Most importantly, it will be the policy of the Department that smoking in shared work areas will be prohibited at the request of non-smokers whose health is affected. It is appropriate that this department should have the strongest smoking policy in government -- one Chat is appropriate for the chief health agency of government. •° "I am sending a copy of these new HEW guidelines to the •chief executives of each of the Nation's ". - , - . . "500 largest corporations, in the hope that they will follow this example. • . . ... Jay Solomon, Administrator of the General Services Administration, has agreed to set up a joint HEW- GSA Working Group with a view toward strengthening GSA's anti-smoking guidelines for the more than I0,000 buildings it manages for the government. Our aim is not only to protect the health and well-being of Federal employees, but to set a standard for other employers across the Country. I am today writing Chairman Alfred Kahn of the Civil Aeronautics Board expressing my strong support for the amendments it has proposed: 00 %.•

C - 17 - First, to ban all pipe and cigar smoking on commercial airliners, and Second, to provide that airline employees shall enforce the rules separating smokers and non-smokers. • ° In addition, I am urging the CAB to consider :" ~avorablya proposal to ban all smoking on ....... commercial aircraft. • .'.° g Twenty-eight states have laws governing smoking in public places and certain facilities like hospitals and nursing homes. ! am writing to the Governors and legislative leaders of states who do not have such legislation or whose legislation could be strengthened -- urging that they enact strong new "clean indoor air" laws. We are including, with our letter, a model for such state legislation, based on the best of the existing state laws, such as Minnesota's and Alaska's. I am directing the National Institute for Occupa- tional Safety and Health to step up its effort, s to develop standards for restricting smoking in certain

I ! ( - 18 - hazardous settings -- especially in such occupations as .the asbestos industry, where smoking increases already-existing health hazards. Chairman Michael Pertschuk'of the Federal Trade Commission has agreed to join in the anti-smoking program. Together with the Federal Trade Commission, we will consider recommendations to: strengthen warnings on cigarette packages and in cigarette advertisements; include tar, nicotine and carbon monixide levels on package levels and in advertising; include in advertisements warnings directed to special groups for whom the dangers of smoking are gravest; empower the Federal government to set maximum levels for hazardous substances such as tar, nicotine and carbon monoxide in cigarettes.

"I k | a J. ( - 19- INCENTIVES i Q q i t i i i 1 .$ 4.. !_ ! -t I I ! i I t I ! I • ° ,. - . Third, we will explore ways of giving people more powerful incentives, financial and othe~;ise, to protect their health by not smoking. • . Treasury Secretary Blumentha! and I are forming an inter-departmental task force to examine tax policies relating to cigarette use. The existing Federal excise tax on cigarettes has remainedunchanged at eight cents since 1951. The question of whether tax policy can influence decisions about smoking deserves careful study in the interest of the public health. The task force will examine a range of possible measures including: • .'. : "" • -... A general increase in the Federal excise tax on cigarettes; A graduated tax according to nicotine, tar and carbon monoxide content, giving manufacturers incentives to market less- hazardous brands, and giving smokers incentives to change to less hazardous brands.

• al • °. ~. - 20 - I am also asking major providers of health, fire, life and disability insuramce =o consider offering special premium discounts and other advantages to non-smokers -- so that non-smokers will no longer have to bear so heavy a part of the enormous costs generated by smokers. RESEARCH The fourth element of the program will b~e greatly expanded and more comprehensive research into =he subject of smoking and health. p Over the past generation, research in the epidemiology of smoking has been well-established and has shown beyond doubt the harmful and fatal effects of smoking. Our support for continued research of this type will continue -- including research aimed at creating a less hazardous cigarette. 08

! • ! f t t I • I i i t ) l . i j .o • .. " ,, ." , . - . - . 1 - 21- ' ( Bu= several other major ques.tions about smoking and health require more complete information: e What more, for example, can we learn about the effects of cigarette smoke on the health of non-smokers? How can we identify individuals and types of smokers who are at greatest risk? Whac factors lead people to decide ~o smoke? Whac are the psychological, behavioral and other factors that lead to dependence upon tobacco? .'~.0 Wha~ methods and techniques-are most effective in helping, people overcome their addiction to cigarettes? GO ~J

! I ! - 22 - ( ( These, then, are the broad outlines of the program. I believe i= is strong, realistic, and comprehensive: ~ha= i= can build on our efforts over the past 14 years on smoking and health. . . . To provide leadership for this new program and for future efforts, we are establishing a new Office on Smoking and Health. The head of the Office will report • ° directly to the Assistant Secretary for Health -- and 'during the early months of this program, will report irecti : d y to me as well Among other things, the new Office will: ... C coordinate all HEW actions on smoking and health; provide "seed money" to government and voluntary agencies for research and demonstration programs; -- oversee the development of new media and information materials on smoking and health: i 00

"4 e~ 0 "4 t O' | I i Much of the authority for the activi=ies of this new Office comes from ~he landmark legisla=ion,'"The Nahi~nal'Conshmer ~ealth Infohnation an~ Reai~h P~omo~ion ~of~{976", •which was sponsored by House Health S~bhbmmittee Chairman Paul Rogers• " | ! i ! ~.. .... ° . . The National Clearinghouse for Smoking and Health, which for years has coordinated our efforts in this field, will become the nucleus of this new Office on Smoking and Healrhi:~:In recent years, ~he Clearinghouse -- the chief government action office on smoking and heal~h -- suffered serious cu=backs in budget. Today we are moving to reverse ~rhose~cu~backs. ~ With new s~atus and visibility, and~wi=h abroad new mandate, the Office on Smoking and Health will:oversee our greatly expanded public heal=h efforts in the an~i-smoking field. This new Office will begin operations in FY 1978 wi=h several million dollars of reprogrammed funds. In FY 1979, it will oversee a $23 million Departmental campaign on smoking and health. In the field of information and education alone, our budget will increase from less than $i million las~ year to more than ~6 million to be spent next year by ~he new Office on Smoking and Health

- 24- ( Finally, I have asked the Surgeon General, in collaboration with the research community and the National Institutes of Health, ~o prepare, for publication next year, a new Report of the Surgeon General. t This new Report will become the major compendium of research on smoking and health over the past generation. ... .. ' ... It will, first of all, give the public the best available answers to all the new questions about smoking and health I have outlined above. • . . . • . . it will bring together the massive collection of existing research data on smoking and health developed since the first Surgeon General's Report in 1964. O0

.i q ~r f - 25 - f. O •. ~,.i° . I I i i I ! I ! | i i. r. , • • ).,,, • , I have announced today many at=ions to deal with =he dangers of smoking. J The major public health problems and the enormous costs created by smoking amply jus=ify all these actions. ; g ..... Clearl , a =he government has an obli tion =o proclaim in straightforward terms its commitmen~ to fostering a heal=by society. Doing this means providing a counterweigh~ =o the blandishments =ha= are influencing thousands of young people =o risk ~heir health by 9moking. • °.... For i= is a pernicious fact =hat tens of thousands of young people are being influenced to smoke, at grave risk =o =heir health, by half a billion dollars' worth of adver=ising -- advertising designed =o convince them that smoking is glamorous, adult, and sexually attractive. I believe we have a responsibility, as a society, to give them reliable information on che other side: ~ha= smoking is unhealthy, dangerous, socially expensive and a leading cause of premature death. 680Z04431

;~, -. j, • r, , ! ! ' ~ " Oahe~-se, hun4re4s of ~housan~s of youn~ ?eop!e ~'il! sear= smoking without comDle=e infor-ma=ion on its risks. ! i So =his Departmant,~ll p!a=e ~he weight of its s¢ien=ific au=hori~y behind programs =o inform =ha public -- especial!7 the yo,u~ng --abou= why =he7- should no= smoke-." and how ~hey can c.ui~ if ~he7 wish. As ~he chief hea!ch . ~:;~i,~~.~-~: . -officer of government, I have a du=7 to see =ha= we do jusz =ha=. With your helm, and wi~h ~he heln of ocher organiza=ions °dedicated to ~he public health, we are going ho do just =ha=. . - •. T=ank y=u. -I , ~-~. ' I ".- .L I I t i I i,;...' .~ ",t -\ .\ t¢ ~J t~