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STATEMENT . BY JOSEPH A. CALIFANO, JR. SECRETARY OF HEALTH, EDUCATION, AND WELFARE BEFORE THE SUBCOMMITTEE ON HEALTH AND THE ENVIRONMENT OF THE HOUSE INTERSTATE AND FOREIGN COMMERCE COMMITTEE February 15, 1978' .

I Mr. Chairman, and Members of the Subcommittee: I appreciate this opportunity to appear before you this morning to discuss the extremely important subject of smoking and the public health. You have long been leaders in the health field and so it is appropriate that you should hold this hearing on a subject of great concern to our nation. Last month, on the fourteenth anniversary of the Surgeon General's Report, I renewed the commitment of the Department of Health, Education, and Welfare to inform the American people about the dangers of smoking in a speech to the National Interagency Council on Smoking and Health. That speech -- and subsequent commentary and debate -- has focused attention again on the health and economic problems posed by cigarette use. I welcome that discussion; only with robust debate can we develop a new public consciousness and an appropriate public policy about smoking --the single greatest cause of disease and premature death in this country today. , I also welcome the opportunity to report to you today _on HEW''s anti-smoking effort -- its goals, its main components, and its limitations. I also hope to persuade some of the program's more intemperate critics that their concern --like their rhetoric -- is greatly exaggerated.

-z- At the heart of HEW,"s anti-smoking program is a deep 'commitment to informed personal choice. I would emphasize the word personal because ours is not primarily a regulatory effort that seeks by rules to change behavior. Nor, even less, is it a prohibitionist campaign designed'to outlaw cigarette consumption. Rather our anti-smoking initiatives are primarily in education and research. Education to better inform Americans especially young Americans -- about the hazards of smoking so that a decision to start or to~continue smoking is based, as fully as possible, on a sound foundation of fact. Research to understand better unanswered questions about why people smoke and how they can effectively stop if they wish to do so. Make no mistake, our efforts are to reduce smoking. But they are efforts grounded in persuasion and information that appeal to:the common sense of our citizens. They are not efforts based on coercion and scare tactics. I have the greatest empathy for the millions of Americans who want to stop smoking, but who find it very, very difficult to do so~. Quitting smoking was have ever done. one of the hardest things I

- 3 - Thus, contrary to those who charge that our efforts are somehow an intrusion on individual liberties, I must underscore that~our primary goal is to provide information and conduct research that will enhance, not reduce, personal choice. If our citizens -- especially those in their teens and subteens who begin smoking for the first time -- are given all the facts from government, or other sources, and still do not wish to give up a personal habit, however hazardous, then, except for protecting,the rights of non-smokers, I think government can properly do no more. The Problem~ I must also emphasize that the anti-smoking effort is premised on a bedrock fact -- cigarette smoking is harmful to individuals and is a multi-billion dollar public health problem for the nation. It is also a major problem for the federal government which in fiscal 1976 paid approximately $40: billion of the nation's $139 billion health bill. Smoking is preventable Public Health Enemy Number One. Those who smoke are committing slow mition sucide. Scientists and physicians -- professionals who are generally cautious in their use of language -- agree that smoking is a major cause of heart disease, respiratory disease, and cancer of the lung and other sites. These are not abstract dangers to our health, but very real diseases. And imthe view of scores of scientists who have studied the problem for decades, both~in this nation and around the world,

4 the link between these diseases an&smoking is "overwhelming." Representatives of the tobacco industry who q!uestion the overwhelming evidence do a disservice to science and to the public. They insist, for example, that not every smoker has been shown to develop lung cancer, but they fail to . acknowledge that smokers are approximately ten times more susceptible to lung cancer than non-smokers. In~fact, the evidence of the serious consequences of smoking has been most dramatically acknowledged by health professionals themselves. Physicians, dentists and pharmacists are the leaders among those who have quit smoking. In 19501about 65 percent of America's physicians smoked. By 1975, 10 years after the Surgeon General's Report, only 21 percent were smokers. Last year, it has been estimated that more than 320,000 people in this country died prematurely from diseases attributable to smoking. Smoking was a major contributor to 175,000 deaths from heart disease, 100,000 deaths from cancer, and 15,000 deaths from chronic bronchitis and emphysema. Over 37 million people --one out of every six American alive today -- will die years before they otherwise would, because of smoking.

5 Some individuals are at especially high risk of smoking- related'disease and death. o Those who are more susceptible to heart disease, emphysema or lung cancer because of other risk factors, are compounding their risk dramatically if they smoke. o Those who work in certain industries and are expose&to occupational hazards such as asbestos, aluminum, coal, cotton and steel, will find those hazards much more harmful if they smoke than if they do not.. o Those women over 30 who use oral contraceptives are about 5 to 10 times more likely to die from heart disease than those who use birth control pills but do not smoke -- and smoking increases the heart disease death rate for women on birth control pills by 40 percent. The economic toll that these diseases impose on the country is also enormous. It has been estimated that in 1975 from $5 to $7 billion,were required'to treat smoking- related related illnesses. Another $12 to $18 billion T.rere lost in productivity in the work place due to absenteeism related to smoking. These costs do not reflect wages or productivity lost due to early death, nor do they reflect the costs of household fires -- about 13 percent of which are estimated to be related to smoking.

6 The most troublesome aspect of the problems related to smoking, in my view, is the fact that so many Americans start smoking at a very early age, as a result, in part, of expensive cigarette advertising campaigns. In fact, each day of the year approximately 4,000 children become cigarette smokers. - Seventy-five percent of American adults who smoke started before they were 21 years old. Ninety percent of today's smokers started smoking before age 25. These startling statistics indicate that to a very considerable degree, smoking in America is a problem of young people. Indeed, teen-age girls are now smoking more heavily than ever in the past. Since 1968, the percentage of teenage girls who smoke has more than doubled, so that the difference in smoking rates between teenage girls and boys has virtually disappeared. In 1969', 10 percent of all teenage girls who smoked used at least a pack a day. -Now, 39 percent of the teenage girls who use cigarettes smoke at least a pack a day. Thus, more teenage girls are smoking > now and they are heavier smokers than ever before._ ,

- 7- Moreover, the rate of teenage smoking is apparently on the rise -- and teenagers are starting to smoke at even younger ages. Teenagers and children who make the decision to smoke V i I a are often not doing so with the benefit of a fully informed perspective about the hazards of smoking. They are often responding to a half a billion dollar advertising campaign which portrays smoking as attractive and mature. When those young people become adults, they discover that smoking is neither adult nor sexy. It is extremely difficult to quit because smoking can often be addictive. Fully 80 percent of the adults who smoke would like to quit if they could find an easy way to do it, and over half have tried unsuccessfully to quit. Finally, health authorities have demonstrated that the increased mortality rate for smokers is significantly higher for those who start smoking as adolescents than for those who acquire the habit later in life. Let me underscore the great danger smoking poses to teenagers by describing four 16 year olds -- a boy and girl who start smoking at that age and a boy and girl who do not: cow ~ ~ Xb j `-

8 The two who smoke (assuming a pack a day)~ will have a 1 in 20 chance of developing lung cancer over their lifetime; the boy and girl who do not smoke will have only a 1 in 200~ chance of suffering from the same disease. o The two who smoke will have 6 chances in 10 of having a'heart attack; the two who don't smoke have only 3 chances in 10. The 16 year old smokers are doubling their lifetime risk of heart attacks by smoking. o The two who smoke have 1 chance in 20 of developing chronic bronchitis or emphysema; the two who don't smoke have only 1 chance in 200 of suffering from the same diseases. Thus, over their lifetime, the 16 year olds who smoke will have a 1 in 10 chance of developing a serious lungg disease such as lung cancer, emphysema, or chronic bronchitis, providing they manage not to have a heart attack. By contrast, the 16 year olds who do not smoke will have a 1 in 100 chance of contracting a serious lung disease over their lifetime.

9 Most strikingly, the life expectancy of the 16 year old make smoker is 65 years (at one pack a day) or 62 years (at two packs a day); the life expectancy for the 16 year o1d male non-smoker is 71 years. Similarly, the life expectancy of a 16 year old female smoker is 72 years (at one pack a day) and 70 years (at two packs a day): the life-expectancy of a 16 year old female non-smoker is 78 years. Thus, at the heart of the anti-smoking effort is a deep concern about smoking health effects =young,people.