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Health Equity Starts With Conquering Big Tobacco

May 21, 2021
By Pivot

It’s time to speak up and have tough conversations about why we’ve accepted this social health problem and what we can do about it.

Most individuals, health care and insurance organizations view smoking as a behavior choice, rather than a hard-to-break addiction.

Tobacco addiction is a massive, unaddressed health problem, an undiagnosed disease that has continued for years and is currently on the rise due to increased stress from COVID-19, housing and job insecurity, isolation and more.

After decades of growth fueled by predatory marketing by the global tobacco industry, it still lures and satiates people into a slippery slope of poor health and life-threatening risk. And yet, we turn a blind eye to the nearly 50 million Americans who need better solutions to tackle a condition that remains the leading cause of preventable death in the U.S. We’ve settled for wellness and weak prevention campaigns, 800- number quit lines and short-term solutions that don’t work.

It’s time to speak up and have tough conversations about why we’ve accepted this social health problem and what we can do about it. Renewed focus on tobacco cessation innovation is more important than ever.

Who’s impacted the most?

Whether cigarettes, smokeless tobacco or vaping, tobacco use continues to expand in socioeconomically vulnerable populations, particularly among poor people of color who are suffering the greatest health consequences.

Black, Latino and Native American communities have been targeted with advertising for cigarette brands with names such as Rio, Dorado and American Spirit, and Black Americans have been on the receiving end of aggressive campaigns that promote menthol cigarettes. The numbers reveal that populations who already lack access to affordable health care also face the overwhelming health burdens caused by tobacco addiction: 24.5% of adult Medicaid recipients smoke while just 14% of all adults in the U.S. smoke. Native Americans have the highest smoking rate of any racial or ethnic group in the country.

Adding even more risk to socioeconomically vulnerable populations who smoke, recent months have shown that racial and ethnic minorities are the hardest hit by COVID-19, and people who smoke are more likely to develop severe disease with COVID-19. Meanwhile, American tobacco companies made nearly $48 billion in profits last year and are spending over $9 billion a year advertising a product that’s wreaking havoc on our country’s health care system.

How did we get here?

A big part of the tobacco and social inequality problem is that we don’t care. Most individuals, health care and insurance organizations view smoking as a behavior choice, rather than a ruthless addiction that’s incredibly hard to break. We cast blame and judgment on people who smoke and treat them as social pariahs, even though the reality is nearly 70% of adult Americans who smoke want to quit. Additional factors perpetuating the problem include:

  • Smokers are targeted and taxed – Vulnerable populations are being taxed, not helped. Tobacco taxes represent perhaps the most regressive taxation system in the U.S., with most states imposing massive tobacco taxes and some rates nearly doubling the price of a pack of cigarettes. This tax money is going toward low-fi, 800- number quit lines, brochures and scare tactic-based campaigns that are ineffective, old and tired.
  • Penalties by employers and insurers – In addition to regressive tobacco taxation, people who smoke and receive health insurance through their employer are often subject to exorbitant insurance premium surcharges. Tobacco users are the only population employers can legally charge more for access to health care. These surcharges do little to help people quit tobacco and create a disincentive for employers to deploy effective ways to help their employees quit tobacco. They also serve as a disincentive for people who smoke to raise their hand and seek help.
  • Tobacco addiction isn’t considered a diagnosis – Equally detrimental to the tobacco and social inequality problem is the reality that diseases like Type 2 Diabetes receive diagnoses and subsequent care, but tobacco addiction doesn’t. Without physicians routinely diagnosing tobacco addiction, the magnitude of tobacco use goes unseen, unanalyzed and unresolved. This lack of diagnoses results in health care and insurance organizations failing to ever make tobacco addiction a priority — even though the condition underlies so many other life-threatening diseases and smoking-related illnesses cost the U.S. $300 billion each year.

What can we do about it?

It’s time to get serious about tobacco addiction and solutions that work, and if we’re serious about health equity and social determinants of health, we need to implement new and fundamental cessation strategies that are equitable and effective. We know scare tactics don’t work and that financially penalizing the most vulnerable isn’t the solution. We must recognize first and foremost that tobacco is highly addictive, both behaviorally and physically. Quitting isn’t just a matter of wishful thinking. And just as health care and insurance organizations don’t give up on individuals who are overweight or have high blood pressure, we can’t give up on people who smoke.

Big tobacco is going to continue to reap billions in profits by targeting minority populations in particular, yet regulation in marketing has proven difficult and slow. So let’s look at accelerating workaround solutions collectively, by viewing smoking as a disease that can be treated with increasingly effective means.

In fact, the good news is we have new tools to work with: Innovative new digital solutions that incorporate human-centered design, offer highly tailored personalization and empower people to take charge of their health — key capabilities in the fight against tobacco and social inequality. These tools are mobile and can incorporate the latest in behavioral science to help people make real, long-lasting changes in their daily lives. Best of all, digital health solutions are already highly accessible across a broad spectrum of the population (86% of adult Medicaid beneficiaries own smartphones and 69% own tablets).

The other good news is that the health care industry has already recognized the need for investing in digital solutions that empower patients to take a more active role in managing their health. Now it’s time to expand beyond solutions for Type 2 Diabetes and high blood pressure. Health plans, employers and health care providers can empower people across all racial and socioeconomic demographics to take control of their health, especially when it comes to conditions like tobacco addiction.

Ultimately, investing in innovation and working in collaboration with community health leaders to find solutions that work is paramount. Investing in solutions that serve our most vulnerable communities will reap benefits across families and for many generations. By prioritizing human-centered design and realistic, usable solutions that work, health care and insurance organizations can systematically make a meaningful investment in the communities that need it most and solve what is likely the largest, most untapped problem in our health care system.

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