It’s time to speak up and have tough conversations about why we’ve accepted tobacco and the social health problems it creates, as well as 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 continues to be a massive, unaddressed health problem, an insidious undiagnosed disease that has continued for years, spurred on, and increased as of late due to things like increased stress from COVID-19, housing and job insecurity, isolation, and more.

Why do we settle for less with tobacco cessation?

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 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, 1-800 number quitlines, and short-term solutions that simply 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 by tobacco use?

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. 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, it’s been proven that racial and ethnic minorities are the hardest hit by COVID-19, and people who smoke are more likely to develop severe diseases with COVID-19. Meanwhile, American tobacco companies made over $48 billion in profits in 2020 and are spending above $8 billion a year advertising a product that’s wreaking havoc on our country’s health care system.

So, how did we get here?

A big part of the tobacco and social inequality problem is that we’ve become apathetic. 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

People who smoke are targeted and taxed

Vulnerable populations are being taxed instead of 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, 1-800 number quitlines, 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 hands 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 receives 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.

The good news?

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 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.

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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