Want to prevent more than 200,000 premature deaths among Americans born between 2000 and 2019? The answer seems like a no-brainer.
Last week, Senate Democrats made a proposal that would do just that – raising the minimum age for purchasing tobacco to age 21. The Institute of Medicine, an independent research group established to advise Congress on science-based policy, estimated that the lives of 223,000 young people born after 2000 would be extended by raising the purchase age to 21.
About 700 kids under the age of 18 become regular smokers each day, and one in three will eventually die as result. Raising the age would restrict access to tobacco to young people directly and indirectly by making it more difficult for younger smokers to find older peers to buy cigarettes for them.
Raising the smoking age would save taxpayer money, too. Although the law would decrease tobacco sales, savings in health care would more than cover the cost. An analysis by the California legislature calculated that the loss of $68 million a year in sales tax revenue would be offset by health care saving as high as $2 billion a year. That means a return of almost $30 for every $1 of forgone revenue.
A public opinion poll by the CDC last year showed that 75 percent of citizens favor the proposal to raise the act. At least 90 localities in eight states, including New York City, and the state of Hawaii have already raised the tobacco sales age to 21. Statewide legislation to do so is being considered in several states, including California and Pennsylvania.
Despite life and cost savings, there are opponents of the change. Some claim it interferes with individual freedom. “If you’re old enough to fight and die for your country at age 18, you ought to be able to make the choice of whether you want to purchase a legal product or not,” said one lobbyist who testified against the California bill. The Hawaii Chamber of Commerce opposed the measure there, fearing it would harm business. And the president of the California Retailers Association warned that raising the smoking age would simply drive young people to the black market. For the tobacco industry, raising the purchase age would deprive Big Tobacco of its most lucrative source of new nicotine addicts, a prerequisite for its long term survival in the U.S. market.
This debate raises fundamental questions. Does government have the obligation and authority to set limits on substances like nicotine, sugary beverages and alcohol – the leading causes of the global epidemics of chronic diseases? Or should the market leave it to consumers and parents to protect themselves and their children against the marketing of the lethal but legal products of Big Tobacco, Big Soda and Big Alcohol?
In the case of the proposed rule on tobacco purchase age, more than 200,000 lives depend on how Congress answers these questions.
Freudenberg is Distinguished Professor of Public Health at the City University of New York School of Public Health and Hunter College and author of Lethal but Legal: Corporations, Consumption and Protecting Public Health (Oxford, 2014).