It was in 1950 when the landmark studies by Richard Doll and Austen Bradford Hill in England and by Earnest Wynder and Evarts Graham in the United States were respectively published in the British Medical Journal (BMJ) and Journal of American Medical Sciences (JAMA). The conclusion was clear: smoking is directly associated with lung cancer.
Since then, countless studies have been published linking smoking with more and more detrimental and adverse health outcomes, including a range of cancers and chronic diseases, as detailed below.
Across Canada, smoking leads to 37,000 deaths every year, meaning that someone dies every 12 minutes due to some smoking-related illness. Altogether, cigarettes kill more people than the combined deaths from traffic accidents, drug abuse, suicides, and murders across the country. In 2014, 18.1% of the Canadian population over the age of 12 years smoked – accounting for more than 5 million people nationwide.
Fortunately, once you quit smoking, your health risks will slowly begin to decline, starting with an adjustment to your blood pressure within 20 minutes of having your last cigarette to bringing your risk of heart disease down to that of a non-smoker within 15 years. Importantly, not only will your health improve, but you will also reduce the effect that your smoking has on others (family and friends) with second-hand smoke. Other benefits include saving money, reduced life and home insurance premiums, and not worrying about finding a place to smoke when in public.
According to the World Health Organization (WHO), smoking is the single most preventable cause of death around the world. For public health, this meant decades-long campaigning to help people quit smoking tobacco and more importantly, advise them to never begin the horribly unhealthy and addictive habit. For instance, Canada was the first country in 2001 to place health warning pictures on cigarette packages. The subsequently steady decline of smoking rates over the years in Canada have shown that many are heading the warning against smoking tobacco.
However, this decline has not been equitable, as smoking rates have been found to be higher among disadvantaged groups. When looking at who is most and least successful in terms of quitting smoking, those who are disadvantaged fail to quit more so than those who are not. Among the disadvantaged are people that are food insecure, dissatisfied with life, renters, single or lonely, rely on social benefits as their main source of income, have a mood disorder, work where smoking is not restricted, have an annual household income less than $20,000, and/or are a visible minority.
Between 2001 and 2014, the total annual change in smoking rates declined by 2.1% annually across Canada. Around the same time, from 2003 to 2013, smoking inequalities increased as the rate of smoking decreased among higher-income Canadians and remained unchanged for lower-income Canadians. Interestingly, if poorer Canadians were as success at quitting smoking as richer Canadians, there would be more than 1.5 million fewer smokers (27.5%) in Canada.
So, why is this the case? Why do lower-income Canadians have a more difficult time quitting? The answer is complex. Many are aware of the health costs of smoking and want to quit but may not know how they can due to a lack of access to resources or because they may feel that they are “too addicted”. More adversely, smoking may be used as a stress-coping mechanism, and there could be fear around quitting and not knowing how to deal with life stresses. These are just a couple of reasons among many that feed into a system of failure at quitting smoking.
So, how can we make public health campaigns directed towards smoking more equitable so that the entire population, as opposed to an advantaged segment, benefits? First, it is necessary that we build our evidence base to better understand how to address and reduce socio-economic based inequalities. Then, a combination of universal and targeted approaches, such as allocating cigarette sale tax revenues towards smoking cessation supports, should be applied to close the gap between the rich and the poor.