After endless badgering when I was 9 years old, my dad drew up a legal contract specifying that he would quit smoking on a date a few months in the future. We both signed it and kept a copy. Always a savvy attorney, he clearly left a few loopholes because he didn't quit smoking for another 25 years. I've since gotten my own lawyer.
At $96 billion per year, smoking-related health care costs don't ring up as high as that other public health crisis, obesity, which accounts for $190 billion. But smoking beats obesity by a mile when it comes to mortality: At 443,000 deaths per year, it is the leading cause of death in the United States. That includes 46,000 heart disease and 3,400 lung cancer deaths in nonsmokers who were exposed to secondhand smoke. Children who are exposed to it suffer increased incidence of ear infection, asthma, bronchitis, pneumonia, coughing and sneezing.
There's no question there are sexier population health issues to direct resources toward — wouldn't we all rather be talking about fresh fruits and vegetables and brisk walks through the park? — but few that can have as much impact on a patient's health and the health of his or her family. In 2009, nearly half of U.S. community hospitals offered tobacco treatment/cessation programs, an excellent start. But reaching out to elementary schools, community centers and expectant mothers with support and education, pushing for a smoke-free campus, and positioning your hospital as the front line in the fight against tobacco-related illnesses should be the next steps. Because we are all paying for them, in some form or another.