It is time to plan the tobacco endgame

The tobacco disease epidemic is an industrially produced phenomenon. Though people have used tobacco in various ways for centuries, the modern epidemic resulted directly from the industrialisation, engineering, and aggressive marketing of the cigarette—without doubt the single most deadly consumer product ever made.1 2 The industrial production of disease calls for measures that go beyond discouraging unhealthy individual behaviour to tackle policy and social norm changes. Smoke-free policies help, but as long as cigarettes remain ubiquitous, it is easy for people to rationalise: “They can’t be that bad if they are still sold everywhere.” There is a major and increasingly inexplicable lack of congruence between the way cigarettes are regulated and the regulation of many other dangerous products (most of which cause far less disease and death when used as intended).

Yet too many public health professionals remain fearful of even suggesting that to end the epidemic these products should, at some point, no longer be easy to buy. They fear that doing so will incite “nanny state” criticism and charges that government is intruding on consumers’ “choice,” despite …