Editorial
Scott C. Ratzan

 The purpose of the Journal of Health Communication is to promote the ethical research and practice of how we communicate health and risk.  Although communication is a major element in health promotion, policy initiatives and ethical leadership are the foundation of effective health communication.  During the past two years, I have written several editorials about mad cow disease, an example of how health hazards and unnecessary expenses can result from a lack of leadership.  The mad cow/bovine spongiform encephalopathy (BSE) issue has cost over $10 billion worldwide.  An immeasurable amount of energy has been misdirected to this "crisis" in Europe and throughout the world.

Resources continue to be poured into the Mad Cow Crisis despite the release of data describing the infinitesimal, hypothetical chance of contracting the purported human equivalent -- Creutzfeldt-Jakob (CJD) by eating beef.  Despite the money and energy spent on the problem, there has not been great progress toward a cure or diagnostic test.  In addition, the public does not understand what went wrong with the process.

The resources that are being used to recover from the mismanaged communication of health information about mad cow disease and BSE would be better spent in an area where the data show a causal link between a behavior and disease. The behavior is smoking, and lung cancer is the disease.

In 1997, tens of billions of pounds of tobacco were grown worldwide and consumed by over 500 million people.  The smoking of tobacco unequivocally causes harm. However, trying to encourage people to quit smoking is difficult, because public health officials and health communicators have to tackle both psychological and biological addiction, as well as the multi-billion dollar industry.

Each day in the United States 3,000 teenagers begin to smoke.  They join the one in four Americans who are already addicted to tobacco.  If you take any group of 1,000 twenty year-old male smokers, statistics show that 500 of them will die early as a result of smoking.  Out of 1,000, 250 middle-age smoker will die early from smoking, and 250 old-age smokers will die early.  Twelve percent of the male population under thirty-five will be dead from smoking before the age of 70.

The challenge of combating smoking will require perseverance.  The primary U.S. response to tobacco aims to reduce teen access to smoking, reduce the promotion and advertising of cigarettes, increase the size of warning labels, and establish research funds to reduce the harm cause by smoking.  This is only a beginning.  Success can only be achieved through the use of a variety of mechanisms, such as economic variables (disincentives to smoke -- i.e., high tax on cigarettes, and incentives to be smoke free -- i.e., reduction in insurance rates), changing social norms, deglamorization of tobacco, limits of where one can smoke "freely," and stricter purchasing limitations.

Unconscionably, many hide behind a smokescreen and blame the smoker or the society for accepting smoking.  It is unfortunate that a majority of U.S. physicians do not counsel their patients to stop smoking at every opportunity.  Smoking is the greatest public health hazard that humankind has created.  As a physician, my primary concerns are prevention of disease and promotion of healthy lifestyles.  My hope is that we can save lives and create quality of life, not just treat the end-stage disease.  My hope is that each of us, from a multitude of approaches, can contribute to a healthier world by delivering an ethical component of health each day.