Children and Bystanders First: The Ethics
and Politics of Tobacco Control in
the United States
Ronald Bayer and James Colgrove
Among liberal democracies, the United States stands out in terms of the extent to which anti-paternalism suffuses popular and elite values and the extent to which antagonism to government regulation of the economy dominates political ideologies. These central and defining features of American political culture would have a profound influence on how America would confront the public health threat posed by tobacco. In the course of the nearly four decades that followed the publication of the first surgeon general’s report on the dangers of smoking in 1964, policy making was dominated by efforts to identify innocent parties in need of protection, on whose behalf government could interfere without setting off alarms of unwarranted paternalism. This was true as attempts were made to restrict advertising, limit smoking in public settings, and impose burdensome taxes on cigarette sales.
An analysis of the public health strategies against tobacco consumption must be understood in the context of the great political and economic influence of the industry. In 1994, a study funded by the tobacco industry calculated that some 1.8 million people were employed in tobacco-related jobs, and that state and federal tax revenues from the industry totaled some $36 billion nationwide. These estimates have been disputed—subsequent studies have arrived at more modest figures—but there is no doubt that the financial impact of the industry remains substantial. In 1998, American growers produced some 1.5 billion pounds of tobacco, valued at about $2.7 billion. Both the total number of farms producing tobacco and the total number of acres devoted to tobacco cultivation have declined since