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Remarks from Acting Surgeon General RADM Boris Lushniak at the Release of the 50th anniversary for the 1964 Surgeon General’s Report on Smoking and Health

January 17, 2014

Being a young tot in the Ukrainian neighborhood of Chicago, I have no recollection of the landmark public health earthquake brought on by Surgeon General Luther Terry’s report 50 years ago.

But as a young and eager commissioned officer of the United States Public Health Service stationed at NIOSH in Cincinnati, I remember the pride of being a member of “Koop’s Troops” as we recognized 25 years of progress in reducing the health consequences of smoking.   

I would never had imagined then, that I would be here now.  As Acting Surgeon General and a career officer in the U.S. Public Health Service, where we live by the mission “Protecting, promoting, and advancing the health and safety of our nation”, I am proud and humbled to release the 32nd Surgeon General's Report on smoking and health, 50 years after Dr. Luther Terry released the first groundbreaking report.  Today marks a new era in the fight against tobacco-related death and disease.

Under the revitalized mantra of “Enough is enough” we, the public health community and all of our partners, rededicate ourselves to new goals pointing us in the same direction  – 12% smoking rates in 2020, 10% in 10 years, or a smoke free generation in a generation.   

This 50th anniversary report is the result of over 5 years of hard work by 85 contributing authors and 120 expert reviewers.

In particular, I’d like to ask the report’s editors to stand and be acknowledged for their outstanding contributions: Dr. Jonathan Samet, Dr. Terry Pechacek, and Leslie Norman.

Also at this time I would like to recognize  my surgeon general colleagues:

  • The 16th Surgeon General, Dr. David Satcher
  • The 18th Surgeon General, Dr. Regina Benjamin
  • My colleague from the Navy, Surgeon General VADM Mathew Nathan,
  • Two former acting surgeons general of the Commissioned Corps of the U.S. Public Health Service, RADMs Ken Moritsugu and Steve Galson.
  • In addition, I’d like to acknowledge the many flag and general officers of our sister services and of the US Public Health Service here today, send greetings to all those who serve our nation in uniform.

When the first Surgeon General’s Report on smoking and health came out in 1964, few people understood or anticipated the enormity of the effect it would have on the nation's health. 

On January 11, 1964, the ninth Surgeon General Rear Admiral Luther Terry M.D., issued a message which was simple but definitive, unequivocal and unapologetic: “Cigarette smoking is a health hazard of sufficient importance in the United States to warrant appropriate remedial action.”

Since then, our knowledge of the health consequences of smoking and involuntary exposure to tobacco smoke has expanded dramatically. 

The conclusions from Surgeon General’s Reports have evolved from a few causal associations in 1964 to a robust body of evidence documenting the health consequences of both active smoking and exposure to second-hand smoke across a range of diseases. 

Over time, both the number and strength of our conclusions on the impact of smoking have increased. 

So this morning, I summarize the 10 major conclusions from this anniversary report, entitled The Health Consequences of Smoking, Fifty Years of Progress:

  1. One. Since the first Surgeon General’s report in 1964 over 20 million premature deaths can be attributed to cigarette smoking. Today, the annual death toll from smoking is approaching 500,000 per year.  Enough is enough!
  2. Two. The tobacco epidemic was initiated and has been sustained by the aggressive strategies of the tobacco industry, which deliberately misled the public on the risks of smoking cigarettes. In the U.S. alone, tobacco companies spend nearly a million dollars an hour, 24/7, to market their deadly and addictive products. Enough is enough!
  3. Three. Since the 1964 report, cigarette smoking has been determined to cause diseases in nearly all organs of the body, to damage overall health status, and to harm a growing fetus. The science has revealed, in stark clarity, that such common diseases as diabetes mellitus, rheumatoid arthritis, and colon and rectal cancer are also caused by smoking.  Enough is enough!
  4. Four. Exposure to secondhand tobacco smoke causes cancer, respiratory, and cardiovascular diseases, and adversely effects the health of infants and children. Enough is enough!
  5. Five. The disease risks from smoking by women have risen sharply over the last 50 years, and women are now as likely to die from smoking as men. Enough is enough!
  6. Six. Cigarette smoking causes inflammation and impaired immune function, reducing the body’s ability to fight off infection and disease.   Enough is enough!
  7. Seven. Although cigarette smoking has declined significantly since 1964, very large disparities in tobacco use remain across groups defined by race, ethnicity, educational level, and socioeconomic status and across regions of the country. Enough is enough!
  8. Eight. Comprehensive tobacco control programs and policies are effective. However, we need to use them, across the nation, if we are to fully benefit from their success. Further gains can be made with the full, forceful, and sustained use of these measures. We must fund these programs at CDC recommended levels.  Enough is enough!
  9. Nine. The burden of death and disease from tobacco use in the United States is overwhelmingly caused by cigarettes and other combusted tobacco products; rapid elimination of their use will dramatically reduce this burden.  Enough is enough!
  10. And Ten. For 50 years the Surgeon Generals’ reports on smoking and health have provided a critical scientific foundation for public health action directed at reducing tobacco use and preventing tobacco-related disease and premature death.   We pray that the 75th anniversary report will have many zero’s, and that the 100 th anniversary will be marked by grainy pictures from the past.  Enough is enough! 

I’d like to spend a little time elaborating on the newly identified health consequences of smoking found in this report. It’s astonishing that, so many years later, we are still making so many new findings. Today we know that smoking is a cause of:

  • Diabetes
  • Rheumatoid arthritis and poor response to treatment of arthritis
  • Erectile dysfunction, and
  • Increased risk of tuberculosis disease and death.
  • We’re adding colon, rectal and liver cancer to the long list of cancers caused by smoking.
  • And stroke is now a known consequence of secondhand smoke exposure.

One of the most disturbing findings is that the disease risks from smoking by women have risen sharply over the last fifty years.

  • Women are now as likely to die from smoking as men
  • Women smokers’ risk of lung cancer is now the same as men’s risk
  • And more women die from chronic lung disease than men.

The news for mothers and babies is also sobering. Smoking can cause potentially fatal ectopic pregnancy and reduce fertility. And for the children of women who smoke during pregnancy,

  • Smoking causes cleft lip and cleft palate
  • Smoking may contribute to behavioral disorders such as ADHD    
  • And smoking can have lasting adverse consequences for brain development.

Other diseases caused by smoking include macular degeneration, a cause of blindness.

Smoking is now known to cause 13 different types of cancer. In 1964 we could only be sure about lung cancer in men. Today we know that smokers have a greater risk of developing lung cancer than did smokers in 1964, even though they smoke fewer cigarettes.  Changes in how cigarettes are made and the chemicals they contain have increased the risk of the most common form of lung cancer.

Cancer patients and survivors who smoke have a higher risk of dying from cancer and other diseases, including breast and prostate cancer, than patients who don’t smoke.

We are still examining why this is the case, but the evidence suggests that smoking results in poorer response to treatment, increases risk of recurrence, and increases treatment-related toxicity.

The need for more rapid action to reduce smoking and tobacco use in the country is further emphasized by our new findings on the economic burden caused by smoking. As you heard from the Secretary, the annual cost to the nation is approaching $300 billion. 

These costs plus smoking-attributable disease and death in our population will continue for decades unless the prevalence of smoking is reduced more rapidly than the current “status quo” projections.

The burden of tobacco use is not shared equally by all of us. Our education, income, race; where we live, especially the Midwest and Southeast; our sexual orientation, and whether we have a mental illness – these factors affect whether we are harder hit by tobacco.

The report also concludes that the root cause of the smoking epidemic is the tobacco industry’s aggressive marketing and promotion of deadly and addictive products.

The last century has taught us that public health leadership is essential to effectively deal with the aggressive tactics of the tobacco industry.

We need to achieve much more rapid progress in helping the 45 million plus smokers in this country, including three million youth smokers, to quit completely. 

For those smokers, the clock is ticking and they can’t wait for slow and steady progress to end the tobacco use epidemic. 

That’s why we must strengthen our resolve and undertake the strategies that Dr. Koh discussed and potentially introduce new strategies to more quickly end combustible tobacco use.  We can’t wait another 50 years.  

I’ve summarized some of the key scientific findings in today’s report. It’s a good read, although I have to acknowledge that, at 980 pages, the report is really geared to a scientific audience.

However, it’s absolutely critical that all Americans understand the report’s findings and recommendations if we’re going to work together to achieve a society free of tobacco-related death and disease.

So today you’ll also find in your packet an Executive Summary and a consumer guide that translates the findings into plain language.

The guide is also available at

The 50th Anniversary should strengthen our resolve to end the tobacco epidemic once and for all. Today we are also launching a public service announcement to remind us that the status quo is unacceptable. I’d like to play it for you now.

With smoking, we are talking about a health scourge that is PREVENTABLE.  If we can quickly and dramatically cut smoking prevalence and prevent young people from picking up the first cigarette, the results will be extraordinary:

  • There are already 16 million Americans suffering from at least one smoking-related chronic disease. If we cut smoking rates dramatically, we can spare additional millions from developing these diseases from smoking.
  • The five and a half million children alive today who will die years early because of smoking will live to enjoy their grandchildren.
  • One out of three cancer deaths will be prevented.
  • We can prevent up to $300 billion a year in direct medical costs and indirect economic losses.

As Chair of the National Prevention Council, I am proud of the federal government’s leadership to address tobacco use, the most common cause of preventable death.  The National Prevention Council brings together 20 federal departments and agencies to provide leadership and coordination related to health, prevention, and wellness, and our Council members have made a strong commitment to promoting cessation and expanding tobacco-free environments.   I’d like to thank many of our council and advisory committee members who are attending today in person or on webcast.

As mentioned earlier by Secretary Sebelius, we are pleasure to have many of the Terry’s family with us today.

Earlier this morning I had the pleasure to present the members of Dr. Luther Terry’s family who are with us today with the Surgeon General’s Medallion.

The citation on the medallion reads: “In recognition of the 9th Surgeon General, Dr. Luther Terry. A pioneer in the 50 year battle against tobacco: 1964-2014.”

We congratulate all of you on this incredible legacy in this battle to create a world without smoking.

Many people have played critical roles in this 50th anniversary SG report, but I’d like to especially thank the staff of CDC, OASH, and my staff in OSG for your commitment to this endeavor.  A special shout out to DR Marybeth Bigley, who for seven years, has carried the torch on SG reports, calls to action, and our journal Public Health Reports. She’ll soon be leaving us for new adventures at HRSA.

We look back with admiration and gratitude to Dr. Luther Terry and many other individuals who started us on this path of progress.  Today, we call upon all Americans to continue to work to advance this bold and noble cause.  As Americans, we know we can achieve great things when we dedicate ourselves to a mission. 

In particular we assign a tasking to that next generation, represented here today by Lukie and Ryan, Larissa and Stephanie, to make a pledge to be partners in making your generation tobacco free.

The mission is to achieve a tobacco free, healthy and fit society to be able to flourish in the 21st century.  Without our health,--  life, liberty and the pursuit of happiness as unalienable rights remain elusive. 

Enough is enough! Thank you.

Now, I will turn it over to the Centers for Disease Control and Prevention Director, Dr. Tom Frieden.