Although Americans are notably less healthy than Europeans in many attributes such as obesity, Americans smoke less than their counterparts in Europe. US cigarette consumption when from 267 yearly per capita in 1914, to over 4,300 per capita in 1963, only to fall again to just over 2000 per capita in 2006. David M. Cutler and Edward L. Glaeser explore the possible reasons behind the disparity between the smoking habits of usually unhealthy US and healthier Europe. The authors look at three explanatory factors, prices, income and beliefs on the consequences of smoking and then estimate the impact of those attributes on the smoker population. Culter and Glaeser reject prices and income as the major determinant in smoking levels and instead site the beliefs of smoking’s negative health effect creates 25-50% of the difference between US and Europe smoking patterns.
The main data for the US came from the US National Survey of Drug Use and Health 1994 and for Europe was found in the World Health Organization files and Eurobarometer Survey of 1994. The compiled data included statistics on income, education, believes on harms of smoking, national surveys on cigarette consumption and prices.
The first reason most think of to explain the consumption difference is prices, which are influenced by taxes and policies. If the US had higher cigarette rates, the lower consumption could be easily explained by supply and demand. However, when comparing cigarettes to a basic commodity (bread), US prices are on average 37% cheaper than European prices. Little correlation exists between the cost of cigarettes relative to the cost of bread and cigarette consumption in developed countries. If one looks at consumption based on price elasticity, American’s should smoke 20% more than Europeans do. Instead, the opposite is true. In addition, the US doesn’t stand out in regulations against smoking compared to European countries.
If prices are not driving the discrepancy in consumption, perhaps different income levels are the cause. Higher income makes cigarettes easier to afford, as the monetary cost is only a marginal percentage of entire income. Taxes would only affect the poor more for this same reason. Yet, the average US income isn’t significantly higher than the average European income. Cutler and Glaeser posit that as income increases, the consumption of cigarettes should decrease because the value of the future increases more. The trade off becomes between the benefit with smoking and the negatives of premature death and cost of lost health. In the US, smoking declines as income (or education) increases while Europe’s smoking is flat with income. The biggest difference in the gap between US smoking and European smoking is with the wealthy and well educated. Maybe 25% of the gap can be explained by income.
Lastly, Cutler and Glaeser turn to the nations beliefs on the negative health effects of smoking as an explanatory variable. The theory is that those who perceive cigarettes as dangerous and who value ways to extend life will smoke less. In the US, 91% of the people think smoking causes cancer. Although some countries in Europe such Norway and Finland have identical rates of beliefs, other countries have much weaker associations between smoking and health risks such as German where only 73% of the people think smoking causes cancer. Looking at the breakdown between non-smokers and smokers, the authors find that beliefs seem to be societal instead of smoker vs. non. In the US, 83% of smokers and 94% of non-smokers believed in the negative harms. In Germany, a mere 52% of smokers and 84% non-smokers made the connection between smoking and cancer. The authors believe beliefs on the harms of smoking can account for 25-50% of the different in US and European smoking rates.
To make sure beliefs influenced smoking patterns and not that smoking affected beliefs, the authors ran tests to check the smoking rates in the US states and European countries against the beliefs of non-smokers. If beliefs are influenced by smoking, the beliefs of non-smokers will reflect the omitted variable. However, the authors find a negative correlation between non-smoker’s beliefs of smoking risks and smoking rates. In the US states, a 1% increase in non-smoker’s beliefs meant a .6% decrease in the share of smokers. On a country level, a 1% increase in non-smoker’s beliefs equated to a .47% decrease in the percentage of smokers.
The authors consider the manner in which the US people became aware of the risks as a crucial part to the 91% statistic of those that believe smoking causes cancer. Unlike Europe, the health movement against cigarettes in the US was instigated by private interest groups first, then the government. The entrepreneurial actions by the anti-smoking groups were influential in dispersing information and changing public opinion better than groups have in Europe.
I have often heard Europeans comment on the absurdity of American’s obsession with smoking’s health consequences. As Cutler and Glaeser note, this obsession is quite odd considering, it seems, everyday a news story or article comes out discussing the US’s problem with obesity. Why has smoking made the cut and not other health risks?
From the authors’ brief history of the anti-smoking campaigns, I have ascertained that smoking had such obvious bad consequences and easy solution, people found it easier to attack. To stop the problem of lung cancer, second hand smoke and yellow teeth, people must simply not smoke. Although addicted smokers have a withdrawal period, not smoking can be achieved. The lines of good (not smoking and healthiness) and bad (smoking and cancer) are so clearly drawn that defending smoking against its health issues is pointless. This idea works succinctly with the authors’ findings. When people know more, the counterargument has an arduous time refusing the evidence for smoking related problems.
However, when one looks at the problem of obesity, the scene is not so black and white. To solve the obesity problem, one cannot simply stop eating. Not eating is another problem that affects many people, especially teenage girls. Consuming calories is a necessity for living. Thus a balance must be reached. Slogans with a definitive action, such as “Don’t Smoke,” have an easier time helping people. A slogan for obesity would probably sound like this: “Don’t eat too much, but still eat enough.” People are confused. The lines are blurred. The directions for the solution are not as clear, and thus is a harder campaign to wage. In addition, the magnitude of people that rely on the food industry (supermarkets, restaurants, hot dog stands, farmers) is much larger than that of the cigarette industry (RJ Reynolds, the mini mart, tobacco farmers).
I enjoyed this paper. Yet two things were odd. One, many of the main points were not stated in the paper until the conclusion section. In addition, many points were confusing until clarified in the conclusion section. Two, the authors go into great depth on the history of American anti-smoking campaign to show how successful the osmosis of information into the US people was. Yet, the authors include no history on Europeans and why the information transmission didn’t work. I assume each country has a different history on smoking, but some depth on general problems would have been appreciated.