Airplanes. Schools. Parks. Offices. Hospitals. All forbidden. Since 1964 — 50 years ago to the month that the surgeon general released its first report on the dangers of smoking — the laws regarding public cigarette use have tightened immeasurably. The era of powerful businessmen lighting up and carelessly flicking a used match into the waste bin are over. Doctors can no longer take calming drags from their Pall Malls next to precious oxygen tanks. And broadly, America’s lawmakers have wised up to smoking as more than just a personal habit, but a public health concern.

Now, a new study commemorating the 50th anniversary of that first report shows over these last five decades an estimated eight million lives were saved thanks to stricter laws, higher taxes, and a culture whose collective mindset has shifted away from tobacco.

Hypothetical Smokers

Published in JAMA, the study investigates the various factors that have contributed to smoking’s overall decline in the last 50 years. Yale University School of Public Health researcher, Dr. Theodore Holford, and his colleagues looked at the actual mortality rates of smoking among various birth cohorts, and compared them to estimates from prior analytical studies into a hypothetical second half of the 20th century, in which tobacco control never existed. The team developed a model to predict how many more people would have died from smoking-attributable causes — e.g., lung cancer, heart disease, stroke — if the federal and state governments had never designed the myriad smoking laws, raised taxes, created clean-air programs, and introduced tobacco education into schools.

The team’s model predicted that between 1964 and 2012, an estimated 17.7 million deaths occurred as a result of smoking. Meanwhile, some eight million lives were “saved” (forestalled premature smoking-attributable deaths), with an expected lean towards male lives (5.3 million vs. 2.7 million). The model also found the number of lives saved increased steadily over time. People under 65 represented 4.4 million prevented deaths in the 50-year time period.

“This implies the avoidance of a large productivity loss due to illness and death during those working ages,” the researchers explained in their report, “which is estimated to impose a cost of about $100 billion annually in the United States.”

Perhaps even more striking are the years saved in life expectancy. Overall, the team estimated, tobacco led to the gain of 157 million total years across the U.S. population, given the difference between the actual death rate and the team’s estimates. Spread out among the eight million people who didn’t die as a result of smoking, that’s 19.6 years of life gained on average.

A Step In The Right Direction

While this trend is necessary in ensuring a healthy and productive population, it isn’t sufficient, the researchers point out. According to the Centers for Disease Control and Prevention (CDC), cigarette use has declined from 42.4 percent prevalence in 1965 to 19 percent in 2011. A drop from four in 10 to two in 10 is appreciable, though the CDC hopes that rate falls to 12 percent by 2020, as per the Healthy People campaign.

"Despite the success of tobacco control efforts in reducing premature deaths in the United States, smoking remains a significant public health problem," the researchers wrote, noting the hundreds of thousands of deaths that result each year from the habit. “No other behavior comes close to contributing so heavily to the nation's mortality burden. Tobacco control has been a great public health success story but requires continued efforts to eliminate tobacco-related morbidity and mortality."

Source: Holford T, Meza R, Warner K. Tobacco Control and the Reduction in Smoking-Related Premature Deaths in the United States, 1964-2012. JAMA. 2014.