President Iohannis, Commissioner, Your Royal Highness, Your Excellencies, ladies and gentlemen. Thank you for the invitation to speak today. The U.S. Embassy is proud to have supported Romania Respira, Ramona Brad, Magdalena Ciobanu, and their partners as they pursued the landmark smoking ban achieved in March of 2016. That year, we honored Ramona and Magda with the Embassy’s International Woman of Courage Award for their efforts coordinating a network of more than 250 organizations in a grassroots movement to protect the human rights of Romania’s citizens and the future of its children.
This law exemplifies the best of the democratic process in Romania. Those of you here today who were part of that effort have demonstrated that, through civic engagement, individual citizens can work together and make policy changes that benefit Romania as a whole. I commend you for your dedication. I hope that others throughout Romania and throughout the world will look to your example as a model for bringing grassroots democratic change to society.
The law’s impact and long-term benefits should not be underestimated. In the United States, despite the progress we have made, tobacco use remains the single largest preventable cause of death and disease. Cigarette smoking kills more than 480,000 Americans each year. One of those was my grandmother. Smoking-related illnesses in the United States cost more than $300 billion a year, including nearly $170 billion in direct medical care for adults and $156 billion in lost productivity. In the EU, tobacco consumption remains the largest avoidable health risk and the most significant cause of premature death, with more than 300,000 deaths per year. The trend is troubling, particularly here in Romania, is deeply troubling, as smoking rates for 15- and 16-year-olds are high and on the rise.
As we continue our efforts to support human rights and prevent tobacco deaths, a brief history of tobacco control milestones in the United States is instructive.
As early as 1956, a scientific study group convened under the aegis of the U.S. Surgeon General found hard evidence of a causal relationship between excessive cigarette smoking and lung cancer. In 1964, the landmark report on smoking and health from the Surgeon General helped launch the modern tobacco control movement by linking smoking with a 70 percent increase in mortality and a twenty-fold increase in the occurrence of lung cancer.
The 1972 the Surgeon General’s report became the first in a series of science-based reports to identify environmental tobacco smoke (ETS) as a health risk to nonsmokers. In 1973, Arizona became the first state to restrict smoking in public places explicitly. In 1989, Surgeon General Dr. C. Everett Koop explicitly characterized cigarette smoking as an addiction rather than a habit. By 1992, the Environmental Protection Agency classified tobacco smoke as the most dangerous class of carcinogen — “Group A” .
In 1994, Mississippi became the first state to sue the tobacco industry to recover Medicaid costs for tobacco-related illnesses, settling its suit in 1997. In 1998, the tobacco industry agreed to a Master Settlement Agreement with 46 states, the largest settlement in history, totaling nearly $206 billion to be paid through the year 2025. In April 1999, as part of the Master Settlement Agreement, major U.S. tobacco companies agreed to remove all advertising from outdoor and transit billboards across the nation. The remaining time on at least 3,000 billboard leases, valued at $100 million, was turned over to the states to post anti-tobacco messages.
For more than 35 years, public health movements such as the Campaign for Tobacco-Free Kids have led the fight to avoid the deadly consequences of tobacco use. Anti-tobacco campaigners have pursued a series of comprehensive reforms addressing taxation, health care reform, and additional smoke-free laws. This dedicated focus on smoking prevention and cessation programs has produced results. Since 1996, the United States has reduced youth smoking by 70 percent and adult smoking by 30 percent.
What did we learn from this history? We have learned that effective tobacco control must be wide-ranging, comprehensive, and holistic. From federal public health officials and environmental regulators, to state legislators and grassroots campaigners, effective tobacco control requires a whole-of-society approach and a commitment not just from the medical community, but also from government, civil society, academia, and the private sector.
Partners such as Romania Respira and events such as today’s help provide the coordinating effort that can lead to even more progress in the global fight against tobacco.
Thank you very much.