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The Elephant in the Room is Smoking

What if I told you we had a simple preventative service that could help avoid 50,000 premature deaths and $14 billion in U.S. health care expenditures every year?

What if I told you we had a simple preventative service that could help avoid 50,000 premature deaths and $14 billion in U.S. health care expenditures every year? Amazing, right?

Good news: This isn’t a “what if.” I’m talking about colonoscopy—the routine screening for colon and rectal cancer that health plans cover for millions of Americans each year and that prevents about half of the expected new cancers and cancer-related deaths, according to the CDC.

Now, what if I told you we had an even simpler preventative service that could avoid 500,000 premature deaths in the U.S. and save $325 billion in U.S. health care expenditures and lost productivity every year? Again, not a hypothetical. Yet here’s where our stories diverge. In this case, I’m talking about programs to help people quit smoking. Small problem? Hardly. One in six U.S. adults smokes, leading to myriad diseases and a 50 percent mortality rate.

Unfortunately, our healthcare system has not prioritized helping people quit smoking nearly as much as it has prioritized screening for colon and rectal cancer. As such, we are losing a very winnable battle.

It comes down to a problem of will. I don’t mean the will of smokers: About 70 percent of them want to quit. I mean the will of health plans and employers to make smoking cessation their top priority. After all, if you go to your physician at age 50 with your colon, you get a colonoscopy, and it’s covered. But if you ask for help quitting smoking, you get counseling and a nicotine patch. They’re covered too, but compared to our investment in preventing colon and rectal cancers, this is like fighting a wildfire with a squirt gun.

How did we get here? Our health system prioritizes procedures and drugs over preventative services and behavioral health. And society sees smoking as a personal choice. We blame smokers for not being able to “just stop”—even though nicotine is as addictive as heroin and “cold turkey” quit methods are successful maybe 2 percent of the time.

Know this: Smokers need help quitting, and smoking is everyone’s problem. Don’t believe me? For every $1 of tobacco sales, we collectively pay at least $4 to cover the resulting healthcare costs and lost productivity. Leaving aside this massive economic impact, secondhand smoke kills 41,000 non-smokers in the U.S. each year. For perspective, car crashes kill about 30,000 people annually. Smoker or not, we are all paying for the costs caused by smoking.

The tendency to view smoking as a personal choice and a concern only for smokers has resulted, predictably, in a lack of investment and innovation in smoking cessation. Phone-based counseling and quit classes are about as engaging as a trip to the DMV. It should be no surprise that fewer than 7 percent of smokers with access to a cessation program through their employer or health plan sign up. And of that 7 percent, fewer than 1 in 4 quit.

It doesn’t have to be this way. We have proven ways to help people quit smoking. And digital technology has given us a way to deliver those methods to almost anyone, anywhere, at any time. This problem is completely solvable. Here’s how we win:

  1. Believe in smokers: Don’t vilify smokers for smoking. Roughly 70 percent of them want to quit but don’t know how to beat their often decades-long addiction. We can embrace smokers while rejecting smoking.
  2. Turn to the pros: Smoking cessation is a science. Invest in and deploy cessation programs that are proven to work and that use evidence-based methods like intensive counseling, trained coaches, and FDA-approved pharmacotherapy.
  3. Get to scale: There are 40 million smokers in the U.S. We can’t get to everyone with phone coaches and classes. Scalable prevention services must be delivered through the smartphone and web.
  4. Go deep and go long: Cessation counseling typically includes five brief sessions over eight weeks. That’s neither deep nor long enough to help a lifelong smoker build the skills for a permanent quit. We need to deliver support that is both more frequent and longer term.
  5. Build a consumer experience: Have you ever seen a smoking cessation program you’d want to participate in? Of course not. Create programs with modern consumer expectations in mind. Don’t model them after other cessation programs. Model them after Apple or Facebook or Nike. Make them engaging, sophisticated, and human-centered.
  6. Classify smoking cessation as a medical necessity: Smoking cessation is so effective at improving health outcomes, it is graded as an “A” by the U.S. Preventative Services Task Force. And it’s a rare “dominant” intervention (cost-effectiveness lingo), meaning that it returns money to the employer or health plan. So, invest in the most robust and scalable services possible, and deliver them through the health plan budget.

Ten people in the U.S. died of a smoking-related illness while you read this. Another 1,500 will die today, and tomorrow, and the next day.

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