Imagine the worldwide alarm if over a year's time 443,000 of the metropolitan Boise population of 587,000 died. Such a massive death toll of 75 percent of the city's people would be twice the 220,000 killed by atomic bombs at Hiroshima and Nagasaki in 1945.
Yet, without much statistical change from year to year and with scant public outcry, more than 400,000 Americans died each year between 2000 and 2004 from tobacco use, inflicting a stunning $97 billion in lost human productivity and $96 billion in health care costs.
Help is on the way, however.
President Obama has picked Dr. Thomas Frieden, New York City's health commissioner, to take over the main federal public health agency, the Centers for Disease Control and Prevention.
The physician-trained Frieden is the right person at the right moment. His record in New York City was awesome. He pushed through smoking bans in restaurants. The city now claims it has 300,000 fewer smokers as a result. He also launched an aggressive campaign against tuberculosis and cut cases of multidrug resistant TB by 80 percent.
"He gets people whipped up," said a member of the New York State Board of Health.
One of the first myths Dr. Frieden must dispose of is that smoking is a private matter and no business of government regulation.
Every smoker that loses a day of work because of a smoking-related illness, seeks medical care through health insurance, is disabled and collects insurance or dies and bequeaths insurance to family has tapped into public resources somewhere and added costs to fellow Americans. Smoking is no free lunch for anyone.
Dr. Frieden also must deal with the impact of second-hand smoke. More than 10 percent of yearly smoking-related deaths—459,000—are the result of secondhand smoke.
As the leading preventable cause of death, smoking is an obvious priority target for Dr. Frieden's celebrated persistence and innovative programming. However, other preventable diseases—diabetes, obesity, and heart attacks—will show up on his agenda and receive the same determined treatment.
Timing is everything. With Dr. Frieden's appointment, President Obama has fortified his commitment to a national health care policy designed not only to provide insurance coverage for illnesses, but a campaign to step up wellness and preventive medicine programs that reduce costs dramatically.
Vital as Dr. Frieden and organized medicine are to health care, the ultimate provider, of course, is the individual, who can avoid illness-inducing habits and lessen the chances of becoming a health burden to family and society.