English: Smoking seemed inevitable until it didn’t

The chart summarizes the history of smoking in the US (the development in other high-income countries was similar). I plotted two different metrics: in purple, you see the rise and fall of cigarette sales, which you can read off the values on the left-hand axis. In red, you see the rise and fall of lung cancer deaths, which you can read off the axis on the right.

Smoking was very much a 20th-century problem. It was rare at the beginning of the century, but then – decade after decade – it became steadily more common. By the 1960s, it was extremely widespread: on average, American adults were buying more than 10 cigarettes every day.

The statistical work that identified smoking as the major cause of the rise in lung cancer deaths began in the post-war periods and culminated in the 1964 report of the Surgeon General. This report is seen as a turning point in the history of smoking as it made clear to the public just how deadly it was.11

Once people learned that smoking kills, they could act on it. It took some time, but they did.

I wasn’t alive during peak smoking, but even I remember how very common it was to smoke in places where it would be unthinkable today. Looking back, I also remember how surprised I was by how quickly smoking then declined. It is a good reminder of how wrong it often is to think that things cannot be different – for a long time, smoking kept on increasing and it looked as if it would never change. But then it did.

Nearly half of all former smokers have quit,12 cigarette sales declined to a third of what they once were, and the death rate from lung cancer declined.