Public health and the power of individual action

Dramatic changes in smoking behaviour occurred over the half century since cigarette smoking was identified as a cause of human disease, and these changes are a major public health accomplishment.1 Perhaps no component of this change has been more dramatic than the reduction in people’s involuntary exposure to tobacco smoke pollution. The fraction of indoor workers protected by a total ban on smoking in the workplace has risen from 3% in 19862 to nearly 70% in 1999,3 and serum cotinine levels in non-smokers declined 70% between 1988 and 1998.4 Much of this progress can be attributed to the courageous and determined actions of individuals applying our advances in the medical sciences. This issue both celebrates those individuals and details their accomplishments. Almost immediately following Surgeon General Jesse Steinfeld’s articulation of involuntary smoking as a public health issue and his declaration of a non-smokers bill of rights,5 airlines became the leading edge of a societal change that would de-normalise smoking and protect non-smokers from exposure to tobacco smoke. As presented by Holm and Davis6 in this issue, aircraft were one of the first public places to have separate smoking and non-smoking sections, and regulation of airline travel would continue to lead the rest of society toward banning smoking in the work environment for the next two decades. Efforts to regulate exposure to tobacco smoke in air travel culminated in the elimination of all smoking on domestic flights lasting less than two hours in 1988, a total ban on domestic flights in 1990, and a ban on international flights in 2000. Progress on airplanes was a highly visible …