On the 11th of January, 1964, the Surgeon General of the United States, Dr. Luther Terry, M.D. published Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health. I was four years old. It would be another four years before my father had a massive heart attack. He was in hospital four six weeks. When he was discharged he wanted to do something for the doctor who had been in charge of his care. “Just promise me that you will never smoke again.” My father promised, and he kept his word. He had been smoking since he was six. His mother would ask him if he had any cigarettes and if he hadn’t she would tell him to take his father’s empty beer bottles to the off-license and buy himself some with the money.
The Advisory Committee that produced the report was composed of ten independent medical and scientific experts from fields such as pathology, epidemiology, internal medicine and pharmacology. Crucially, they were selected to avoid any real or perceived conflicts of interest with the tobacco industry. Over the course of more than a year, the committee reviewed over 7,000 scientific studies and articles from around the world, analysing data on the effects of smoking on both individuals and public health. Their goal was to determine, with scientific rigour, whether there was a causal relationship between cigarette smoking and disease.
The report reached several key conclusions that reverberated throughout the medical community and society at large:
- Cigarette smoking is a cause of lung cancer in men and a probable cause in women. Although lung cancer rates among women were lower at the time due to historical smoking patterns, data strongly suggested a rising risk with continued use.
- Cigarette smoking is the most significant cause of chronic bronchitis, and a major factor in other respiratory illnesses.
- Smoking contributes to coronary heart disease, though the language of causation was cautious in 1964 compared to later reports.
- Evidence indicated that pipe and cigar smoking, while less risky than cigarette smoking, still carried health dangers, particularly when smoke was inhaled.
The report also highlighted the addictive qualities, although the language of “addiction” was not yet widely adopted. It starkly noted that the scale of tobacco use in the population meant that smoking constituted a major public health problem.
The release of the report was handled with considerable care by the United States government. It was unveiled on a Saturday to maximise press coverage while minimising immediate market shocks. The findings were widely reported in newspapers and on television, making the health risks of smoking a topic of national conversation. This moment is frequently cited as the beginning of the modern anti-smoking movement.
In terms of impact, the 1964 report initiated a cascade of public health interventions. Warning labels on cigarette packs became mandatory in 1965. Restrictions on tobacco advertising followed, including the banning of television and radio cigarette adverts in the United States by 1971. The report also laid the foundation for ongoing research, fuelling policy debates across the world and encouraging other nations to take similar steps against tobacco use. It inspired subsequent Surgeon General’s reports that would expand on the dangers of smoking, including its strong link to cardiovascular disease, emphysema, and the harmful effects of second-hand smoke.
The “Smoking and Health” report is now considered a historic document because it changed not only scientific understanding but also social attitudes toward smoking. Before its release, smoking was widely accepted and even glamourised. After 1964, the tobacco industry faced increasing scrutiny, and public health campaigns gained legitimacy and momentum. Today, it stands as a foundational text that combined medical evidence with government action, ultimately saving millions of lives by shifting public behaviours and shaping modern tobacco control policies. The report’s legacy continues in contemporary anti-smoking efforts across the globe, reaffirming the critical role of science in safeguarding public health.