...And Tobacco Is One Of The Big Culprits

Among the many factors contributing to the indifferent health of low-income Americans, notes economist Jeffrey E. Harris of Massachusetts Institute of Technology, is the prevalence of smoking. "Cigarette smoking is now responsible for a fifth of all deaths in the U.S. annually, and the poor are the heaviest smokers," he says.

Some 35% of American adults below the poverty line are regular smokers, compared with just 20% of those from households with incomes above $50,000. Harris, who is a physician as well as an economist, estimates that lifelong smokers live seven years less on average than nonsmokers. In addition, secondary smoke harms children and other nonsmokers in a household.

Similarly, smoking is more prevalent among blacks than among whites--and blacks have higher death rates from smoking-related diseases. For example, 86% of deaths from lung cancer are attributed to smoking, and blacks' death rates for this ailment are more than twice those of whites.

Such stark statistics are one reason many health groups are calling for a $2 increase in the federal cigarette tax. To be sure, such a hike would hurt poor people who continue to smoke more than it would higher-income smokers. On average, a household with two adults each smoking a pack and a half a day now shells out nearly $2,100 a year for cigarettes, and a $2 tax hike would raise it to $4,200. But economists argue that the regressiveness of the tax would enhance its effectiveness in curbing smoking.

"Health information sways the more affluent and educated," says Harris, "while the poor are more concerned about costs." And although the proposed hike would be regressive, the benefits of quitting are progressive: In other words, the poor, who suffer the most from tobacco use, are the most likely to improve their health by kicking the habit.

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