Smoking on the Streets: A Public Health Issue

This morning, while walking along Sherbrooke Street in Montreal heading towards the downtown campus of McGill University, I overheard a conversation between two middle aged men smoking cigarettes while standing next to the entrance of a large office building.

“This cough just won’t go away.  I should have asked my doctor about it.  I think I’m going to head to hospital tomorrow to get some antibiotics.”

Though it seems that the flu season has come early to Montreal this year, and coughs have many different causes and may last for varying durations, there is one small step that everyone can do to take care of their personal health and contribute to the public good: stop smoking.

Though smoking can be seen as a source of pleasure, enjoyable for its social aspects and as a personal release, the health consequences for the smoker’s lifestyle are steep.  The life expectancy for a person who smokes is at least 10 years shorter than for a person who does not smoke; furthermore, smoking increases the risk of death from bronchitis and emphysema by 17 times in men and 12 times in women.[1]

However, the adverse effects from smoking are experienced throughout society not only in the form of secondhand smoke, which has been named as a contributing factor in the deaths of 2,500,000 nonsmokers in the United States alone since 1964,[2] but also in the public healthcare system itself. As a result of the cancers, diseases of the heart and lungs, and the myriad of other health conditions directly linked to smoking, smokers tend to demand more health care compared to the average nonsmoking individual and as a result create greater healthcare expenses throughout their adult lives; in 2002 cigarette smoking in Canada accounted for $4.4 Billion in direct medical expenses[3] and in 2015 the annual healthcare cost per individual smoker was estimated to be $3,071 compared to $858 per overweight individual.[4]

Canada’s public healthcare system, commonly referred to as Medicare, takes the form of a provincially administrated health insurance system which is largely publically funded but privately delivered.  When analyzing Canadian expenditures on healthcare, the vast majority (71%) of expenses are shouldered by the taxpayer in the form of provincial and federal spending on healthcare purposes with the remaining amounts are split between private insurers and out of pocket expenditures (13% and 14% respectively).[5]

Furthermore, as Canadians born during the postwar baby boom age begin to demand greater amounts of healthcare benefits due to chronic and age-related medical conditions, the Canadian public health system faces increased strain both in terms of finances and capacity issues (in 2011 there were 1.9 doctors and 2.1 hospital beds per 1000 people in Canada which is significantly below the OECD average).[6]  In order for the Canadian healthcare system to provide adequate and reliable service for decades to come, reforms must be made to ensure its sustainability; however, the onus is on ordinary citizens to develop and nurture healthy habits with the goal of leading healthier lives (with the positive consequence of reducing avoidable healthcare costs).

The solution for our man on the street is clear, though his cough may indeed be a consequence of a bacterial infection and can be easily remedied by antibiotics, the long term health of both his lungs and the Canadian healthcare system would be fortified if he kicked the habit.  After all, for smokers who quit before the age of 40, the risk of dying from a smoking related illness/health condition is reduced by around 90%.[7]  Though greater smoking cessation will not solve every malady of the healthcare system, on an individual level it’s a good place to start.

John Butler

Works Cited

[1] United States Centers for Disease Control and Prevention (CDC) factsheet on Tobacco

[2] United States Centers for Disease Control and Prevention (CDC) factsheet on Secondhand Smoke

[3] Alberta Health Services.  Cost of Smoking In Health Care Terms

[4] Krueger, Hans. Krueger, Joshua. Koot, Jacqueline.  “Variation Across Canada in the Economic Burden Attributable to Excess Weight, Tobacco Smoking and Physical Inactivity.”  Canadian Journal of Public Health, May/June 2015,

[5] Deloitte 2015 Health Care Outlook: Canada

[6] Deloitte 2015 Health Care Outlook: Canada

[7] United States Centers for Disease Control and Prevention (CDC) factsheet on Tobacco

Pictured titled, "whiff of smoke", taken by Thomas8047 on February 1, 2014, obtained through Creative Commons (