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March 2, 1994

Actual Causes of Death in the United States

Author Affiliations

University of California—San Francisco

JAMA. 1994;271(9):660. doi:10.1001/jama.1994.03510330037022

To the Editor.  —Drs McGinnis and Foege1 recently published an article pointing out that the most prominent cause of death is tobacco (419 000 deaths) compared with other behaviors, such as illicit use of drugs (20 000 deaths), which command much greater public attention. Their article only tells half the story, however. As the Figure demonstrates, the federal government devotes resources to these problems in inverse proportion to the real public health impacts, despite the fact that there are proven public health interventions that can control many of these diseases, particularly tobacco. For example, in California voters increased the tobacco tax by 25 cents per pack of cigarettes and devoted 5 cents to an aggressive media and community-based tobacco control campaign. Despite the fact that the legislature and governor have never fully funded these programs,2 the rate of decline in tobacco consumption in California tripled.3 At a

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