How Do We Reduce the High Cost of Care in North Carolina? UNC Researchers Point to Tobacco Control

News | March 5, 2018


Adam Zolotor
Publisher, North Carolina Medical Journal



Media Release


Morrisville, NC (March 5, 2018)—Tobacco use is responsible for most preventable deaths and diseases in North Carolina and the country. This is why UNC-Chapel Hill researchers point to tobacco control as a means to reduce health care costs in the current issue of the North Carolina Medical Journal.


Researchers from UNC’s Lineberger Comprehensive Cancer Center and Gillings School of Global Public Health note that smoking causes 30% of cancers in the state and that an estimated 180,000 of North Carolina’s youth will eventually die prematurely from smoking.


“Greater investment in tobacco control is needed in the state to fight a leading killer here in North Carolina,” said Sarah D. Mills, PhD, lead author of the article and postdoctoral fellow at UNC-Chapel Hill’s Lineberger Cancer Center.


In addition to the toll on lives, tobacco use has enormous cost implications. The authors wrote that smoking causes $3.8 billion in annual health care expenditures and $4.2 billion in productivity losses in the state. Meanwhile, North Carolina has higher rates of smoking compared to other states but lags behind in tobacco control.


“I hope policymakers see the value of tobacco control in North Carolina, from both the public health and economic perspective,” Mills said. “Tobacco control saves lives without causing economic harm.”


As tobacco farms and revenue decline in North Carolina, the authors argue, “taxing tobacco products is one of the most effective ways to reduce tobacco use, and it provides significant government revenue”—particularly as tobacco’s role in bolstering the state’s economy is undoubtedly changing. Farm cash receipts have dropped to 6.8% compared to 27% in 1983, and tobacco manufacturing employment accounts for less than 2% of total state manufacturing compensation.


“Despite popular belief, the large decline in the number of tobacco farms and in revenue has not ruined the state’s economy,” Mills said. The “Big Five” in new industry, technology, pharmaceuticals, banking, food processing, and vehicle parts sectors, developed in North Carolina as tobacco declined.


Authors also expect growth in the health care industry in the state. For example, Durham, once the center of the tobacco industry as home to the American Tobacco Company, is thriving as a leader in health care with one of the nation’s top hospitals. Now declared the “City of Medicine,” Durham has more than 300 health-related companies with a payroll of over $1.5 billion per year.


“Resources that were once used to produce a product that kills are now being used to treat tobacco-related illness,” Mills said.


To read the full article, “Cultivating New Directions: The Changing Role of Tobacco in North Carolina’s Economy,” by Sarah Mills and colleagues, as well as other NCMJ articles, visit


The North Carolina Medical Journal is a journal of health policy analysis and debate co-published by the North Carolina Institute of Medicine and The Duke Endowment. The NCMJ publishes six issues per year. To learn and read more, visit