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NC Department of Health and Human Services
NC DPH: Chronic Disease and Injury Section

Tobacco Prevention and Control Branch

Eliminating Tobacco-Related Disparities

"Social position, economic status, culture, and environment are critical determinants of who is born healthy, who grows up healthy, who sustains health throughout their life span, who survives disease, and who maintains a good quality of life after diagnosis and treatment."

-- National Cancer Institute, The Nation's Investment in Cancer Research for Fiscal Year 2002

"The landmarks of political, economic and social history are the moments when some condition passed from the category of the given into the category of the intolerable. I believe that the history of public health might well be written as the successive re-definings of the unacceptable."

-- Geoffrey Vickers

Equity vs. Equality

Equality vs Equity


  • Health Disparity: A population-based difference in health outcomes.
  • Health Inequity: A health disparity due to inequitable, socially determined circumstances.  Because health inequities are socially determined, change is possible.
  • Health Equity: When every person has the opportunity to realize their/her/his health potential - the highest level of health possible for that population or person - without limits imposed by structural inequities. Health equity means achieving the state in which all people have the opportunity to attain their highest possible level of health.
  • Structural Inequities: Structures or systems of society - such as finance, housing, transportation, education, social opportunities, etc. that are structured in a way that they benefit one population unfairly (whether intended or not).
  • Structural Racism: The normalization of an array of dynamics - historical, cultural, institutional, and interpersonal, that routinely advantage white people while producing cumulative and chronic outcomes for people of color and American Indians. 

The North Carolina Tobacco Prevention and Control Branch seeks to:

  • increase parity by bringing those at greatest risk for tobacco use, illness and death in line with those at the least risk for tobacco use, illness and death; and
  • increase diversity by inviting all stakeholders in tobacco prevention and control to the table to participate in all aspects of tobacco use prevention and control include planning, implementation and evaluation of tobacco use prevention and control programs.

The Tobacco Prevention and Control Branch seeks to improve health equity by advancing evidence-based media, policy and program services interventions in each of the three goals with a fourth goal as cross-cutting: (1) prevent initiation of tobacco use (including emerging products including e-cigarettes) among youth and young adults; (2) promote quitting among adults and youth; (3) eliminate exposure to secondhand smoke, and (4) advance health equity by identifying and eliminating commercial tobacco product-related inequities and disparities. These goals can be achieved by implementing a state-based tobacco control program that includes the following: a) state and community interventions; b) mass-reach health communication interventions; c) tobacco use and dependence treatment interventions; d) surveillance and evaluation; and e) sound infrastructure, administration, and management processes.

Adult Smoking Rates, 2018

Adult Smoking Rates, 2018 (View full size)

Workplace Secondhand Smoke Exposure, 2018

Workplace Secondhand Smoke Exposure, 2018 (View full size)

Despite tobacco use and dependence reduction among the general population, tobacco use and dependence and secondhand smoke exposure is still higher among some population groups. Persistent disparities exist among African Americans; American Indians/Alaska Natives; Asian Americans, Pacific Islanders and Native Hawaiians; Hispanic/Latinos; lesbian, gay, bisexual, transgender and queer (LGBTQ) individuals; people of low socioeconomic status; people living with a disability; individuals with behavioral health conditions (including mental health conditions and substance use disorders); and by individuals living in different geographic regions, including the Southeast. According to the Best Practices User Guide: Health Equity in Tobacco Prevention and Control, multiple coordinated efforts can reduce tobacco-related disparities among groups with the highest tobacco use and dependence and secondhand smoke exposure. These efforts can include implementing comprehensive smoke-free laws, increasing tobacco product prices, reducing targeted tobacco industry advertising and offering comprehensive cessation services.

National Networks

CDC has a Consortium of National Networks (PDF, 324 KB) to provide technical assistance at the national, state and local level to improve health equity and eliminate tobacco-related health disparities.

Social Determinants of Health and Health Equity

Related Research

TPCB Research and Data Information






Updated: January 14, 2022