Years of anti-smoking laws and campaigns have amounted to a public shaming
of smokers that could make it harder for them to quit, a group of UBC
researchers argue in a new report.
There is an "urgent" need for governments to revisit their anti-smoking
policies, the academics say, suggesting that the stigma around smoking could
lead to patients hiding their tobacco use from doctors, and feeling
desperate about ever kicking the habit. The policies run counter to how
other addictions are treated by the public-health field, they argue.
"People are made to feel really, really bad about their smoking and are
treated quite badly, but feel quite helpless in quitting," said Kirsten
Bell, a medical anthropologist at the university and lead author of a paper
just published on the issue.
"They feel really negatively about themselves, but quitting seems like an
impossibility ... They're not really given much support."
Her views raise questions about decades of conventional wisdom on how to
combat the threat of tobacco use, blamed for 45,000 preventable deaths in
Canada yearly. Anti-smoking advocates reacted vigorously to the article in
the journal Social Science and Medicine, saying policy-makers have strived
not to victimize smokers themselves, while the falling rate of tobacco use
is clear evidence the programs have succeeded.
The researchers' "shoddy" work just parrots the tobacco industry's attempt
to portray anti-smoking efforts as an attack on individuals, said Garfield
Mahood of the Non-Smokers Rights Association.
"What they've done with this paper is mischievous and careless and
ill-informed," he said. "These people ... have simply bought into the
tobacco industry's mischief."
The paper and further research yet to be published by Ms. Bell and
colleagues was supported by a grant from the ethics branch of the Canadian
Institute for Health Research.
Their work looks at a range of anti-smoking measures they contend have
"de-normalized" smoking and smokers themselves. Those include restrictions
on where people can light up, bans on convenience-store "power walls" and
other limits on tobacco sales, publicity campaigns to deter smoking, and
graphic warnings on cigarette packages.
Such programs have generally been hailed as a public-health triumph, with
smoking rates plummeting to about 20% in Canada from 50% in the 1960s,
according to the most recent federal statistics.
Intentionally or not, though, such policies have also stigmatized the
remaining smokers, with various potentially negative impacts, the paper
argues. It cites anecdotal reports of surgeons and other doctors refusing to
treat cancer patients who smoke heavily. As many as one in four doctors who
responded to a 2005 Canadian Lung Association survey admitted to providing
lesser care to smokers. A University of Washington survey published last
year found just under one in 10 smokers hid their tobacco use from doctors,
often because of stigma.
In a survey of 25 smokers and ex-smokers soon to be published by the UBC
group, respondents talked of being refused access to city buses after they
were spotted smoking at a bus stop, harassed by strangers in public and
otherwise treated as pariahs. "You really are labelled as a bad person if
you smoke," said one person.
Ms. Bell, whose work focuses on tobacco and cancer, said her interest was
piqued by what she sees as the contrast between how smokers are treated, and
the non-judgmental, "harm-reduction" approach now widely applied by public
health to people with other addictions. Illicit injection-drug users, for
instance, often have access to needle exchanges and, in Vancouver, a
safe-injection site, all designed to curb the spread of HIV and other
infectious diseases, and to keep them in touch with public-health officials.
Tobacco policies also now disproportionately affect the poor, the paper
argues, as smoking rates are almost twice as high among low-income Canadians
as among the highest-income group.
Katherine Frohlich, a public-health expert at the University of Montreal,
said studies by her research group found that poorer smokers feel the
policies have discriminated against them by, for instance, restricting their
social interaction and isolating them at home.
"We shouldn't dismiss the fact these interventions have been incredibly
successful," she said. "[But] we have to take into consideration the fact
that there are some pretty serious unintended consequences."
Cynthia Callard of the group Physicians for a Smoke-free Canada rejected the
notion, however, that smoking is now a predominately low-income phenomenon.
The rates may be higher among the poor, but the sheer numbers are still much
larger in middle- and upper-income groups, she said.
"Soccer moms smoke significantly more than single Moms," said Ms. Callard.
Mr. Mahood said the tobacco-control movement has not tried to stigmatize
individual smokers, but argued it is positive that society now views smoking
as unhealthy, rather than sexy and glamourous, as was the case just a few
decades ago.
Source : The National Post
