World No Tobacco Day: Quitting smoking is good, stigmatizing smokers is not. Opinion
In the 20th century tobacco use killed an estimated 100 million people – more than both world wars combined. Most of them had no idea of the consequences of tobacco use since tobacco’s harmful effects were exposed only 50 years ago. Nowadays, information on tobacco’s deadliness is widespread, still, one in five adults worldwide continue to smoke…
The war on tobacco has been raging for decades in the most developed countries and smoking rates in the Americas, and to a lesser extent in Europe and other regions (with the notable exception of China), have begun to decline considerably. This important outcome is the result of a string of anti-smoking measures implemented in virtually all developed countries – including “smoke-free” legislation in public indoor areas, tax increases or bans on tobacco advertising. Everywhere, those measures have gone into effect with near-universal support – as opposed to other health-oriented campaigns that became fodder for national debates about freedom and individual rights.
The lack of resistance to these policies reflects the greater awareness of the health risks of smoking by it also is a sign of the stigma that has come to surround tobacco products and the people who still use them. In some countries, the level of anti-smoking sentiment has become ridiculous these days: in the UK a recent, publicly funded anti-smoking campaign went: “If you smoke, you stink” – in Italy, according to a TV campaign by the Health Ministry, “Chi fuma é scemo” (those who smoke are dumb).
Could we possibly imagine a public campaign with the slogan ‘if you’re fat, you’re ugly’? It would be deemed as insensitive as rude! Nevertheless, it has in many places become acceptable to denigrate smokers and give them dirty looks. Not only is it morally wrong, but it is also prejudicial to the very objective of health authorities.
Tobacco control policies have played an essential role in reducing smoking rates, but they have also contributed in stigmatizing smokers, forcing them to huddle outside public buildings, restaurants and bars. In many countries, people tend to give smokers a wide berth and regard them with a mixture of pity and revulsion. Consider for a moment the plight of the average nicotine addict. Though they partake in something that, for the time being, is still legal, the level of opprobrium directed towards them is astounding. They are shunned and mocked, accused of killing themselves, and worse, of killing us too (bastards).
Well, stigma can be useful to deter people from smoking, but it can also have unwanted consequences – like tempting smokers to hide their addiction from their doctors, placing an additional burden on already vulnerable populations (cigarette taxes are overly burdensome, especially for the poor) and making diagnoses of smoking-related diseases embarrassing.
Health care officials know that stigma can kill: they have been fighting the stigma attached to other conditions for decades, from depression to AIDS. In many countries, stigmatization still represents an added psychological and social burden on people living with HIV or AIDS and it also fuels the spread of the epidemic. Yet in the instance of tobacco control policies, the consequences of stigmatization have been given very little consideration.
Smokers are given a stark choice: quit smoking or die. Whether they are the victims of social stigma or not is irrelevant. We will soon achieve a smoke-free society and it will be perfect bliss. But where do we stop? Do we pass laws against smoking in private homes? Against frying food indoors (which also releases carcinogens into the air)? Eating the wrong kinds of food? Eating too much? Weighing too much? Exercising too little? And what about the exhaust fumes from our cars? That is the question.