In response to my post suggesting that there may not be compelling enough scientific evidence of unavoidable harms of outdoor secondhand smoke exposure in open, public places (where people's movement is basically not restricted), a number of anti-smoking advocates have suggested that the widespread public support for these measure is sufficient justification for tobacco control advocates to continue to push for the adoption of these policies.
However, I do not feel that public support for these measures, in and of itself, is a sufficient justification for public health advocates to promote this type of policy. In this post, I attempt to explain why.
The Rest of the Story
First of all, there is no question that public support for a policy proposal is a significant factor that needs to be considered in deciding whether public health advocates should support such a proposal.
At the most basic level, a policy for which there is little public support is unlikely to succeed, even if it were highly justified. Enforcement of a policy and compliance with the policy are certainly factors that are associated with the effectiveness of the policy, so there is no question that public opinion needs to be taken into consideration.
However, the fact that the lack of any substantial public support for a policy casts doubt on the potential effectiveness of that policy and thus might lead advocates not to push for it does not imply, I think, that the converse is true. It is not the case, in my view, that the presence of overwhelming support for a policy proposal justifies that proposal.
Here I guess I adopt a Madisonian view of the role of government. In many ways, I think that democratic government should aim to protect the public not only from the tyranny of the minority, but from the tyranny of the majority as well. Our system of government was designed specifically to try to put enough checks in the system to protect against precisely this kind of a problem.
For example, I saw a poll not long ago showing that here in my "progressive" home state of Massachusetts, the majority of the citizens do not support the rights of gay individuals to marry. They are certainly entitled to their opinion, but the presence of that majority support for measures to ban gay marriage does not, I think, justify them.
I have been told (and I don't know if it's true) that in some states, a majority of citizens support restrictions on the freedom of women to have abortions. I certainly don't think this public support justifies policies to restrict what I view as that fundamental right.
Support for capital punishment approaches 50% here in Massachusetts and exceeds 50% in perhaps most states. But again, I don't think that public support justifies the adoption of this type of policy.
And so it goes with outdoor smoking bans. As a public health practitioner, I certainly would think carefully about trying to implement outdoor smoking bans if the public didn't support them at all, but the presence of public support does not sufficiently justify these policies.
What would sufficiently justify them, for me, is if the scientific evidence suggested that the hazards of secondhand smoke in outdoor public places were so severe that despite people's ability to move about to avoid the smoke, the public health is being substantially affected.
Ultimately, I think that the arguments I have heard this week about de-normalizing smoking, setting a moral example for children, and giving the public what it wants do more to hurt the cause of promoting smoke-free environments than to help the cause. Because these arguments suggest that the issue is not a public health issue any more. It appears to many (including myself) that it is simply part of some broader agenda, of which health is just a part.
In many ways, I am learning, I think, that the anti-smoking movement is essentially a crusade of its own, separated by a large distance from the field of public health in which I have been trained.