In a letter to the editor published December 31 in the Philadelphia Inquirer, the regional president of the American Heart Association of New Jersey praised legislation approved recently by the New Jersey Senate which would ban smoking in workplaces, including bars and restaurants in New Jersey.
According to the letter, this legislation is "lifesaving," and is premised on the principle that "No one should be forced to contend with increased risk factors for heart disease or stroke, particularly as a result of their employment conditions."
The legislation, according to the American Heart Association, has "provided an important step in the delivery of the ultimate gift for the public health of the citizens of New Jersey." And if enacted, the bill "would ensure that thousands of our state's workers would be protected from secondhand smoke."
The Rest of the Story
What the American Heart Association's statement does not reveal is that the proposed legislation would essentially require the state's 48,000 casino workers to continue to work in smoke-filled environments in order to obtain their living, thanks to an exemption placed into the legislation for casinos due solely to political intervention on behalf of casino business interests.
The American Heart Association's statement could just have easily stated that the legislation would ensure that thousands of our state's workers -- 48,000 to be exact -- would not be protected from secondhand smoke and would continue to be forced to contend with increased risk factors for heart disease or stroke as a result of their employment conditions.
If the legislation is truly premised on the principle that "No one should be forced to contend with increased risk factors for heart disease or stroke, particularly as a result of their employment conditions," then there is no public health justification for excluding casino workers from this protection, especially when there are so many workers involved (this is not some minor exemption that will have minimal public health implications).
While the Heart Association argues that this legislation is "an important step in the delivery of the ultimate gift for the public health of the citizens of New Jersey," I would argue instead that this legislation is unjustified, nonsensical, as it creates an unlevel playing field for workers and establishments in New Jersey, and will set back rather than propel forwards the public's health by ensuring that precisely the workers most threatened by secondhand smoke exposure in New Jersey are the ones who are denied protection for a long time to come.
Some might argue that this is a step in the right direction and the law will simply be amended next year to include casinos. However, history and experience tell us that this is not the case. Instead, history tells us that state smoke-free legislation is almost never strengthened, and if it is, it takes many years. The truth is that once state legislation passes, it virtually closes the door on protecting workers from secondhand smoke because state legislators do not like to reconsider the same legislation in subsequent years. (This is very different from the pattern with local smoke-free laws, where an incremental process of policy adoption is the norm and can happen quite rapidly).
Essentially, much of the public health community in New Jersey has basically written off the health of casino workers. There is no question that these workers are being forced to suffer in order for the health groups to be able to take part in this political compromise of their health for the benefit of others. And to me, this violates a basic principle of public health practice - to do no harm.
While I differ with the New Jersey health coalition on this issue on philosophical as well as strategic grounds, I would not necessarily be so critical of their actions if it weren't for the fact that they are so obviously attempting to hide the flaws of the bill. If they were simply up front and told it like it is, calling a spade a spade, I would have a lot more respect for what they are trying to accomplish.
But as this letter makes clear, they are not being up front. In fact, no where in the letter does it even mention the fact that the legislation would deny apparently basic health protection to 48,000 casino workers in the state, a large percentage of the state's working force that is not currently protected from secondhand smoke, and a segment of its workers that almost certainly represents the most heavily exposed group, and therefore the group most deserving of protection.
In addition, the letter tries to convince us that the justification for this legislation is that all workers should be protected from secondhand smoke because of its effects on heart disease and stroke; however, this cannot possibly be the true justification because the bill denies protection for a huge segment of the state's workforce (and again, precisely for that segment of the workforce that is most heavily exposed).
If the Heart Association were truly sincere in its statement, I find it difficult to imagine that they could fail to mention the state's 48,000 casino workers and the lack of protection that these workers are provided or the fact that these workers are in fact the most heavily exposed in the state and that the degree of suffering due to secondhand smoke exposure is substantial among this group.
And if the Heart Association were sincere in its statement, then I find it difficult to imagine that they would praise the law as it is, rather than criticize it for excluding casino workers and call on the New Jersey Assembly to pass a level-playing field law that protects all workers, removing the political casino exemption.
If the Heart Association truly believes that sacrificing the health of the state's casino workers is justified and appropriate in order to provide protection for bar and restaurant workers because of their perception that this compromise is necessary for political reasons, then they have every right to pursue such a political strategy. But as a public health group, they should at least have the decency to be honest and forthright about the reasons for their actions and their lack of any true public health justification.
If the health groups in New Jersey would simply be honest and admit that this is a purely political maneuver designed to appease politicians, rather than a public health measure that makes public health sense, I would have a lot more respect for what they are trying to do.
No matter how anti-smoking groups feel about the strategic wisdom of pursuing this type of compromise legislation, what I hope we would all agree upon is that we should be honest, forthright, and transparent in our actions as public health advocates.
That is clearly not happening right now in New Jersey.
I think it's time to call a spade a spade. And that's what the Rest of the Story will continue to do.