Over the past few months, I have obtained the impression that anti-smoking groups feel that all smoke-free laws that they are supporting make perfect public health sense and will not cause harm to anyone, and that anyone who challenges this dogma is not only wrong but needs to be attacked.
But the truth is that a number of smoking policies that some anti-smoking groups have supported do not make a whole lot of public health sense and would, in fact, cause harm to a substantial number of people.
Before getting to my argument, a few examples.
Several weeks ago, I suggested that perhaps the New Jersey smoking law, by exempting casinos but banning smoking in the nearby bars in Atlantic City, would cause harm for those local bars by resulting in a loss of their smoking customers to casinos where smoking is still allowed. In addition, I suggested that this could increase secondhand smoke exposure for casino workers. Finally, I pointed out that the number of workers being denied protection - 48,000 - was substantial and that it should be acknowledged that this represented a flaw in the law that was due solely to a political compromise to appease the powerful casino lobby.
In contrast, some anti-smoking groups responded by ignoring the fact that casino workers were being denied protection and in one case of massive deception, misleading their constituents by suggesting that all workers were indeed being protected.
Recently I suggested that the District of Columbia's smoking ban was nonsensical because it provides a powerful incentive for restaurants to go into the tobacco sales business by exempting from the law establishments that can earn 10% or more of their revenues from tobacco sales. There is certainly no public health reasoning behind this policy. If secondhand smoke is a health hazard for bar and restaurant workers, then it is certainly no less of a hazard for those who work in establishments that derive 10% of their revenues from tobacco than those which do not.
And just yesterday, I questioned the rationality and justification behind the Oklahoma smoking law, which bans smoking in restaurants only if the business owner chooses not to allow smoking (in a separately ventilated smoking room) and which fails to protect bar workers from the alleged severe health effects of secondhand smoke. I suggested that for workers in those smoking rooms (even if it represents only a small proportion of overall restaurants), secondhand smoke exposure will be extremely high and certainly much higher than it is at present. In addition, smoke exposure in bars will be higher as smokers will shift somewhat from bars to restaurants.
In response, one commenter from Oklahoma refused to acknowledge that any harm would be caused by this law, and basically wrote off what he claimed would be the 2% of restaurants that do implement smoking rooms as well as 100% of the bars.
Please note that I am not necessarily taking issue here with public health advocates supporting these measures. Sometimes there are severe political constraints and perhaps it's the case that this is the "best" law that could be obtained. That is a strategic issue and I'm not necessarily questioning the strategic decisions made by these groups (at least not here).
However, what I am questioning is the complete reluctance (or should I say refusal) of many anti-smoking groups to simply admit that: (1) the policies are inconsistent and are not based on some rational public health justification; (2) the policies could do harm by increasing secondhand smoke exposure for some workers; and (3) the reason for the policy is not that it makes public health sense, but that certain politicians needed to be appeased in order to obtain their support.
What I'm pushing for here, then, is not different strategic decisions or for anti-smoking groups to necessarily reject proposals that are not "perfect," but instead, for simple honesty, transparency, and forthrightness in being willing to call a spade a spade and tell it like it is, rather than cloud the truth behind a veil of "this is a step in the right direction" rhetoric that ignores, dismisses, or hides the harm that these policies could do for some workers.
The Rest of the Story
There is no question, I think, that the Oklahoma smoking law is going to result in harm to some restaurant workers. For employees who work in the smoking rooms, they will be exposed to very high levels of secondhand smoke, and their exposure, on average, will increase by more than an order of magnitude.
It doesn't matter whether only a small proportion of restaurants build these smoking rooms. For those employees who work in them, it is going to increase their exposure. This means that if anti-smoking advocates are correct about the severe hazards of secondhand smoke, the Oklahoma law is going to cause health damage and disease (and possibly death) for a number of restaurant workers.
Now while it is my contention that we probably should not be supporting a public health policy that causes disease for some workers (in other words, that protects some workers at the expense of others), I recognize that it is possible that this provision in the law may have been the result of politics.
Fine. Then call a spade a spade, admit that it was solely politically motivated, and admit that the policy doesn't make sense and has no public health basis or rationale. That's all that I'm saying.
What possible harm could it do to be forthright and honest and admit that some workers are going to be harmed because of increased secondhand smoke exposure?
Now it was suggested yesterday that only 2% of restaurants in Oklahoma would fit into this category. First of all, we simply don't know what the proportion will be and so there is little basis to be able to determine the number of workers who will be affected.
But let's say that it is just 2%. Well, shouldn't we be forthright and admit that for that 2% of workers, the policy is going to result in health harm (or at least, in increased exposure to secondhand smoke)?
And if we discount or ignore the 2% of restaurants which will be smoke-filled, then the same reasoning could justify ignoring restaurants all together. In the desire to provide smoke-free workplaces for all employees, why worry about restaurants, which make up less than 2%, I believe, of all workplaces?
Moreover, while it may be 2% of all restaurants, it will likely be a much larger proportion of restaurants with high levels of smoke. Because the restaurants most likely to take on the expense of building a smoking room are precisely those with the most smokers (so that it would make sense to build a smoking room). Thus, it is precisely the workers who are most affected by secondhand smoke who will have to work in these smoke-filled smoking rooms.
In addition, by exempting bars, it is highly likely that many smokers will start hanging out less in restaurants, and more in bars. This would increase secondhand smoke exposure in bars. I don't think this is rhetoric. I think it's likely to be true, at least to some extent. Should we not be forthright and admit that this will likely occur, and that if it does, bar workers will face higher exposure and possibly, health harm?
Again, I'm not suggesting that health advocates not ever support exemptions or compromises. That's the process of policy making. But I do think we should be forthright about it and admit that yes, these policies are the result of compromises for political, rather than public health reasons and that yes, they will likely result in health damage for some workers.
One commenter yesterday posed the question: "If 98% of Oklahoma restaurants are smokefree, then what is the problem both with this policy other than the other 2% of the businesses have this smoking room?"
This is precisely my point. The problem is that 2% of businesses will expose their employees to an average of 10 times increased secondhand smoke exposure. Forget about any "other" problem. The comment seems to be ignoring or dismissing the very problem that I was trying to call attention to.
At very least, I think we need to be forthright and acknowledge that there is something quite irrational about a policy that protects the bulk of restaurant workers by having some of those workers face drastic increases in exposure to secondhand smoke and the resulting health damage.
OK - it may be the case that this provision was necessary for political purposes. Fine. But that doesn't mean we have to pretend that the policy makes public health sense. It doesn't, so what's wrong with simply admitting that?
Finally, I want to note that while I don't personally think that a smoking ban that creates a level playing field for all businesses will result in any economic harm, I do think there is strong reason to believe that an unequal playing field will benefit some establishments at the expense of others.
I don't think it is unreasonable to posit that establishments which can afford to install smoking rooms will be successful in attracting large numbers of smoking customers, possibly drawing them away from other businesses that simply cannot afford to build these smoking rooms. I don't think it is unreasonable, therefore, to suggest that in addition to health harm, the policy may cause some economic harm.
Don't get me wrong, I'm not suggesting that the economic harm outweighs health concerns. But I also don't see any damage caused by being honest and acknowledging that some restaurants may lose some customers due to this policy.
The rest of the story is that regardless of the rationale behind strategic decisions of anti-smoking groups to support restaurant smoking policies that are not "perfect," I think there is a need for groups to be more forthright about the lack of consistency in some of these policies, the lack of public health sense in some of these policies, and the very real fact that some of these policies will, if one accepts the scientific arguments of the policy proponents, result in increased secondhand smoke exposure and health damage for a number of workers, and possibly in economic harm for some establishments.