On Monday, the American Lung Association issued a press release announcing its new report on the toll of lung cancer among African Americans, entitled "Too Many Cases, Too Many Deaths: Lung Cancer in African Americans."
The report highlights the role of menthol cigarettes in the epidemic of lung cancer among African Americans. According to the report: "The tobacco industry’s [marketing] efforts have been wildly successful. According to a November 2009 report from the Substance Abuse and Mental Health Services Administration, nearly 83 percent of African American smokers aged 12 and older choose menthol cigarettes. This compares to 32 percent of Hispanic smokers, and only 24 percent of white smokers. It has been suggested that this difference in the use of menthol cigarettes may contribute to the health disparity between black and white smokers." ...
"Research suggests that:
• Menthol smokers have higher levels of cotinine, a byproduct of nicotine, in their blood than nonmenthol smokers. These increased levels of cotinine have been related to higher nicotine exposure and may be associated with more severe levels of addiction.
• Menthol smokers are less likely than non-menthol smokers to feel confident in their ability to
• Menthol smokers are less likely to attempt cessation, more likely to relapse after successfully
quitting and less likely to report sustained smoking cessation than non-menthol smokers."
According to the press release, Charles D. Connor, the American Lung Association President and CEO, stated: "As an organization dedicated to public health, we have an important role to play in raising awareness and reducing the toll of lung cancer as the number one cancer killer among African Americans. While some progress has been made, especially in reducing smoking rates and exposure to secondhand smoke, much remains to be done. Reducing lung cancer needs a focused effort. The Lung Association stands ready to work with the healthcare industry as well as governments, community leaders and individuals, to eliminate the disparity of lung cancer in African Americans."
The Rest of the Story
The American Lung Association stands ready to work with the healthcare industry as well as governments...to eliminate the disparity of lung cancer in African Americans?
Quite on the contrary, the American Lung Association stood ready to work with Philip Morris to help maintain the disparity of lung cancer among African Americans by supporting legislation that banned cigarette flavorings but exempted menthol. Even worse, the American Lung Association was part of a coalition which actually opposed an amendment to the legislation that would have eliminated the menthol exemption.
In other words, the American Lung Association effectively lobbied to kill legislation that would have addressed the very problem it bemoans at length in its report: the role that menthol cigarettes play in addicting and killing African Americans.
I'm sorry, but we know where the American Lung Association stands when it comes to the issue of addressing the problem of menthol cigarettes. The ALA had its opportunity, and it used it to eviscerate legislation that would have eliminated the problem and gone a long way to help actually reduce disparities in lung cancer among African Americans. The American Lung Association puts on a good show - they can certainly talk the talk, but they are clearly not willing to walk the walk.
When it really counted, the American Lung Association was simply not there for the African American community. Instead, the ALA sided with the nation's largest cigarette company - Philip Morris - in making sure that the FDA tobacco legislation did not affect the sales of menthol cigarettes, by far the leading brand of cigarettes used by African American smokers, adults and youths alike.
Sadly, the American Lung Association itself has cited, in this report, all of the evidence necessary to understand the role that menthol plays in addicting African American smokers. The ALA itself has acknowledged that menthol is related to higher levels of addiction and that "Menthol smokers are less likely to attempt cessation, more likely to relapse after successfully
quitting and less likely to report sustained smoking cessation than non-menthol smokers."
What is most troublesome here is the hypocrisy of the American Lung Association, not simply its position. If it had not gone to great lengths to bemoan the problem of menthol, then one might excuse its failure to support a ban on menthol flavorings. But you can't have it both ways. You can't argue how terrible it is that cigarette companies are marketing menthol cigarettes to African Americans and how it makes it much more difficult for them to quit smoking, then talk about how committed you are to reducing disparities in lung cancer among African Americans, and all at the same time, hide the fact that your organization stood shoulder-to-shoulder with Philip Morris in ensuring that the sales of menthol cigarettes would be specially protected by the legislation.
Last Thursday, in my Social and Behavioral Sciences class, I explained to 120 public health students how the American Lung Association's actions are an example of institutional racism: a systematic (though unintentional) bias in health protection on the basis of race which serves to increase racial health disparities. The American Lung Association's role in supporting this form of institutionalized racism is bad enough. But to then come out and boast about how concerned you are about reducing racial health disparities is nearly unconscionable.
Now let me say that I can handle the fact that the American Lung Association may have decided to make a political compromise with Philip Morris in order to appease the company and ensure the passage of the legislation. There's nothing wrong with the ALA playing politics. However, if you are going to do that, then you sacrifice your ability to then boast to the American people how tough you are in standing up to reduce racial health disparities.
The fact is: the American Lung Association sold out the health interests of the African American community as part of a purely political compromise to secure passage of the legislation. That may be a good decision or a bad one, but it is certainly not an example of standing up to the tobacco companies in order to reduce racial disparities. It goes a very long way towards maintaining the racial disparity in lung cancer.
In fact, it is precisely actions like those of the American Lung Association which I believe are largely responsible for the maintenance of racial health disparities like the one that the ALA is bemoaning. It is the failure to stand up against economic and corporate interests and to accept the status quo -- supporting legislation and policies that may look good on paper but which don't actually make the changes necessary to reduce disparities -- that contributes to the maintenance of racial health disparities in the first place.
You see, many organizations in tobacco control talk the talk - they include African Americans on boards and they design programs which they claim are targeted to African Americans. But when you look at the actual allocation of resources, when you look at the actual participation of African Americans in the decision-making processes, you'll find that there is more talk than action.
For all of their talk about reducing racial health disparities, the American Lung Association and its coalition supporting the FDA tobacco legislation did not include the African American community and its leaders in discussions about the menthol issue when this bill was being negotiated with Philip Morris.
It's all very nice for the American Lung Association to secure an African American physician to highlight its report about how terrible a scourge menthol is to the African American community, but where was the American Lung Association's interest in consulting with the African American community when its health was on the trading block during the Congressionally-mediated negotiations with Philip Morris? Why did the American Lung Association not consult with Dr. Hicks and other leaders in the African American community when it decided to lend its support to the amendment that protected menthol sales to the African American community?
It's sure nice to include an African American in your quotes about your new report, but it would have really meant something to include the African American community in the organization's decision-making around whether or not to sell out the health of African Americans to secure passage of the legislation.
In light of its own statements about the role of menthol cigarettes in addicting and killing African Americans and in light of its widely disseminated promise to reduce the disparate burden of lung cancer among African Americans, might I suggest that "It is obvious today that (the American Lung Association) has defaulted on this promissory note insofar as (our) citizens of color are concerned. Instead of honoring this sacred obligation, (the American Lung Association) has given the (African American) people a bad check; a check which has come back marked 'insufficient funds.'"
The rest of the story is that despite its promises, the American Lung Association has sold out the health interests of the African American community by using menthol as a bargaining chip to secure passage of a deal negotiated with the tobacco industry, thus leaving African Americans holding a promissory note that is not worth the paper upon which it is written. In this case, the check might not come back saying "insufficient funds," but "insufficient fortitude."