Physicans for a Smoke-Free Canada (PSC) this week called for a government buyout of Canadian tobacco manufacturers, with the government to run the country's tobacco business or see to its administration by a non-profit entity until 2030, when prohibition would take place.
According to a newspaper article that describes the PSC proposal: "a public interest agency would take the place of tobacco manufacturing companies." Tobacco companies would thus be a non-profit, rather than for-profit entity. It is undecided whether this agency would be run by the government or by some private non-profit entity, but it would basically run the country's tobacco business, including the manufacture and sale of tobacco, until 2030, when prohibition would become effective.
According to one of the PSC directors: “The important thing to us is we transfer the tobacco industry to one that supports our health-orientated tobacco policy rather than running counter to it.”
That PSC director stated: “There are already strong public health reasons for the government to take over the tobacco industry. If BAT implements yesterday’s announcements, much of the Canadian capacity to control cigarette manufacturing in ways that reduce smoking will be lost. That is why it is urgent for the federal government and all stakeholders to work quickly to develop a strategy for public management of this industry.”
According to a study prepared by PSC: "Because the public health goal of reducing tobacco use directly conflicts with the tobacco industry’s profit motive, the way to overcome the health, social and economic problems caused by 'big tobacco' is to take the business of supplying cigarettes out of their hands and put it into the hands of public organizations with a clear public health mandate."
One author of that study stated that: “Business corporations are the wrong choice for tobacco. They have a long and well-documented history of working against public health measures. And where the public interest is vulnerable, Canadians have often chosen to place public-interest agencies in control. This choice should now be made for tobacco.”
Another co-author commented: "There are many types of public-interest enterprise that could provide cigarettes to smokers while supporting public health goals. These include familiar government and non-government agencies: crown corporations, co-operatives, non-profits and charities, as well as more innovative models, like the community interest corporation.”
The Rest of the Story
In my opinion, this is one of the most ludicrous and absurd (yes both ludicrous and absurd) "public health" proposals I have heard in a long time, one that I think would be extremely damaging to the very integrity of what we call public health.
To start, I have heard little that is more absurd than the notion that an entity, whether for-profit or not-for-profit, can "provide cigarettes to smokers while supporting public health goals." In what possible way does manufacturing and selling a product to 5 million people that results in the deaths of 45,000 people per year, which represents the leading cause of preventable death in Canada, support public health goals?
Perhaps I was simply not aware that producing and selling a product that kills 45,000 people annually is supportive of a public health goal. In my training, contributing to people's deaths didn't even make the long list of goals that we were encourged to pursue.
The very thought of putting the government or a non-profit agency in the express business of manufacturing and selling a lethal product is sickening from a public health perspective. In my view, it would substantially erode the entire public perception of the goals and meaning of public health and of the role of the government in trying to improve health, not manage the administration of deadly consumer products.
Next, I think the proposal severely distorts the way that the public health problem of tobacco should be defined and framed. I do not define tobacco as a public health problem because tobacco companies make profits from the sales of their product. I define it as a public health problem because the product results in death and disease. It doesn't make it any less of a public health problem if the products are originating from a for-profit corporation, a non-profit agency, or the government.
One of the PSC directors stated that the important thing is to "transfer the tobacco industry to one that supports our health-orientated tobacco policy rather than running counter to it." I don't think that's the important thing at all. The important thing, I think, is to do what we can to decrease tobacco-related morbidity and mortality, and to do so in a way that is consistent with public health principles and ethical principles. Not to mention the fact that it hardly seems rational to argue that an entity that produces and sells a deadly product to several million members of the population can in any way be supporting a "health-orientated tobacco policy rather than running counter to it." Killing 45,000 people a year for no reason (not even to make a profit and prevent economic collapse) sounds pretty counter to health to me.
I also don't view tobacco as a public health problem because the for-profit nature of the cigarette manufacturers leads those companies to oppose anti-smoking measures and undermine anti-tobacco messages. That's certainly an obstacle, but not one that justifies putting the government into the business of selling a deadly product. Plus, I can't think of a more effective way of undermining anti-smoking messages than having a government body or non-profit agency selling the product.
The next problem, and it's a severe one, is that the proposal would destroy the civil justice system as we know it. Once tobacco manufacturing and sale is in the government's hands, there is no one for citizens to hold accountable for any damages they may suffer from their use of the product or from the manufacturing entity's failure to take appropriate steps to produce a safe or safer product. Not only would thousands of Canadians continue to die from smoking, but they would not be able to seek justice for any wrongs they feel they have suffered.
Then there is the problem of the government becoming dependent upon tobacco revenue. The money required to buy out the tobacco companies would create an intense, long-term economic pressure to sell large volumes of cigarettes in order to recover the capital expenses. And once those expenses were recovered, the government would become accustomed to using the tobacco revenue for essential services. Just look at what has happened with the tobacco revenues generated by the Master Settlement Agreement in the United States.
Dependent upon tobacco revenues for basic government services, any incentive to eliminate tobacco production would be gone (regardless of any well-intentioned public health desire to eliminate the product or any statutory requirement to eliminate the product) and almost certainly, the date of eventual elimination of cigarettes would be continually extended, negating that alleged public health benefit of the proposal.
In some ways, the situation could become worse than the status quo, because government receipt of the more than $1.2 billion annually would add substantially to the $7.7 billion it now brings in from tobacco tax revenue, resulting in nearly a $10 billion a year business. That is dough that even the progressive and forward-looking legislators of Canada are not going to be able to give up.
Next we get to the ethical problems. I think it is highly unethical for the government of a country to be engaged in the selling of death and disease to the citizens of that country. I think it is absolutely wrong (immoral) for even one cent of my tax dollars to go into the production of and sale of a deadly product. And I certainly don't think it would be ethical to use taxes paid by Canadian citizens to produce and sell a deadly product.
The very idea that an agency that would take over the production and sale of tobacco products could be called a "public interest agency" is an oxymoron if I've ever heard one. How is selling a product that will kill 45,000 Canadians each year in the public interest?
And the idea that perhaps a charity would be the appropriate entity to do this job begs for a re-definition of that term. How charitable it is to provide cancer sticks for the population!
I sympathize with those who are frustrated by the problem of tobacco and I appreciate the attempt to search for ultimate solutions to the problem. But I don't think that in searching for an "ultimate" solution, we can throw everything else out the window, including our conception of the basic role of government, the basic role of public health, the appropriate use of taxpayer money, the importance of the civil justice system, and basic ethics.
Perhaps what is behind the proposal is the illusion that if only cigarette advertising and promotion were eliminated, cigarette demand would largely disappear and then the product could be phased out quickly. I disagee with that assertion and that's why I call it an illusion. While cigarette advertising and promotion has been shown to significantly affect cigarette consumption, the effect is relatively small in terms of the overall level of cigarette consumption in the population. The empirical literature does support the prediction that there would most likely be a decrease in cigarette consumption, but not anywhere near the magnitude necessary to make phasing out cigarettes feasible (if the feasibility of such a phase out is indeed a concern, which it appears to be).
It's not at all clear to me why the proponents of this policy "solution" to the tobacco problem believe that they will be able to feasibly phase out cigarettes and other tobacco products within 25 years. What is going to change? How many smokers are going to quit? Exactly how and why is cigarette demand going to decrease so drastically that a phase out of the product becomes feasible.
I just don't see any plausible scenario by which that could occur, especially in an environment where physicians are looking for a quick-fix, ultimate solution to the problem, rather than focusing on the daily battle that I think needs to be waged to address this public health problem.
The major reductions in smoking prevalence in the United States came about not from any drastic federal legislation, but from the daily battle fought by members of a grassroots social movement.
There simply is no deus ex machina ending to this problem, and the search for one I think may be getting in the way of what we need to do to address the problem right now.
In the words of Gil Scott Heron, "the revolution will not be televised."