Thursday, November 10, 2005

IN MY VIEW: Why the Beneficial Effects of Smoking Bans on Reduced Smoking are Not an Appropriate Justification for These Policies

As I mentioned yesterday, I received a great deal of feedback on my post about the questionable justification for banning smoking in open outdoors areas (such as parks, beaches, parking lots, etc.), which seems to be an increasing trend in public policy.

One aspect of that feedback was that many anti-smoking groups and advocates, pressed by this challenge to the dogmatic agenda, were apparently forced to scramble to try to find reasons to justify these outdoor smoking bans (since arguing that the problem is a substantial public health problem by virtue of its serious and unavoidable health effects on a population level doesn't seem to be available).

As I have recently concluded about the anti-smoking agenda:

"It is an agenda that if challenged causes anti-smoking groups to scramble to try to justify their actions - and they come up with new ways of defending their actions, resorting to weaker and weaker arguments to do so."

One such justification for outdoor smoking bans is, apparently, the argument that they serve the government interest because they de-normalize smoking. By exposing fewer youths, for example, to smokers smoking in public, smoking rates may well decrease.

The Rest of the Story

I feel compelled to emphasize strongly that I feel this particular justification for outdoor smoking bans is completely inadequate, ludicrous, and inappropriate. And more importantly, I think it is a dangerous justification to rely upon.

I simply do not think it is an appropriate function of public health practitioners to regulate lawful, individual behavior in public places simply so that people will not see behaviors that could be harmful to them.

I actually am finding it difficult to argue this point, because it just seems so ludicrous a concept to me as a public health practitioner that it hardly seems necessary to spend time trying to make the point. But perhaps some analogies will help.

Should we ban the use of alcohol in public because it will de-normalize alcohol use and lead fewer kids to abuse alcohol?

Should we ban eating fatty foods in public because it will de-normalize poor nutrition and help solve the nation's obesity epidemic?

Should we ban people from sitting sedentarily on a park bench because it will de-normalize sedentary behavior? After all, if people were required to be physically active when they were in public, kids would see so much physical activity that we would probably be able to solve the obesity epidemic quite quickly.

Suggesting that we should regulate individual behavior simply because others might view that behavior is perhaps the most paternalistic and inappropriate example of a proposed public health policy that I can think of.

There is really only one situation I can think of in which an otherwise lawful behavior could legitimately be regulated in public simply because of an inherent societal interest in not exposing people to that behavior. And that is in the case of behavior that offends the public morals.

For example, laws that prohibit public nudity in places where children are present are, I think, justified, because society places a very large moral value on what it defines as public decency.

Essentially, then, the only appropriate justification for regulating individual behavior that is otherwise harmful and that does not directly harm other people, for the sole purpose of trying to avoid exposing people to that behavior, is to protect the public morals.

The fact that this argument is being advanced vigorously by a number of anti-smoking advocates suggests to me one of two things:

1. It is possible that these advocates simply do not appreciate individual privacy, liberty, and the value of autonomy, and are willing to trample on these values if it will advance the public health cause.

2. It is possible that these advocates are actually morally offended by the idea of someone smoking in public and this is the reason they appear to view smoking in public in a similar way as public nudity.

In the first case, I think that we are going quite far astray because we do have to have some appreciation of individual liberty, privacy, and autonomy in public health practice. I don't think it is appropriate to legislate how people have to behave in public if they are doing something that is otherwise lawful, does not directly harm others (including property), and is not in some way an affront to the public morals.

In the second case, I think we have gone quite far astray because we are defining smoking as an immoral behavior. That is completely inappropriate.

While the effects of smoking bans on reduced smoking certainly represent a beneficial "side effect" of smoke-free policies, I do not believe they are, in any way, a sufficient justification for such policies.

Where does the danger come in? It comes in because if we start regulating one behavior because some anti-smoking advocates don't want kids to see people doing that behavior, then we open up the door to regulating other behaviors because other groups don't want to see people doing that behavior.

If we cannot justify outdoor smoking bans on the basis that the behavior is substantially harming other people who need to be protected from the smoke, then we simply cannot justify these policies.

And the more anti-smoking advocates attempt to do just that, the more I become scared. The more it becomes apparent that there is a hidden agenda here beyond a public health one. The more it becomes apparent that there is simply not any regard for the value of individual liberty, privacy, or autonomy and that any means to achieve our desired goal is acceptable.

This is not a road that we want to start going down. I hope that the anti-smoking movement will take a quick U-turn and return to the main highway - the public health highway.

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