Monday, January 16, 2006

IN MY VIEW: New Jersey Smoking Ban is Simply Wrong

I'll be honest. I've had enough of this "It's a step in the right direction" nonsense. To me, bad public policy that is not justified from a public health perspective is not a step in the right direction. It's precisely a step in the wrong direction.

Take the case of Vince Rennich. He's a 47-year-old casino floor worker who has lung cancer due to what he claims is 25 years of heavy exposure to secondhand smoke, which he describes as working in "a modern-day coal mine." "A good majority of the time, I'm surrounded in a cloud of smoke," he said.

Rennich can thank the New Jersey legislature, governor, and public health advocates for the fact that he will not be protected from secondhand smoke exposure and neither will thousands and thousands of his co-workers, thanks to an exemption in the state law that resulted from politicians and public health advocates cowering down to the casino lobby in the state.

And take the case of Alan Angeloni. an Atlantic City restaurant owner. His establishment is located just two blocks from the casino strip, and while customers in his facility will not be able to smoke, they will be able to smoke at any of the 12 nearby casinos.
"Do you know how many conventioneers eat here and come out to the setting a bar to smoke afterward?," he asked. "You can kiss them goodbye, now. They won't even leave the casino."

The New Jersey smoking ban fails not only because it fails to protect thousands of casino workers from a hazard that is apparently bad enough to warrant a complete ban on smoking in bars, restaurants, and virtually all other workplaces, but also because it fails to provide a level playing field for all businesses in the state. It will, therefore, almost certainly result in economic harm for some unlucky establishments, not only tarnishing the law's implementation but setting a precedent of harm that will make it even more difficult to pass legitimate public health policies to protect workers in the future.

And perhaps the worst thing is that this policy is almost certainly going to make health conditions worse in the casinos. There is almost no question that this policy is going to result in more people smoking, or spending more time smoking (or both) in the casinos. As a result, secondhand smoke exposure among casino workers is going to increase, and so are the health effects.

There is a basic tenet we have in medicine, which I think should apply equally to public health: "First, to do no harm." In other words, a public health policy should not protect some people at the expense of severely harming the health of others.

The New Jersey smoking ban violates this basic tenet of public health and medical practice. It is almost certainly going to harm casino workers. I find it unacceptable and inappropriate that the promised health benefits for other state workers is going to come at the expense of the health of casino workers. That's not fair, not just, and not justified in my opinion.

The argument that the legislature will revisit this issue and remove the exemption next year is also unacceptable. If the policy is bad enough that policy makers are already talking about amending it, then it should not have been passed, or supported by public health advocates, in the first place!

And the reality is that the legislature is not going to amend this law any time soon. Experience from across the nation demonstrates that state-level smoke-free laws are almost never strengthened in any reasonable period of time. Promising to revisit the issue is a vain promise that public health advocates can simply not back up, based on loads of experience in other states. It's insincere at best, and a false promise at worst.

And for Vince Rennich and thousands of people like him, it's simply not fair. This attempt at a rational public health policy failed. It's simply wrong, and public health advocates should never have cowered down to the casino lobby for purely political reasons. I don't think that should be in our job description as public health practitioners. Either have the courage to stand up for and fight for what you believe in, or sit down.

Or to put it another way, either start swimming, or get out of the water!

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