Friday, February 10, 2006

Anti-Smoking Group Seems Inconsistent and Insincere in Defending Smoking Ban Exemptions

An anti-smoking group in Scotland yesterday defended the exemptions in the Scottish smoking ban, which goes into effect on March 26, suggesting that there is a good reason behind each of the exemptions in the ban.

According to an article in the Scotsman, ASH-Scotland responded to questioning of the justification behind certain smoking ban exemptions by stating: "The very few exemptions have been carefully debated and are there for good reasons."

The smoking ban, which will eliminate smoking in almost all workplaces, including restaurants and pubs, provides exemptions for "designated rooms in adult care homes," "designated rooms in psychiatric hospitals," and "detention or police interview rooms."

The Rest of the Story

I don't see any way that a public health advocate who supports a ban on smoking in workplaces and public places can possibly justify exemptions that would allow smoking in nursing homes, psychiatric hospitals, and police stations. And if there are good reasons to ban smoking in pubs, then I certainly do not think there are good reasons not to ban smoking in these other indoor workplaces, where both workers and "clients/patients" are present for long periods of time and cannot escape exposure to the smoke.

If secondhand smoke is so hazardous that we cannot allow pub workers to be exposed (or patrons at pubs), then how could it be safe for confined elderly people, mentally ill people, or police officers to breathe?

Is this not discriminating against the elderly, the mentally ill, and police officers in making them not subject to the same health protection that other citizens are offered? Does this not suggest that we are somehow deeming these individuals less worthy of health protection?

Don't the mentally ill deserve the same level of protection as the rest of us, and isn't it degrading to them to suggest that they don't?

While I am not necessarily arguing here either for or against any particular exemptions in the Scotland law, what I am trying to point out is that it is simply inconsistent public health policy, and quite unjustified on public health grounds, to provide protection to some people but to deny that protection to others, especially when the group you are denying protection to is largely unable to defend themselves.

Many mentally ill and elderly residents of nursing homes and psychiatric hospitals are not competent enough to be able to protect themselves, or to lobby for their own health protection. Is it fair and just to deny them health protection that we as public health practitioners are arguing that everyone else deserves?

My point is simply that no matter how one feels about smoking bans (whether one believes that smoking bans anywhere are unjustified or that smoking bans everywhere are justified), it seems one would have to agree that this policy makes no public health sense.

I therefore question the contention that the exemptions in the smoking ban are justified and there for good reasons. They are not there for any possible public health reason. They make no public health sense, are unjustified from a public health perspective, and result in a public health policy that is inconsistent, with unequal application of public health protection to different groups.

The law creates an unlevel playing field, discriminates against certain (largely helpless and politically less powerful) groups in denying them health protection that is afforded to everyone else, and basically cannot make up its mind whether secondhand smoke is indeed harmful or not.

I would add that this law bans smoking in any enclosed outdoor area, including, it appears, an outdoor smoking area!

Even if 49% of an outdoor smoking area is open, you cannot smoke in it. But you can smoke up a storm when being interrogated by the police to find out why you were smoking outdoors in a smokers' shelter. And you can also smoke when sent to a psychiatric hospital because the blatant hypocrisy of the smoking ban's provisions makes you mad. And you can't smoke in the cab or van that takes you to your nursing home, but as soon as you get there, light up and enjoy!

I'm sorry, but there is no way that an anti-smoking group can or should attempt to defend the rationality of these smoking ban exemptions.

And it is for this reason that I question the sincerity, as well as the lack of consistency, of the anti-smoking groups that are defending these exemptions.

I have no problem with these groups simply admitting that the policies are inconsistent, that the stupidities within the policy are present because they were needed for political reasons (to garner enough votes or support to get the policy through).

But don't pretend that there is some logical, reasonable public health rationale for forcing people to be involuntarily exposed to a hazard that you yourself have declared is so toxic and so hazardous that you cannot even allow smokers to be exposed to in outdoors areas that are no more than 49% open.

That is not, in my view, being sincere. That's simply not being forthright enough to admit that the exemptions are the result of political compromises, not any sort of sound, public health reasoning.

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