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Why banning cigarettes is the next step in tobacco control

If saving lives is the goal, a ban on tobacco looms large to anyone who cares to look. David Hegarty

The Federal government’s High Court win on cigarette plain packaging is another sign that the carcinogenic mist is dispersing to finally reveal the smoking elephant in our collective lounge room. The pachyderm is the ban on tobacco that Australia wants, but can’t quite wrest from its subconscious and out into the light.

Australia now has smoking bans in workplaces, pubs, clubs, restaurants, educational institutions, entertainment venues, sports stadiums, patrolled beaches, playgrounds, cars carrying children, and on public transport. The dangers of passive smoke inhalation, including a nearly 30% increased risk of lung cancer in non-smokers, has led some jurisdictions to restrict hospitality workers entering outdoor areas where smoking is still permitted.

Why hesitate?

Such sweeping measures indicate a wide appreciation of the health threats posed by cigarettes. The practise kills up to half of those who indulge, and imperils those unlucky or unwary enough to share the same air space. Yet we still permit the sale and use of tobacco. It’s time we removed our tar-encrusted goggles, saw the smoking elephant in all its cankerous decay, and called a final halt to the decimation.

Nor would this be the act of a nitpicking nanny state meddling in the legitimately self regarding behaviour of adults. In On Liberty, John Stuart Mill laid a liberal foundation that most democracies embrace. He concluded the state was warranted in constraining individual liberty to prevent actions that harm others.

Mike Rowe

The stunning breadth of anti-smoking statutes is testament to the reality of smoking’s third-party harms. These extend to the public health burden from smoking-related lung disease, diabetes, stroke, and heart attack, and the extra taxpayer dollars needed to fund it. This is not nannyism but justified state paternalism.

If you’re unconvinced, consider how you’d respond should someone decide to spray particles of highly carcinogenic blue asbestos into the air at a major train station. Most would deem this an act of biological terrorism, call 000, and in quiet horror shepherd their children out of harm’s way. It’s a fascinating quirk of social psychology that we don’t automatically place smoking in the same category.

Nearly a century of advertising and product placement in films has positioned tobacco as the pursuit of the rich, glamorous, and rebellious. And some doctors even recommended it to their patients. All before a swathe of compelling research revealed its true and malignant nature. Yet those aspirational associations persist in our neural circuitry and may take many years to fade.

Increasing happiness

The unwavering response from Big Tobacco appeals to a consequentialist ethic. Ultimately, things will become worse if tobacco is banned. Tobacco sales will shift underground, ciggies bootlegged at exorbitant rates will further cash-strap smokers, organised crime will step into the breach to bolster supply, the rebellious at heart will take up smoking to protest tar totalitarianism, and so on. And indeed, there is a real live public health experiment that provides some support for such claims.

Tiny Bhutan, already a world leader in promoting Gross National Happiness as an indicator of citizen well-being, bravely implemented a ban on tobacco sales in 2005. And subsequently there were reports of tobacco products appearing on the black market at inflated prices. But if consequences are to be weighed in the ethical balance, it is surely public health benefits that will prevail.

M. de Lipman/Wikimedia Commons

A public smoking ban in Colorado was found to lessen the risk of preterm births; Arizona’s state-wide ban reduced hospital admissions for angina, heart attack, stroke, and asthma; Ireland’s veto on smoking in pubs led to improved pulmonary function in bar workers; hospital admissions for heart attack dropped by nearly 10% in New York State after their smoking prohibition; and a Swiss study estimated that anti-smoking laws could prevent the need for up to 41,000 hospital bed days, from the effects of passive smoking alone.

The anti-paternalist may still complain that we permit other risky practises, such as hang-gliding, which also place burdens on the health system when the inevitable crashes occur. But hang-gliding, like many sports, carries inherent risk that is significantly reduced by ensuring adequate training. By contrast, cigarette smoking is never without risk, even when carried out by skilled practitioners.

We are Nero, fiddling by inches towards a tobacco ban, but meanwhile Rome’s health continues to go up in smoke. Our intentions are honourable but they ignore their inexorable conclusion. If saving lives is the goal, a ban on tobacco looms large to anyone who cares to look.

Read the argument against banning cigarettes

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