Pragmatism versus prohibition: the future of public health
Sunday, June 15, 2014 at 16:01 Last week Scotland on Sunday published a report about NHS Scotland's new guidelines on smoking cessation.
There was positive news for advocates of e-cigarettes (Health experts back e-cigarettes to quit smoking). But there was also a warning.
I was genuinely curious to hear from another tobacco control campaigner so we tweeted e-cig advocate and former director of ASH Clive Bates and asked:
NHS Scotland says the "ultimate aim" is to "remove reliance on nicotine entirely". Where do you stand?
He replied:
Totally disagree with that view. Aim is not elimination of caffeine or alcohol either. It's harm not moralising that matters.
Clive then updated a post on his blog, Arguing about e-cigarettes: a Q&A, adding a new section that lists four objections to the complete cessation of nicotine use.
You can read them here.
He also added this interesting point:
If publicly funded ‘public health’ wants to become a temperance movement it needs to show that abstinence leads to harm reduction that provides value for money consistent with norms for public spending. If it is drawing on charitable funds (eg from cancer or heart charities) it needs to ensure that abstinence – rather than harm through cancer or heart disease – is consistent with the relevant charitable objectives.
The first thing to be said is, hats off to Clive for giving a straight answer to a straight question. But where does it leave us?
I agree that public health is in a danger of becoming a temperance movement, a moral crusade that has little to do with harm reduction.
I agree too that if total abstinence rather than evidence of harm is the goal then the 'charitable' objectives of many tobacco control groups – not to mention their funding – will have to be re-examined.
Where Clive and I differ is that I support harm reduction in relation to tobacco (or alcohol or sugar) as long as it doesn't involve prohibition or coercion.
Like many people I don't believe the state should force adults to give up or reduce their consumption of any legal substance, whether it be tobacco, alcohol or sugary drinks. They may be advised to do so but whether they heed that advice is their choice.
Clive however supports the comprehensive smoking ban. He backs it, I imagine, because of concerns about 'passive smoking', though how he can accept the 'science' on secondhand smoke having witnessed the lengths to which some 'experts' will go to demonise e-cigarettes is beyond me.
I am guessing though that Clive also supports the smoking ban because it forces smokers to cut down or even quit.
My worry is that harm reduction (a noble idea) is being used to justify all manner of prohibitionist policies ranging from a ban on tobacco vending machines to the removal of branding and everything in between.
Whilst I embrace the concept (who doesn't?) adults must be able to purchase and consume a full range of tobacco products (for example) without being demonised or ostracised for doing so.
That said, we are not a million miles apart, Clive and I. In fact, it seems to me that the traditional two party debate (loosely if incorrectly described as anti and pro tobacco) is now a three party system.
Imagine a line with Forest at one end and ASH at the other. Somewhere in between are people like Clive Bates.
Like the Lib Dems (circa 2010) Clive's group - anti-tobacco but not anti-nicotine - probably hold the balance of power. The question is, do they form a coalition with the pragmatists (Forest) or the prohibitionists (ASH and NHS Scotland)?
The answer to that question could determine public health policy for the next 25 years.
Reader Comments (1)
Either way, the only people who won't be heard in that debate are smokers.
Vapers will be listened to as will tobacco haters but we smokers are scum who are here only for our betters to tell us how stupid we are.