Smoking Isn't a Public Health Issue


When the tobacco companies said they would no longer cooperate with the effort to pass anti-smoking legislation, the Clinton administration said it didn't really matter. "We will get bipartisan legislation this year," Secretary of Health and Human Services Donna Shalala told NBC. "There's no question about it, because it's about public health."

And that, in a nutshell, is the problem. The incantation of the phrase "public health" preempts all questions and erases all doubts. It tells us to turn off our brains and trust experts like Shalala to think for us.

Given that expectation, it may seem rude to ask why, exactly, smoking is a matter of "public health." It's certainly a matter of private health, since it tends to shorten one's life. But lung cancer, heart disease, and emphysema are not contagious, and smoking itself is a pattern of behavior, not an illness. It is something that people choose to do, not something that happens to them against their will.

If smoking is a matter of "public health," and therefore subject to government control, then so is any behavior that might lead to disease or injury. And in fact, public health officials target a wide range of risky habits, including not just smoking but drinking, overeating, failing to exercise, owning a gun, and riding a bicycle without a helmet.

There is no end to the interventions that could be justified in the name of public health, as that concept is currently understood. This audacious claim of authority should send a chill down people's spines. Yet somehow it serves to banish skepticism about policies aimed at protecting us from ourselves.

Consider the tobacco legislation that received nearly unanimous approval from the Senate Commerce Committee in early April. Sponsored by Sen. John McCain (R-Ariz.), the bill would take half a trillion dollars away from smokers and give it to various special interests, including trial lawyers, politicians, anti-smoking activists, public health officials, and tobacco farmers. The exact distribution of the spoils has not been determined yet.

Supporters of the McCain bill would like to pretend they're punishing the evil tobacco companies. But the measure requires cigarette manufacturers to pass on the cost of any payments to their customers, in effect dramatically raising the tobacco tax. Since cigarette taxes are highly regressive, the bill would steal from the poor to give to the rich.

Tobacco's opponents defend this money grab by arguing that higher cigarette prices will deter teenagers from smoking. Yet more than 90 percent of smokers are adults, and selling cigarettes to minors is already illegal in every state. On the face of it, better enforcement of these laws seems like a more appropriate response to underage smoking than forcing all smokers to pay higher prices.

In response to that suggestion, tobacco's opponents say teenage smokers typically do not buy cigarettes over the counter or from vending machines. Instead, they get them from their parents, siblings, or older friends. But if that's the case, raising cigarette prices would cut teenage smoking mainly by reducing smoking among adults. The idea seems to be that if Mom and Dad quit, Junior will have a harder time obtaining cigarettes.

Since tobacco's opponents want everyone to stop smoking, it's hardly surprising that their preferred method for preventing teenagers from getting cigarettes is to discourage adults from buying them. "The best way to keep kids from smoking is to reduce tobacco consumption among everyone," writes anti-smoking activist Stanton Glantz. "The message should not be 'we don't want kids to smoke'; it should be 'we want a smoke-free society.' "

The "we" probably refers to Glantz and his anti-smoking friends. But they cannot achieve a smoke-free society without the support, or at least the acquiescence, of most Americans. "We" must unite to fine, restrict, hector, ostracize, and vilify the foolish remnant that stubbornly continues to puff away, despite the well-known hazards involved. Having conquered smoking, we can move on to sloth and gluttony.

I wish I were kidding. A recent article in the Journal of the National Cancer Institute explicitly recommends using the tactics of the anti-smoking movement to encourage exercise and better eating habits. Academics such as Yale obesity expert Kelly Brownell are calling for a "junk food" tax, and they are beginning to get a respectful hearing.

Brownell also wants to censor fast-food commercials. "To me, there is no difference between Joe Camel and Ronald McDonald," he says. "We have to start thinking about this in a more militant way." Otherwise we will never achieve a cheeseburger-free society.