HEALTH CARE/Joan Retsinas

Smoking Bans: They Work

Even the troglodytes among us know that smoking is bad for hearts, bad for lungs, bad for all our innards. And bad for the non-smokers who breathe the toxic fumes. Now that scientists have made their point, governments have responded with restrictions on the sale of cigarettes to minors, on the locations of vending machines, on advertising. High taxes on cigarettes have further dampened demand.

But restricting the sale of a product is not the same as barring its use. We restrict, and tax, the sale of alcohol, but don’t ban its use. Indeed, restaurants and bars encourage us to drink.

Legislators throughout parts of the world, however, have taken the “Don’t smoke” message much further, with outright bans on smoking in public indoor (and some outdoor) places, as well as in the workplace.

In a generation we have turned from a nation where smoking a cigarette after a meal, during a meeting, or inside an airplane is no longer routine. The early advertisements for cigarettes show not just John Wayne (he died of lung cancer, as did the actor who played the Marlboro Man) lighting up, but physicians recommending specific brands. Go to a 50-year college reunion: most of the returning alumni smoked in their halcyon college years. Few do now. Even in European cafes, where people still linger over coffee and wine, many of those lingerers no longer smoke.

As for those people who do smoke, in the United States they hover on the social sidelines — literally on the sidelines, often on sidewalks. Here the practice is almost taboo: guests rarely light up in a host’s home without asking permission (which the host may deny). Pregnant smokers incur disapproving stares: after all, they are putting their infants at risk for premature birth. Teenagers may light up, in sync with rebellion, but the odds are that as adults, they will stop.

The World Health Organization supports “smoke-free” environments; and many locales, even without outright bans, are smoke-free. Indeed, the bans have happened in unlikely places: Irish pubs, New York City parks.

So, in pursuit of health, many people stopped the noxious habit of their grandparents. The professionals promised that we would be healthier if we gave up the weed. Yet sometimes many of us wonder: are we healthier? We Americans are fatter than our forbears, we take a heftier pharmacopoeia of medications, we still suffer from a grab-bag of ailments, including lung cancer and heart disease. And we still record a troubling number of premature births. “What went wrong?” the cynics among us might wonder.

The good news is that the Calvinist exhortations have paid off: in measurable ways, we are healthier. (“Effect of smoke-free legislation on perinatal and child health: a systematic review and meta-analysis,” The Lancet, March 2014.) Researchers looked at 11 studies (5 local North American bans, 6 national European bans) — in all, 2.5 million births – that investigated the impact of smoking bans on measurable health outcomes. They linked the bans to fewer preterm births and fewer hospital admissions for asthma. Children, in short, benefited. Coincidentally, those lower hospital and emergency room admissions translated into savings.

This mega-study did not focus on adults, but other studies have linked “no smoking” legislation to declines in hospitalizations (and emergency calls) for cardiac disease, strokes, and asthma. One study showed that after German states restricted smoking in restaurants (allowed in bars), hospital costs dropped 9% for angina pectoris and 20% for acute myocardial infarction (Clin Res Cardiol. March 2012).

Smoking bans evoke a blend of Nanny State with Big Brother. They violate the principles of an open marketplace, where consumers can drink, eat, and smoke what they wish. Citizens who accepted strictures on the sale of cigarettes to minors, high taxes on cigarettes, and public health billboards showing diseased lungs might reasonably balk at bans. Libertarians might deplore them as a dangerous intrusion of government into the private sphere.

Yet if the goal is a healthier populace, the bans work.

Sometimes the wellbeing of the public trumps the freedom of consumers to buy whatever the marketplace is willing to sell.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, May 15, 2014