According to the President of the American Public Health Association
“For the vast majority of people in our society, the life circumstances leading to poor health are not adopted as a matter of personal choice, but are thrust upon people by the social and economic circumstances into which they are born.”(1)
The Surgeon General of the United States disagrees,
“About 87 percent of lung cancer deaths are caused by smoking [and] smoking remains the leading cause of preventable death and disease in our nation.”(2)
The American Cancer Society concurs,
“Cigarettes kill more Americans than alcohol, car accidents, suicide, AIDS, homicide, and illegal drugs combined.”(3)
Even the World Health Organization states that,
“Tobacco is the single largest preventable cause of cancer in the world today.”(4)
Public officials warn that smoking can lower life expectancy by up to 15 years and claim that nearly half a million Americans lose their lives every year because of smoking-related illnesses.(5)
The claim that smoking is the primary cause of preventable death and disease is one of the greatest scams in modern history.
There is no question that smoking is linked with death and debilitating disease. However, because two events are linked does not mean that one causes the other. Injured workers are more likely to work in unsafe workplaces. That does not mean that injured workers cause unsafe work.
The fact that smokers are generally more susceptible to lung disease does that mean that smoking, on its own, is the cause. However, that is what we are told. When a miner who smokes gets lung cancer, his disease is always blamed on his smoking and never on his job. If a child who lives near a toxic waste dump gets lung cancer and her parents smoke, her cancer will be attributed to secondhand smoke. For the most part,Only when someone has never smoked, and has never lived or worked with smokers, will that person’s lung cancer be attributed to anything but smoking.
While there can be no question that smoking damages health, campaigns against smoking are misdirected. They target smokers instead of demanding that industries eliminate toxic emissions that damage our health at work and in society.
Smokers and non-smokers belong to different classes
In general, smokers and non-smokers belong to different social classes. Factory workers are more likely to smoke, and smoke heavily, than managers and professionals.
“Smoking is highest among those individuals who are exposed to possible deleterious occupational factors. For instance, 71 percent of construction painters are current smokers while only 27 percent of teachers have that habit. In fact, when occupations are arranged by prevalence of smoking, 29 out of 40 occupations in which smoking is most prevalent are also those with high exposure to dusts and fumes, while in only 4 of the 40 occupations with the lowest prevalence of smoking are workers exposed to such hazards. There is a strong tendency for a higher proportion of individuals who do dirty work to smoke, compared to individuals who do clean work. Thus, in a statistical sense, the category smoker may be primarily an index for worker exposed to occupational hazards.”(12)
We know that health improves as people move up the social ladder. People higher up the social ladder also tend to smoke less and have an easier time quitting than those lower down. When social class and occupation are held constant, the difference in cancer rates between smokers and non-smokers largely disappears.(13,14)
People who smoke less suffer less disease because they are generally higher up on the social scale, while those who smoke more tend to be lower down. Smokers who manage to quit have lower disease rates than those who keep smoking. They also tend to have occupational profiles similar to those who never smoked. In effect, those who don’t smoke, smoke less, or successfully quit smoking have lower rates of “smoking-related diseases” because they belong to a higher social class that suffers less disease to begin with.
This does not mean that smoking is harmless; it means that the damage caused by smoking cannot be separated from the damage caused by class oppression. People lower down the social ladder are exposed to more industrial pollution on the job, and they also live closer to hazardous waste dumps, polluting power plants, and industrial parks.(15)
The increase in respiratory diseases among children whose parents smoke is as much related to their family’s class position as it is to their smoking.
Children of smoking parents are more likely to live in industrial areas with more pollution and their parents are more likely to bring home toxic dust on their clothing, hair and skin. These families also tend to suffer more stress. The same is true for non-smoking spouses of smokers.(16) For all these reasons, the labels of ‘smoker’ and ‘smoker’s family’ are interchangeable with the label of ‘most exposed to stress and pollution.’
Infants of mothers who smoke are often shorter and smaller than infants of mothers who don’t smoke. Since people tend to be shorter as one moves down the social scale, and since shorter people have shorter children, smoking mothers may have smaller infants because they live in more deprived conditions characterized by poor nutrition, less prenatal care, more health problems and more stress, as well as more smoking. When smoking is designated as the sole or primary cause of low-weight babies, systemic causes go unaddressed.
Rising industrial pollution
The dramatic rise in lung cancer after World War II is commonly attributed to more people smoking. However, as Barry Commoner notes in The Closing Circle,
“most pollution problems made their first appearance, or became very much worse, in the years following World War II.”(17)
The end of the war saw the development of the atomic bomb, nuclear power, the arms race and an explosion in the production and widespread use of toxic chemicals.
As more women entered the workforce after the war, their rates of lung cancer rose. They also began to smoke more. Working women are more likely to encounter industrial pollution, and they are also torn between work and family responsibilities. Many women smoke to manage stress, and stress reduces the body’s ability to fight disease.
A 1975 study found that lung cancer rates for Blacks rose dramatically after they migrated from the rural southern states to the urban northern states.(18) Racist hiring practices cause Black workers to be exposed to more industrial dust and toxic chemicals on the job. Also because of racism, Black Americans are 80 percent more likely to live in highly polluted areas.(19) This may explain why, on average, Black Americans smoke fewer cigarettes than white Americans do, yet suffer much higher rates of lung cancer.(20)
Among teenagers, working longer hours is linked to more smoking. One study found that adolescents aged 13 to 16 years who worked between 11 and 20 hours per week were more than three times more likely to smoke compared to non-working teens. Teens working more than 21 hours per week smoked the most.(21)
Blaming smoking for lung disease enables employers to deny compensation to smokers. In one example, a disabled miner with “a long period of exposure to underground mining” who was also “a very light smoker” was denied compensation on the basis that his lung disease was caused by his smoking and not by his work.(22) Blaming the victim is more cost-effective than removing dust and fumes from the mines.
Since the 1964 Surgeon General’s report on Smoking and Health, the U.S. government has blamed smoking for every possible disease. According to the ACS,
“Smoking is also a major cause of heart disease, bronchitis, emphysema, and stroke, and… is associated with increased risk of miscarriage, early delivery (prematurity), stillbirth, infant death, and is a cause of low birth weight in infants. Furthermore, the smoke from cigarettes has a harmful health effect on those around the smoke…Each year, a staggering 440,000 people die in the US from tobacco use. Nearly 1 of every 5 deaths is related to smoking…Because cigarette smoking and tobacco use is an acquired behavior, one that the individual chooses to do, smoking is the most preventable cause of premature death in our society.”(23)
This being the official government position, there is little incentive or funding to investigate the relationship between social class, environmental pollution, and disease.
Research shows that air pollution is the primary cause of lung cancer. Lung cancer rates are higher in cities than in the countryside, and higher in larger cities than in smaller ones. The risk of getting lung cancer increases for people who migrate from areas with lower cancer rates to areas with higher cancer rates.(24)
Despite these facts, the National Cancer Institute, claims that environmental pollution accounts for only 7 percent of all cancers, while diet and smoking account for most of the rest – 65 percent.(25)
The American Cancer Society actively discounts people’s fears about pollution. According to the ACS web site, the 40 percent of the population who believe that
“living in a polluted city is a greater risk for lung cancer than smoking a pack of cigarettes a day” are mistaken because “Being a smoker, or even being frequently exposed to secondhand smoke is more dangerous than the level of air pollution encountered in US cities.”(26)
The ACS dismisses the overwhelming evidence connecting air pollution with a variety of diseases, (27,29,29) on the basis that
“Most people tend to overestimate the risk caused by factors imposed on them by others, and to underestimate the seriousness of risks caused by their own behavior.”(30)
Consequently, the ACS devotes less than 0.1 percent of its budget to environmental and occupational causes of cancer.
The same governments that condemn smoking also subsidize farmers to grow tobacco and profit from the sale of cigarettes.
On each pack of cigarettes, governments receive 15 times more profit than tobacco companies receive. Between 1999 and 2001, U.S. federal, state and local governments collected more than $29 billion annually in tobacco revenue — more than $630 for every American adult smoker each year. The three levels of government pocket more tobacco revenue per minute ($55,872) than the average working family brings home in a year.(6)
Instead of spending their tobacco revenues on smoking-prevention programs, states are using the money to balance their budgets.
In 2006, the combined amount that all states allocated for smoking prevention was just $551 million. Compare this with the more than $21 billion obtained that year from the 1998 tobacco settlement and state tobacco taxes. In contrast, the tobacco industry spends more than $15 billion a year to market tobacco products – nearly 28 times the amount that states spend on smoking prevention.(7)
In 1997, executives from tobacco giants British American Tobacco, Imperial, Philip Morris, Rothman’s and RJ Reynolds made a secret pact to “strenuously resist with all means at their disposal …claims … that one cigarette is healthier or less harmful than another.”(8) They had little to fear from governments that are heavily invested in tobacco sales.
In 2005, Justice Department officials ordered lawyers prosecuting the tobacco industry to “throw the case down the toilet” and reduce their claim from $130 billion to $10 billion. This money was being claimed to fund stop-smoking programs.(9)
No matter how loudly they shout about the dangers of smoking, governments are addicted to tobacco revenue. They need people to keep smoking because states have borrowed from future tobacco revenues to meet growing budget deficits.(10,11)
Catch 22 – the smoke-filled workplace*
Smoke-filled workplaces are a hazard to workers’ health, just as coal dust is a hazard to coal miners.
Many people who work in restaurants, smoking lounges, bars, cocktail lounges, and casinos are exposed to continual and high levels of toxic cigarette smoke produced by the patrons of these establishments, most of whom are also working-class. How can we eliminate such hazards without turning one set of workers against another?
The tobacco industry vigorously opposes smoke-free environments because they undermine the social acceptability of smoking and reduce cigarette consumption. In 1994 the US tobacco industry mobilized opposition to the Occupational Safety and Health Administration’s (OSHA) proposal to create smoke-free workplaces. Tobacco giants claim that smoke-free environments would reduce revenues and cause job-loss in the hospitality and gambling industries.
Effective solutions to social problems cannot be achieved in a social system that upholds the ‘right’ to make a profit.
The tobacco industry supports improved ventilation as the solution to second-hand smoke in the workplace. To that end, it has partnered with the American Society of Heating Refrigeration and Air Conditioning Engineers. The tobacco industry also supports the hospitality and gambling industries to oppose smoke-free ventilation standards that would cut into profits and make building owners and operators responsible for the health of occupants.
Blocked by industry interests and compromised governments, health advocates believe that their only option is to ban smoking. Unfortunately, this position pits the needs of smokers against the needs of non-smokers. In fact, both groups would benefit by demanding that human health come first, regardless of the cost to business. Because this cannot happen under capitalism, we have only two options, fight for a different society or blame the (smoking) worker.
Blaming the victim
Unwilling to challenge capitalism, the anti-smoking movement is dominated by blame-the-victim moralism – the conviction that smoking is the result of self-indulgent, irresponsible, even sinful choices. As a result, smokers are denied compensation, banned from public places, lectured, socially shunned, forced to pay “sin” taxes, suffer job discrimination, and even denied medical care on the basis that they ‘chose’ to harm themselves.
For over 12 years, the sole lung cancer surgeon in a small Ontario mining town has refused to operate on smokers. According to Dr. Alberto de la Rocha,
“The only way to contain [lung cancer] is by making people responsible for their actions.”(31)
What is the responsibility of the mining corporations? Forty-nine mines have operated in the area since 1909. Minerals extracted include: gold, silver, nickel, copper, cadmium, indium, talc, zinc, sulphur, stone, selenium, serpentine, silica, and the platinum group. Non-metal mining consists of granite, marble, hematite, and magnetite. About 90 exploration companies operate in the city including multinationals such as Texas Gulf, Sulfur, Falconbridge, and Placer Dome.
Mining destroys worker’s lungs and mining processes contaminate the environment. Blaming smokers lets the mine-owners off the hook.
The workers’ drug
It is not hard to explain why those who are most oppressed, most exploited, and work in the dirtiest jobs smoke the most and have the greatest difficulty quitting.
Feeling powerless is depressing, and smoking is known to combat depression.(32,33, 34)
Adolescents labeled with ‘Attention Deficit Disorder’ are twice as likely to smoke and have a harder time quitting than adolescents not so labeled. Researchers investigating this phenomenon found that nicotine worked as well as the drug Ritalin to calm symptoms of ‘ADD.'(35)
Smoking is the drug of choice for the working class. Smoking calms the feelings of powerlessness generated by the unsolvable conflict between what one wants and needs and what life under capitalism delivers. It should not surprise us that miners are some of the heaviest smokers. No one wants to spend their days working underground in dark, dirty, dangerous, noisy, fume-filled conditions. Smoking soothes the pain of alienation, which Engels so vividly describes,
“Where voluntary, productive activity is the highest enjoyment known to humanity, so is compulsory toil the most cruel degrading punishment. Nothing is more terrible than being constrained to do some one thing every day from morning until night against one’s will. And the more a man the worker feels himself to be, the most hateful must his work be to him, because he feels the constraint, the aimlessness of it for himself. Why does he work? For love of work? From a natural impulse? Not at all! He works for money, for a thing that has nothing whatsoever to do with the work itself; and he works so long, moreover, and in such unbroken monotony, that this alone must make his work a torture in the first weeks if he has the least human feeling left.”(36)
The conflict between human need and corporate greed drives the smoking habit and lung-destroying air pollution. Until we can eliminate capitalism and the many miseries it creates, workers will be blamed and pitted against each other, keeping us all divided and sick.
- Miller, C..A. (1976). Societal change and public health: A rediscovery. American Journal of Public Health, 66. pp. 54-60.
- Centers for Disease Control. (2000). Press release: New Surgeon General’s Report provides strategies for halving U.S. smoking rates by year 2010.
- American Cancer Society. Cigarette Smoking and Cancer. Accessed December 8, 2003.
- World Health Organization. Cancer prevention. accessed January 11, 2004 http://www.who.int/cancer/prevention/en
- CBC. (2002). Smokers cost U.S. $158 billion a year in health costs, job losses. April 11.
- R.J. Reynolds. Tobacco Taxes & Payments. Accessed August 25, 2002.
- Katz, J.M. (2005). Study says states don’t use tobacco money for prevention. Associated Press, November 30. http://www.tobaccofreekids.org/reports/settlements/
- CBC. (2000). CBC finds ‘smoking gun’ in tobacco wars. Fri Jul 7.
- Lichtblau, E. (2005). Lawyers fought U.S. move to curb tobacco penalty. New York Times, June 16. http://www.nytimes.com/2005/06/10/opinion/10fri1.html
- Pérez-Pera, R. (2002). Officials weigh tobacco funds as a fiscal fix. New York Times. November 21. http://www.nytimes.com/2002/11/21/nyregion/21FISC.html
- Fuerbringer, J. (2002). Tobacco money could harm credit rating of some states. New York Times, November 29. http://www.nytimes.com/2002/11/29/business/29RATE.html
- Statement Professor T.D. Sterling, Simon Fraser University, March 16, 1982.
- Sterling, T.D. & Weinkham, J.J. (1976). Smoking characteristics by type of employment. Journal of Occupational Medicine. Vol 18, No. 11, November. pp.743-754.
- Sterling, T.D. (1977). New evidence concerning smoking and health. Medical Journal of Australia. Vol. 2. pp.538-542.
- Associated Press. (2005). Study: More African-Americans live with pollution. Sci-Tech Today, December 14.
- Sterling, T.D., Glicksman, A., Perry, H., Sterling, D.A., Rosenbaum, W.L. & Weinkam, J.J. (1996). An alternative explanation for the apparent elevated relative mortality and morbidity risks associated with exposure to environmental tobacco smoke. Journal of Clinical Epidemiology, Volume 49, Issue 7, July, pp. 803-808.
- Commoner, B. (1971). The closing circle: Nature, man & technology. New York: Alfred A. Knopf. p.125.
- Mancuso, T.F. & Sterling, T.D. (1975). Lung cancer among black and white migrants in the U.S: Etiological considerations. Journal of the National Medical Association. March. Vol.67, No. 2. pp.106-111.
- Associated Press. (2005). Study: More African-Americans live with pollution. Sci-Tech Today, December 14.
- Sterling, T.D. & Weinkham, J.J. (1978). Smoking patterns by occupation, industry, sex and race. Archives of Environmental Health. November/December, pp. 313-317.
- Young working teens at higher risk for cigarette use. At work, publication of the Institute for Work and Health, Issue 24, October 2001. p5. ISSN #1261-5148
- Sterling, T.D. (1978). Does smoking kill workers or working kill smokers? The mutual relationship between smoking, occupation, and respiratory disease. International Journal of Health Services, Vol. 8, No. 3, Farmingdale, N.Y.: Baywood Publishing Company. p.438-9.
- American Cancer Society. Cigarette Smoking and Cancer. Accessed December 8, 2003
- Sterling, T.D. & Pollack, S.V. (1972). The incidence of lung cancer in the U.S. since 1955 in relation to the etiology of disease. American Journal of Public Health, February. pp.152-158.
- Epstein, S. (1998). The politics of cancer revisited. Freemont Center, NY: East Ridge Press, p.373.
- Gansler, T. Air pollution or smoking: Which is greater risk? American Cancer Society. Accessed December 8, 2003
- Sterling, T.D., Pollack, S.V. & Phar, J.J. (1967). Urban hospital morbidity and air pollution. Archives of Environmental Health. Vol 15. September. pp. 362-374.
- American Heart Association. (2003). Air pollution, even at “safe” levels, is bad for the heart. November 11.
- Yelaja, P. (2002). Dirty air can cause lung cancer, study says: Urban pollution comparable to second-hand smoke. The Star, March 6.
- Gansler, T. Air pollution or smoking: Which is greater risk? American Cancer Society. Accessed December 8, 2003
- Mackey, B. (2003). Taking a stand in Timmins: Quit smoking or forgo surgery. Canadian Medical Association Journal, June 10, 168 (12). p.1582.
- Thank you to Alan Maki for drawing my attention to this important issue. See also, Mandel, L.L & Glantz, S.A. (2004). Hedging their bets: tobacco and gambling industries work against smoke-free policies. British Medical Journal.
- Glassman A.H. et al. (2001). Smoking cessation and the course of major depression: A followup study. Lancet, Jun 16, Vol. 357. pp.1929-32.
- Niaura R. and Abrams D.B. (2001). Stopping smoking: A hazard for people with a history of major depression? Lancet, Jun 16, Vol. 357. pp.1900-1
- The Medical Post. (2001). Antidepressants: Smokers? brain changes studied. November 13, p62.
- Friedman, R. (2003) SFN: Nicotine as good as Ritalin on core measure of Attention Deficit/Hyperactivity Disorder. PSL Group, November 13.
- Engels, F. (1844) The condition of the working-class in England: From personal observation and authentic sources. Progress Publishers, p. 140.