'Research in Scotland has found that smoking is a greater source of health inequality than social class. This can no longer be ignored.' Is that really so? What is a 'health inequality'? Is it more than a fancy term for simple 'inequality' (a term which carries the implication that those on the lower end of the scale are worse off than those at the top end)? Or does it mean 'unequal health outcomes'?
Laurence Gruer, of NHS Health Scotland, Glasgow tries to help us out in his address: How does smoking cause health inequalities. 'Contrary to popular belief, recent research shows clearly that low-income non-smokers live longer than high-income smokers.' Is that so? I'll suspend disbelief temporarily. But it gets more incredible yet:
Over the past 60 years, smoking rates have declined much faster in higher than lower socio-economic groups. This may now account for as much as 80% of the differences in death rates between higher and lower socio-economic groups in the UK.'Eighty per cent? Er ... okay, although this looks like a very simplified view of the range of problems to which less affluent people are exposed (and it may be that their problems are about to get worse, especially if winters continue as bitter as this year). To sum up, he has now decided that those people who still smoke come chiefly from the lower quartile of society and feels compelled to explain why this is:
Why do more people in lower income groups in the UK become regular smokers? Regular smoking usually starts in the teens or early twenties. Important factors include other smokers in the family, low parental supervision, friends who smoke, and lower intelligence and educational attainment. Young people not in employment, education or training have very high smoking rates, young offenders even higher.Misguided, easily led, badly educated low achievers form the highest rates of smokers. In other words, the difficult-to-persuade hard core ... Dr Gruer's solution is:
Increasing the cost of cigarettes, reducing their accessibility and visibility, and enforcing laws on legal age of sale are the most likely ways discouraging disadvantaged young people from starting to smoke. A comprehensive package of new Scottish legislation has this aim and its impact on health inequalities will be evaluated.Is he really trying to persuade this disadvantaged hard core by raising cigarette prices and making cigarettes invisible at the point of sale? Has he even heard of the illegal market?
His logic is absurd. These people, hard-core smokers, still smoke and their health is worse as a result. Take away the temptation to smoke and they will cease to become feckless, easily-led and irresponsible and start being a good example to their children, perhaps even start working and earn themselves out of the poverty trap ...
They still haven't got it: the temptation to smoke does not come from a tobacco display or visible prompts. Not everyone in life is grabbed by superficiality, as these anti-smokers clearly are (and as they imagine that everyone else is too). Many people like smoking. But if it is associated with poverty and chaotic lifestyles there could be a reason for that too: It is calming. Poverty and chaos in the lifestyle are stressful, and probably in themselves major contributors to ill health. Of course medics will argue that the comfort from smoking is illusory, but if the illusion is comforting, why should the smoker care if he or she is just trying to get through each day? (Some people say the same of religion.) To put it simply if you want to stop poor people needing to smoke, help to eradicate their poverty, homelessness and chronic insecurity. Don't just point at the symptoms of poverty and persecute people for exhibiting them [yes I know you care about them and are just trying to help them by 'denormalising' their habit ... bampots].
ASH Scotland's press release mentions the 'widening health inequalities gap'. One is tempted to ask why the health inequalities gap is still widening after nearly six years since the smoking ban was voted through Holyrood, and why, having failed to narrow these inequalities with a smoking ban, we are still paying tobacco control advocates to come up with other fantastic schemes.