Wednesday, 22 June 2011

Ten-minute rule motion passed to ban smoking in cars: let's get some perspective

At Westminster today a Bill was approved that would ban smoking in cars carrying children. As a backbencher's  Bill it collected less than 150 votes, but it got media attention because of its subject matter including mainstream attention from the BBC and ITV (among others) and the blogosphere, where it attracted the attention of Big Brother Watch.

The argument goes that having protected adults from secondary smoke, we must now protect children. But legislation banning smoking in enclosed public places has existed in the Republic of Ireland since 2004. At this time they were beginning to think of introducing it to Scotland and legislation to do this was passed in 2005, around six years ago. In other words it has taken the great and the good over six years to come to the conclusion that what might hurt adults in areas they need not go, might also hurt children in areas where they have no choice about going.

The real issue is of course that they could almost get off with designating private businesses as 'public places', but public opinion had not caught up with the idea that you can interfere with the smoking habits in the undeniably private areas of the home and car. Having established the right of interference in quasi-public places, their courage (if you can call it that) is growing. It has nothing to do with the level of risk involved, or the vulnerability of those affected, and everything to do with a steady process of invading autonomy in businesses, then in family cars, then in family homes.

How can you say in July 2005: 'the risk of exposure is unacceptable. We'll ban it with effect from next March'? There are other ways of handling bans of risky commodities, that leave you in little doubt that the government actually believes there is a risk and isn't just trying to mess you about.

The risk itself? The UK has a poor record on clean air quality, and it is to be expected that the government will concentrate its 'air quality' efforts on the smoking issue. This typifies the focus on lifestyle issues now being taken by global bodies, including the World Health Organisation, which has recently been trying to ratchet up interest in non-communicable diseases. This effort is reflected in the media by stories such as Unhealthy lifestyles to kill 52 million yearly by 2030. Such stories may not reflect the intention of the World Health Organisation (who knows?), but this one says that 'most' chronic diseases are caused by 'unhealthy and ethically wanting lifestyles'.

It looks as if they intend to blame the poor for getting ill needlessly. But they still want to treat those conditions that the poor would not be getting if only they behaved themselves. Is someone making money out of this?
The framework confirms the industry’s crucial role in continued investment in R&D programmes to develop drugs for the prevention and treatment of non-communicable disease, with over 1,500 products in the pipeline currently. It also commits the industry to target its innovation towards the specific needs of the developing world. To this end, in addition to the framework, there will be a programme of research, to improve understanding of the specific needs of developing world populations. [emphasis added]
Yes, there might be some very lucrative contracts here ... prevention and treatment of conditions that are killing off people in vast quantities (conditions that the patients bring on themselves, let's not forget!). The paragraph quoted above reads almost like a business plan for pharmaceutical companies.

The truth of course is that while lifestyle factors may contribute to ill health and many non-communicable diseases, there is no certainty about how much. It is not known to what environmental and other hazards workers, urban dwellers or other groups are exposed ('developing countries' include most of the world's population and a vast variety of working and living conditions), and while it might sound catchy to say that lifestyle factors are a common cause in their sicknesses, it is also profoundly lazy. Public policy will become limited to warnings about lifestyle issues, rather than awareness training about environmental issues and hazards at the workplace, for example.  I hasten to add that I am guessing, but it looks like the World Health Organisation is taking a moralistic, judgemental and simplified approach to the issue of non-communicable diseases, rather than a scientific, measured one. And as we have already established, non-communicable diseases kill older people and people in wealthier parts of the world, more often than infants and young adult breadwinners. The 'paradigm shift' in the focus of pharmaceutical companies might be good for their balance sheets – will it result in improved conditions for people, or neglect for their most basic needs?

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