We’ve already discussed two of the papers (see here and here) in the October issue of Tobacco Control. The introductory editorial Imagining things otherwise: new endgame ideas for tobacco control by Ruth Malone describes the issue as dealing with:
Where are we going in tobacco control long-term, and how will we get there? This issue of Tobacco Control features three new contributions to the growing ‘endgame’ literature with possible answers to those questions: big-picture radical ideas that seek to propel the tobacco control movement more quickly towards a time when the global tobacco disease pandemic that began in the 20th century will be ended. Could the multitude of social structures and institutions that sustain the tobacco problem be unlinked? Could altered market forces, price controls, supply controls, render tobacco less attractive to those who profit most from continuing to addict new generations? Could there come a time when cigarettes, the most deadly consumer product ever made will no longer be commercially sold? Can a stake someday be driven through the heart of the tobacco industry?
This supposed thinking outside the box is anything but. Some less common but not exactly new ideas are put forward yet the glaring error in this exercise is the maintenance of the same cognitive straight jacket that typifies TC thinking which is the inability to treat tobacco use as a health issue, that is the inability to treat it as any other risk associated behavior.
Yes, disease is mentioned but only as impetus for political solutions with no consideration of the simple idea of disentangling tobacco use from the health consequences. Common sense would dictate that if you remove the health risks associated with tobacco use there would be few reasons to worry about tobacco at all and I suppose the great fear is that there would no longer be any reason to fund Tobacco Control either.
The following demonstrates the very heart of this philosophy in expressing the desire to prohibition, to controlling that of which they do not approve. To think the unthinkable, just ban it.
Every person who becomes newly involved in the tobacco control movement, whether as an activist, researcher, programme planner or health professional, remembers that first moment of realising: it doesn’t have to be this way. Often, that realisation is coupled with the notion that cigarettes should just be banned, and incredulity that it has not already been done. Then, seasoned veterans explain the interlocking political, physiological, legal and economic webs that constrain such policy change. But the first step towards breaking through those webs is to rediscover our ability to imagine things otherwise.
Oh, the strength and imagination to consider tough solutions. Yes, solutions like mandatory incarceration, solutions which avoid taking people or general social harm into account. The problem is framed as one of a righteous group fighting the tobacco companies and being unfairly hindered by existing regulations and social norms. Nicotine users (and their friends) seem to be irrelevant to the debate.
I don’t think Malone quite realizes the import of her own summary. She is right, it doesn’t have to be this way. Tobacco control could reenvision the problem as being one about people and not politics, about the need to reduce the harms of tobacco use rather than being diverted by caring about whether someone uses it or not.
If we fail to exercise our moral imaginations to envision radical change, we are abandoning future generations to suffer and die from the mistakes of the past. We must instead continue to wrestle with, critique, develop and advocate for new visions of tobacco control. It doesn’t have to be this way.
-Paul L. Bergen