Being a Dirty Smoker: How public health academia villainises the poor

In my first week of my PhD at the London School of Hygiene and Tropical Medicine I made a terrible mistake. We were all settling in working on our literature reviews and I’d gone out into the courtyard for a cigarette. Suddenly an unidentified voice from a few stories above started shouting down at me: “What do you think you’re doing!? You can’t smoke in here!”.

A feeling of guilt, fear, and urgency rushed into my body. My moment of thought and relaxation suddenly turned into a rabbit-in-the-headlights dart for the gate into the world outside. I was confused, how can I plead my innocence when I don’t even know who shouted? I’d never been in an institution where you couldn’t smoke outside, in the place the government tells me to.

Two years later, at the beginning of my final year, I attended an evening seminar which included a talk on the tobacco industry – a favourite target amongst Global Public Health departments in UK universities. I walked into the Keppel Street building, scanned in my pass, and walked through the grandiose reception foyer. As I had done many times before, I climbed up several flights to the top of the white stone, spiral staircase – a feature comically demonstrative of an ivory tower if ever I’ve seen one.

The speaker showed us a graph of how policies restricting access to cigarettes – the inside smoking ban, plain packaging, and price rises – had gradually decreased the number of smokers in the UK, signified by a bar getting smaller and smaller across the slide. Okay, I thought, but when can I tell you my story of that figure on the graph? Instead he went on to describe how the tobacco industry was dangerously using arguments about civil liberties to argue their case. He told the story of how his policy group had approached Boris Johnson when he was Mayor of London with a well-evidenced proposal on the benefits of banning smoking in parks. As if it was a joke, he told us how Johnson threw them out saying “I can’t do that, I’m a libertarian!”. Everyone laughed.

I left feeling irritated, ostracised, and defiantly rolling a cigarette. I got the train back to my local pub and sat in the garden with a few regulars drinking pints, smoking rollies, and offloading about our days. Stepping down from the ivory tower of the John Snow Lecture Theatre and into a pub an hour down the line came with a massive sigh of relief. Now reflecting back, I have started to work out why I was made to feel so uncomfortable and voiceless in an institution supposedly designed for debate, and so much more comfortable in a place that public health experts are telling me I shouldn’t be.

In my time in Global Health research I have seen smokers represented in two ways: 1) They are too weak or uneducated to understand how or why to stop smoking; 2) They are too selfish and thoughtless to think about how their smoking impacts on other people’s health. And I have seen both of these discourses reproduced in the everyday lives of myself and other smokers I know.

The first discourse treats smokers as if they’re unenlightened victims of the tobacco industry (and indeed Boris Johnson). These academics squeeze people into a bar on a chart which represents smokers as poor sufferers of a disease. But if they ever spoke to smokers they might realise that for many smoking is a conscious choice, a small pleasure in life because the rest of life isn’t always so pleasurable. And if they ever spoke to smokers (or indeed a lot of people) they might realise that our actions are not always based on extending our lives, but living them.

Rather, these researchers campaign to put in measures which attempt to eliminate smoking as a viable decision for those they deem as being unable to make choices for themselves. From their voice and tone in the lecture halls it seems they honestly believe that putting up the price of tobacco and displaying gross pictures on packaging are purely benign measures which just haven’t worked yet on this dying population. If only we could ban smoking in parks maybe we could solve the problem.

But if they ever spoke to one of the smokers I know they might find out about the struggle of keeping up with the cost of tobacco, and that they’ve made us so broke that now we just buy our tobacco on the black market (try measuring that one).  If they ever spoke to smokers they might realise that cigarettes help people calm down in stressful situations like struggling at work or figuring out how to deal with your debts. And if they ever talked to smokers they might have known about the anger when it turned out the government use pictures of real dead people on cigarette packaging so families now see their dead dad plastered round pub gardens for the sake of this noble cause.

The second way in which Global Health research controls smokers is not just by vilifying them, but indeed villainising them. In the lecture I was aligned with Boris Johnson and the tobacco industry, and in the courtyard, I was shouted at as if I was thoughtless rogue. Both of these were seen as socially acceptable, in ways I have never experienced with people driving through London, eating steak, or spraying pesticide on their garden plants. Personally, I started smoking regularly when I was a being stalked the summer before I started my PhD. If only that unidentifiable woman three stories up knew that, maybe she wouldn’t have shouted so violently at me after surveillancing me from the window in my first week on the new start, new job. I’m not saying I only smoke when I’m stressed, but doing something I enjoy, like going to the pub and having a pint and a cigarette after work, is relaxing and enjoyable. Much more enjoyable than being stalked. Here’s another tip for the anti-smoking revolution. Before you start shouting at people, and telling them what to do, maybe ask them what’s going on in their life.

Both of these discourses act to surveil and control smokers in everyday life. But for many smoking (along with those other enjoyable things like drinking, drugs, and bacon), is a (reasonably successful) way of coping with the world. A way of sitting back after a hard days’ work where you’ve probably been paid a pittance, and zoning out from the shitty world in which we live. From my experience, the reason more working class people smoke has nothing to do with education (as if anyone doesn’t know smoking isn’t good for you), and neither is it because they’re more easily duped (indeed if anything people who are being done over in the world have only more reason to practice scepticism).  It’s because people with harder lives experience more shit they need to zone out from.  But rather than change these circumstances, this seemingly benign, even heroic, area of research exerts control, yet again, over a predominantly working class, stressed, and underpaid population.

Because of this, public health scholars need to start thinking about where they direct their research. Of course, I’m not underestimating the difficulty of navigating change in a world so ubiquitous and criss-crossed with inequalities, nor am I underestimating the usefulness of using a graph to see the broader picture. But changing the world through our everyday practices, rather than broad-stroke campaigns, not only requires greater commitment but might also help us be more thoughtful, and indeed more precise, about the impact of our actions. And in the meantime, if you don’t want me to smoke near you then please just ask, I’m not too deluded and stupid to understand, and neither am I an evil villain trying to ruin your day.

6 Replies to “Being a Dirty Smoker: How public health academia villainises the poor”

  1. Whoa Hannah!! Now I wasn’t expecting that !! Having had lots of fascinating discussions with you it seems we have never stumbled upon an issue where in some respects we are so diametrically opposed!
    I don’t want to preach to any one but there is a third reason for wishing someone didn’t smoke and that is “I have seen some one die horribly and in their early 40 s leaving two children under ten ( amongst other grievers) and I don’t want to see that happen to anyone, least of all much loved friends!!”
    I either feel a coffee coming on – or maybe you can do without someone else adding to your discomfort! Val K

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    1. Hi Val! No I guess it hasn’t come up in conversation! Happy to talk over a coffee – your third reason is certainly a valid one I’m just not too keen on the other two I spoke about here. I’m not suggesting we shouldn’t do research on smoking it’s more the way it’s currently framed and put into practice. Drop me a text and we can arrange a time to meet up 🙂 H.

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  2. You have a very good point when it comes to the vilification of people who engage in one self-destructive behavior over another, and those who engage in environmentally destructive behaviors that affect others. I also take your point about the vilification of the working class. But I don’t think that lets you off the hook. It simply argues for putting more people, on the hook for those negative non-smoking behaviors.

    However, I’m not sure on what grounds you can object to being told you cannot smoke in public places where your smoke can affect others. Smoke outside doors and windows can often get drawn in through vents (I know this from experience). Your smoking outpost by a door means that nonsmokers who despise the smell must walk through your smoke to enter or leave a building. Ditto in parks, beaches or other public places: why should nonsmokers have to organize or shift where they sit or play in relation to your smoke and the wind?

    Since you are in medicine, let me give you another insight from my experience as an advanced cancer patient. When I see a person smoking–especially a doctor or other health professional–it is a slap in my face. Here I am, struggling to add a few more months to my life here and there (really, that’s what it amounts to) by enrolling in risky clinical trials and undergoing chemo. Here I am, willing to do anything in my power (diet, exercise, etc. etc.) to live (I’m shooting for age 60 if I am lucky–how does that sound?) and I see a person with a perfectly good body–a cancer-free body that I would give anything to be living in–willingly, voluntarily putting it at significant risk. What a luxury.

    And let me add that I have a hard time summoning up sympathy about your stress. Being stalked is awful. But I take it that it a thing of the past and you have the possibility of doing many other things than smoking to get past it. Go to therapy. Exercise. Quilt. Meditate. Whatever. Given your education, you are unlikely to be living the dead-end lives of the working class smokers you describe: What structural inequalities hold you back? I, on the other hand, cannot “get past” a Stage 4 diagnosis for which there is no cure. I don’t say this to conjure up pity, but to help you understand why it might be a good idea to do your smoking in very private places (or smoking sections of pubs) where no one can be bothered by your smoking–either physically or emotionally.

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    1. Hi Riva, thanks for your comment and your insights. Just to clarify – I am not talking against the inside smoking ban here (in fact I am more than happy to smoke outside), and I think I would talk for a lot of people in saying that I am always considerate of where the smoke ends up and who is around me. The difficulty I had in the courtyard scenario was the level of violence in the communication. H.

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