News
Email
Print
Public health must take precedence
ADVERTISEMENT
Published: January 31, 2009
As state policymakers prepare to debate legislation to make all workplaces smoke-free, we can expect some familiar battle lines to be drawn: Smokers vs. nonsmokers. Business owners vs. employees. Tobacco companies vs. everyone. But before we get caught up in discussions of whose rights matter most, it's important that we not lose sight of the fundamental issue at stake: public health. Cigarette smoke hurts nonsmokers more extensively than most people realize, and the most vulnerable populations are often the hardest hit.
Smoke-free policies have been shown to drive smoking rates down, in addition to producing myriad health benefits related to decreasing secondhand smoke.
Many may assume that secondhand smoke is no different from smoke from a wood fire. In reality, cigarette smoke is a toxic blend of over 4,000 known chemical compounds, including arsenic, lead and formaldehyde. Included in this noxious mixture are 69 known or probable carcinogens. According to the National Cancer Institute, secondhand smoke causes an estimated 38,000 deaths each year -- 35,000 from heart disease alone. Risk of heart disease increases 30 percent because of secondhand-smoke exposure.
Children's health is particularly at risk. Secondhand smoke accounts for more than 1 million annual illnesses in children and has been identified by U.S. Surgeon General Richard H. Carmona as one of the causes of Sudden Infant Death Syndrome (SIDS), which is the leading cause of death in healthy infants.
If, as the surgeon general unequivocally states, secondhand smoke causes death and disease and is unsafe at even small levels of exposure, we could expect to see a decrease in death and disease when smoke-free policies are put in place. And that's exactly what has happened. As more and more states and cities go smoke-free, it's becoming ever more clear that getting rid of secondhand smoke leads to immediate and dramatic improvements in public health.
A recent review of communities that implemented smoke-free policies showed a 20-percent reduction in hospitalizations for heart attacks within a year or two. A CDC report found that hospitalization rates for heart attacks dropped 40 percent in Pueblo, Colo., within three years of implementation of a smoke-free workplace policy. In neighboring areas without smoke-free laws, heart-attack rates remained the same. When the options are smoky restaurants or 20 to 40 percent fewer heart attacks, the choice seems clear.
In addition to reductions in human suffering, consider the reductions in health-care costs. Consider the savings to cash-strapped states responsible for Medicaid and state employee health programs. Consider savings to taxpayers related to Medicare and other federal programs. Consider lower costs of private insurance. We could all use a little more cash these days, as well as cleaner air.
More than 76 percent of white-collar workers are protected by smoke-free workplace policies, compared with fewer than 60 percent of blue-collar and service-industry workers. A large proportion of service-industry workers are black Americans, Hispanics, American Indians and members of low-income families, who are therefore more likely to suffer the effects of secondhand smoke.
Medical tests confirm high levels of secondhand-smoke exposure among minority and low-income individuals and their children. And the lower the income, the higher the levels of exposure -- yet another instance in which the greatest health problems are experienced by those with the least access to health care. Some of this exposure can be attributed to high levels of smoking in the home. This is all the more reason to make public spaces smoke-free.
Despite the fears of some -- especially in the hospitality industry -- that going smoke-free will hurt their businesses, volumes of sound research support the conclusion that there is no negative economic impact. In fact, businesses frequently see cleaning costs and absenteeism decline and worker productivity improve.
The role of government is to ensure worker and consumer health. Just as government rightly regulates other aspects of the hospitality industry -- for example, health inspections of restaurants -- government cannot ignore its responsibility to address the documented health risk to workers and consumers posed by secondhand smoke.
Ultimately, the smoke-free issue is not about personal preferences of individuals or business owners. It's about heart disease and cancer. It's about health disparities and fairness for all workers. Above all, it's about public health. And public health could improve dramatically by making North Carolina public places smoke-free.
■ Ronny Bell is a professor in the department of Epidemiology and Prevention and the director of the Maya Angelou Center for Health Equity at the Wake University School of Medicine. Dr. David Goff is a professor and chairman of the department of Epidemiology and Prevention, Division of Public Health Sciences at the Wake University School of Medicine.
■ The Journal welcomes original submissions for North Carolina Voices on local, regional and statewide topics. Essay length should not exceed 750 words. The writer should have some authority for writing about his or her subject. Our e-mail address is: Letters@wsjournal.com. You may also mail a typed essay to: Letters to the Journal, P.O. Box 3159, Winston-Salem, NC 27102. Please include your name and address and a daytime telephone number.
Email
Print
