Voor het eerst worden in een belangrijk wetenschappelijk tijdschrift, de American Journal of Public Health, vragen gesteld bij de richting die de anti-rokenbeweging de laatste 10-20 jaar is ingeslagen. Twee wetenschappers van de Columbia University stellen in een artikel dat het stigmatiseren, buiten de maatschappij plaatsen of het afschilderen van rokers als het schuim der aarde contra-productief is en de volksgezondheid allesbehalve dient.
Het betreffende artikel is zonder betaling niet direct opvraagbaar, maar delen ervan worden geciteerd op de blog van Michael Siegel, die de conclusies van dit artikel ten volle onderschrijft (en natuurlijk prompt verwijten krijgt uit de anti-rokenbeweging dat hij de zaak een slechte dienst bewijst).
“I am concerned because of the lack of response I have received from the tobacco control community. If it seemed that any substantial fraction of that community was truly concerned and interested in discussing this issue, I would feel reassured. However, the lack of interest in discussion that might, in some way, interfere with the professed agenda of the movement scares me.”
For perhaps the first time in a major public health journal, these authors are questioning, on an ethical as well as utilitarian basis, whether the stigmatization of smokers is justified in public health. They note that efforts to reduce smoking by stigmatizing smokers “run counter to a revisionist orthodoxy that had emerged during the last years of the 20th century that asserts that stigmatization of those who are already vulnerable provides the context within which disease spreads, exacerbating morbidity and mortality by erecting barriers between caregivers, and those who are sick, and by imposing obstacles on those who would intervene to contain the spread of illness. In this view, it is the responsibility of public health officials to counteract stigmatization if they are to fulfill the mission to protect the communal health.”
The authors note that the tendency of the tobacco control movement to “ignore without comment the overarching concerns raised in prior years about the relation between stigmatization and effective public health interventions. … the moral question of how to balance the overall public health benefit that may be achieved by stigmatization against the suffering experienced by those who are tainted by ‘spoiled identities’ is virtually never addressed.”
The authors suggest that the answer to this balancing question may lie with a careful analysis of “the nature and extent of stigma-associated burdens and on how the antitobacco movement deploys stigmatization as an instrument of social control. For example, policies and cultural standards that result in isolation and severe embarrassment are different from those that cause discomfort. Those that provoke a sense of social disease are not the same as those that mortify. Acts that seek to limit the contexts in which smoking is permitted are different from those that restrict the right to work, to access health or life insurance, or to reside in communities of one’s choice.”