‘Stigmatiseren van rokers is fout’

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.”

Michael Siegel’s blog

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  • "Es ist schwieriger, eine vorgefaßte Meinung zu zertrümmern als ein Atom."
    (Het is moeilijker een vooroordeel aan flarden te schieten dan een atoom.)
    Albert Einstein

  • "Als je alles zou laten dat slecht is voor je gezondheid, dan ging je kapot"
    Anonieme arts

  • "The effects of other people smoking in my presence is so small it doesn't worry me."
    Sir Richard Doll, 2001

  • "Een leugen wordt de waarheid als hij maar vaak genoeg wordt herhaald"
    Joseph Goebbels, Minister van Propaganda, Nazi Duitsland

  • "First they ignore you, then they laugh at you, then they fight you, then you win."
    Mahatma Gandhi

  • "There''s no such thing as perfect air. If there was, God wouldn''t have put bristles in our noses"
    Coun. Bill Clement

  • "Better a smoking freedom than a non-smoking tyranny"
    Antonio Martino, Italiaanse Minister van Defensie

  • "If smoking cigars is not permitted in heaven, I won't go."
    Mark Twain

  • I've alllllllways said that asking smokers "do you want to quit?" and reporting the results of that question, as is, is horribly misleading. It's a TWO part question. After asking if one wants to quit it must be followed up with "Why?" Ask why and the majority of the answers will be "because I'm supposed to" (victims of guilt and propaganda), not "because I want to."
    Audrey Silk, NYCCLASH