'Public health' priorities in a pandemic

The media love a good story about banning smoking outdoors. Radio stations get the phone ringing off the hook. I'm not quite sure the latest one justifies all the media attention. As far as I can see, Oxfordshire council have said that it would be nice if there were fewer smokers. Banning smoking outside hospitality venues has been mentioned but seems unlikely to win a vote, not least because the hospitality industry would be up in arms.

Nevertheless, the vultures at ASH have been all over it and it has made headlines so I've responded in the Telegraph today...

 

The policy, such as it is, is being spearheaded by Dr Adam Briggs, a public health consultant best known for his modelling of the sugar tax, which he reckoned would result in a measurable reduction in the obesity rate (spoiler: it didn’t).

Echoing recent remarks from Chris Whitty, the Chief Medical Officer, he said that “we have got a condition that is entirely a commercially driven cause of death and disease” and noted that the annual estimated death toll from smoking-related diseases is larger than the number of people who died from Covid-19 last year. If smoking-related diseases start spreading from person to person via bacteria or viruses, this statistic will be of relevance to public health. Until that day comes, smoking will remain none of Dr Briggs’s or Oxfordshire Council’s damn business.

The pandemic has been a useful reminder of the difference between societal health threats which require collective action and personal health risks which don’t. If people enjoyed getting Covid-19 and could not pass it on to others, there would be no moral argument for the Government to intervene. If lots of people opted to contract it at the same time, the threat to the NHS could be used as a plausible objection – but even this does not apply to smokers, who pay vastly more in tax than they cost in healthcare.

The paternalists’ argument that we must stop people smoking because it is deadlier than Covid is as specious and illogical as the lockdown sceptics’ counter claim that the Government should do nothing about Covid because it hasn’t banned smoking. Both wilfully ignore the issue of infection, which is what turns a health problem into a public health problem.

Battered by lockdowns, the hospitality industry is unlikely to welcome a policy that encourages its customers to stay at home. Since there is no conceivable threat to health from outdoor second-hand smoke, and Britons have not yet descended to Californian levels of hypochondria, a ban offends our sense of fair play and tolerance. As a proposal, it is probably dead on arrival. Nevertheless, it is interesting to see where the “public health” lobby’s priorities lie.

 

Read it all if you can.