Smoking is a dirty, polluting and life-threatening habit. People don't smoke because they can, they smoke because they have to - and they like it. Then they die. Any Government that takes positive action to stop smoking deserves all the help it can get.
Governments merit extra support because tobacco companies systematically concealed negative information about the effects of smoking and put profit over human health for decades. Health campaigners worked with both hands tied behind their backs. Thousands of people who died prematurely from smoking-related diseases might not have died so soon if they had better information, leading to appropriate personal and medical intervention.
Smoking is so bad, and has such a shocking industrial history, that governments can rest assured their strategies for reducing the number of smokers and for attacking the tobacco cartel will win widespread voter support. This is as it should be.
But the effectiveness of anti-smoking strategies and legislation has not yielded the same outcome. In Ireland, the percentage of smokers in the population has dropped since campaigns first started in the 1970s but is rising since 1988. The number of women dying from smoking-related diseases is increasing, and is expected to rise even further as their age profile rises. The number of men in the same position is on the wane.
The question is why, with such broad consensus, anti-smoking strategies don't work better? Governments can address the concerns of passionate anti-smoking campaigners relatively easily with ever-increasing restrictions on smokers and distribution of tobacco products, as Micheal Martin's new plans demonstrate.
Yet although everyone feels better, not everyone manages to kick the habit. Even in the United States, the anti-smoking capital of the world, rates of smoking among minority ethnic groups have not dramatically declined since the American establishment decided to treat tobacco as a more lethal weapon than the handgun. The strategies used appealed best to middle-class white men and middle-class white children, in that order. The same fortunate people are now seriously discussing whether to penalise smokers and former smokers for the costs of providing smoking-related healthcare.
The language in which such campaigns were described reinforced middle-class assumptions of having a moral edge over other groups by using words such as "willpower" and "motivation", and relying on social ostracisation rather than addiction-sensitive campaigns. The question is whether having a broad consensus, at least among the middle classes, is actually dulling people to the evidence that campaigns have not worked as well as they should. Critical attitudes used to examine other areas of Government policy, and health policy in particular, are not used in relation to anti-smoking strategies and campaigns.
Huge ground has been covered, with massively reduced opportunities for advertising tobacco products and explicit media campaigns which state that smoking kills. But these are, in a sense, rational middle-class beliefs based on the view that people will act wisely if given correct information or put under economic pressure. The current Budget's increase of cigarette prices made no discernible impact on smoking habits so far, and damaged inflation figures rather than tobacco companies' profits.
Nicotine addiction is never a rational thing. Smoking involves massive self-deception, even when smokers experience self-disgust too. I know. Smokers either disbelieve their own mortality, or believe the issue is too big to solve. The more criticism is thrown at them, the more they want to sneak off for a fag. The relationship between smoker and cigarette involves levels of loyalty otherwise reserved for long-term relationships based on mutual love. You wake up in the middle of the night; your cigarette is there for you, offering comfort and support. Stupid, ill-founded, but that's how addiction works.
Smoking is more lethal for women than for men, says recent research. But more women smoke nowadays. Early Irish television ads targeting women addressed us in what someone believed were genuine female concerns.
Later ads picked up the populist phrase that kissing a smoker was like kissing an ashtray. That didn't work either. Even intellects as powerful and politically conscious as the writer Doris Lessing failed to see the dangers of nicotine for what they are. Lessing's autobiography reveals gleefully how she had an early menopause at age 40 because she smoked. Her glee was because she didn't have to use contraception any more. What she did not say, and perhaps did not know, was that early menopause removes women's biological advantage yielded by age-specific hormone levels, leaving them as vulnerable to stroke, heart attack and other debilitating diseases as men.
The Minister says he wants to introduce a "strict" regime. No doubt this will increase the feel-good factor among anti-smoking lobbyists and elements of the 69 per cent majority non-smoking population. It is appropriate to get strict with tobacco companies and suppliers, and arguably to increase challenges to them on legal grounds whenever possible. But the Department of Health offers no evidence that strictness works in itself when it comes to the individual smoker. In general, this society responds badly to being controlled or told what to do.
The nature of addiction remains a low priority for government-sponsored research and actions. If anti-smoking campaigns are to work better, faster, and for a wider societal grouping than they do now, understanding addiction must become a priority. Smokers may be foolish, unwise and reckless, but they are not amenable to being treated like naughty children, even though they know that is precisely what they are.
mruane@irish-times.ie