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The costs to society of smoking and excessive alcohol use are many and varied. The health of individuals suffers, not only those who smoke or drink, but those who live with them. Families are torn apart by alcohol abuse, breadwinners die from smoking related illnesses. The economy as a whole suffers. In 1994, the Medical Research Council estimated that for every R1 the government received from taxes on cigarettes, it spent R2 on treating tobacco related illnesses and on lost productivity due to these illnesses. Similarly for alcohol, it was estimated that in 1996, taxes on alcohol brought the government 570 million. However, 1,7 billion was spent on alcohol related trauma, disease and lost productivity.
So the question is not so much whether smoking and alcohol are bad for society, but how to stop people from indulging in them too much, if at all. This is a very complex question. One of the thorny issues involved here is the individuals fundamental right to choose how he or she behaves. Some people believe that imposing restrictions on smoking or drinking alcohol constitutes an infringement of this right. However, in choosing to smoke or misuse alcohol, most people are not making a simple, informed choice. The reasons are as follows.
Firstly, people must be well informed of the consequences of their actions if they choose to indulge in a certain behaviour. If there are dangers to themselves or others attached to that behaviour, then they must be fully aware of these. In the case of smoking, research has shown that this is not always the case. In low and middle income countries, people are less aware of the dangers than they are in high income countries. For example, in China, 61% of people questioned about smoking thought that it did them little or no harm. Even in high income countries, people who smoke believe the risks of smoking to be lower than non-smokers do, and tend to think that the risks don't apply to them personally.
Secondly, the choices to use tobacco or alcohol are frequently made in adolescence, when the capacity to make such choices is not fully developed (it has been shown that most adult smokers began the habit whilst still teenagers). Society already protects teenagers from the consequences of unwise decisions by setting the age of voting or consent to marriage at a certain lowest limit. Therefore it seems reasonable to do the same for decisions to drink or smoke, which will also have far-reaching effects on their lives.
Thirdly, when making a decision which has potentially negative consequences, a person should not be swayed in the direction of that decision by an outside force. This is exactly what advertising tries to do to convince people that smoking or drinking alcohol is cool or attractive, and associated with success and happiness. This is unfair, and constitutes manipulation of the public by the industries which use this advertising, and limits the ability of the individual to make a truly unbiased decision about his or her lifestyle.
Thus although educating people in order to enable them to make informed choices about drinking or smoking is a good idea in theory, in practice it doesnt seem to work. Either the messages dont convince the target audience, or the habit is so entrenched in society that it needs something more powerful than education to dislodge it, or peoples lifestyles are such that they facilitate substance abuse, and make stopping very difficult in poor communities for example, alcohol may be used as an escape from the realities of a desperate life. In the United Kingdom, anti-smoking education was used for many years as a means to encourage people to stop, but it was for the most part unsuccessful. Now tobacco advertising has been banned in that country, and the images of smoking as being a passport to a successful, desirable life are no longer part of peoples consciousness.
Therefore something needs to be added in order to help people make healthy choices, and this something is legislation. Legislation, when properly enforced, can change behaviour effectively and for the better. Consider the wearing of seatbelts: before it became law to do so, few people buckled up. However, once the possibilty of getting a fine for not doing so became a reality, people did wear their seatbelts, until eventually something which was initially a nuisance became a habit. In many countries the wearing of seatbelts has decreased the fatalities due to motor vehicle accidents significantly.
Hopefully government involvement in trying to bring down the use of tobacco and alcohol will have the same effect of creating an ethos in society where smoking and the misuse of alcohol are the exception to the rule, rather than the norm. If buying alcohol as a teenager is difficult because the legislation of not selling it to people under the age of 18 is enforced, then fewer teenagers will drink. If people have to go to a designated area to smoke instead of smoking at their desks, many may find it more convenient not to smoke at all. The aim is not to create a police state where illegal trade in alcohol and tobacco flourishes and personal freedom is in fact restricted, but to create an environment where the healthy choice is the easier one to make.
This is essentially the reasoning behind the Tobacco Products Control Amendment Bill which was recently passed. This legislation places certain restrictions on the marketing, sale and consumption of cigarettes (see summary of the bill later in this issue). The main aim of the bill is to make it more difficult for people to smoke. This will not only mean that people who already smoke will have added incentives to smoke less, or to stop smoking altogether, but will also make it less attractive for people who have never smoked to start smoking. The same principles would apply to legislation which aimed to curb alcohol use, although such legislation is not being developed at the moment.
If the aim of our society is that everyone in it enjoys the best quality of life possible, then introducing public health measures to limit smoking and the use of alcohol can only help to bring this about. |
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