New strategies needed to cut smoking rates further

Bhutan tried to stamp out smoking, under threat of imprisonment. ISIL has flogged and executed smokers. Yet some still puff away stubbornly under both regimes. You’d think the powers-that-be in Canada, embarking upon their own blessedly less-extreme tobacco endgame, would get the message. You can’t eliminate smoking altogether.

Granted, tobacco control has been a successful public health battle in Canada, where we’ve brought the rates down from nearly 50 per cent in 1965 to 13 per cent now. The next goal is an ambitious reduction in the smoking rate to five per cent by 2035.

But the current 13-per-cent smoking rate doesn’t tell anywhere near the real story. Embedded in that are these grim facts: Fiftyseven per cent of indigenous people who live on-reserve or in the North smoke; one-third of low-income Canadians smoke; 30 per cent of those with a mood or anxiety disorder do, too.

Meanwhile, in the category of “severely mentally ill,” the smoking rate has, in the past decade, been as high as 85 per cent. The root cause in these cases isn’t nicotine. The challenges are more deep-seated.

Given this reality, how on Earth do policymakers plan to reduce smoking much more? If the government were serious about reducing the body count — and if we conceded government should be in the business of telling people what they can do to their own bodies at all — it would have different ideas than the ones recently proposed.

Among those ideas: raising the smoking age

Given this reality, how on Earth do policymakers plan to reduce smoking more?

to 21; banning smoking in parks, campuses and multi-unit dwellings; a specific strategy to reduce smoking among indigenous people; switching smokers over to e-cigarettes; and finding ways to offer more support for those who do want to quit. The focus on smoking among indigenous people is good. But we don’t know much about it, yet, and what discussion there is about socio-economic and mentalhealth factors is vague at best.

Some of the rest has happened piecemeal already. It’s hard to find an apartment where you can smoke these days, and we do have this legacy of property rights that makes it tricky — not to mention dubious in principle — to dictate what people can do inside their own homes.

Smoking’s already banned in Ottawa city parks (and within nine metres of said parks) — quite probably the silliest anti-smoking measure ever devised. It’s the same in many other cities. Banning smoking on university campuses is sheer stupidity: Most everyone on campus is an adult already, and lighting up outside a building is no different from smoking outside the pub. Young though they may be, these adults should be treated as such. If you get to vote and go to war, you should probably get to make the choice to smoke. That wipes out the case for raising the smoking age to 21, too.

You’ll also note the youth smoking rate — 82 per cent of smokers having inhaled for the first time by age 18 — has flatlined since 2013 at 9.7 per cent. (Worth noting is that this statistical grouping is those aged 15 to 19, which captures perfectly legal smokers in some provinces.)

The idea of raising the smoking age is that, among high schoolers, none of their peers would then be able to buy tobacco products, making it less likely that underage users could get their hands on them. (On Monday, incidentally, a task force recommended that doctors put more effort into preventing, and stopping, young people from smoking and urged more research on how to best do this.)

It’s fairly clear that the crisis in smoking isn’t among university students, nor is it in someone relaxing with a smoke on a park bench. It’s with the many other Canadians who’re being failed in other ways, too.

Those are difficult challenges, and health agencies need to think beyond stale polices if they want to bring smoking rates down in those groups.