Tobacco Documents Online

For Philip Morris/Madrid ' Peter L. Berger: The Anti-Smoking Movement in Global Perspective . ------------------------------------------------------------------ What is it ? The anti-smoking movement is a relatively new phenomenon, at least in its present form (there were always some people who thought that tobacco use is evil, but they were more or less marginal types). Originating as an organized movement about twenty years ago in the United States, it is now a powerful conglomerate of voluntary associations, political action groups, segments of professional organizations, and (last not least) government and inter-governmental agencies. This conglomerate, thXough;still centered in North America, is now international in scope. The self-described purpose of the movement is to eliminate or, barring that, to greatly reduce smoking. This purpose is to be accomplished by a mix of public advocacy ("education", in the movement's understanding) and government coercion (via regulation, taxation and, where feasible, prohibition). Early on in the recent history of the movement, one of its spokesmen announced that its goal was "to make smoking an activity engaged in by consenting adults in private". There are a number of places, especially in the United States, where the movement has come close to achieving this goal. Compared to the many other movements which, during the same period, have sought to influence behavior and attitudes, and to enlist government in their campaigns, the anti-smoking movement must be considered remarkably successful. Within the short time span of about two decades, in fairly large areas, an activity that had previously been considered self-evidently normal and acceptable, is now stigmatized, segregated and sometimes prohibited N 01 outright. ~ ~ What does it say_it is ? a ~ 1-~ The movement defines itself as a campaign in the service of public health. ~' Smoking is defined as a serious health hazard, in the rhetoric of the movement

- 2 - commonly described as the singlemost important cause of preventable death in the world today. It is assumed within the movement that the scientific basis for these claims has been established beyond reasonable doubt; indeed, there is now relatively little elaboration of the scientific arguments in the movement's propaganda, as compared to the earlier period. Given this assumed scientific warrant for the movement's aims, resistance to the latter is explained either by self-serving rationalization ("addicted" smokers who don't want to face the consequences of their behavior) or by the manipulations of the tobacco industry (whose vested interests are obviously threatened by the anti-smoking movement). The present paper outlines a sociological approach FTO is, iie-tries to understand the anti-smoking movement in cultural dimensions. Such a sociological approach must to this phenomenon. That its social, political and bracket (put on the shelf, claiming incompetence) the scientific assumptions of the anti-smoking movement; put differently, the sociologist is in no position to arbitrate differences of opinion concerning the health hazards of smoking, matters that he must leave to various natural-science disciplines. But there is one question that must still be asked: If people believe that smoking is bad for them, does one need any further explanations (sociological or otherwise) of why they would mobilize against smoking ? The answer to this question is: Yes. And for rather simple reasons. The scientific evidence against smoking is complex and highly specialized, much of it based on epidemiological statistics. Very few people can assess this evidence; they must rely on the authority of others. But to believe something on the authority of others always implies a readiness to believe. This readiness calls for sociological or psychological explanation, regardless of the evidence from the natural scientists. For example, Americans who don't believe a word uttered by the Secretary of Defense about, say, the need for a Strategic Defense Initiative immediately believe everything said by the Secretary of Health and Human Services about the dangers of smoking: Why 2503001915

3 t'his readiness to believe one type of government official and not the other ? Further, not everybody in the world shows the same positive response to the anti-smoking message. There are significant differences between and within national societies. These too call for explanation. Where is it ? And who belongs to it ? As mentioned before, the movement in its recent form is of North American provenance and it is everywhere marked by this provenance; that is, it has the characteristic features of other crusades that originated in this crusade-prone country. That in itself is not surprising: United States culture today, both in its popular and (to a somewhat lesser degree) its more sophisticated versions enjoys virtual hegemony worldwide. (This is not to be understood as an anti- American statement. It is purely descriptive. The reasons for this cultural hegemony cannot be explored here). From Valparaiso to Vladivostok, from Stockholm to Singapore, people wear American-designed clothes, dance to American music, eat American-style food, and embrace ideas that come from America - from feminism to environmentalism - and so, not surprisingly, when smoking is looked at askance in America, many people elsewhere at least pay attention. Nevertheless, anti-smoking is no longer a phenomenon limited to the United States. How is it distributed globally ? Its heaviest concentration is in what one could broadly call the North Atlantic culture area and some of its remoter outposts. Anti-smoking campaigns and legislation are strongest, and smoking has declined most sharply, in North America (United States and Canada) and in Northern Europe. In the latter, there are strong anti-smoking manifestations in Britain, Germany and the Netherlands, while the Scandinavian countries have gone farther than anyone else in legislating against smoking By contrast Southern and Eastern Europe have remained relatively 0 . , ~ ~ moderate in their embrace of the anti-smoking',campaign, and people in these countries continue to smoke with considerable enthusiasm (led, for whatever reason, ~ c~

4 by Greece). Among the outposts of this North Atlantic region one may mention Australia (where there is a vigorous anti-smoking movement) and English-speaking South Africa (South African Airways was the first airline anywhere that banned smoking on all domestic flights). T, ~ekA possibly useful observation: ~ the broad North American/European culture area, anti-smoking is primarily a Protestant phenomenon. This is not to suggest that there are some profound theological reasons turning Protestants against smoking. For one thing, this hasn't been the case in the past; even Martin Luther reputedly enjoyed his pipe. But one might hypothetize that there is a certain secularized Protestantism, which has a propensity toward crusades intended to eradicate this or that alleged evil; if, unlike Luther, one can no longer throw inkwells against the devil, more secular demonologies will have to serve the need. The anti-smoking movement certainly supplies a demonology. Be this as it may, outside the North Atlantic region and a few of its outposts the anti-smoking movement has not made great inroads. Latin Americans, Asians and Africans continue to smoke,if not quite as furiously as before, still in great numbers. There is an anti-smoking plank in the platform of Islamic revival movements in several countries, part and parcel of a general puritanism, but this does not seem to have had a great impact thus far on others'' behavior and attitudes. It appears that Latin American converts to Protestantism are averse to smoking, but this too does not as yet seem to have had a wider impact. Where the North Atlantic crusade has made inroads outside its own region, it has been through quite different channels (of which more in a moment). But even within its "home territory", the success of the anti-smoking movement has not been uniform. Its relative successes and failures are mainly class-specific, to a lesser extent related to ethnicity and region. In the United States smoking has decreased more among whites than among racial minorities, and more on the two coasts than in the less metropolitan areas of the country. Most important, though, is the difference between classes:

- 5 - As one goes down on the income ladder, smoking increases. Put differently: Anti- smoking, both in behavior and attitude, is primarily an upper-middle-class phenomenon; the working class and even the lower middle class have been far less ready to jump on the anti-smoking bandwaggon. Given these data, one may see the phenomenon in yet another light: The anti-smoking movement, especially in the United States, is one in a long list of campaigns in which the upper middle class sought to impose its values on the lower orders of society, by "education" if possible, by government coercion if necessary. The temperance movement, culminating in Prohibition, is the paradigm of all these movements of (so to speak) bourgeois agitation and propaganda. The sociological specification "upper middle class", while quite valid, is not enough to locate the phenomenon on the social map. While all upper-middle-class people are more susceptible to the anti-smoking message than those belonging to other classes, this message is most loudly heard in one particular sector of the upper middle class - namely, in the so-called "New Class" or, to use a somewhat more felicitous term, in the new knowledge class. This is not the place to elaborate this concept and its implications for an understanding of advanced industrial societies. For the present purpose, the new knowledge class may simply be defined as those people who make their living by the production and distribution of symbolic knowledge. They are the educators, the "communicators" (especially in the mass media of communication), the miscellaneous categories of therapists, the activists for various causes dedicated to social uplift, and last not least the government bureaucrats concerned with matters of social justice and the "quality of life". This class (or, if one prefers, sub-class or stratum), of course, is a relatively small minority within the overall population, but it exerts power and influence way beyond its numbers because of its strategic location in those institution that create and administer the symbols by which the society defines itself.

6 The new knowledge class is strongly established in those institutions, both governmental and non-governmental, that seek to change people's behavior and attitudes to better conform to this or that ideal of social progress. New-class professionals have been aptly called "lifestyle engineers" (by Hansfried Rellner, a German sociologist) and "moral entrepreneurs" (by James Hunter, an American colleague). Their "engineering" and "entrepreneurship" is applied to a large and ever-changing number of causes. It is not hard to understand, though, why the anti-smoking cause has a very good "fit" with the general propensity of this group to change the world in its image. Now, while this class has fully matured only in the societies of the advanced industrial countries, it has available to it an international network of organizations and agencies through which it seeks to extend its power and influence to countries outside the North Atlantic region. There are private organizations that do this, such as foundations and religious bodies centered in the United States and Northern Europe. But there are also governmental and inter-governmental agencies whose agendas are to a large extent defined by an international consortium of new-class intellectuals. As far as the anti-smoking cause is concerned, the most important of these agencies is the World Health Organization, but there are also multilateral and bilateral relations between government agencies in the developed and less developed countries (notably health ministries and agencies for development assistance). Through these vehicles agendas originating in the new knowledge class of the advanced industrial societies are effectively diffused into other parts of the world. The term that suggests itself here is that of cultural imperialism. Let it be quickly stated that this does not presuppose some Marxist or understanding of North/South relations. But one does not have quasi-Marxist,,, to be a dependencia theorist to see that the relations between developed and less developed are Cn ~ w © 0 ~ ~ asymmetrical in terms of relative power, and that this asymmetry extends to

cultural relations. Ideas, opinions and new lifestyles generally move from North to South, not the other way. In that sense, at any rate, one can speak of a cultural "dependency". In the international anti-smoking movement, then, there is a "metropolis" in the advanced industrial societies of the North Atlantic region, then there is a cultural "ruling class" in that region's new knowledge class, &''Tcolonizing" ou-rpemch'tfifough the aforementioned international networks, and finally a"comprador class" consisting of the local agents and clients of the same international institutions. Why is it ? - Politics The anti-smoking movement has designated the "smoking interests" as its principal adversary, meaning by that, of course, the tobacco industry and whoever may be the latter's political allies. The sociologist will have no quarrel with this designation. Obviously the tobacco industry has vested interests in the issues raised by the debate on smoking and health, and obviously the tobacco industry would be very happy if it could be shown that smoking is a sure cure for diseases ranging from the common cold to cholera. But the sociologist will also have to insist that, if there are smoking interests, there are also anti-smoking interests, who in turn would be delighted if it could be shown that smoking causes cholera. Let it be stipulated that there are individuals, and perhaps even groups of individuals, with no vested interests whatever: They do what they do out of pure, disinterested love of humanity. In other words, let Mother Teresa be stipulated. There are not many Mother Teresas in the world. The question, then, is: Who are the anti-smoking interests ? - They come essentially in two groups, distinct, although they have come N tn 0 co C3 0 to have ~~ all sorts of relations with each other. The two groups ~ ~ are the anti-smoking activists (the "movement" proper) and the anti-smoking 0 bureaucrats. They have somewhat different vested interests.

8 Both derive Otak income and influence from the anti-smoking campaign. Put simply, there are jobs to be had in the campaign and as a result of it, and both groups derive not only livelihood but power and prestige from these jobs. The activists, however, are much more dependent on the voluntary support of the members of their organizations, and to retain this support they must keep the rhetoric at a fairly shrill pitch. The bureaucrats, by contrast, can afford to be more reasonable in tone and in their stated aims. Most of them, of course, work for governmental or other large bureaucratic agencies (such as medical foundations), and these would continue to provide security for them even if, one fine day, the anti-smoking campaign fizzled out. There is some evidence to the effect that activists tend to go from one cause to another, a factor that would also push them toward a less radical stance. Still, it may be said that the activists at least rhetorically favor the eradication of smoking, while the bureaucrats are more content to settle for its regulation. In any case, the two groups some time ago began to mix: The activists became more "professional", the bureaucrats adopted more of the activists' rhetoric. An instructive example: Some years ago a telephone operator in the United States started a lawsuit to require her employers to furnish her with a"smoke-free environment". She was a typical activist at that point, with no vested interests beyond her immediate campaign. She was also, it seems, an individual with only moderate education. Some time later she appeared at one of the World Health Organization's anti-smoking conferences as a consultant who was in business for herself, setting up anti-smoking counseling services for companies and other organizations. In other words, she had successfully "professionalized" herself. Thus there now exists, especially in the United States but to a somewhat lesser degree in other advanced industrial societies, a network of both activists and bureaucrats, with professionals or quasi-professionals in both

- 9 - groups, with a strong vested interest in the anti-smoking cause. They have large resources at their command, mostly from government coffers. As indicated before, this anti-smoking conglomerate has internationalized itself by means of organizations such as the World Health Organization, health ministries, development assistance agencies, private foundations with activities in health and/or development, and communication media converted to the cause. This international network can now co8pt individuals in comparable organizations in the less developed countries, even if these individuals may regard the anti-smoking cause as far down if present at all on their list of priorities. Vested interests almost never present themselves to the public as vested interests, but rather as disinterested defenders of some self-evident good. In this particular contest the tobacco industry, as a collection of commercial enterprises, is at a decided disadvantage, despite its impressive resources: It can hardly present itself as a disinterested party. The anti-smoking interests, of course, are much better positioned to do so. But, at least in Western democracies, they have had a serious problem: It is a common value in these countries that individuals should be free to choose their own lifestyles, including the risks that a lifestyle may entail. Even if people might agree that smoking creates health hazards, they might still feel that no one should interfere with an individual's right to choose which health risks to accept. Indeed, the tobacco industry has made some effective use of this kind of argument (if the analogy is not taken too far, a"pro-choice" position as against the "pro-life" position of the anti-smoking regulators). This democratic value of choice, however, is clearly limited if an individual's choices threaten the wellbeing of others (again to take the abortion analogy, the "pro-choice" party has had to deny that the foetus constitutes such an "other", precisely the point that "pro-life"rhetoric has been hammering away at). Put simply: If people want to harm themselves, who has the right to stop them ? 2503001g22 For quite a while the anti-smoking movement had no good answer to this

- 10 - question. It did its best to frighten smokers - with considerable success; many were frightened - but it was not very successful in rousing non-smokers to take any action. In order to accomplish this, the anti-smoking movement had, as it were, to find an "innocent bystander" - someone who would be harmed by the individual who smokes (the author of the present observations is immodest enough aucl its pcSS"~-te So2v1'io:tto note that he pointed out this proble~before71U-~solution was found). In LiELJ theory, early on, there were two possibilities of solving the "innocent bystander" problem. The first was via the argument on so-called "social costs" : If my smoking causes me to become ill or die early, not only I suffer, but a lot of- other people will have to bear the costs - my employer (deprived of my productive capacity), by extension the economy as a whole, obviously my family dependents, but also the state which will have to take care of me and (after my presumably well-deserved demise) them, and everyone whose insurance premiums may go up because of the costs incurred by me. The anti-smoking movement has indeed made use of the "social costs" argument, but it is fair to say that this did not get very far. Perhaps it is too abstract an argument; also perhaps it has rather sinister undertones - what behavior of mine, if pursued to its ultimate consequences, may not incur "social costs" ?! I like rich foods -.I may die of an early heart attack - social costs left and right - next step: government regulation of pizza parlors .... And so on ... The problem was solved, not by way of the "social costs" argument, but by the discovery (or, perhaps, invention) of "environmental smoke". This, of course, is smoke that finds its way into the non-smoker's environment. Of course there have always been people who were annoyed when other people smoked in their vicinity. But it would have been hard to mount a crusade on the grounds of annoyance alone; after all, there are so many other things that can annoy when people congregate in public (loud talking, pushy movements, the smell of food or perfumes, and so on). The solution of the "innocent bystander" problem came when the anti-smoking movement could claim, on the basis of alleged scientific