Poverty may be the trigger, but smoking is often the bullet
In Hamilton, as in communities around the world it is well documented that people struggling with poverty have markedly shorter lifespans than more affluent groups. The Hamilton Spectator won awards for its acclaimed “Code Red” project in 2010 which documented the correlation between poverty and premature death in Hamilton. But between the existence of poverty and poor population health lies a significant intermediate factor that affects low income people disproportionately—smoking.
ASH—an acronym for Action on Smoking and Health is a respected UK Anti-Smoking organization led mainly by scientists and the medical establishment. Its first Director when ASH was founded in 1971 was a former UK Health Minister. This year ASH produced a paper on health inequalities and smoking that stated, “Smoking is the single most important driver of health inequalities. The more disadvantaged someone is, the more likely they are to smoke and to suffer from smoking-related disease and premature death.” Surprisingly though, ASH suggests the solution requires more than throwing money at poverty. “ Improving social conditions is not, however, a sufficient strategy to reduce smoking prevalence in more disadvantaged groups. The specific drivers of smoking uptake and tobacco addiction must also be addressed. In poorer communities, young people are more exposed to smoking behaviour, more likely to try smoking and, once hooked, they find it harder to quit.” The paper even goes on to suggest that quitting smoking can have a reverse effect on poverty. “Smoking is so corrosive to individual, family and community health that any success in reducing smoking in disadvantaged groups has (spinoff) benefits for the wider determinants of health, above all through reductions in poverty. One obvious reason for this is the high price of smoking. A 20 cigarette-a-day smoker in Ontario will spend about $200 per month on legal tobacco—about half that if smoking contraband cigarettes. The ASH paper reported that poorer smokers proportionately spend five times as much of their weekly household budget on smoking than richer smokers. The report also said that roughly 400,000 UK children would rise above the poverty line were it not for smoking in their homes.
The ASH paper demonstrated that smoking has a greater effect on health than poverty alone. A long-term study of 15,400 residents of Renfrew and Paisley in Scotland, followed up over 28 years, found that smokers in the highest socio-economic group were more likely to die than non-smokers in the lowest socio-economic group.
The report acknowledges that Lower income people smoke more because of the poverty and sense of hopelessness they experience, but adds, “social policy designed to improve socio-economic conditions is not sufficient. Once these needs have been met, there is no guarantee that a smoker will be able to quit. Smoking is too addictive and too ingrained in particular communities for this to be true. Once basic needs are met, the problem shifts.” The ASH paper recommends aggressive government support for anti-smoking measures; admitting that up to now stop smoking services have had limited success because, “ smokers from disadvantaged areas find it more difficult to stop with the help of stop smoking services than their more affluent neighbours. They suggest that smoking cessation messaging should be part of every contact poor people have with the system—not just the healthcare system but criminal justice services and children’s services. In Scotland even the payday loan industry has been enlisted to refer smokers to help agencies.
Unlike the Ontario government which has recently decided to crack down on so-called “Vapes”—electronic cigarettes ASH firmly believes in “harm reduction”—doing whatever works to reduce smoking, including alternative nicotine products. The New York Times made a similar, albeit unscientific finding in a study it conducted in Clay County Kentucky where the poverty is the worst of any county in the US and where the incidence of smoking is among the highest. Wrote reporters Sabrina Tavernise and Robert Gebeloffmarch, “When a ban on smoking in public places went into effect, it was hard to tell who at the Huddle House restaurant hated it more: the clientele or the staff. Two years later, Mike Feltner, a cook, was puffing stealthily on an electronic cigarette (Marlboro flavor) while cooking eggs. He said all four of the smokers on the staff now used the devices, which he said were considerably cheaper than his old two-pack-a-day habit. He put the savings toward a down payment on a house.”
“Despite the highly addictive nature of smoking, government interventions can make a difference, researchers say. While the smoking rate has largely been stuck for Americans living in deep poverty in the South, it has fallen significantly among that income group in the Northeast, where strong antismoking measures such as those enacted under former Mayor Michael R. Bloomberg in New York have been taken.”
What emerges from all of this, is that there is no question a strong correlation between poverty and lower life expectancy; but there is an even stronger correlation between smoking and premature death, as there also is a strong correlation between smoking and poverty. An approach to poverty that does not address in a significant way, the smoking equation is not likely to solve the health issue.
Written by: John Best