Saturday, January 16, 2010

The United States Government Saved My Life

I moved to Prague in November of 2008. It was the day after the Presidential election so I left full of hope and excitement for my country's future. The preceding month, however, with the credit crisis and the bank bailouts pretty much drove American belief in the fairness of our system out the window. It would have been so, so easy to give up in cynicism. I was grateful to be in Prague where I would be avoiding the continual depressing drumbeat of economic calamity in American news.

When I came to Prague, I discovered Czechs had their own cynicism about democratic politics. I'm not talking about before 1989, but after. Immediately after the Velvet Revolution, Czechs felt all of the assets of the country were stripped away in a big "grab" by politicians and carpetbaggers.

I don't want to be cynical. It's not my nature and cynicism never advanced the cause of humanity. So as I made my transition to living in a new country, I vowed to celebrate one wonderful thing about my government and the Czech government so that I could keep cynicism at bay. In my next post, I'll talk about one wonderful thing I admire about Czech government, even though there are actually many things (just as there are for America). Today, I'd like to celebrate my own government's actions. It actually ended up saving my life.

A typical sign
that conveys how socially unacceptable
smoking is in America.

I am grateful to the United States government for providing leadership in my country on the elimination of smoking as a socially acceptable practice. This wasn't a grass-roots movement from the people pushing up but a top-down campaign from the Surgeon General of the United States (our top public health official) to the people.

In 1964, the Surgeon General declared that "smoking causes cancer." That took real courage to say back then because 46% of American smoked. They smoked in cars, elevators, planes, offices, and their homes. The 1964 report was issued on a Saturday, so great were the worries about what it would do to the American stock market.

The news that smoking causes cancer finally sank into my brain in 1991 when I was 31 years old. Up until that point, I smoked more than I care to admit (okay, I'll admit it: 3-4 packs a day).

When I came to Prague, I had never seen so many smokers! Not even when I was 17 years old and thought smoking was cool. Just walking down one of Prague's very lovely streets, one has to be careful not to get a cigarette burn in one's coat because people are actively walking and smoking at the same time! I once talked to a young Czech college student who was smoking and he was astonished by the idea that anyone would want to quit. "It relaxes me." I don't even think he knew it could kill him. And it's not just Czech young people who smoke.

Most educated people in the USA have educated themselves about the danger.  In America, the majority of smokers left have less than a high school education. I've entered salons frequented by Prague intelligentsia where nearly 100% of the people had a PhD. But they are uneducated about the dangers of tobacco. The air was so thick with smoke you could see it move!

I  was mystified by how unlikely it would be that my country led on this and the Czech Republic lagged on this. After all, in a socialist health care system, wouldn't the government want to eliminate preventable chronic disease because it would eliminate expense? Wouldn't Czech people resent their neighbor's smoking if that drove up national health care costs and their taxes? Isn't it in a socialist government's fiscal interest to change this smoking culture?

Maybe the taxes raised on cigarettes more than cover the cost of the increased disease and people who smoke are used for financing public budgets. I don't know. I will occasionally razz, with a joking smile, my smoking friends who are huddled outside for warmth where they've been banished nationwide in America: "hey taxpayer, thanks for paying more than your fair share through your smoking. You make it easier on the rest of us. But you don't have to kill yourself in the process - why not just mail in the money if you're so insistent on paying these extra taxes?" One of my young coworker has taken to calling his smoking breaks "paying everybody's taxes."

Why did my country lead on curtailing smoking culture when we had a giant tobacco industry that was hugely powerful, created tons of jobs, and lots of export income? The government continually, over and over again, did the right thing despite all that. We have all kinds of industries back home that sway the government from doing the exact thing in the best interest of the public as a whole. I would love to understand why the American government was so terrific on this issue when the government didn't even bear the health care costs of increased smoking, insurance companies did. What do you think, Americans? How could this sort of extraordinary leadership on an issue be reproduced? We sure could use an awful lot more of it.

I am so grateful to the Surgeon Generals of the United States for saving my life. Thank you for continually reminding the public that we were killing ourselves. And since all movements have a drum leader, I would like to take a moment to honor the individual human beings who have led this movement in my country. Thank you!

American Surgeon Generals from that period onward:

Leroy Edgar Burney (first federal official to state that smoking causes lung cancer)
Luther L. Terry (commissioned landmark 1964 report on smoking)
William H. Stewart
Jesse L. Steinfeld
Julius B. Richmond
C. Everett Koop (led a campaign to create a smoke-free society by 2000)
Antonio Novello
M. Jocelyn Elders
David Satcher
Richard H. Carmona
Regina M. Benjamin

See, it's not so hard to keep cynicism at bay! Next post I will talk about what I most admire about the Czech government:

How Czech Government Delighted Me As a Consumer


Anonymous said...

There is another term for it - The nanny state.

Karen said...

Fair enough and thanks for the laugh.
Ideological purity wouldn't be very useful to me if I was dead. The older I get, the less threatening the Nanny State looks - it's seems more like crowdsourcing - learning from the wisdom of the crowd.

Chaplain said...

Hi Karen - Like you, coming from a country where smoking is increasingly seen as socially unacceptable, (it was finally banned from all enclosed public spaces in England from 1st July 2007), I find the attitude of so much of Czech society towards smoking, difficult to comprehend. The health risks are known. But so many smokers convince themselves that somehow, lung cancer/heart attacks/strokes, 'won't happen to me'!

One of the real problems, both in the Czech Republic and elsewhere in Europe, is with younger females who are convinced that smoking will keep them slim. Have you ever noticed that it often some of the most fashionable and attractive Czech young ladies who smoke? Of course, there is an element of truth in what they believe because smoking does suppress appetite. People who give up smoking, both male and female, frequently complain that they start putting on weight.

What may finally bring about change here in the Czech Republic is the economic pressure of the tourist industry. With similar smoking bans to those in the UK & USA now in place in Scandinavia, Germany, France, Italy and elsewhere, increasingly visiting tourists do not want to eat or drink in bar-restaurants where the atmosphere is thick with cigarette smoke.

Anonymous said...

If I understand that correctly, you needed from the state to force you to stop smoke? If state didn't stop you, you would now be dead?

Gosh, I love Americans and theirs emotionals statements :)

Karen said...

Ricky, that's exactly why I started smoking.

Anonymous, I did not need the state to force me to stop smoking. That was an accomplishment I did all on my own (and a very difficult one too, probably the most difficult thing I've ever done). What I appreciate is the constant message from my government that this is a practice that will kill you.

Anonymous said...

Karen: Al right. Well, same thing did communist government in CSSR.

Karen said...

The communist government of Czechoslovakia sent out the same "don't smoke" message? Maybe they were sending other messages besides that one that lessened their credibility with the Czech and Slovak people.

*lynne* said...

That's an interesting way of putting it - acknowledging that without the (sustained) push of the Surgeon General(s), you might not have paid attention to the "smoking is bad and dangerous" message. That's what those messages are for - to push people past the awareness stage and into the deciding to change stage!

It *is* nice to not be assaulted by all that smoke upon entering a bar nowadays. In Malaysia more and more bans on smoking in public places are being dictated, but enforcement is another thing altogether. The 'cool' and 'diet' perception is still very much alive.

Chaplain said...

Hi again Karen - I wouldn't take too much notice of a commenter who will not properly identfy him/herself and chooses to be 'Anonymous'. As far as I am concerned, if you want your comment published you should also identify yourself.

I firmly believe that one of the rolls of government is to protect the health and wellbeing of its citizens. Therefore successive Surgeon Generals in the USA clearly spelling out the dangers of smoking once they became known, were seeking to protect the health and wellbeing of US citizens. Successive Chief Medical Officers in England did exactly the same over the same timeframe that you outline in your blog.

Of course, when governments legislate to ban smoking in enclosed public places, opponents always cry 'Nanny state'. But once again, all governments are doing by such legislation is protecting the health and wellbeing of the majority of the population who are non-smokers.

I was interested in your reply to my earlier comment explaining that you too, took up smoking at 17 because you believed it would keep you slim. Recent statistics from the UK show that these days, amongst the under 30 age group, more women than men smoke with explanation of keeping slim being the most common reason given by female smokers for doing so.

Anonymous said...

It's interesting how different societies react to this. Dubai enacted a no smoking law in 2007 for public places, including shopping malls, which are hugely popular places for people to hang out, particularly in the heat of summer. At the time everyone laughed and said it would be unenforceable, so strong was smoking in the Arab culture. However people obeyed it almost immediately and they are now introducing it on a national level and extending the places covered, which is great news.

Did you ever see the movie The Insider, with Russell Crowe - the true life story of a tobacco executive whistle blower? Great movie.

Karen said...

Ricky, America could use a little more Nanny State, in my humble opinion. And when I was researching this post, I discovered that your country led all others on warning it's citizens about the dangers of smoking. The USA 1964 report came out shortly after the U.K's report.

Expatriatelife, I haven't seen that movie. I shall have to look for it. One that I immensely enjoyed, both as a book and a movie, is "Thank You for Smoking" about the life and values of a tobacco lobbyist.

Karen said...

I'm still waiting for an American to tell me how we get our government to act like that again! No one seems to have an answer.

PetersAHS76 said...

Interesting post...nice to see somebody who sees the government taking a position as something other than a threat. I'm not sure when we decided that anything from the government is bad. I've got as much of a "you can't tell me what to do streak" as anybody and there is absolutely such a thing as going too far - but for my money, the government taking a leadership role in reducing something that is a threat to life and health like smoking is a good thing.

Karen said...

Saturday, September 26, 2010 - I just learned there's a study that actually quantifies what it is worth financially to the Czech Republic to encourage smoking among the citizens. It was commissioned by who else - the American tobacco company Phillip Morris.

Their study showed that yes, there were increased health care costs associated with having citizens smoke.

There were however, three main benefits to the state:

1) huge tax revenues from cigarette sales,
2) heath care savings from the early deaths that resulted from citizen smoking,
3) pension savings from early deaths that resulted from cigarette smoking, and
4) saving in housing costs for the elderly from early deaths from cigarette smoking.

The net savings of encouraging smoking among Czech citizens is $147 million or $1,227.00 per citizen.

So if you're a nonsmoker in the Czech Republic, your government is essentially transferring wealth to you from the people who are still smoking. If you're a smoker, I guess you get to die early and be the one to transfer your wealth.

My source for this information is the first 10 minutes of Episode 2 of this lecture series, "Justice" at Harvard University.

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