Public Health versus Private Freedom?
In contrasting decisions last month, a United States Court of Appeals struck down a US Food and Drug Administration requirement that cigarettes be sold in packs with graphic health warnings, while Australia’s highest court upheld a law that goes much further. The Australian law requires not only health warnings and images of the physical damage that smoking causes, but also that the packs themselves be plain, with brand names in small generic type, no logos, and no color other than a drab olive-brown.
The US decision was based on America’s constitutional protection of free speech. The court accepted that the government may require factually accurate health warnings, but the majority, in a split decision, said that it could not go as far as requiring images. In Australia, the issue was whether the law implied uncompensated expropriation – in this case, of the tobacco companies’ intellectual property in their brands. The High Court ruled that it did not.
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Underlying these differences, however, is the larger issue: who decides the proper balance between public health and freedom of expression? In the US, courts make that decision, essentially by interpreting a 225-year-old text, and if that deprives the government of some techniques that might reduce the death toll from cigarettes – currently estimated at 443,000 Americans every year – so be it. In Australia, where freedom of expression is not given explicit constitutional protection, courts are much more likely to respect the right of democratically elected governments to strike the proper balance.
There is widespread agreement that governments ought to prohibit the sale of at least some dangerous products. Countless food additives are either banned or permitted only in limited quantities, as are children’s toys painted with substances that could be harmful if ingested. New York City has banned trans fats from restaurants and is now limiting the permitted serving size of sugary drinks. Many countries prohibit the sale of unsafe tools, such as power saws without safety guards.
Although there are arguments for prohibiting a variety of different dangerous products, cigarettes are unique, because no other product, legal or illegal, comes close to killing the same number of people – more than traffic accidents, malaria, and AIDS combined. Cigarettes are also highly addictive. Moreover, wherever health-care costs are paid by everyone – including the US, with its public health-care programs for the poor and the elderly – everyone pays the cost of efforts to treat the diseases caused by cigarettes.
Whether to prohibit cigarettes altogether is another question, because doing so would no doubt create a new revenue source for organized crime. It seems odd, however, to hold that the state may, in principle, prohibit the sale of a product, but may not permit it to be sold only in packs that carry graphic images of the damage it causes to human health.
The tobacco industry will now take its battle against Australia’s legislation to the World Trade Organization. The industry fears that the law could be copied in much larger markets, like India and China. That is, after all, where such legislation is most needed.
Indeed, only about 15% of Australians and 20% of Americans smoke, but in 14 low and middle-income countries covered in a survey recently published in The Lancet, an average of 41% of men smoked, with an increasing number of young women taking up the habit. The World Health Organization estimates that about 100 million people died from smoking in the twentieth century, but smoking will kill up to one billion people in the twenty-first century.
Discussions of how far the state may go in promoting the health of its population often start with John Stuart Mill’s principle of limiting the state’s coercive power to acts that prevent harm to others. Mill could have accepted requirements for health warnings on cigarette packs, and even graphic photos of diseased lungs if that helps people to understand the choice that they are making; but he would have rejected a ban.
Mill’s defense of individual liberty, however, assumes that individuals are the best judges and guardians of their own interests – an idea that today verges on naiveté. The development of modern advertising techniques marks an important difference between Mill’s era and ours. Corporations have learned how to sell us unhealthy products by appealing to our unconscious desires for status, attractiveness, and social acceptance. As a result, we find ourselves drawn to a product without quite knowing why. And cigarette makers have learned how to manipulate the properties of their product to make it maximally addictive.
Graphic images of the damage that smoking causes can counter-balance the power of these appeals to the unconscious, thereby facilitating more deliberative decision-making and making it easier for people to stick to a resolution to quit smoking. Instead of rejecting such laws as restricting freedom, therefore, we should defend them as ways to level the playing field between individuals and giant corporations that make no pretense of appealing to our capacities for reasoning and reflection. Requiring that cigarettes be sold in plain packs with health warnings and graphic images is equal-opportunity legislation for the rational beings inside us.
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9 comments on "Public Health versus Private Freedom?"
September 09, 2012 5:54pm
Cigarettes should be labeled as a dangerous drugs. We are all paying more money on health insurance because of the sale of cigarettes.
Breath is the essence of life, cigarettes are the essence of death.
September 09, 2012 7:41am
There is another issue that people are not considering. About a year after moved into my townhouse, my neighbors moved away and a heavy smoker moved in. Now I am breathing in her second hand smoke, and I have developed respiratory problems. My attempts to fix this on my end, including having someone patch all the holes and buying an expensive air purifier, have been only slightly successful. A big part of the problem is the design of the building I live in. Basically, I will probably have to move to escape the smoke. This is why the issue is NOT simply about 'private freedoms'. Many of us, especially people who live in apartments, condos, and townhouses, are forced to breathe second-hand smoke in our own homes. Nicotine is more addictive, and way more dangerous, than most of the currently-illegal drugs.
September 08, 2012 7:52am
When you gave your government the permission to prohibit heroin, you gave them permission to ban tobacco. Either all of us are free or none.
September 07, 2012 7:26pm
Richard. Well spoken, had you never smoked, but hypocritical from a former smoker. You gave yourself permission to smoke for 40 years! Now that you have canonized yourself Saint Non-Smokeless, you propose that other smokers become criminals, forced to go underground to meet the Marlboro Man. Not a word about early smoking prevention, affordable nicotine replacements or Smokers Anonymous groups. The air must be very thin up there on your high horse.
September 07, 2012 5:58pm
I believe you enter a very slippery slope here. You are assuming that at any given time full facts are known about a given product which as history has borne out does not happen. Freedom of speech is designed to protect EVERYONE so that the prevailing knowledge or government can not suppress beliefs, information, or opposing opinions—otherwise you have a totalitarian state. Once you start making exceptions you open the loophole for oppression and suppression. As a professor of bioethics, I am certain you can appreciate the issue and importance of legal precedent and the delicate balance between common sense and abuse.
Let's look at the tobacco industry. There was a time (not really that long ago) when the medical community prescribed cigarettes! If there were not the protection of freedom of speech, the very horrible health implications of smoking might have never come to light—and in fact took a long time to be considered standard knowledge. Similarly you could argue that other medical techniques administered today are beyond questioning, but as history shows us, nothing is beyond examination and evolution. Antibiotics, once a panacea, have now created new, untreatable diseases due to their indiscriminate use and the warnings of early critics going unheeded. Certain vaccines, once considered able to impart life-long immunity, are now failing. Pesticides and herbicides, considered the answer to all food production problems, have been producing resistant insects and weeds at an increasing rate. If information about these developments is not protected by freedom of speech, increasing public and personal health issues could arise.
Many of the items you cite as unsafe—food additives, lead paint—are now only publicly known to be unsafe because of freedom of speech protections.
In the particular case you cite, it seems to be splitting hairs that images infringe on the rights of the tobacco industry where text does not—and therefore it is a weak defense and argument. But I implore you to argue against the case on merits other than qualifying freedom of speech—to do so may lead to limitations that you may regret in the future, as might we all.
September 07, 2012 1:53pm
It seems to me that making smoking illegal will not work. As noted it just creates a black market and we already have enough drugs on the black market.
Controlling free speech (advertizing) is a slippery slope. What's next after cigarette?
The current prohibitions of smoking in _public_ places should be extended to all states, perhaps as a requirement of participation in the national health care system (in the same way that the drinking age was lowered to 18 by tying it to federal transportation assistance).
The current education campaigns seem to be working, though slower than some might like. However, a democratic society does not move quickly until there is truly a consensus (and obviously there is not, or smokers would not compose more than 20% of the population). Keep up the education, develop new approaches, and use cigarette taxes to pay for it.
It does gall me to pay for medical benefits of smokers who knew smoking was unhealthy. However, it does not seem a good idea to exclude anyone from public health care for this reason. There are simply too many foolish and unhealthy thinks that we all do--what is a fair way to decide which are cause for exclusion from benefits? For a start, there are more obese citizens (over 30% and increasing!) than smokers. Education with behavioral encouragement (e.g., no smoking in public places, limiting the sale of unhealthy sized portions) seems like an approach more appropriate for a democracy.
September 07, 2012 1:31pm
I wonder if anyone has bothered to try to calculate the cost in increased healthcare cost to America per cigarette smoked by Americans
September 07, 2012 10:47am
Speaking as a 10 year reformed smoker after 40 years of addiction to this product, the government should make this product illegal and stop the use of this political football that continues to be a staple of the campaign rhetoric used by Liberal politicians over the past 45 years as well as a bonanza for Federal, state, and local governments that keep increasing this onerous tax on an addictive product with no effort to provide any real secession programs for addicted users. One can only imagine the enormous savings in medical costs to treat smoking related illnesses that would probably dwarf the tax income from the continued sale of this product. In addition, given the current price + Tax of tobacco products, it’s clear that the addiction is the sole blame for the continued use of this product by average Americans who are struggling to pay bills and put food on the table in this current economic downturn. This tax is a real death tax imposed on helplessly addicted users that could eventually retreat from the addiction and live full lives if this product was no longer allowed. A segment of the Stop Smoking Lobby continues to use the tired argument associated with the results of Prohibition early in the last century to justify the continued availability of this dangerous product when the truth concerning increased criminal activity in that era was the result of a collapse of our economy equal to the one today. Prohibitions demise can be attributed to the same forces that keep all sorts of addictive products in play today, a Capitalist system that will continue to demand the unrestricted right to sell anything that results in a profit for the business sector. A former Surgeon General even justified their continued existence because of there historical relationship to our country’s beginnings as tobacco was sold to finance our revolution against the British. The battle against smoking continues on in a society that, like many in Europe, has made the use of this product socially unacceptable and the changes, compared to an America of only forty years ago, are dramatic. I can relate to smokers who are hopelessly hooked on this product and blame anti-smoking forces for the social discrimination against their habit. I can remember when I was in their camp but secretly there was a voice from inside me that screamed help me escape this addiction by removing this product from the store shelves, too many current and future lives are at stake !
September 07, 2012 9:34am
I have no problem with graphic warnings on tobacco packaging, as well as making packaging less attractive and more generic-looking.