PHM-Exch> Smokescreens: How Working Kills Smokers (4)

[Claudio Schuftan]

From: Ronald Labonte <rlabonte at uottawa.ca>

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 I agree with Susan Rosenthal that the attribution rates of cancer to
tobacco and the focus on smoking as the number one preventable health
problem in the world are misleading. Public health research has long
accepted the multi-causal determinants of disease, as well as their
embeddedness in social hierarchies of power (class being one, but not the
only, such stratification). But to say that smoking causes cancer, my
statement to which she takes scientific exception, is not to say it is *the
*cause of cancer. Nor is unscientific or implicitly victim-blaming. Many of
the constituents of tobacco smoke are the same carcinogenic and mutagenic
toxics as those that workplace activism has attempted to eliminate or
reduce exposure to, in their struggles to create healthier working
conditions. Would stating that arsenic causes cancer be victim-blaming to
miners exposed to it? And unlike the example of spurious association in her
blog (nail-biting and workplace accidents) there is no spurious association
between tobacco use and cancer. Rather, there is a substantial and credible
scientific evidence, including detailed biological pathways.

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My concern is that, as health activists, we run risks in devolving all
forms of health inequalities to social class causation. I am no fan of
capitalism’s depredations, especially in its current neoliberal globalized
version. But we should not ignore or minimize the importance of proximate
causes in a singular deference to their most distal ‘causes of the causes
of the causes,’ any more than we should accept simplistic behaviourism and
‘lifestyle drift’ in how we understand and act upon the determinants of ill
health.****

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