Time for some sympathy for smokers

I’m a smoker. I don’t currently smoke but I find it easier to stay on top of my addiction by never letting myself think that I don’t have an addiction.

I’ve tried that, and it inevitably results in having ‘just one’ which I bum from somebody because a non-smoker doesn’t have her own ciggies, and then buying a packet a couple of weeks later because ‘I could smoke just one then, so why not now?’ That is always how a lapse looks.

Fortunately, I’ve become quite matter of fact about giving up and don’t feel as daunted by it as I did in my 20s. It’s staying given-up that’s the real challenge.

I started smoking when I was 19 and have quit many times. When you’ve given up, you’re allowed to join the rest of society in condemning the habit and anyone who indulges in it. For quite a while I’d become a sanctimonious, holier-than-thou non-smoker after successful quit attempts.

I now accept that giving up is the easiest bit of an incredibly hard task and am far less smug about not smoking and far more understanding of those who still do.

Smoking is one of those addictions we don’t seem to have much sympathy for. I’m not suggesting we have a great deal of sympathy for any addiction, but we seem much quicker to define smoking as a ‘choice’ that can be unchosen through willpower as opposed to, say, drug or alcohol addiction.

It’s legal and for a long time, no matter how much you did it, socially acceptable. Smokers aren’t cognitively impaired when they use, and the daily life of a smoker looks unaffected in a way that those addicted to alcohol or drugs does not.

Aside from smelling like smoke and maybe having a deep throated laugh or cough, the payback on smoking usually arrives in your later years. And then it really arrives. Five thousand people die in New Zealand each year due to smoking-related illnesses.

Shame and stigma have been highly successful in making smoking socially unacceptable. Slowly but surely, we’ve banned smoking – in bars and restaurants, in public places like university campuses and hospital grounds, and latterly in cars with kids in them.

We’ve hiked prices to $32 a packet, making it financially prohibitive and rich territory for beneficiary bashing and judgment.

We’ve run large advertising campaigns designed to make people feel bad about their smoking.

We have banned retail displays of cigarettes, and have plain packaging with pictures of black lungs, babies, and mouth cancer on them. We’ve done a lot. And a lot has worked and that’s great.

Yet many academics, anti-smoking groups, and health professionals believe we will fail to meet the target of being smokefree by 2025 and the Government is not doing enough.

In a recent RNZ article, the University of Otago's Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme is reported as having calculated there will be more than 300,000 smokers in 2025 if the current approach to smoking cessation continues. The 2025 smokefree target of under 5 percent of the population smoking requires that only 120,000 people smoke.

Fully 36 percent of Māori women and 29 percent of Māori men are counted as daily smokers. Once again, Māori are disproportionately represented in health statistics where deprivation, lack of education, and wealth inequality are underlying causes.

Despite the stance and advice from Māori health organisations like Hapai te Hauora around the use of vaping as a cessation tool, the Government is dragging its feet on regulating e-cigarettes, instead choosing to focus on the easier win of banning smoking in cars with children in them.

That ban is good, don’t get me wrong, but it’s a social shaming tactic more than anything else; a broad signal to the masses that smoking is bad and that smoking in confined spaces with children is even worse.

The use of social shaming has worked incredibly well to get people like me to quit.

White, well-off people who have a nice life with fewer stressors than those disproportionately represented in our smoking statistics.

People whose peers no longer smoke because it’s not cool anymore. People who are well placed to take care of their own health and have more than a smoke to look forward to after a tough day.

People who own their own homes and are house proud.

People who are well educated.

People who can afford to think beyond a pay day.

People who have hopes beyond wanting somewhere warm and dry to live, and who have 'what other people think of them' above food, clothing, work and shelter on their list of things to worry about.

Since quitting ‘properly’ four years ago, I’ve lapsed the odd time. Each time, I’ve kept it secret, too ashamed to tell anyone I'd failed. I’d never smoke in front of people and even when I did admit it or got busted, I’d make a big fuss about how awful it was, how I was definitely stopping again tomorrow, and I was a weak, stupid person who was ‘stressed’.

When I did admit it to doctors (avoiding them for as long as possible while smoking), they’d never ask why I started again. No one really ever asks that unless they’re expressing supreme disappointment in you. Quitting and failing is always an isolating, negative and shameful experience. It takes a lot to give up and even more to stay that way.

As we countdown to 2025, Associate Minister of Health Jenny Salesa admits a smokefree New Zealand is an aspirational and difficult goal to achieve.

If we don’t achieve it, it’ll affect Māori more than any other part of the population. By saying it’s ‘an aspirational and difficult goal’, we’re essentially saying that saving the lives of Māori is also aspirational and difficult.

If that is truly the case, then we need to try new and bolder ways of getting people to quit because current strategies are running out of puff.

Six years away from 2025 and we’re at the pointy end of the smokefree battle, the complicated end, the end that might require thinking about things differently rather than maintaining the status quo.

Perhaps we should be at the end of using shame and social unacceptability as a blunt instrument in a fight that requires a more targeted approach and some sympathy for those who can’t quit a habit that’s widely referred to as more addictive than heroin.

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