As part of Challenge Poverty Week 2018 John Watson of ASH Scotland wants to throw out the old stereotypes about poverty and smoking, so that we can start a new dialogue between health and anti-poverty groups.
Working in public health I’m very conscious that we do what we do because we care about people and want them to be better off. Clearly we share that goal with people working in a range of community-based support services, from housing and family support to money advice.
So I’m wondering why it is that we don’t see more collaboration between health campaigners like me and anti-poverty, social and community interests (if you’re reading a Challenge Poverty Week blog then that may well be you) ?
One of the stated goals of this Week is to highlight the reality of poverty and to challenge stereotypes. I’d like us to include the stereotypes that prevent health and social interests from working together.
Taking action on smoking and health is often a battle between two opposing ways of “framing” the issue. Whether you see smoking as a recreational pastime or as a harmful addiction will go a long way to determining what (if anything) you feel should be done about it.
It won’t surprise you to hear that I see smoking as a problem, and am horrified by the damage it does to health and well-being at both the individual and community level. I’m particularly aware of the huge impact on inequality, with smoking responsible for more than half of the difference in life expectancy between the richest and poorest in our society. Yet I do listen to the other voices, presenting a picture of smoking as a freely-chosen recreational pastime that the state has no right to interfere in.
The more I engage with anti-poverty and community groups the more I see a third perspective at play. We’re calling it the “social” approach (as opposed to the “health” or “recreational” views). In this worldview smoking is a more complex mix of costs and benefits. Rather than wanting to smoke or to quit smoking, people are looking for coping mechanisms, something to do or a little “me time” when they can relax and forget their worries – and weighing up these perceived benefits against the financial costs and the physical and social impacts that smoking brings.
Developing a social model of smoking is the key to understanding why smoking rates are higher in disadvantaged communities – if factors such as stress, uncertainty, anxiety or boredom drive people to seek a coping mechanism in smoking, and make it harder for them to quit, then we can see that the people most likely to experience those factors are most likely to smoke.
This immediately throws out the lazy, hateful tabloid view of smoking as poor people making bad choices. But by focusing instead on how different people have different choices available to them it also presents a challenge for anyone who only sees the world through a frame of what you should or shouldn’t do. If there are understandable (and unequally distributed) reasons why someone reaches for a cigarette then anyone looking to help needs to do more than simply ask them to stop.
I firmly believe that we can best help people by bringing together the best of the health and the social approaches (the very small minority of adults who genuinely engage with smoking recreationally are not my interest). We in the health sector know that smoking is harmful and that most smokers say that they want to stop. When we listen to smokers about the valid needs that people are seeking to address, and look to support resilience and the development of less harmful coping mechanisms, we create the space for better dialogue and collaboration with social concerns.
ASH Scotland is already working with the youth work sector, family support services, financial support services and community based mental health services, to help frontline staff to reduce the harm smoking causes to their clients.
We are now partnering with the Poverty Alliance to build a discussion of this interaction between health and social approaches, looking for the language, assumptions and actions that we can take forward together.
We are organising focus groups to hear what health and social organisations have to say. If you would like to be part of this discussion then we’d love to have you involved.