The subject of this essay however, is whether or not it is a Public Health issue. We will argue strongly that it is and produce evidence to support this stance.The Wanless Report (2002 ) defines Public Health as The science and art of preventing disease, prolonging life and promoting health through organised efforts and informed choices of society, organisations – public and private, communities and individualsOn that basis we would suggest that the argument is already made since there is little doubt that smoking – both active and passive – will shorten life and cause disease.
The evidence to support this statement comes from papers such as that by Prescott ( et al. 1998) who carried out a huge study looking into the effects of primary smoking and the risk of myocardial ischaemia in the general population. The results of the study were absolutely unequivocal with a finding of an increased risk of myocardial infarction in women of 2.24 and in men of 1.
43. the reasons for the sex difference are several including genetic factors (Bennett 2004) and hormonal factors (Chapman 1999)To take a step further back, we have to define HealthAn authoritative definition of Health comes from the WHO who currently tell us that health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity. ( WHO 1992). A difficulty with this definition is that today many people confuse the attainment of happiness with the attainment of health (Kemm 2001).Ironically, in the context of this essay, Freud also offered us an observation on the definition of Health when he observed that most people equated well-being with happiness rather than health (Freud 1975) and he amplified this by observing that he had been advised by his doctors to give up cigars in order to improve his health.
He commented that he was far more healthy but much less happy (Saracci 1997).Although Freud’s comment was clearly flippant, it does exemplify a deeper truth, that part of the problem with smoking is the pleasure that some people derive from it. One can always advance the argument that in a free society one should always have freedom of choice to damage yourself if you wish. (Hegel 1971)That is clearly the case, but in adopting that view you must also accept two further consequences of that position.
One is that society is expected to pick up the bill when you are ill (via the NHS) and that by smoking, you may not only damage yourself but you may well damage others through the medium of passive smoking. (Kuhse ; Singer 2001)