Smoking, Ice-Cream and Logical Progressions: Why We Shouldn’t Ban Smoking in Outdoor Public Places

It’s a beautiful warm sunny day, and you have decided to take your children to join a group of friends for a barbecue at the local public park. The wine is flowing (orange juice for the kids), you have managed not to burn the sausages (vegetarian or otherwise), and there is even an ice-cream van parked a conveniently short walk away.

An idyllic scenario for many of us, I’m sure you will agree; one might even go so far as to suggest that this is exactly the sort of thing that public parks are there for; they represent a carefree environment in which we can enjoy the sunshine and engage in recreational communal activities with others.

Here are some things that I am not particularly worried about when I occasionally find myself in something approximating this happy situation. First, I do not worry that the smoke that the barbecue creates contains polycyclic aromatic hydrocarbons that might pose a health risk. Second, I do not worry that my enjoying a glass of wine normalizes the consumption of alcohol to innocent children who happen to catch a glimpse of me drinking, and that this might thereby influence them into doing something similar in the future. Finally, I do not worry that the lurking ice-cream van is a malevolent entity normalizing the consumption of sugary foods and thereby contributing to the current obesity epidemic.

With this vignette in mind, consider Lord Ara Darzi and Dr Oliver Keown’s recent letter to the British Medical Journal  (reported here and here) arguing in favour of cities in the UK following the example of New York City in extending anti-smoking legislation to encompass a ban on smoking in public parks and squares. They write that such a ban represents a ‘logical progression’ from the current UK ban on smoking in enclosed public spaces (which they point out has been highly effective in reducing passive smoke exposure, acute cardiovascular incidents, and producing a downward trend in the prevalence of smoking). In support of their proposal, they point out that the current ban enjoys wide public support, and that extending the scope of the ban would reduce the significant effect that social norms can have on influencing adolescents’ decision to take up smoking.

However, Darzi and Keown’s proposal is not simply an innocent ‘logical progression’ from the current ban on smoking in enclosed spaces. The moral motivation for the current UK ban is the direct threat that passive smoking poses to non-smokers in enclosed spaces. Notice that the encroachment on individual liberty that the current ban involves is compatible with Mill’s harm principle, which states that:

The only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others.

Part of the reason that the current ban might be deemed permissible by those who endorse the harm principle is that, even though the ban encroaches on people’s freedoms, it does so in order to prevent harm to others, rather than the individual herself.

Mill’s harm principle is often invoked in discussions of public health interventions. However, considered in itself (and in isolation from the various ways in which Mill himself and others have defended the principle), the principle leaves a number of important questions unanswered. Whilst the harm principle might prohibit certain paternalistic intervention that seek to prevent individuals from harming themselves, it provides little moral guidance about the sorts of interventions that we might permissibly use to prevent harm to others; as such, in our moral analysis of such interventions we need to go beyond a mere statement of the harm principle alone. To illustrate, whilst it seems plausible to claim that we would be morally warranted in exercising power over another in order to prevent them from culpably causing serious direct harms to others, it is less clear that we would also be morally warranted in acting in a similar way to prevent very minimal harms to others, or to prevent others from being exposed to very low risks of harm. This is especially so when exercising power over another involves a serious encroachment on their freedoms, and when we lack evidence about how effective this encroachment will be in preventing the harm to others that we are targeting.

In view of this, whilst the harm principle (considered in isolation) is a useful tool in our thinking about public health interventions, it should represent only the starting point of our moral analysis. A deeper moral assessment of the interventions that are designed to prevent harm to others should also take into account, among other things, the severity and likelihood of the harm that the proposed intervention seeks to avert, the likely effectiveness of the proposed intervention, and whether there are other alternatives to the proposed intervention that might feasibly achieve similar results whilst encroaching on fewer freedoms.

With this in mind, Darzi and Keown’s claim that the proposal to extend the current ban to outdoor public spaces is a logical progression of the current ban raises at least two questions. The first is whether the harm to others that their proposal intends to target is of comparable severity and likelihood to the harms that the current ban seeks to prevent. The second is whether their proposal is likely to be similarly effective in preventing the harm to others as the current ban. Consideration of these issues will show that whatever we think of Darzi’s and Keown’s proposal, it is far from representing a simple logical progression of the current smoking ban.

Consider first the nature of the harm that the proposal aims to prevent. The first thing to acknowledge against Darzi and Keown’s argument is that it would be highly implausible to claim that their proposal is a logical progression from the current smoking ban if that is understood to imply that the proposal seeks to prevent exactly the same harm as the current ban. As I pointed out above, the moral motivation underlying the current ban is that passive smoking can cause harm to non-smokers in enclosed spaces. The claim that a smoker poses a threat of passive smoking to another individual in a large open space (such as a public park) in the same way that they do in a small enclosed space (such as a pub) borders on the absurd. Indeed, if Darzi and Keown were to appeal to this type of claim, then their case for banning smoking in outdoor public places would surely extend to banning outdoor public barbecues. Not only do they typically produce a great deal more (harmful) smoke, it is also normally the case that you have to place yourself in the vicinity of barbecue smoke if you want to eat barbecued food.

However, we should not concern ourselves with this objection in great detail, since Darzi and Keown seem to have another harm in mind in their argument. Yet this is still an important observation to make, because it suggests that their argument is unlikely to be a strict logical progression in the way that they might want to claim.

It seems that the main moral motivation underlying Darzi and Keown’s proposal is their claim that banning smoking in public parks and squares would be likely to lead to a reduction in smoking because it would serve to redress the observed norms that might influence smoking behaviour. As such, Darzi and Keown might claim that, like the current ban, their proposal is compatible with the harm principle, insofar as individuals can be harmed simply by their exposure to these sorts of influences. Yet it is not clear that this harm is comparable to the harm that the current ban seeks to prevent. The ban on smoking in enclosed spaces reduces the significant direct harms posed to others by passive smoking. However, the harm to others that the Darzi and Keown’s proposal seeks to prevent is exposing others to influences that might make it more likely that they will engage in an activity that harms themselves (i.e. smoking).

It is an interesting theoretical question whether this harm really constitutes ‘harm to others’ of the sort that the harm principle invokes. Regardless of the answer to this question though, we can surely agree that the risk of (indirect) harm here is far more remote than the (direct) harm to others posed by passive smoking. Although Darzi and Keown claim that evidence suggests that media and peer role modelling can have a significant effect on adolescents taking up smoking, it is far from clear that this effect makes the probability of harm as high as the probability that an individual will be harmed by passive smoking in a smoky enclosed environment. As such, the claim that the proposal amounts to a simple logical progression again seems to break down here; the difference in the probability of harm here is a morally significant point that we must take into consideration in our moral assessment. Furthermore, we might point out that it is far from clear that the studies they cite in support of the claim that media and peer role modelling norms influence smoking behaviour extend to seeing strangers smoke in a public place. It is one thing to claim that because adolescents are influenced by celebrities we ought to erase the cigarette from Paul McCartney’s hand on the seminal Abbey Road album cover (as an aside, I thought that this decision was farcical – I should imagine that most adolescents cared very little about the album cover, and those who did probably didn’t realise that McCartney was holding a cigarette until the furore that was caused by its removal); it is quite another to think that adolescents will be less likely to start smoking once they are no longer exposed to the sight of a (non-internationally famous) stranger puffing on a cigarette whilst he’s walking his dog in the local park.

However, lets assume that the harms that the proposal aims to prevent are comparable to the harms that the current smoking ban prevents. The second question we should ask is whether the proposal is likely to be effective in preventing these harms. Again, we see that Darzi and Keown’s claim that their proposal represents a simple logical progression from the current ban breaks down.

The current ban on smoking in enclosed public spaces is highly effective because it removes the substance that is causing direct harm to others from an environment in which many people will congregate, and from which the substance cannot easily escape. And Darzi and Keown may be right to suggest that a great deal of empirical evidence supports this. However, would banning smoking in public places be effective in redressing the social norm in favour of smoking (which, we are assuming for the sake of argument, would be highly effective in preventing people from taking up smoking)? In support of this claim, Darzi and Keown point to data from New York City’s ban on smoking in public place that suggests that there was a large reduction in the number of smokers following the ban. However, as they concede, this evidence is inconclusive with regard to the effectiveness of banning smoking in public places per se, since this ban was introduced in a period where a number of public health measures aimed at reducing smoking were introduced (such as tobacco taxation). In fact, Professor Simon Chapman argues in his response to Darzi and Keown’s letter that we lack any real empirical evidence for the claim that banning outdoor public smoking would lead to a significant decrease in people taking up smoking.

In fact, there is an argument for claiming that this measure would be counter-productive. This argument is admittedly speculative, but as we have seen above, so is the argument in favour of the claim that banning smoking in public will result in a decrease in people taking up smoking. People are generally opposed to being coerced; they are even more opposed to being told what is good for them. This, it seems, is particularly true of adolescents; as such, we might first acknowledge that a ban might simply reinforce the social norm amongst adolescents that smoking is a ‘cool’ thing to do because it is forbidden. However, a ban might also be counter-productive in preventing individuals who are not susceptible to this sort of adolescent norm from smoking in public. The public support for the current UK smoking ban suggests that people’s opposition to coercion may reduce when they believe that it is necessary to prevent direct harm to others. However, it is not clear that their opposition will reduce similarly when the justification of the coercion is the prevention of an indirect harm of the sort considered above. Indeed, in the absence of a direct harm to others that smoking in public might cause, individuals might interpret a ban as a paternalistic measure aimed at preventing people who already smoke from harming themselves by reducing their opportunities for smoking. The UK has a long liberal tradition that strongly and defiantly opposes this sort of paternalism, and in view of the difficulties with enforcing a ban on smoking in large public spaces such as parks, it does not strike me as implausible to suggest that banning smoking in such places might lead many people to smoke there more often, in a spirit of a defiance, and in the belief that they are harming only themselves, which they should be free to do in a liberal society that endorses a Millian harm principle.

Whatever one makes of the above speculative suggestion, we can agree with Darzi and Keown that we need more empirical data about the effectiveness of banning smoking in public places in preventing smoking behaviour. I myself am sceptical. Moreover, it seems that there are less restrictive alternatives that could be used to achieve this goal; we can reduce the power of social norms without banishing smokers from public view.

I have argued that extending the current UK smoking ban in the way that Darzi and Keown suggest is not a simple case of logical progression, as they claim. A justification for extending the ban in this way must draws on further moral arguments and empirical data than that which supports the current UK ban. However, let us suppose that none of the objections that I have raised here are convincing, and that Darzi and Keown’s proposal should be adopted. By their own lights, (and as Simon Chapman intimates in his reply piece) we must then be prepared to accept the ‘logical progression’ of their policy; and this will involve eliminating the possibility of the type of scenario that I illustrated in the vignette at the beginning of this piece. Whilst it is an old argument to make, childhood obesity and alcohol-related deaths cause public health harms that are comparably serious to the public health harms caused by smoking; and if smoking in public influences smoking behaviour, so too will drinking in public influence drinking behaviour, and so too will eating sugary foods in public influence our eating behaviours.

Darzi and Keown claim that their proposal is aimed at securing the “great beacon of healthy living, clean air, and physical activity our green spaces are designed for.” I think our public spaces are designed for something else: I believe that they are designed to increase our well-being by providing an environment in which we can enjoy outdoor recreational communal activities with others. If these communal activities involve physical activity and healthy living then that is good. But they should also be able to involve eating ice-cream, drinking wine, and smoking cigarettes.