Michael Schwalbe is author of the recently published book Smoke Damage: Voices from the Front Lines of America’s Tobacco Wars (Madison, WI: Borderland Books, 2011). He is a professor in the Department of Sociology and Anthropology at North Carolina State University in Raleigh. Recently, Corporation and Health Watch editor Monica Gagnon interviewed Schwalbe about his new book. An edited version of the transcript is presented here.
CHW: Why did you want to write a book about the people affected by the tobacco industry?
We know a lot about how many people die, but we don’t know a lot about how the dying and the decline affect people around them. Watching what my mother went through for a year and a half—between the first diagnosis, treatments, and my father’s death—made me think that this was something that really needed to be documented.
CHW: How did you end up expanding from tobacco widows to all of the faces we see in your book now?
MS: As I thought more about it, it occurred to me that there are many categories of people in our society whose lives are changed in dramatic ways because of the health damage caused by tobacco use. I thought the book would be more compelling if I could document a wider range of the experiences related to tobacco-related disease.
CHW: Your book has a lot of images and seems like it’s really about giving the tobacco industry’s victims a human face. What did you hope to accomplish by that?
MS: I wanted to make the magnitude of the problem have more emotional weight. We can look at the statistics and say that 443,000 die every year [in the United States] of tobacco-related disease. We can say that 3.6 million suffer from some kind of chronic disease related to tobacco use. But those figures are overwhelming, so it’s hard to feel what they mean. If people don’t feel what those figures mean, as well as grasp them intellectually, I don’t think it motivates much action. That’s why I did the photographs and the interviews—to try to put the experience in people’s own words. In the book there’s a brief descriptive paragraph about each person and then a 500-word excerpt from the interview in which the person talks about his or her experience as related to tobacco and tobacco-related disease.
CHW: What was it like taking photographs of these people—meeting them and hearing their stories?
MS: Some of the stories were familiar to me from my own family, but I learned a lot about how people experience the problem in different ways, especially struggling with addiction. Some of the people I interviewed were still struggling to quit smoking. Talking to the litigators was new for me. I found it interesting to get their perspective on the industry and on efforts to use the courts to bring the industry to heel. Legislators were a new group too, and it was interesting to get their perspective on what they hoped to accomplish. It took me ten months to find three ex-tobacco farmers. These are people who the industry portrays as absolutely dependent on tobacco to make a living. Certainly there’s an economic dependency on the part of some farmers, but the ones I interviewed had decided that they didn’t want to be in it anymore, [not just] for market reasons [but also] for moral reasons. And they were doing fine as farmers. So this idea that farmers can’t get out of the industry is simply not true. I had never talked to farmers in that situation before, so that was new to me. In general, people in every category were cooperative and helpful.
CHW: How did you feel the experience was for them, to talk about their interaction with tobacco in this context?
MS: Part of what makes the material in the book powerful is that people spoke honestly about some very difficult experiences in their lives. I think it comes through in the text.
CHW: Talk about the economic and political interests that keep tobacco so widely available to the public.
MS: Most people know that the tobacco corporations have a clear interest in profits and in continuing to profit from selling an addictive and disease-causing product. Many government units also have a stake in deriving revenues from tobacco taxes and the Master Settlement Agreement. So I don’t think we’re going to see the government move any time soon to put the tobacco corporations out of business. And of course there are a host of secondary industries dependent on tobacco—advertising, marketing, retailing. It’s an industry that has its tentacles spread deeply throughout our society, throughout our economy and into government, so it’s a difficult industry to combat.
CHW: What concerns should readers have about workers in the tobacco industry?
MS: Certainly we want to look for solutions that aren’t going to deprive ordinary folks of their livelihood. On the other hand, we don’t want to hold that out as a reason for protecting industries that do more harm than good. This is what the tobacco industry has done for a long time. We see it clearly in North Carolina. I say we should weigh tobacco industry jobs against the economic costs of the 12,000 North Carolinians who die every year from tobacco-related disease. In this state, it doesn’t take long for tobacco to kill more people than it employs. We also pay about $2.5 billion a year in health care costs because of tobacco—again, that’s just in North Carolina. So, while we need to be concerned with how people can make a living, we also need to be concerned with how people can live. In the long run, this is an industry that has to go by the wayside.
CHW: How have the tobacco companies changed to adapt to the new environment they face?
MS: They’re amazing in their ability to adapt to new marketing restrictions. They can’t use terms like “light” and “mild” anymore to suggest that some cigarettes are safer than others, so they’ve started to color-code the packs to convey the same message. Now that more people can’t smoke in the workplace and in some public spaces, they’ve put money behind smokeless products that can be used anywhere. Tobacco products that can be used without giving off smoke are partly a way to keep people addicted. In fact, if you look at the advertising for some of these products, you’ll see that these aren’t offered as paths to quitting, but as alternatives to smoking if people can’t smoke in a particular situation.
In other parts of the world, tobacco industry marketing operates pretty much as it did in the U.S. thirty or forty years ago. In some parts of the world there’s also a considerable amount of illegal activity. In Africa in particular, cigarette giveaways and breaking up packs to sell one or two at a time are ways to get kids addicted. This is why comprehensive marketing bans are so important.
CHW: What do you think is the role of the tobacco industry in exacerbating health disparities?
MS: The industry is adept at targeted marketing. They know what kinds of messages appeal to which groups. Some of this developed over time; the classic example is probably the marketing of menthol cigarettes to African-Americans. Once that market began to take shape, it became something the industry could continue to exploit with its marketing imagery, selling Newports and Kools and other menthol cigarettes to African-Americans. What the industry cares about is selling its product, and it will find ways to sell product to different demographic groups based on the kinds of messages that are likely to be appealing to those groups. Marketing is a craft in that sense—a craft of figuring out how best to tap into the manufactured desires and insecurities of different groups of people and sell them a product that they’re led to believe will resolve their insecurities and satisfy their needs. In the larger sense, we’re seeing patterns develop today where it’s clear that the more education people have, the less likely they are to smoke; it’s almost a linear relationship. So we see much higher rates of smoking among high school dropouts and less-educated people in general. Rates are also higher among people in poverty. The industry takes advantage of the fact that these vulnerable populations exist. Marketing messages are tailored to these demographics, especially to young people, who are the industry’s main concern – “replacement smokers,” to use their language.
CHW: On the individual level, what can people do to influence this face of tobacco that you’ve portrayed in your book?
MS: When people ask this, I always tell them to look for a group to join so that they can benefit from other people’s experience and from the power of collective action. But whether you’re part of a group or speaking as an individual, there are certain kinds of policies that we know work and need to be lobbied for. This means bringing pressure to bear on legislators. I also tell people that a good way to pull resources away from the industry, if only in a small way, is to quit smoking. Every pack of cigarettes bought gives the industry money to continue to promote its products, and so it’s a small act of individual resistance to withdraw support from the industry, even at that level of not buying its products. Most CHW readers probably aren’t smokers, but still they can use these kinds of arguments to encourage others not just to quit smoking, but to quit giving the industry money to carry on its destructive behavior.
CHW: What about the role of the tobacco survivors in helping to mobilize people?
MS: I think it can be effective, but it’s a small effort in the face of a still-powerful industry. Education is important, and that’s one of the roles survivors can play. But policy is important too. We need policies and laws that restrict the industry’s behavior. That’s what’s crucial. So my hope is that when the survivors take their message out, they’re not just saying, “You shouldn’t smoke,” but rather, “Not only should you not smoke but you need to press your representatives for policies that will, in the long run, keep other people from becoming addicted.” We especially need policies that give people additional incentive to quit. Smoke-free air laws and higher taxes on tobacco products have this effect.
CHW: What about a grassroots movement against tobacco? Do you think that public interest on this issue has given way to newer issues or is there still a vibrant movement against the tobacco industry? If not, how would you suggest we re-mobilize the grassroots movement?
MS: The movement has taken different forms over the years. Originally there was a lot of mobilization around control of advertising and passing smoke-free air laws. We’ve still got a ways to go on the smoke-free air laws. About half the states do not have comprehensive indoor smoke-free air laws, so there’s clearly work to be done in those states—and people are doing it. There’s also been an institutionalization of the movement, which has meant less energy at the grassroots level and more professionalization. Most states have tobacco-control agencies and branches that work on the issue. And so yes, in places where smoke-free air laws have been won there has been a predictable easing-up of effort. Now it seems like, “OK we’ve won, we’ve got smoke-free air laws. We can relax.”
On the other hand, there are strengths to institutionalization. Thousands of people have full-time professional careers in tobacco control, and they’re tremendously knowledgeable. They understand tobacco industry strategies and how to counter those strategies, and that’s a good thing. The institutionalization of the movement is a two-edged sword. Yes, some of the grassroots energy has been dissipated, but at the same time we’ve developed a stable base of expertise and personnel. In general, grassroots groups working with tobacco-control professionals have been extremely effective in promoting smoke-free air laws and other practices that have helped reduce tobacco-related disease.
Another problem is that movement organizations can get caught up in the issue of the day, so I think lately there’s been some displacement of public health energy from tobacco to obesity, for instance. Obesity is a serious problem, of course, and needs citizen energy as much as tobacco. But I think people have to remember that the tobacco problem is not behind us. That’s part of what I wanted Smoke Damage to do—keep public awareness of the issue alive and help people understand that there’s much more that needs to be done. We can’t be complacent. If politicians are going to do the right thing, grassroots groups need to bring pressure to bear. As far as reigniting the movement, people have to understand that corporations act in the interest of profit-making, not public health, and that if we’re going to protect health, we’re going to have to confront corporate power. Maybe what we’ll see is a kind of an enfolding of grassroots tobacco-control efforts into a larger anti-corporate power movement directed against corporate interests that promote obesity, tobacco use, and other kinds of unhealthy behaviors.
CHW: Where do you think there is potential for bringing health advocates together across these issues?
MS: Some of this is going on already. Maybe the uniting vision needs to be one that looks at all the determinants of public health and asks, “What needs to be challenged?” If people understand the threat that corporate power poses, that could be an umbrella under which people come together. Industry, whether fast food or tobacco, wants to define public health problems as stemming from individual choice. They benefit from promoting the notion that this is all about individual choice. They don’t want us to see our national health problems as consequences of how corporations engage in marketing, lobbying, buying political influence through campaign contributions, and shaping public opinion. So maybe that awareness would help people come together. It’s work that needs to be done, and sometimes you have to rise above your particular issue to see what the issues have in common, whether it’s obesity, alcoholism, or tobacco-related disease.
1. Smoke Damage
2. Sherryl Kleinman