Via Andrew Sullivan, Keith Humphries in the Washington Post asks Why have the wealthy quit smoking while the poor have not? While I wouldn’t describe the article as offensive, I think it does embody something that is. I’m talking about the miserable quality of our media’s discourse on issues relating to poor and working class Americans.
Now, I’m not a researcher on this topic but a few possibilities come to my mind. Unfortunately, the ones that seem most obvious to me are totally unmentioned in the article. It’s emblematic of how badly the media understands the lives of poor people and how subsequently bad it makes them at educating middle and upper class Americans on the facts of life faced by those at the bottom.
First, let’s look at the causes Humphreys does mention. First, he says poor smokers get more addicted because they smoke harder:
1) Lower income smokers take longer and deeper drags on each cigarette than their remaining better-off counterparts. This strengthens their addiction (e.g., craving) and makes it more difficult to turn a resolution to quit into an enduring change.
He links to a firewalled research paper that ostensibly supports that conclusion, but since I haven’t paid the $19 for it and neither have you, I guess we’ll take his word for it. But from the summary, the paper appears to be saying that higher taxes cause smokers to inhale more deeply so as to extract more nicotine and, I suppose, increase the value proposition of the cigarettes. This may be true but I’m suspicious that this is a big factor. With smoking rates nearly three times higher for low-income workers than for the rich it seems like this can’t possibly explain more than a point or two. I guess I’m just suspicious because I have smoked and I have been in that 6-11K income bracket and I’ll tell you, the idea that I would inhale more deeply as cigarettes got more expensive seems kind of ridiculous. I can tell you there are far bigger factors, but I’ll get to those in a second.
The second claim – the wealthy face more peer pressure:
Because income tends to segregate where people work and live, poor smokers often have to make quit-attempts alongside people who are continuing to smoke, but wealthier smokers usually do not. The last physician in a hospital who still smokes will face social disapproval from colleagues for smoking and receive social approval from those same individuals for quitting; the first worker on a roadside cleanup crew who tries to quit may face precisely the reverse social incentives from his smoking coworkers.
Ok, fine, but at best this effect tells us that there is some snowball effect at work here. That makes sense, but it doesn’t address what started the ball rolling in the first place. Why did the wealthy start quitting in greater numbers? Where do these peer pressures come from, and why do they diverge with different income levels?
His third point is that the poor have less access to resources that help a person quit smoking:
Although lower income people’s access to health care is being improved by the Affordable Care Act, they are still likely to lag middle class people in their access to effective smoking cessation treatments. They also may face challenges in accessing care for co-occurring mental health problems (e.g., depression) which make quitting smoking more difficult.
Of the three, this comes closest to addressing some of the real-life issues that might keep a person hooked on cigs. But – and again, while I am a professional researcher, I have done zero real research on this topic – how many of the wealthy quitters got help from their doctors or therapists when they quit? According to the American Cancer Society the vast majority of quitters (91.4 percent) quit by going cold turkey. Only 6.8% of former smokers quit using drug therapy and/or counseling. This negates Humphreys’ point, at least the way he states it. However, I think health care access likely does help insofar as just having a person with medical authority tell you every year or so “you really need to quit smoking” probably makes a big difference. (Now, I study I would like to see but never will would study how often doctors tell their wealthy patients to quit versus their poor patients).
These are three things worth considering, but they totally leave out the factors that seem most important and obvious to me. If you walked down the street in Detroit and found a smoker who made $11k per year and you asked them “Why do you still smoke?” Or “What has prevented you from quitting smoking?” What do you think they’d say? Do you think they would say “I smoke because of my health insurance status?” Do you think they’d say “I smoke because my friends do?” Let me tell you, as someone who has been extremely poor and who has smoked during poverty, why poor people don’t quit:
1. Quitting smoking is very stressful, and stress is more risky to poor people. The quitting process fills your brain with stress chemicals, makes you irritable, and makes any small stressful occurrence in your day feel like a major catastrophe. It can be seriously exhausting. This creates more risk for poor people than for the wealthy. If the boss has a nic fit and starts biting people’s heads off he might face some disgruntled workers, but he’ll be fine. If an employee experiences nic-withdrawals and bites off the boss’ head it can mean serious consequences ranging from losing hours to being passed up for raises or promotions or even job loss if their boss is a serious dick. How safe is your job as a Wal-Mart cashier if you have a chemical reaction going on in your brain that makes you apt to snap at customers and managers both? On the home front, what happens when you have that huge, loud blowout with your spouse because your brain is making you see red? If you’re wealthy, you get a motel room or crash with a friend or retreat to separate areas of the house. If you’re poor the cops come, maybe haul you off, maybe you’ve violated your probation, maybe you get locked up or fined more money you can’t afford. Stress is a bigger problem for the poor and they have ever rational reason to avoid it.
2. Stress causes relapse, and the poor are under more stress. For those who do try to quit, there are more obstacles when you are poor and forced to navigate a life full of stressors. Car broke down? Got a speeding ticket? Kid got a cold? Common occurrences for most people. For the wealthy, not a big deal. For a poor person any of those speedbumps can be catastrophic events. The article doesn’t mention success rates, but I’d bet a lot of money that poor people who do try to quit relapse more often and more quickly.
3. When you are really poor, that cigarette may be the best damn part of your day. I’m serious. When you make $9.00 per hour getting hung up on, yelled at, or spending your days sandwiched between shitty customers and shitty bosses, smoking becomes a bright spot in the day. When you get off work having a beer and a cigarette can feel like oxygen. I’m sure if Gwynneth Paltrow smoked she’d view it as a shameful dirty-dirty and she’d hide her face and she’d quit as soon as possible, all the while distracting herself with gluten-free vegan tofu livornese and trips to Bora-Bora. But being poor can make life really suck, and when life really sucks booze and cigarettes (and other drugs) can sometimes be the only respite within reach. Giving them up might make you feel physically healthier, but going without one of the only simple pleasures your life holds is a more serious sacrifice for the poor than for the wealthy.
4. Poor people have more immediate worries. When you are wealthy and life is pretty much going your way, worrying about your smoking habit giving you cancer seems like something you really ought to worry about right now. Also, cancer doesn’t care about your paycheck. Which is to say that as one gets richer, many of life’s worries fade away which has the effect of pushing health concerns up toward the top. (Indeed, the reason medical science has been such a success story for the human race is that the rich get sick too. If the rich died in famines we’d have eliminated that with ease long ago). When you are poor, your priority list looks a little different. Worrying about your life 20 years from now is a luxury that you don’t have time for when you have to worry about your life next week.
5. Have you looked around in a poor neighborhood lately? This seems like the most obvious omission to me. When you walk around a poor neighborhood you see stores on every corner advertising, on the outside, liquor, beer, wine, lottery and cigarettes. When do you think the last time was that David Koch saw a sign advertising a two-for-one deal on Newports? This phenomenon is well-known, oft-discussed, usually cited in any discussion of the socioeconomics of smoking, and seems glaringly absent here.
My big problem with the article is that it talks about the lives of poor people without seeming genuinely interested in the lives of poor people at all. If you just asked a a handful of smokers who make $15k per year, they’d be able to give you ten times the insight that this article does.
What’s worst though is what you see in the comments (I know) where people link smoking with education. I bring it up not just because of internet comments. It’s very often cited in articles like this (to his credit, Humphreys has avoided it) about smoking, and you see the same thing in articles about all sorts of other problems that plague poor people’s lives. Yes, there is a correlation between smoking and education. The more educated people are, the more likely they are to quit smoking. Too many people stop there. That’s the story. Poor people are dumb. If we just send them to college they’ll learn that smoking is bad.
This is total bullshit. No one goes to college and takes “Smoking is bad for your health 101″. In the last 4 decades or so, the vast majority of anti-smoking education has taken place on television; a medium consumed in greater quantities by the poor. And if poor people smoke more and get more cancer, that means poor people have watched more of their relatives die of smoking-related cancers. They know smoking is unhealthy. They know better than anyone.
This is a problem I have with a certain vein of liberal thought that places education at the center of anti-poverty efforts. The implication is that poor people just don’t know things. They just don’t know how to not be poor. We’ll get them in night school, and then we can teach them that stealing is bad, crack is whack, and smoking is bad. And once they have degrees they can go out and just grab one of those high-skilled jobs that grow on trees in Detroit.
To the contrary, what I think we see is that it is the wealthy and middle classes who are uneducated on matters of poverty. Harvard doesn’t offer classes in how to set up payment plans for your electric and water bills. No one at Yale has had to learn that if you don’t have money for a dentist you can buy fish antibiotics at the pet store that will clear up an oral infection. And apparently, no one has been taught about why poor people smoke.
I started wondering about a big gap in this whole narrative. All the studies seem to talk about the demographics of people who quit smoking. But the speculations that are being made often relate not to quitting but to trying to quit. Is it that poor people try to quit less often than wealthy people, or is it that poor people are less successful at quitting? That’s important. Well, I did some googling and I had a hard time finding answers, but I did find a summary from this study that says:
Except for an inverse association with age, attempting to quit was not associated with sociodemographic variables.
If that’s true it’s interesting and important. It means poor people try to quit just as much as wealthy people but are just a lot less successful at it. Vital information if you’re trying to answer the questions Humphreys is looking at.
My beef with Humphreys’ article, though, isn’t that he got this wrong, or that he talked about education. He made no mention of education and he rightly concludes that poor people have a harder time quitting. My beef is that the way he talk about poor lives omits much of their reality which leaves the door open for lots of the typical anti-poor bias. I’ve lived many years as a very poor person in America who smoked, and I don’t see an ounce of my experience in his article. I want to see people speaking about the poor. I’d really love to see poor people speaking about being poor, but if the closest I’m going to get to a voice for the poor is Keith Humphreys’ well-meaning article, then I’d like it to at least resonate with the basic realities they face.
I’m not troubled by this article specifically. I’m troubled by the general distance I see between contemporary liberals and poor people. I think your average white center-left plugged-in Clinton supporting liberal has very little idea what it’s like to be poor in America. Liberals have spent too long talking about poverty as if it’s a complex web of environmental factors that we can fix with social work, health policy, housing policy, etc. It’s time to consider that poverty is not a product of the poor and that we can’t solve it by changing poor people’s behavior. You don’t solve poverty by giving money to health insurance companies, researchers, social workers, NGOs, policy institutes, Democrats, small businesses, or schools. You solve poverty by giving money to poor people.
Islamic jihadist terrorists want desperately, above all else, to lead all of Islam in an uprising against the world’s powers. To this end, they claim to represent all of Islam and indeed Allah himself. They want a Islam vs. The West war and they want the power and status that comes from being Islam’s vanguard in that war.
I am considered an appeaser because I refuse to grant them this status. I refuse to acknowledge an insane and imaginary holy war that pits the world’s billion Muslims against European and American culture. I want to deny them the status they seek and leave them to be considered what they are – criminals who should be hunted down and brought to justice. I want them to be nobodies. I want their names to be forgotten, not hung on posters.
Most, it seems, of the American commentariat seems ready to fearfully grant them all the status they desire. White faces, nodding solemnly, are tripping over themselves in the media to hand these zealots all of Islam on a silver platter by portraying them as the embodiment of Islam itself. Islam is violent, they say. Islam is a civilization that is engaging in a “clash”, led by these vanguard jihadists, with The West.
Why is not considered appeasement to expend vast amounts of air and ink in an effort to make every Islamic terrorist’s bloodiest dream come true? Why are those of us who resist and deny the terrorist’s world view the appeasers while the people who are taking their claims, affirming them, and spreading them as gospel considered the “serious” people who really understand the threat?
John McCain is once again getting solemn props from a lot of liberals and Democrats for breaking rank and speaking out against torture. This time, in the context of his defense of the Senate Intelligence Committee’s report on CIA torture.
Why is he being given any kind of moral credit for this? He’s given his heart and soul to creating the perfect storm for torture. He has, from the beginning, been one of the Iraq and Afghanistan wars’ most loyal supporters. He’s perpetuated the idea of a War on Terror™. He’s continually spoken about terrorism in the good-guy/bad-guy narrative of a Tom Clancy novel. The CIA’s torture program did not spring into being one day from the ether. John Brennan did not say to George W. Bush one morning at the breakfast table “You know what would be cool is if we…”
Those torture programs were bricked together gradually beginning at about noon on 9/11/01. Every demonization of Muslims, every dehumanizing remark about Arabs, every assertion of America’s inherent moral superiority contributed. Every call for unnecessary violence, every righteous defense of an Islamic exceptionalist view of global threats, every breathless exaggeration of the threat of Islamic terrorism…every time, another brick in the wall.
This has always been the most frightening thing about John McCain as a potential Commander in Chief. He believes the glory of war can be had separate from the filthy, evil parts. He believes that war can be honorable. But has there been a war in human history that didn’t come with insane brutality? Even if one believes the good-guy American mythology of WWII, the American military that liberated the concentration camps is the same American military that tortured and mutilated Japanese soldiers. The America that recoiled in horror over lampshades made of Jewish skin is the same America whose soldiers mailed ashtrays made of Japanese skulls back home to their wives as keepsakes. This is the horror of war. It dehumanizes everyone involved. Everyone, the victors, the losers, the torturers and the tortured, they are all reduced to an animal state. And via the mental anguish of its survivors, the awfulness lasts long into subsequent generations.
Supporting war means supporting that. That’s why war is a last resort. You don’t send your son or daughter into a torture chamber unless your and their survival depends on it, and even then you think twice. But not John McCain. To him, and many others, war is an easy call. If you can point to good guys and bad guys then what else is there to think about? Nothing but the glory, the honor, and the gentle feeling of your fears being soothed by those brave men across the world doing brave things. And when it gets ugly, as it inevitably does, we can just tell ourselves we never meant for that to happen, right?
Matt Yglesias is a blogger for whom I have much respect, and one I read regularly. Prior to his Slate days, he was one of the best widely read bloggers on the web in my opinion. He’s intelligent, doesn’t talk down to his audience, and often quite insightful.
One of the reasons I appreciate him is he’s one of the few economy bloggers who has covered the post-2008 conditions with a consistent concern for the lives of working class westerners. The human tragedy of economic collapse and austerity policies is not talked about enough, especially in the circles he blogs in, and Yglesias stands out in this regard.
Yglesias is a genuinely smart and often insightful blogger, but when critiquing his work it should always be mentioned that what launched his career was his since-admitted wrongness about the Iraq war. This should tell you that he’s an intelligent blogger who is also capable of some gigantic lapses in judgement, as is the case here.
Interestingly, his lapses in judgement mostly seem to have a common thread of gross indifference to human suffering in deference to some greater good, usually American-dominated global capitalism. He commits the same error many communists did and the “libertarians” do today; his faith in his system is more powerful than his love for his fellow human beings. Any suffering caused by the system must be accepted, because the system will eventually make everything better.
I don’t think this is all Yglesias’ fault. Talking about the intrinsic value of human lives isn’t a viable strategy for someone in his position who is trying to get ahead or even stay in his position. The media and the political world both are full of powerful incentives for those involved to compromise basic principles such as “innocent until proven guilty” or “all men are created equal”. And inside a power system such as the one in which Yglesias functions, you’re not going to get far without acknowledging the legitimacy of the system itself, or at least using the language that the system uses to legitimize itself.
As such, language in this debate works in an interesting, and sinister, way. People talk about the trade-off involved in weighing what they call ‘safe jobs’ or ‘minimizing accidents’ versus what we call ‘growth’ or ‘jobs’.
Terms like ‘safe jobs’ and ‘minimizing accidents’ are functioning as sort of weird reverse-euphemisms for what is more properly called human life. But when we talk about human lives we sound drippy and sentimental, and that doesn’t help anyone trying to claw their way to the top of the commentariat through their powers of nod-inducing wisdom combined with snarky nonchalance. So what is really a trade-off between the lives of some people vs the money of others gets described in absurd language like “implementing unnecessarily immiserating workplace safety standards at the cost of economic well-being”. By allowing the system to place a lower value on Bangladeshi lives than on American lives, we are actually doing the Bangladeshis a favor! We’re giving the freedom “to make different choices on the risk–reward spectrum”.
…because so far the attack in Boston hasn’t validated or reassured me of a single previously held opinion.
We tend to think of it as a simple choice, but having sympathy for other people can take immense mental strength and self-discipline. Like physical strength, though, it gets easier with exercise.
This opinion piece from psmag seems like a pretty smart take on the Post Office, the nature of its budget problems (manufactured by Republicans), and why it would be smart to bring back postal banking.
A typical, succinct liberal defense of the drone program from a discussion I recently participated in:
There clearly needs to be better policy around deciding when and how to use drones. They cannot be used to assassinate those who simply disagree with the US but for targeting leaders or resources that are a clear and present danger to US lives. Imagine if China decided anyone speaking against its leadership was a danger and they flew drones in to the US to kill dissidents.The US cannot do the same. There has to be some certainty that Target X is actively involved with terrorist activity that targets the US.
While I can understand Pakistanis being resentful of the drone strikes, I also have no empathy for them. At a very fundamental and basic level, Pakistan has continued to harbor and actively shelter actor like Osama Bin Laden who have openly declared war on the US and have taken innocent US lives. We have not declared war on Pakistan, but their policies towards the US and terrorists place them firmly in the realm of being an enemy state. Its just that neither side will openly say it.
I am sure the residents of Dresden resented the fire bombings much like the residents of London resented the bombing of their city. The distinction without a difference is that the US and Pakistan have not openly declared war like Germany and England in WWII.
The comments above do a great job of crystallizing the monstrous morality behind drone strikes. He says “While I can understand Pakistanis being resentful of the drone strikes, I also have no empathy for them…Pakistan has continued to harbor and actively shelter actor like Osama Bin Laden..” According to him, there is no such thing as an innocent Pakistani. In fact, there is no such thing as a human being in Pakistan with any rights whatsoever.
A Detroit cop indicts law enforcement for its use of traffic enforcement as a revenue source.
This is unjust by itself. No one should profit from crime. The justice system exists in part to ensure crime doesn’t pay. When it becomes a revenue source to someone, suddenly crime goes from something we want to minimize to something we need. Even if it means creating more of it by defining new activities as “crime”. Like lowering speed limits.
But more importantly to me, and more unjust, is the way traffic violations and other civil infractions are assigned penalties that are vastly harsher on the poor than on the rich. A heart surgeon speeds and it costs him an hour’s wages at most, and it will mean no real impact on his life other than some minor inconvenience. A laid off factory worker does the same thing and they are faced with choosing between food and electricity.
Just one of the glaringly obvious injustices that we tacitly accept every single day.
I intent to post something more in depth soon, but for now I just want to say I find myself in a strange position. My politics seem to have changed dramatically. Not on any actual positions, I’m on the left of nearly all issues as I have been for most of my life. But because of a few things in my life that I’ll go into later, and because I cannot stomach Obama’s drone-warfare program and other abuses of power, I find myself no longer welcome among some of my long time friends and allies.
The short of it is, I’m tired of liberal politics in which principles are something that are nice tools with which to win an argument, but can be safely abandoned at the slightest hint of danger. I’m tired of Democrat-party loyalists who regard putting principles above politics to be naive or old-fashioned. American’s rights to marriage? Don’t tread on them or risk being buried beneath the moral truisms (and rightly so). But a Pakistani’s right to not be killed? Well, we can’t worry about that when there are more important things on our plate, like American issues in America.
I’m especially tired of macho-tough-guy liberalism. The kind that takes pride in its ability to every bit as savage as anyone else, but thinks itself superior because it’s “smarter” about its use of violence. Because I suppose there is something “smart” about rationalizations in which Americans have the right to life and liberty, but people in other countries not so much.