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One of the
more disturbing contemporary trends in tobacco control is the increasing use by
both anti-smoking activists and governments of “denormalization” campaigns
against the industry. As used by the tobacco control movement, denormalization
is as a made-up word that functions as noun and verb to describe both a state
in which the tobacco industry and smoking are perceived to be non-normal,
aberrant, and deviant and a series of activities designed to achieve this
end.
Though there
is some controversy as to where the term originated, the first systematic use of
the concept can be traced to
California’s
series of TV attack ads launched during the 1990's as part of Proposition 99.
The first and most widely known of these ads, “The Board Room”, featured actors
depicting industry executives worrying about replacing their steadily dying
customers and aired in 1990. The TV spot was accompanied by a print ad “First,
the Smoke. Now, the Mirrors” which ran in all of the major newspapers throughout
the state. The ad concluded with following lines: “So we seem to know about the
smoke. But what about the really dangerous stuff - all those carefully polished,
fatal illusions the tobacco industry has crafted to mess with our minds so they
can mess with our lives.”
While there
is significant debate as to the success of the California’s experiment with
denormalization, the move to incorporate denormalization as an integral, if not
central part of tobacco control programmes has rapidly spread. Massachusetts,
Arizona, Oregon and Florida have all adopted parts of the California model,
while anti-tobacco activists in Canada, ever the home to cutting edge failures
in tobacco control, are pushing their federal government to make
denormalization the centrepiece of a new national strategy on tobacco. In fact
the Canadian denormalization campaign would dwarf even California’s efforts,
with about C$200 million in proposed funding over the next five years. Indeed,
in part due to the influence of
Canada’s
representatives at the FCTC process, denormalization will be taking its place as
another leading first world tobacco control export to the developing world.
Despite
certain local variations, what defines and unifies denormalization are three
things; first a core assumption about tobacco control, second a series of key
goals and third a set of consistent tactics. The assumption behind the use of
denormalization campaigns is that the most effective way of reducing tobacco
use in general and more particularly in preventing tobacco use by young people
is to focus on
changing the behaviour of the tobacco industry rather than attempting to change
the behaviour of current or potential smokers. This assumption, of course, rests
on a the further assumption that the industry causes the behaviour of smokers.
As Canada’s Non-Smokers’ Rights Association, one of the world’s fiercest and
most aggressive industry critics notes “... forcing changes in the behaviour of
the tobacco industry has far more impact than efforts to directly change the
behaviour of current or potential smokers.” Thus at its core denormalization is
part of a larger attempt to change industry as opposed to smoker behaviour.
The goals of
denormalization are equally sweeping, for the campaigns aim through their
focus, as the term implies, on the abnormal nature of both smoking and the
tobacco industry to “change social norms about the use of tobacco” and, more
importantly, the manufacturers of tobacco through portraying them as deceptive,
manipulative and close to, if not explicitly, criminal. These goals in fact
frame the entire California campaign from the initial attack ad with its
industry executives plotting in the stereotypical smoke-filled room to its 1994
ad “Do they think we’re stupid” which featured the company CEO’s in their
congressional testimony on addiction. Each of the campaign’s components was
carefully designed to highlight the industry’s allegedly deceptive and
manipulative character and to imply that it was in some sense a moral outlaw
operating outside the normal business environment.
More recent
denormalization efforts in Massachusetts, Florida and Canada have aimed to
position the tobacco industry as the money-driven “disease vector” of the
tobacco epidemic that targets kids through its advertising in order to addict
them to tobacco. Denormalization advocates consistently speak about having the
industry take the place in the minds of kids of such traditional
anti-establishment targets as parents, adults, school and government through
portraying the industry as “those people who mess with your bodies and with your
mind”. Even more expansively and frankly many activists note that the real goal
of denormalization is to change the public’s perception of both the industry and
smoker’s in order to alter not only the judicial environment hearing tobacco
litigation, but the wider social and legislative environment in order to garner
support for ever more draconian tobacco policies. As Canada’s NSRA put it in a
2001 funding request “denormalization facilitates the transfer of the focus of
normal teen rebellion away from parents and teachers and toward the industry
which is targeting them... Denormalization has the potential to keep many teens
out of the tobacco market, encourages cessation and supports the development of
public policy on tobacco.”
What unifies
denormalization efforts is not simply assumptions and goals, as the campaigns
are also consistent in their tactics. The menu of tactics are driven by the
claim, largely unargued for, that the only way in which to effect the power of
the tobacco industry is to remove its legitimacy. Denormalization is tobacco
control’s answer to the industry’s claim that it is a legitimate industry
engaged in a legal business enterprise. For the advocates of denormalization
this legitimacy is “false” in the sense that it masks the industry’s alleged
lies about the risks of its products, addiction, and marketing practices.
The tactics
of denormalization are thus designed to remove the industry’s faux legitimacy
through telling the so-called truth not about its products but about its
behaviour. These tactics include:
highlighting
the alleged past behaviour of the industry with respect to marketing,product
manipulation and smoking risks;
refuting the
industry’s “myths”about not targetting youth, safer cigarettes, ETS, and
addiction;
attacking
the industry’s current efforts to style itself as a responsible corporate
citizen through its support of youth access and education programmes;
portraying
the industry as a moral outlaw outside the bounds of the regular business
community and discouraging its business partners and suppliers from having
normal business relationships with it;
ensuring
that the industry is excluded from any meaningful participation in tobacco
policy development or prevention research; emphasizing the impossibility of the
industry changing in any fundamental way given that its financial viability is
based on recruiting new, young smokers through deceptive marketing;
and changing
the guilt that smokers have about smoking into an anger against the industry for
targeting and addicting them as children.
As the menu
itself suggests the neat distinction between products and behaviour breaks down
since denormalization’s criticisms of behaviour are often criticisms about
products, e.g. addiction, safer cigarettes and ETS.
There are at
least two major problems with the move to denormalization, problems not simply
for the industry but for anyone interested in effective public policy. The first
of these problems is with the efficacy of denormalization campaigns. The problem
here begins with the legitimacy of the core assumption that frames
denormalization, namely that the most effective way to change the behaviour of
smokers is to change the behaviour of the industry. Far from being obvious or
supported by empirical evidence as the advocates of denormalization assert, most
of the academic research about preventing smoking or facilitating quitting,
particularly by young people, suggests that interventions to change the
behaviour of smokers are the crucial ingredient of effective tobacco control
programes.
If one looks
at the research which reports the most significant results in terms of
prevention they have nothing to do with so-called changes in industry behaviour
but everything to do with interventions to change smoker’s behaviour. In fact
one could go further and argue that it is precisely the anti-smoking movement’s
20 year obsession with trying to change industry behaviour through attempts to
ban marketing that has led to the failure to come to terms with youth smoking.
Instead of addressing the root causes of youth smoking, both governments and the
anti-smoking movement have instead focused on changing the industry’s behaviour.
What the
driving assumption behind denormalization has done is to effectively waste a
generation in coming to terms with youth smoking through perpetuating an
enormous confusion at the centre of tobacco control policy, namely youth smoke
largely because of the marketing tactics of the industry. Once this assumption
is accepted then the control menu, including denormalization readily follows.
But if we were to start with a different assumption, namely, cigarettes exist,
therefore as part of the process of growing up young people will experiment with
them, we have the possibility of asking a genuinely open question- what it is in
the process of growing up that leads young people to experiment with cigarettes
and what might we do about it? And the answer to this question will, based on
the overwhelming majority of the research literature, not be the one that
supports industry denormalization and demonization.
But it is
not only the problem of the core assumption behind denormalization that raises
questions about its efficacy, it is also the empirical results of the actual
campaigns. And here the evidence comes not from the tobacco industry, but from
the tobacco control community itself. One of the problems about denormalization
is that like so much in tobacco control there is a distinct unwillingness to
devise
measures
that evaluate whether much touted programes actually produce the only sort of
changes that count- changes in smoking behaviour. Despite being around for over
a decade the number of studies on denormalization programes is still relatively
small.
And these
few studies suffer from a number of problems. Most are based on small, cross
sectional samples that are unable to allow any causal conclusions. More
disturbingly, many of the studies have been done by the same people either
running or advocating denormalization programes so they are hardly models of
objective rectitude. As Donley Studlar of West Virginia University notes
“advocates of denormalization policies area sometimes also the authors of
evaluation studies.” Further, most of the studies are poorly designed, being
flawed with respect to control groups and use of recall data, and coming closer
to advocacy rather than careful social science research. Most of the studies
fail to show that denormalization has any direct effects on smoking and it is
impossible to find that any “anti-industry” effect has changed smoking
behaviour.Karen Gutierrez at the Center for Disease Control has noted that
denormalization campaigns “won’t make someone quit or not smoke around
others...” This is echoed by C. Pechman who writes that it ”is unclear whether
ads that attack the tobacco industry can dissuade young people from smoking.”
Studlar is even more direct arguing that it is “difficult to isolate a specific
industry denormalization effect”and “modest, largely indirect effects
predominate”.
All of the
“studies”are plagued by the problem that what people say they believe or will do
are often at variance with their behaviour outside of the interview.
As Carolyn
Celebucki of the Massachusetts Department of Public Health observes
“perceived effectiveness may be a weak proxy for impact on behaviour.”
The two
major independent studies on denormalization (Siegel and the University of CA),
both found no significant effect on youth smoking in California and
Massachusetts. Youth prevalence in California was not statistically different
than prevalence in other states. Additionally, the study done by the National
Institutes of Health concluded that denormalization campaigns had not made a
difference in youth smoking in the states in which they had been used.
The
problems, however, go beyond the fact that denormalization campaigns fail in
reducing youth smoking as they also work against effective tobacco control
through discrediting industry supported efforts to limit youth access to tobacco
products and support education programes to discourage tobacco use by youth. But
of course, this is what denormalization is designed to do: discredit the
industry so that its efforts in youth prevention are discredited and it is
denied any place at the tobacco control policy table.
Thus,
despite its advocates claims, denormalization fails the most significant test of
good public policy- effectiveness- in that through its grounding assumption it
diverts resources and attention away from the root causes of youth smoking, it
fails itself to reduce youth prevalence in those jurisdictions in which it has
been tried and it attempts to discredit the industry’s efforts at youth
education and access control.
The second
problem with denormalization is what might be called the legitimacy problem,
namely the question of whether a democratic government might justifiably engage
in a campaign of what is effectively the stigmatization of a legal enterprise
for the purposes of social engineering. There are at least two senses in which
legitimacy is an issue, first with respect to stigmatization and second with
respect to social engineering.
It is, of
course, one thing for the government, in the interests of health, to provide its
citizens with accurate information about the consequences of various forms of
risk taking. It is another thing for the government to attempt to persuade its
citizens, again in the interests of health, to do one thing or avoid something
else. But there is something quite different in character from either providing
objective information or engaging in persuasion for a government to attempt to
“denormalize” something that it has not proscribed as illegal. It is not simply
that so much that is said as a part of denormalization is demonstrably false,
either by being taken out of context or directly in contradiction of the
existing evidence, e.g. the claims about the purposes and effects of
advertising, the nature and consequences of addiction, and the risks of
secondhand tobacco smoke , but that the purpose of saying such things is to
render both an industry and a class of individuals first aberrant and then
abhorrent. And there is no doubt that this is precisely what denormalization is
about for according to its proponents the activities of denormalization are
specifically designed to use evidence of aberrance to generate feelings of
abhorrence and de-legitimacy. And it is this action, this artificially generated
sense of aberrance and abhorrence that is outside the scope of moral government.
It is too
easy to reply that what we are dealing with here is the tobacco industry, as if
this ended the need for moral rigour. But suppose that it were not the tobacco
industry, suppose that the government decided in the interests of preventing
AIDS- a legitimate health interest- it would henceforth attempt to denormalize
homosexuality through a denormalization campaign designed to portray such
activity as aberrant and abhorrent. Would we find nothing morally objectionable
about such activity? The answer is that whatever our views about AIDS or
sexuality we would find such actions to be morally objectionable because for a
democratic government the tool for censuring either its citizens or its
corporations is not denormalization but the criminal law. To forget this is to
forget that the last century’s experiment in denormalization ended in the
concentration camp and the gulag.
But
denormalization runs afoul of legitimacy in a second sense in that it represents
a vast and unacceptable instance of social engineering. Its proponents are not
hesitant to trump this as its great virtue for they openly proclaim that their
goal is to effectively re-order the consciousness of individuals with respect to
smoking and the tobacco industry. This is not the provision of information or
even reasonable persuasion but instead social marketing designed to manipulate
the social and intellectual environment so that the central aspect of democratic
life- individual autonomy, the right to shape one’s own mind, behaviour and
life- is effectively suppressed.
The
increasing use of denormalization campaigns is worrisome then not simply because
they represent another failure to address the problem of youth smoking but
because they represent a new and dangerous assault on our core democratic
traditions. Like so much in the tobacco wars they are a very bad prescription
for supposedly good health. |
