Technorati href="http://www.technorProfile Thinking Nurse: 'Choice', Smoking and Health Promotion

Thinking Nurse

This blog will reflect my interests in learning disabilities, nursing, nursing theory, philosophy and politics and my general interests in the arts and literature. (Nursing is an art as well as a science!) Philosophy and nursing have been intrinsically linked since the days of Socrates, his mother was a midwife, and taught him everything he knew!

Monday, February 21, 2005

'Choice', Smoking and Health Promotion

I got rather animated, even "abrasive" in a recent discussion on the International Council of Nurses Student Nurses Discussion Boards here:

It was a discussion about smoking and whether Student Nurses who smoke can give health promotion advice. I felt that a lot of the posters were thinking in terms of 'individual choice', either in the argument 'it is someones choice to do it, so we should respect that choice' or the other argument 'it is their choice to do it, so they deserve everything they get'. I disagree (at least partially) with both these arguments, and feel we need to think a lot more deeply about how we go about promoting health - to find out why, read on....

I think 'choice' is one of the most misused words in the dictionary - particularly in the modern world.
I had a 'choice' of whether I shop at the local greengrocer, butcher and baker, or whether I go to the big multinational superstore that opened up out of town - until those shops went out of business because the superstore was there. Now my elderly neighbours who dont have cars have to eat convenience food out of packets bought from the local newsagent (the only source of food within walking distance) - so much for their ability to make healthy choices...

We are told that smoking is a 'choice'. But of course once you're hooked, it isn't a choice any more, if it ever really was in the first place - how many smokers out there ever made a conscious decision 'I am going to be a smoker' - most people get into smoking by having the occassional cigarette with friends at school - they dont think about it any more deeply than that, until they are on 20 a day...

Then the health fascists (I.e. nurses!) tell them that they should give up smoking, otherwise they will not be entitled to certain treatments, and The insurance companies jack up their premiums.

Noone looks at the amount of tax smokers are paying on their habit, (far more than the total cost of smoking to the health service), or at the fact that because smokers die earlier, they save the state and pension companies a fortune in pension payments, and noone says 'perhaps these people are just as entitled to health services as the rest of us?' because their behaviour is 'self-inflicted' and they deserve everything they get - dont they?

Smoking is an addictive behaviour, so is drug taking (illicit or prescription), alcoholism, overeating, dieting, getting tattooed, gambling, self harm, marathon running, extreme sports, cult membership, church membership, surfing the web and writing blogs.

Some of these behaviours are more harmful to a person's health than others, but once you get into them, it is very very difficult to get out.

People who have no knowledge of you, or the things you are dealing with by using these behaviours, are not helping when they judge you for them.

Such people are very, very unlikely to succeed in ever persuading you to change these behaviours - and when they do, chances are you will replace them with something else far worse, unless they can come up with something better that fills the same function as the original addictive behaviour.

As for nurses - we indulge in all the behaviours listed above, and many more - even though we know slightly more than the general population about the harm these things can do. We do them because we are human beings in a stressful job, and stressful situations, and we use them to cope, just like the rest of the population.

Time to get real - if we want to promote healthy behaviour, and healthy lifestyles, we are going to have to get into things a bit more deeply than simply preaching the gospel of fresh fruit and vegetables, exercise and non-smoking. Nobody listens when they are preached at. They have heard the same message a million times, and it hasn't worked. Perhaps instead we can share information, and explore together with real people ways of making our lifestyles better, in ways that fit in with real lives and circumstances?

And perhaps we can also explore some of the social and economic reasons for unhealthy behaviour - such as the demise of local greengrocers and the rise of supermarkets and multinational fast food chains. Such as the brewing and gambling industries funding political parties so they can get more liberal licensing laws. Such as the long working hours culture that leads to high levels of stress - stress being THE major factor in inducing people to behave in ways that are harmful to their health. Such as POVERTY, the biggest single factor in ill-health by a mile, and at the root of so many other problems.

If we want to really promote healthy lifestyles, we are really going to have to think at a deeper level about why our society seems to be promoting precisely the opposite?

One place to start: The film 'Supersize me'.


At 12:38 PM, Blogger Thinking Nurse said...

This report from the BBC:
shows how decades of health promotion advice still have not got through to smokers about the true impact of the habit.

The approach of banning smoking from public places, seems far more effective than moralistic and guilt-inducing messages - which human brains, with their capacity for self-deception easily divert from consciousness as being meant for 'someone else'.

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