Difference and Diffusion: Cross-Cultural
Perspectives on the Rise of Anti-Tobacco
Allan M. Brandt
In the course of the last half-century, the harms of cigarette smoking have become a categorical part of our science. The fact that smoking causes serious disease and premature mortality has become a critical aspect of modern understandings of epidemiology, statistical inference, and medical science.1 Although the process of demonstrating the harms of smoking was neither simple nor straightforward, by late in the twentieth century there was no longer any serious debate among physicians, public health officials, and scientists over whether smoking constitutes a health risk of enormous consequence. Despite this impressive consensus, however, there remains considerable disagreement both within and across nations about the most appropriate public policy response to these scientifically understood harms. In this respect, the cigarette serves as a remarkably sensitive device for reading a specific culture’s beliefs and values concerning risk, autonomy, individuality, the role of the state, and the nature of harm reduction (to name a few). A comparative assessment of these meanings also reveals how policy and debates about policy relate to deeper cultural perceptions about smoking itself.
Any examination of law and regulation, on the one hand, and cultural belief and practice, on the other, shows that cultural beliefs are not directly determinative of policy.2 In the case of tobacco, there is no question that powerful economic interests of both corporations and nations have in large measure determined the limits of public health policy. Nonetheless, the cigarette’s historical and social position does shape the parameters of