As mentioned in a previous post I’m currently auditing a seminar on tobacco related health disparities. We have an underused message board where topics can be discussed outside of class. Below is my response to one of the postings that was made to try to encourage discussion. I thought I would cross post it here as well. I should fore-mention that I’m coming to this with a bias. I’ve recently been trying to wrap my mind around the idea of “free will v. determinism” and my posting may reflect this. I’m hoping that it won’t sidetrack the discussion, but I believe the underlying philosophy is pertinent to the discussion.
“I thought another interesting aspect from the last session was the question and brief discussion around ‘How do you get someone to quit something that feels good?’”
My first thought is that we need to understand what it is about the behavior that “feels good.” Be it social, biological, or a combination, better understanding the underlying reasoning for the person’s behavior will allow us to generate successful interventions. Assuming a person’s future behavior is dictated by past and present events combined with the laws of nature, research needs to be focused to identify which events are statistically significant in predicting the unwanted behavior. If a model of causation can be formed the question may morph into what additional event, or series of events, will most efficiently and ethically produce the desired outcome (quitting the unwanted behavior) for the individual, or more likely group of individuals, whom share a similar chain of causation? I believe this paragraph presents the task in a very idealistic if not overly simplified manner, as the undertaking should not be seen as anything less than enormous.
“Is it the job of prevention, intervention, public health and medical researchers, educators and personnel (etc.) to get people to stop something that feels good? Is it our job to tell people how to live? Or is the task to layout the facts (as we understand them) and reasons for certain behaviors and choices, hoping that our arguments and information are compelling and that people will move initiate behavior change themselves?”
The way I interpret the above questions is the following: What is the best way to dissuade an individual from engaging a socially unacceptable behavior, regulate it or educate about it? It should be noted that either way they may not cease the behavior.
I think the answer to this question depends on what the specific socially unacceptable behavior or activity that “feels good” is. For the purposes of this example we’re focusing on tobacco use. The problem is not that tobacco use “feels good.” Instead, the problems are the harms associated with tobacco use. If it were not for harm being associated with tobacco use it would not be considered a problem. Thus, the important questions become: What harms are associated with tobacco use? Should the harms be reduced? Who should be accountable for reducing the harms, the individual or society? And is regulation, education, or a combination of both the most efficient and ethical way of reducing the harms?
Depending on the specific tobacco related harm being discussed and the philosophy you bring to the table the answers could vary greatly. Some individuals believe it is the role of government to do nothing more than ensure a few basic rights and let the free market sort out things like product related harms, while others would argue government has a obligation to regulate against various harms associated with tobacco use. Again, the actual best practices for reduction or elimination of these harms will vary based on the harm. No matter the choice of intervention, the consequences (both intended and unintended) should be carefully monitored and adjusted for to ensure the solution remains in the balance of being both efficient and ethically sound. For example, while the criminalization of drug possession may have been successful in reducing access to these substances and some of the associated harms, the overall harm associated with drug possession may have risen as of the behavior as been made more risky instead of eliminating it. The intervention may also unintentionally affect certain populations disproportionately and not always in the intended manner. Because of these unintended consequences it’s possible a different intervention (whether regulation or education based), or combination of, would better meet the efficiency and ethics criteria.
