Americans welcome Memorial Day as the traditional kick-off to summer and are grateful for the long weekend. Public health concerns focus on protecting revelers from sunburn or overindulgence in grilled meats. Its easy to overlook the original meaning of the holiday, that sacrifice at the end of May is about more than losing scorched hotdogs to the grill gods. Memorial Day is of course a day we are supposed to remember military veterans who have given their life in service to their country, and this Memorial Day a research team from the University of California San Francisco help to refocus public health concern on veterans health, and the assault that it suffers from service-related tobacco use. Especially troublesome is government promotion of smoking followed by the denial of disability claims related to the habit.
Until 1975 cigarettes were part of military rations, and are still sold at discounted prices on bases. Veterans are 1.5 times more likely to have ever smoked compared to the non-veteran population: 74% vs. 48%. Public health research estimates that military service during WWII and Korea increased veterans' smoking rates by 30%, and some researchers consider smoking to be engrained in military culture. VA medical facilities are mandated to provide smoking areas, even as they spend an estimated $5 billion a year treating lung conditions, 80% of which are caused by smoking. So should smoking could be considered a "service-related" condition? The UCSF public health researchers suggest so, yet the VA doesn't agree, and won't provide disability benefits to veterans whose health has been damaged by smoking. Though stopping short of considering it drug abuse, senior VA officials have variously declared that smoking-related disabilities claims can be denied on the grounds that the habit constitutes "willful misconduct," or that approval would be "borderline absurdity." Contrary to public health, sociology, and other sciences showing that our health choices are strongly influenced by, as well as amenable to change from policy and culture, the military overwhelmingly views smoking as a personal choice, condemning veterans to suffer personally for the consequences of a habit promoted by the services they gave their time, and sometimes their lives, to.
The tobacco industry has argued in favor of considering such claims service-related (which appears to legally exonerate smoking itself as the causing.) A shift away from service-related towards labeling smoking "willful misconduct" could also hurt the industry should the military attempt to reduce smoking rates by instituting tobacco control measures. The high rate of smokers among veterans clearly represents a valuable source of new smokers to replace the half-million or so Americans that the tobacco industry kills each year with tobacco-related illness.
Ending the public health scourge of war is perhaps an unrealistic dream this Memorial Day, but reducing the scourge of smoking among veterans is certainly attainable. Reducing the government promotion of smoking among veterans, and recognizing the habit as service-related represents a good start.