As I place Mr. X on a breathing machine he flashes me a look from his terrified eyes. I know this look well, the desperate cry for help of a drowning man. But he is not drowning in water. He has spent a lifetime drowning in smoke and his lungs are now so shattered that his tiring, heaving shoulders are unable to bring in enough air for his next breath. I will not be able to pull him back to shore. His lungs are failing, he is dying and he knows it.
He is not the only patient I will see this shift who is dying from a smoking related disease. Mrs. Y is clutching her chest and short of breath having suffered a heart attack and Mr. Z who will no longer be able to use the right side of his body or even communicate has had a massive stroke. All were struck down by cigarettes.
Tobacco has a long and complex history. From its original sacred and ceremonial purpose amongst the Ongwehon:we people of Turtle Island to its commercialization and engineering into the cigarette, one of the most addictive products in the world, there is much to tell.
Like sugarcane, tobacco was one of the plants that through human labour could be transformed into an immense source of wealth. Tobacco was the original economic cornerstone for the colonization of North America and the building of the United States of America. It was known to the early colonists as “brown gold.”
John Rolfe, whose fame is partially due to him having “married” Pocahontas, was the first colonist to successfully commercialize and grow the plant on a cash-crop scale for the European market.
Between 1618 and 1640 the harvest of tobacco grew from 20,000 lbs to 1.5 million lbs and alongside it the European settler population jumped from 18,000 to 78,000. Britain’s global empire was largely kick-started by profits from this commodity spawning further waves of colonization across the world. Because of the huge amount of labour required for its cultivation and processing, tobacco production also lead to the development of a slavery based economy.
Cigarettes were essential in maintaining troop morale during the First and Second World War, calming the nerves of soldiers and providing them with what has been called “a mild but smelly antidepressant.” In a major deal with the US during World War Two, Britain spent more on tobacco then it did on tanks or ships or planes.
In the second half of the 20th century, the tobacco industry continued to flourish using cutting edge marketing to build up a vast consumer base, maintaining it by suppressing the health harms associated with it and replacing consumers lost to cancer, lung and heart disease by advertising to the next generation of smokers: children.
As early as the 1930’s the association between smoking and lung cancer as well as lung and heart disease was becoming clear. This information – well known by Big Tobacco – was expertly suppressed. A Tobacco executive once famously said “We don’t smoke the sh*t, we just sell it. We reserve the right to smoke for the young, the poor, the black and the stupid.” Public health advocates only began to win concessions in the 1990’s. These years also saw major successful lawsuits against the tobacco companies. In a joint legal action, 46 US states were able to win $200 billion in compensation for the healthcare costs of treating sick smokers.
Tobacco control methods such as bans on advertising, restrictions on where people were allowed to smoke, clear messaging about the harms of smoking and – last but not least – high levels of taxation were successful at dramatically decreasing smoking rates over the last 20 years.
Now tobacco is at the forefront of an economic renaissance for Haudenosaunee people. What does this mean for the health of Ongwehon:we and non-Ongwehon:we peoples?
Poverty has a powerful impact on the health of a community. It determines other important factors necessary for good health such as housing, nutrition and education. It is estimated that child poverty rates are over 50% on most reserves and housing and access to clean drinking water is grossly inadequate.
The Ongwehon:we tobacco trade is undeniably improving the income and along with it, the economic independence and self-determination of Ongwehon:we communities. After centuries of impoverishment and abuse, Ongwehon:we people are using the profits from tobacco as a nation-building tool much in the same way that Britain and America did, minus the slavery and colonization of other peoples.
On the other hand it is undeniable that tax-free cigarettes defeat one of the key methods for improving public health by making cigarettes affordable. However, Ongwehon:we people haven’t taxed Canada for the social and healthcare costs that alcohol – a harmful European substance – has caused their communities.
So why are cigarettes so addictive and why are they so harmful to human health? Cigarettes are the ultimate delivery system for nicotine. Their design and additives allow smoke to be delivered deep into the lungs where they contact the small blood vessels of the body allowing a large amount to be taken up by the blood. This in turn circulates to the heart and brain. Nicotine is both an upper and downer. It powerfully stimulates the reward centres in the brain generating feelings of well-being and relaxation while also causing the release of activating neuro-transmitters which sharpen the mind and make the user more alert.
At the same time as nicotine is pleasuring our nervous system, the products of tobacco combustion are irritating our airways, blood vessels and toxins are building up in our cells. This leads to cancers of the mouth, throat, lung as well as emphysema and bronchitis and of course heart attacks and strokes amongst many other diseases.
Every single shift that I work in the emergency department, I treat patients with smoking related diseases. Smoking is the number one cause of preventable deaths. Fifty percent of cigarette smokers will die a premature and tobacco related death.
Unlike the doctors of the 1950’s who proudly endorsed cigarettes, I would like to see cigarettes drop off the face of the planet. However, as much as I pray for that day to come, it is a long way off. Smoking rates are declining in developed countries but they are sky-rocketing in developing countries where the advertising and marketing tricks that big tobacco perfected so well over the last century are being used to recruit millions of new smokers, many of them children.
In the historical context of colonialism and its systematic destruction of traditional Ongwehon:we economies it does seem hypocritical for Canada and the United States to allow companies like Phillip Morris and JR Reynolds to continue profiting from tobacco while criminalizing the Native industry.
I would hope that just as tobacco helped nation build for the United States so too it may allow Ongwehon:we nations to rebuild their sovereignty and along with that other economic opportunities that are less harmful than commercial Tobacco. In the meantime, attempting to deny them this right will only lead to further poverty, marginalization and criminalization all of which are powerful contributors to ill health and chronic disease.
Dr. Chris Keefer is a physician in the emergency department of the Brantford General Hospital.