RICHARD HOPKINS

A long time ago, in my first year of medical school, we had a lab where we were looking through the microscope at blood smears from children with various kinds of leukemia. Our teacher was an up-and-coming young pediatric hematologist-oncologist (years later he became the chairman of pediatrics at a prominent medical school). He was smoking cigarettes all during the lab — this was a long time ago, remember. One of us confronted him: “Dr. O … How can you, as a cancer doctor, possibly justify smoking cigarettes?” His reply was, “I consider it an act of faith in medical progress.” In other words, by the time he developed lung cancer, there would be a cure for it. 

Some years later I was a young epidemiologist at the Florida state health department. There was some public concern that AIDS might be able to be transmitted from one person to the next by the bite of an infected mosquito — we had a lot of mosquitoes and a lot of AIDS, after all. A speaker at a public meeting pressed me on this point, and seemed to be saying that public health officials knew this was true but were hiding it from the public. I said, “I wish it was true. I would much rather control AIDS by spraying for mosquitoes than by trying to persuade people to change their drug use and sexual behaviors.”

I think of these events often in connection with our impending climate crisis. I don’t know if it’s just us Americans, or if it is a universal human trait, but we seem to prefer medical treatment over prevention. Whether it’s heart disease, AIDS, lung cancer, car crash injuries or COVID-19, we seem to be very reluctant to change our behaviors in ways that would reduce our risk of illness, injury or death, if it is at all inconvenient for us. We want a pill or a shot that will absolve us of the bad consequences of our behavior — after those consequences are manifest. For some of our illnesses we do have a pill or a shot. For climate change we don’t. 

There can be quite a long interval between the behavior that triggers an illness and the onset of clinically evident symptoms and signs. A lung cancer that started as a few malignant cells may take years to become big enough to cause you harm, and by then it is quite large and perhaps widespread. The same dynamic is true for climate change: The effects of greenhouse gasses that we release this year will likely not be fully felt in the climate system, and sea level rise, for 10 or so years. The effects we are seeing in weather events now — heat waves, droughts and floods, and also forest fires — are the result of CO2 and other greenhouse gases that we put into the atmosphere some years ago. We haven’t yet seen the full impact of the CO2 and other greenhouse gas releases of the last 10 years.

The eventual bad effect that we worry about is most often the consequence not of a single large event, but rather of a large number of small events. Each individual cigarette, or each time we fill up the gas tank of our car, does not cause much harm; it’s the accumulation of many thousands of such events that causes the harm. 

We know that community interventions can lead to change in individuals’ risk behaviors. The prevalence of cigarette smoking among U.S. adults has fallen from about 50% at the time of the first Surgeon General’s report about smoking, in 1964, to less than 15%, and youth smoking has similarly fallen dramatically in the last 20 years. This decline has not been as fast as some would have wanted, and the big tobacco companies and their allies fought the change, but it is proving durable. These changes in adult and youth tobacco use have followed a multi-pronged strategy that had several parts: 

• Educate adults, children and teens on the facts about tobacco and health, including secondhand smoke, in school, in the media, in medical settings.

• Implement edgy media campaigns: TV spots with teens asking tobacco company executives, ‘Why are you trying to kill us?’; gory photos.

• Train health care professionals to be more effective in helping people to quit.

• Make telephone “quit lines” widely available to support those trying to quit.

• Raise the price of tobacco to the consumer by recovering monetary damages from the tobacco companies for the harm done to the public’s health and costs to health care programs. That’s what the 1998 Master Settlement Agreement between the states and the big tobacco companies did. 

• Restrict the ability of tobacco companies to promote their wares, especially to kids.

• Increase taxes on cigarettes, effectively more than doubling their price.

• Restrict sale of tobacco products to minors.

• Eliminate smoking in indoor public places, by regulation and by changes in attitudes about acceptability of public smoking.

What many of these measures have in common is that they helped change attitudes about tobacco use. It is no longer OK to smoke around children, or in a closed place with non-smokers.

I believe we — citizens, activists, political leaders and so on — need to move ahead on multiple fronts with respect to climate change, just as we did with tobacco. Educate, subsidize, train, counsel, enforce standards (like building codes, renewability of electricity or carbon content of heating fuels), recover damages from fossil fuel companies and their enablers, and work ceaselessly to change public attitudes about fossil fuel use. Hold our elected officials and community leaders accountable for taking action within their scope of responsibility that will move us toward a zero-carbon state. Make sure that needed changes in vehicle use and home heating are accessible and affordable to everyone. We can hope that before too long, putting greenhouse gases and other pollutants into the atmosphere with a gasoline car or a fuel oil home heating system will be just as uncommon as smoking around children.

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Dr. Richard Hopkins is a retired public health official who has devoted himself to volunteer activities to try to reduce climate change. He is a member of the board of the Climate Economy Action Center of Addison County, and of the town of Middlebury Energy Committee.