Power relations and the public health challenge

The disease, suffering and premature death caused by tobacco products are unevenly distributed. This is at least partly because smoking prevalence in many countries, particularly those at later stages of the tobacco epidemic, is much higher among marginalised groups: minority groups who experience various forms of discrimination; people who are financially deprived; those who are mentally ill; and those in prisons and jails, among others. However, these same groups, compared with those who are relatively more advantaged and powerful in society, may also experience other forms of health injustice—more targeted marketing of deadly products, reduced access to preventive health services, communities with more environmental toxins, crime, stress, and fewer economic opportunities. Tobacco is a social justice issue, and the papers in this special collection help draw attention to that fact and call on each of us to acknowledge the ways in which our power (or lack thereof) shapes our health status. Curry et al 1 document the phenomenon of e-cigarettes made especially for inmates of prisons and jails, a population with extraordinarily high tobacco use rates who too often are forgotten in public health initiatives. While many institutions now have smokefree policies to protect the health of nonsmoking inmates, e-cigarettes could alter the landscape in unknown ways. Some claim their availability increases morale and decreases contraband issues. However, it is still unknown if there are any long-term effects from e-cigarette use on nonusers in enclosed institutional settings. The fact that this population is challenging to study should not be an excuse to allow them to be exposed as captives to potential new risks without assessing possible effects on health. In an important review, Hill et al 2 analyse the socioeconomic impact of six tobacco control interventions: price increases, smokefree policies, ad bans, mass media campaigns, warning labels, and …