Philippe Boucher's Rendez Vous with . . . Elizabeth Barbeau
Center for Community-based Research in the Dana-Farber Cancer Institute and Department of Health and Social Behavior at the Harvard School of Public Health.
Rendez-vous with . . . Elizabeth Barbeau
By Philippe Boucher
Friday, November 24, 2000
PB : Thank you Elizabeth for accepting our rendez-vous.
May I ask you to introduce yourself?
Elizabeth Barbeau : Thank you for this opportunity, Philipe. I am a faculty member with the Center for Community-Based Research at Dana-Farber Cancer Center and Assistant Professor with the Department of Health and Social Behavior, Harvard School of Public Health.
Q1. On September 14-15, 2000 you led Conference in Boston on Organized Labor, Public Health and Tobacco Policy. Could you tell us about the program, the speakers, the participants?
EB : The participants and speakers represented labor unions, public health, and tobacco control organizations from around the country.
The labor leaders were from unions that include a diverse range of occupations, including clerical, health care, laborers, building trades, firefighters, nurses, and others. The public health and tobacco control groups present included the CDC, American Legacy Foundation, American Public Health Association, National Cancer Institute, American Lung Association, American Medical Association, and a number of grassroots organizations.
Q2. The Unions are rarely perceived as natural supporters of tobacco control policies. Many advocates seem to have experienced a lack of interest if not strong opposition from union leaders. Could you explain the reasons you see behind this situation as well as how it can change and is it changing? Do you have specific examples of tobacco control success stories involving organized labor?
EB : There are several historical barriers to unions and tobacco control organizations joining together on tobacco issues, but times are changing.
As background, let me note that many labor unions hesitated to speak out against tobacco out of solidarity with tobacco workers unions.
Many public health/tobacco control groups may not have appreciated this. On the public health side, professionals who entered worksites to conduct health promotion activities may have lost credibility with unions if they aligned too closely with management or if they worked on personal health habits, such as smoking, while ignoring other occupational health hazards.
However, times have very much changed, as indicated by several conference presenters. Dennis Rivera, President of 1199, NY's largest health care union, described his union's statewide political effort to pass an increase on the state's tobacco tax to help provide health insurance to uninsured adults. Kathleen Conlan of the Laborers, which represents 800,000 laborers nationwide, and Deborah Chaplin of the California Building Trades presented their smoking cessation programs that have been tailored to the occupational culture in the construction industry.
Notably, these two groups have tied issues of occupational health and safety in with tobacco control messages, and these have great appeal to workers. Don Courtney of the Worcester Firefighters described his local's effort to get state support for smoking cessation for addicted firefighters.
Don also told participants how his union grieved the city's no smoking ordinance, not because they disagreed with it, but because they wanted to tie the smoking issue to another occupational lung carcinogen - diesel exhaust. Once the city agreed to install the diesel ventilation systems, the union dropped its grievance against the city's no-smoking ordinance.
Q3. You estimate that the core market of the tobacco industry in the US are the blue collar workers. What data support your analysis and how are they assessed by organized labor?
EB : The CDC presented data from the National Health Interview Survey and the Current Population Survey to support this, but it is as of yet unpublished. It should be released shortly.
Q4. Some people think tobacco control campaign finally increase health inequalities because they mostly reach and impact the more educated part of the population. Is that how you feel? Are the campaigns ignoring the blue and pink collar workers, the less educated? If so, what should change?
EB: I think it may be an overstatement to say that the tobacco control movement has contributed to health disparities, if I understand your question. There is no doubt, however, that we have work to do to close the growing gap between the working class and others. Working class employees are more likely to smoke, smoke more, are less successful in quitting, and are more likely to be exposed to ETS at work than their professional counterparts.
We have made great gains in some population segments, but not in others. We need to focus on closing this ever-widening gap.
Q5. You had set up post conference goals. Did you achieve them? Are there new projects that can be considered as a follow up of the conference? Last but not least, will some proceedings be available on line?
EB : The post-conference goals are long-range ones. We developed a consensus statement for joint public health and labor union action on tobacco policy issues.
I am in the process of circulating that for feedback and signatures to conference participants, so it is not ready for distribution just yet.
The statement addresses advocacy, training/tech assistance and research needs and priorities. I will send a copy to you, Philippe, and would be very pleased to have you place them on your site.
Q6. Is there anything else you would like to add ?
EB : Yes, just one thing. Working with labor unions, as is true for any other community-based group, requires building a trusting relationship that is based on shared goals.
It is not just about getting labor unions to join on the tobacco control bandwagon. They have their own sets of concerns that we all need to understand and appreciate. Like tobacco control folks, labor unions are very concerned about their members' health, but they balance this with many other union priorities, such as health and safety in the workplace, wages, job security, and working conditions.
With these caveats in mind, public health and tobacco control groups should reach out to labor unions to assess their interest in taking on these issues. Given the growing disparity in smoking rates by social class, labor unions really are in an ideal position to reach their members, who remain at increased risk.
PB: Thank you Elizabeth for taking the time to be with us today.
Rendez-vous is supported by a contract from the Robert Wood Johnson Foundation
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