June 9, 2020 / Steven Lacey

Changing the Narrative to Protect Vulnerable Workers

In the landmark 1964 Surgeon General’s Report on Smoking and Health, Dr. Luther Terry spelled out the dangers of cigarette smoking, linking the practice to lung cancer and other health concerns. Tobacco companies reacted by arguing that experts disagreed on the negative effects of tobacco. That was, of course, not true—the “controversy” was entirely a PR campaign invented by the industry to maintain profits and downplay risks.

Still, the companies’ campaign worked. Years would pass from Dr. Terry’s first report until popular opinion changed, and local and national governing bodies passed large-scale clean air acts. Thanks to courageous health professionals who uncovered the danger of airborne carcinogens, Americans eventually agreed that cigarette smoke was not acceptable in public spaces. The narrative changed so much that lighting a cigarette in public today is viewed by many as offensive.

Last Memorial Day weekend, I pondered the success of the competing public health narratives that surrounded smoking. Stopping at a local restaurant to pick up my take-out, I was greeted with a sight unnerving in our post-COVID-19 world: a full restaurant, with barely any room between the tables. If the managers had attempted to limit occupancy, I couldn’t tell. Only the restaurant workers were wearing masks, while the customers carried on as if it were any other Saturday, as if the death toll in America was not inching toward the 100,000 mark as the result of a disease transmitted though respiratory droplets and close personal contact.

Health professionals’ success in battling the COVID-19 pandemic depends on that of the story we tell about it, and we are entering a new phase of the narrative. Although the risk of COVID-19 is still present in every community, the burden of the disease is increasingly being pushed on workers—including the staff at the restaurant—who have to rely on the actions of others to maintain their own safety. The health story that we have told for months has been “Protect Yourself and Your Family,” but now, our IH community should begin to tell the story of our collective duty to essential and service workers. Otherwise, we will fail in our most basic responsibility.

We’ve already started to outline this story. In the past few months, essential and service workers—disproportionately often low-wage workers of color—have been publicly recognized as especially at risk for COVID-19 because of the requirements of their work. Part of that risk results from our society having gotten too used to seeing products and services separate from the people who provide them. From meatpacking plants to grocery stores to restaurants, it is everyday workers who are exposed daily to the greatest risks of the pandemic, and yet too often, their stories are silenced.

This is not an argument for economic ruin. We can begin to open up the economy safely if we continue to cover our faces and keep our physical distance, and if testing and contact tracing systems are put in place. But in the rush to secure financial fortunes, the reality that workers are the economy is often lost. What kind of economy can we expect if we gamble with the lives of those upon whose work it is based?

Stories can change, with great impact. A JAMA study estimates that 8 million Americans avoided premature death from causes associated with smoking because of the efforts of Dr. Luther Terry and other public health workers. Soon, I hope we will come to the point where wearing a mask and practicing social distancing during a pandemic is as simple and as respectful a public action as smoking only in designated areas. After all, looking back, was it really that hard to step outside of a restaurant to smoke?

Steven Lacey

Steven Lacey, CIH, CSP, PhD, is a professor and Chief of the Division of Public Health at the University of Utah School of Medicine, as well as an AIHA past president and fellow.


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