Everyone likes a good ranking, especially one involving their home city. So Portland, Oregon, residents might be proud that their hometown this week received two gold medals and an overall bronze-medal ranking from a foundation that measures health policy.
Upon closer examination, however, the rankings do little to reward improvements in health – and much to reward cities that pass a mish-mash of policies ranging from subsidizing housing to restricting the sales of alcohol and tobacco.
In fact, one of Portland’s – and Oregon’s – celebrated policies could actually have a deleterious effect on public health. As The Oregonian reported this week, the state’s biggest city “received gold medals in two categories relating to tobacco use: the state’s tobacco purchasing age of 21 and its ban on smoking and vaping indoors.” It’s easy to see how raising the purchasing age of cigarettes and limiting their use indoors might create healthier lifestyles. But banning the use of electronic cigarettes indoors flies in the face of the latest health-based thinking.
In a perfect world, no one would use any nicotine-related products. But in the real world, vaping is an increasingly popular – and much less deadly – alternative to traditional cigarettes. Public Health England, Great Britain’s health-care agency, published independent evidence showing that “e-cigarettes are significantly less harmful to health than tobacco and have the potential to help smokers quit smoking.” The agency concludes that “there is no evidence so far that e-cigarettes are acting as a route into smoking for children or non-smokers.”
Restricting the use of e-cigarettes makes it more difficult for smokers to switch to a safer product. That concept appears lost on the CityHealth initiative – the group that recently awarded Portland its medals. The initiative is the work of the de Beaumont Foundation and Kaiser Permanente.
It’s not surprising that CityHealth’s report has the same blind spot that other policy experts have when it comes to tobacco-related initiatives. For instance, several California municipalities, especially in the San Francisco Bay Area, have passed bans on flavored cigarettes. Those bans include vaping in their definition of smoking. That means smokers won’t be able to buy e-cigs in their communities but will be able to grab a pack of Camels. How does that promote public health?
The problem with such studies is that they don’t actually measure health improvements; they simply reward cities that adopt certain restrictive political approaches. Anyone can hand out medals for any reason they choose. Which is why I give the group my “Chunk of Coal Award” for failing to recognize that vaping is not the same as smoking and that restricting the use of e-cigarettes doesn’t improve public health. It imperils it.