Signs designate the childcare center at the Yale School of Medicine as a smoke-free area, but cigarette butts litter the sidewalks and smokers regularly light up on the Medical School campus. This tolerance of smoking across the street from Yale-New Haven Hospital sends a mixed message to patients, students and community members, who look to the school and the hospital for guidance on all matters related to health.
Yale University proudly advertises its many sustainability efforts, including the Yale Farm, biodiesel buses and LEED-certified Kroon Hall. However, there is a missing component to this picture: sustainable health. In order for Yale to promote sustainability on all levels, the administration should adopt a 100 percent tobacco-free policy for all indoor and outdoor areas of the medical campus.
In the context of our current health-care debate, tobacco control programs demand attention. We already pay a high price for smoking. According to the Centers for Disease Control, in the years from 2000 to 2004, cigarette smoking resulted in $193 billion in annual health-related economic losses, $96 billion in direct medical costs and $97 billion in lost productivity in the U.S. These losses amount to $10.47 for every pack of cigarettes sold.
Money aside, the health reasons behind a tobacco-free policy are clear. Tobacco use is the top cause of preventable death in the U.S.; smoking is responsible for one in five deaths and the loss of over 5 million potential years of life annually. Cigarettes and smokeless tobacco are linked to cancer, heart disease, respiratory disease, infertility and premature death. Smokers do not bear this burden alone; secondhand smoke is associated with almost 50,000 deaths per year. The good news is that smoking cessation at any age decreases an individual’s risk for smoking-related illness and death. The desire to quit is actually high among smokers. In a 2007 CDC survey, 53 percent of smokers between ages 18 and 24 and 40 percent of all smokers have attempted to quit smoking. Behavioral changes are most successful in a supportive environment; thus, a tobacco-free policy on Yale’s medical campus would encourage individual smoking cessation efforts as well as promote a community-wide message about the benefits of quitting. Implementing a tobacco-free policy at the University would not be an innovation. Rather, Yale would be following a growing trend. According to the American Lung Association, 172 American colleges and universities are tobacco-free. We have already started this movement at Yale: this past January, tobacco was prohibited at Yale-New Haven Hospital. And though they have not adopted complete tobacco bans, other members of the Ivy League, including Harvard Medical School, Columbia University Medical Center and Weill Cornell Medical College have adopted smoke-free indoor and outdoor polices.
Even temporary exposure to secondhand smoke can adversely affect health-compromised individuals, the usual inhabitants of any hospital or medical setting. For example, a 2004 study in Helena, Mont. associated a public smoking ban with a significant reduction in hospital admissions for myocardial infarction. Secondhand smoke is not only a health hazard but also a potential legal liability under the Americans with Disabilities Act, as colleges are required to provide reasonable accommodation for students and employees with medical conditions aggravated by secondhand smoke. In addition, several common law theories could become the basis of litigation, such as nuisance or warranty of habitability for a dorm room infiltrated by cigarette smoke. Lastly, although some question the need to forbid smoking outside, a recent Stanford study demonstrated that active smoking outdoors can lead to similar smoke concentrations as in indoor settings.
Tobacco-free policies are not inherently anti-smoker; their purpose is to support a healthy environment, not to exclude those who smoke. Considering the economic and health burdens of tobacco use, Yale University should join the tobacco-free movement, creating a cleaner and safer campus, setting a health-promoting example for students and the community, and achieving sustainability in both health and environment.
Julie Kunrath is a first-year student at the School of Public Health.