For years, smoking was perceived solely as a personal choice – a habit that a person chose for themselves, and therefore its health toll was also their exclusive responsibility. However, today more and more experts understand that reality is much more complex, and that behind cigarette addiction stand deep social, environmental, and psychological mechanisms as well.
The new approach in the medical world does not eliminate personal responsibility, but it seeks to look at smoking as a much broader phenomenon – one that was built over decades through cultural norms, high accessibility to cigarettes, environmental and social influences, and sometimes also social and economic disparities that begin at a very young age.
This approach, known in the medical world as Structural Competency, seeks to understand how the social structure and the environment in which a person lives affect their health, their ability to stop smoking, and also the decision whether to seek medical treatment in time and persevere with it.
<br>Not only a personal addiction, but a broad social phenomenon
Today, the tendency is to treat smoking not only as a personal addiction, but as a broad social phenomenon that was built over years through cultural norms, high accessibility, and environmental influences.
Similarly to how a person suffering from obesity cannot be blamed solely for their personal choices, when processed food is cheaper and more accessible than healthy food in many cases, so too in smoking there are environmental and social disparities that affect who starts smoking, at what age, and in what environment they grow up.
There are populations and areas where cigarettes are much more accessible, sometimes already at a very young age. For decades, smoking received broad social legitimacy: It was presented as fashionable, social, calming, and even as a status symbol. Entire generations grew up on these messages, long before they truly understood the health implications of smoking. We see the damages of those perceptions to this day. When a person grows up into such a norm, it is very difficult to look at addiction solely as a personal choice.
The silent price of guilt and stigma
One of the central issues that the medical community encounters among COPD, lung cancer, and other smoking–related disease patients is the sense of guilt that accompanies many of them.
Many patients feel that they "brought the disease upon themselves," and therefore are ashamed to seek treatment or believe that they can no longer be helped.
This sense of shame is not just an emotional matter. It becomes a real medical barrier. Today it is known that stigma and guilt directly affect health: They cause people to hide symptoms, avoid tests, delay turning to a doctor, and even fail to persevere with treatment.
There are patients who are ashamed to use inhalers or oxygen therapy next to other people, and others simply give up in advance out of a sense of despair.
COPD: Much beyond smoking
COPD is one of the most common and significant chronic respiratory diseases in the world. It manifests in shortness of breath, a chronic cough, phlegm, a decline in functioning, and sometimes also in severe exacerbations that lead to repeated hospitalizations.
Smoking is the central risk factor for the disease, but not the only one. Exposure to air pollution, cooking in stoves with an open fire – which is considered a central factor in developing countries – certain working conditions, and additional environmental factors may also affect its development.
Despite this, many of the patients still feel that society treats them as "guilty," and this feeling harms their ability to cope with the disease.
The therapeutic approach has changed: Not only to survive, but to live better
This approach is currently also receiving professional reinforcement from the central international guidelines for the treatment of COPD. According to the guidelines, COPD is a chronic disease that can be treated, and not a "death sentence" for people who smoked.
The guidelines emphasize that alongside support for the smoking cessation process, advanced drug therapy, pulmonary rehabilitation, tailored physical activity, and improvement of the patients' quality of life must be integrated.
The professional literature also refers to the importance of reducing the stigma around the disease and to the understanding that nicotine addiction is not just a personal choice, but a result of complex biological, social, and environmental mechanisms that require attention, treatment, and compassion.
In recent years, the world of COPD treatment has undergone a significant change. Today, a variety of advanced treatments exist that make it possible to reduce exacerbations and hospitalizations, improve functioning and quality of life, and allow patients to manage a better and more active life routine.
Among the treatments, there are also targeted biological treatments, given once every two weeks or once a month, which allow a more precise adaptation for certain patients. Alongside this, solutions that assist in the smoking cessation process also exist.
Reduce guilt and increase public responsibility
Alongside medical progress, broader public steps are also required today. On the one hand, the sense of guilt among smokers and patients must be reduced. On the other hand, accessibility to cigarettes must be narrowed down, and we must ask how even today many young people are still exposed to smoking at an early age.
The responsibility here is not only of the private individual, but also of society and of the state.
Ultimately, perhaps the most important thing is to make people understand that even if they smoked for years, it does not mean they do not deserve to receive treatment, support, and a real opportunity to improve their health and their quality of life.
Dr. Inbal Shafran, Senior Physician at the Pulmonary Institute at the Sheba Medical Center and Board Member of the Israeli Association of Pulmonary Physicians