Actions have consequences. For every effort put forth, and every risk taken, a chain reaction of consequences, good and bad, takes place. Many of today's health problems are negative consequences that result from the actions that we as a people freely perform. And yet, we as a society sometimes divorce these consequences from their actions, especially if we take pleasure from such actions. Other times, if the action is considered socially unacceptable, we try to prevent the action from occurring. Some of society's most dreadful health problems are primarily caused by two actions: smoking and sexual intercourse. How we deal with these separate actions and the problems they create say allot about ourselves as a society.
The three leading causes of death in the United States today are heart disease, cancer, and stroke ("1995 Final Mortality Statistics Released"). The numbers are startling: almost 770,000 incidents of death from heart disease per year, nearly 477,000 deaths from cancer, and approximately 150,000 deaths per year from stroke ("Health Care vs. Disease Care"). All of these deadly ailments are caused in varying magnitudes by smoking.
In 1989, the US Surgeon General issued a report that concluded that cigarettes and other forms of nicotine were addictive, and was a major cause of stroke, the third leading cause of death in the United States. Despite this warning, and the countless studies since, that proves the harmful effects of tobacco products, the National Household Survey on Drug Abuse reports that 45 million Americans continue to smoke cigarettes. In November 1996, The Centers for Disease Control and Prevention issued a report that forecasted that an estimated 16.6 million of today's kids will became regular smokers and almost a third of this number will die prematurely from smoking ("Drug Information: Tobacco").
American society's attitudes toward defeating this problem are balanced between discouraging the action -- smoking -- and finding a cure for the consequences -- heart disease and cancer. There are federally funded programs to research cures for these problems. The National Cancer Institute will receive an estimated 2.2 million dollars in 1998, making it the highest federally funded health research program in America, and The National Heart, Lung, and Blood Institute will receive an estimated 1.4 million dollars, making it the third highest ("Office of Management and Budget Report"). The importance of these programs, and the money spent, reflects the compassion felt by most Americans for anybody suffering from a deadly disease. This also is an effective way of dealing with a negative consequence of an action that most Americans, especially smokers, consider their right.
However, hidden beneath the sympathy for the suffering, is a not-so-subtle rejection of smokers. At every possible chance, smokers are reminded that they are engaging in a "filthy habit". They are not allowed to smoke while flying on passenger airplanes or in government buildings, they have special sections set up for them in many eating establishments, and they can be found outside any office building or workplace, huddled together in sometimes inclimate weather, exercising their right to fill their lungs with a substance they know is killing them slowly. Hardly any non-smoker would feel regret at suggesting that people should not smoke. This stigmatization and healthy rejection of smoking by society is an effective way of dealing with an action that is known to cause dire consequences, which society ultimately pays for.
In 1995, the number of people who died from AIDS peaked at about 50,000. Since then, that number has declined to about 37,000 deaths per year ("A Deadly Dance" 77). Since the reported outbreak of HIV and AIDS, there have been over 548,000 cases in the United States, with 343,000 reported deaths ("AIDS: Quick Facts"). Roughly 25% of these cases were from IV drug use, a smaller number of cases were from transfusion or transplants, and the rest contracted the disease from sexual contact ("US AIDS data through December 1995").
Although unprotected sex puts anybody who practices it at risk, the most at-risk group in the United States are male homosexuals. Despite this fact, a variety of surveys found that about one-third of gay men in their 20's typically engage in anal intercourse without using condoms ("Young gay men ignore safe sex warnings, scientists say"). No such statistic could be found for the number of heterosexuals who practice un-safe sex, but it is probably just as common. Un-safe homosexual sex is becoming so prevalent, a new term has emerged: "barebacking". As reported by Newsweek, young gay males are actually advertising through electronic mail searching for "barebacking" partners (77). For some, it is the thrill of looking over the edge, tempting fate. For others, it would actually be a relief to catch the disease and stop worrying about it. Still others have confidence in new forms of treatment. Finally, and this is something shared by homosexuals and heterosexuals alike, safe sex is often inconvenient.
American society's attitudes toward this problem are somewhat askew when compared to smoking. Although AIDS is not a leading cause of death in America, not even in the top five, The Office of AIDS Research will receive an estimated 1.5 million dollars in 1998, making it the second highest federally funded health research program in America ("Office of Management and Budget Report"). This reflects not only concern for the victims, but also the concern over the spreading of the disease. Everyone who engages in sexual intercourse is at risk, and since just about everybody likes to have sex, the concern of this disease over others, such as smoking, is increased. It may be this concern that tips the scales in favor of focusing on eliminating the negative consequence of this action.
When discussing the action in this matter -- sexual intercourse, gay or straight -- there is not a clear-cut morality to make the discussion easier. A non-smoker holds the moral high ground over a smoker. Other than clergy, who holds the moral sexual high ground? It is not an easy matter for one person to say to another "don't do it". Anybody that seriously suggests abstinence or monogamy as a way to prevent catching HIV and AIDS is usually setting themselves up for ridicule and condescension. Instead, the focus is on "safe-sex", the use of condoms. This is really only a half step.
Since the term "free love" came about in the 1960's, many people feel the battle over sexual freedom has been won. Expressing yourself sexually with multiple partners has come a long way to acceptance in American society. Along with this victory has come an increase in unwanted pregnancies, most disturbingly among teenagers, and sexually transmitted diseases, including AIDS. But that connection is seldom made -- one thing has nothing to do with the other, the action and the consequences are divorced. It is easier to believe that these modern problem have modern remedies, that the consequences can be dealt with, than it is to believe that the sexual revolution was a mistake, and that we should "regress" to more fundamental morals about sex. Victims of the AIDS virus were only doing what comes naturally, they couldn't help themselves, and should not be held responsible, according the politically correct thought of our time.
Actions have consequences, and sometimes these consequences affect society. Should the society restrict the action, maybe trampling on individual rights? Or should the society focus on defeating the consequence, even though doing so may encourage the action to continue? These questions can be applied to every modern societal problem. The pattern must fit the circumstance, and can't be one-size-fits-all. The final question is this: How far should society go to pay for the consequences of the risky behavior of individuals? This has yet to be answered.
By Matthew R. King
"1995 Final Mortality Statistics Released". National Center for Health Statistics June 17, 1997. On-line. Internet. October 6, 1997.
"Aids: Quick Facts". CNN Interactive April 1997. Fitness and Health. On-line. Internet. October 6, 1997.
Collins, Tom. "Health Care vs. Disease Care". LifeMatters Magazine. Health. On-line. Internet. October 5, 1997.
"Drug Information: Tobacco". Drug-Free Resource Net. On-line. Internet. October 5, 1997.
Manning, Anita. "AIDS death rate continues to decline". USA Today August 11, 1997. Health. On-line. Internet. October 6, 1997.
"Office of Management and Budget Report". Fedstats September 11, 1997. On- Line. Internet. October 5, 1997.
Peyser, Marc. "A Deadly Dance". Newsweek September 29, 1997: 76-77.
Rutz, Dan. "Young gay men ignore safe sex warnings, scientists say". CNN Interactive July 8, 1996. Food & Health. On-line. Internet. October 4, 1997.
"U.S. AIDS data through December 1995". USA Today August 9, 1997. Health. On-line. Internet. October 5, 1997.
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