From a relatively early stage in his life, my father was a smoker. There was nothing unusual in this. He grew up at a time when well over 50% of Canadian men smoked. Through his university days, his doctorate in engineering, and the early years of his career at the utility Ontario Hydro, he continued a habit that he shared with at least a large minority of his fellow Canadians.

How times have changed. Smoking rates have declined rapidly in Canada, to the point that a recent survey says that as few as 11% of Canadians smoke daily. Cigarette packs carry mandatory warning labels with graphic images of decayed teeth, cancerous mouths and other grisly health damages. And, most important to me personally, my father quit smoking around the time of the birth of my older sister. He hasn’t smoked a cigarette in over 35 years.

But the transformation is more than just about awareness of health risks. It is also about cultural perceptions. My attitude towards smoking was formed early in my life: I was taught – at home, at school, and by the media – to regard smoking as not just dangerous, but also disgusting and shameful. In my experience, Canadians, at least non-smokers (who form the vast majority), overwhelmingly regard smoking as something to hide, something to be embarrassed about, something done by the poor, the uneducated, the lowest-ranking members of our society, or by the elderly who have never managed to mend their ways.

I don’t mean to say that this is a wonderful state of affairs. Surely, the association of a disgusting habit with low-income and less-educated people has its undesirable side. And I don’t entirely know how this happened. But, at least as far as reducing smoking goes, it seems to have served its purpose: smoking provokes feelings of revulsion and looks of disgust.

Living all my life in Canada, and then in Princeton, New Jersey, for my PhD, I found those attitudes were quite common. I have a hard time remembering seeing someone smoke on the Princeton campus more than a handful of times. In such a place of higher learning, in particular, the shame of smoking would expectedly be intense.

High cool quotient

And then, 20 months ago, I moved to France. There were a number of things I had to get used to: stores that close for 3 hours at lunch, the intricate rituals of the immigration department and its officials who never answer their phones and send you to the local tobacconist (which, to foreshadow the story to come, are ubiquitous) to obtain important immigration documents, and the delicious bread and ensuing weight gain. But most shocking of all was the smoking.

Recent estimates of French smoking rates are around 30% of adults. In the context of Europe this is not unusual – in fact, the rate has declined considerably from what it was decades ago. But what was remarkable to me was the openness of it, the way people in nice suits or with fancy handbags walk confidently down the street with a cigarette in hand, and the propensity to smoke among academics and the generally well-off. There almost seems to be a sense of coolness, of sophistication, in having a cigarette dangling from your mouth, from blowing clouds of smoke – a coolness that existed in North America decades ago but has long since evaporated.

The statistics support this interpretation as well: a recent Eurobarometer survey on attitudes towards smoking finds that, among both ex-smokers and those who attempted to quit in the previous 12 months, only 1% cite “society’s disapproval of smoking” as one of the factors that influenced their decision. This is the lowest value of any country surveyed. And while just one data point, it is consistent with my observations that there simply isn’t any disapproval of smoking by society at large.

To the extent that ideas of style and sophistication are influenced by young adults, a partial explanation can be found in the statistics on rates of smoking among different age groups in France: smoking rates are higher than the national average for people aged 20-44, at 40.6% for males and 32.8% of females, compared to only 27.2% and 17.1% of those aged 45-64. The situation is especially bad among young women: an additional 22.9% are former smokers, leaving only 44.3% who have never smoked, which is the lowest in the European Union. (As a young man interested in meeting young women, but for whom non-smoking is non-negotiable, I can confirm that this is strongly in line with my observations; the percentage of otherwise attractive young women I see with a cigarette is disturbingly high.)

The role of culture

Of course, there could be many factors involved here, but I am certain that culture is one of them: in France – and probably in other European countries as well – the common cultural attitudes towards smoking are far more positive than in North America. And at least some people in France are aware of the problem: an anti-smoking group made headlines a few years ago when it commissioned ads comparing smoking to forced oral sex. Whether or not this was the best way to make smoking appear disgusting – some people complained that it trivialised sexual abuse (though note the implication that risks of smoking are “trivial”) – it does indicate a sense of desperate frustration at the continued lack of social pressure against smoking in France.

Given the profound health risks from smoking, it is clear that understanding and addressing the cultural aspects of the French smoking problem is essential. Canada once had a similar problem, in which smoking was regarded as an acceptable and even sophisticated behaviour, and yet through a variety of measures, including government action, these attitudes have been dramatically shifted. Smoking is now widely regarded as a disgusting habit that pollutes oneself and one’s family and friends, with considerable social pressure against its practice.

So why did I just write this long story about culture and smoking in France and Canada, for a publication based in India? The simple point that culture can matter for behaviour and health outcomes is an important one in the Indian context as well, particularly in the area of open defecation. As was the case with smoking in Canada decades ago, many people in rural India regard open defecation as a perfectly normal, even healthy behaviour. See, for example, a recent paper by researchers at the Research Institute for Compassionate Economics, which demonstrates that even in households that own latrines, a large fraction of individuals choose to defecate in the open, including as many as 40% of those living in households with government-provided latrines. Clearly the problem is far more complicated than just a lack of toilets.

New research continues to point to important costs of open defecation, including impacts on cognitive development and on future earnings. As with smoking, awareness of these health risks will play an important policy role – many people in rural India are unaware of the damages caused by open defecation. But as in modern-day France, even a solid understanding of the health risks is unlikely to be enough to eliminate the practice.

Just as in the case of smoking in France, changes in cultural attitudes, by reducing the social acceptability of open defecation, must play an especially powerful role in India. The Canadian experience shows us that culture can and does change – but that doesn’t mean that it is easy.

Nicholas Lawson is an economist at the Aix-Marseille School of Economics and is a non-resident fellow of r.i.c.e.