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ebate has been rife over whether smokers can receive state-paid healthcare benefits, which I argue they should. In light of Jakarta Governor Fauzi Bowo’s proposal to exclude smokers from free healthcare in Jakarta, it is timely to review the reasons why this plan can’t be justified.

One of the most cited justifications for the governor’s proposal is an economic argument. Smokers, proponents of the plan say, are not poor or can’t be considered poor and therefore do not deserve benefits intended for the poor.

But how do we define and measure poverty? Can smoking be included in the measurement?

One way to look at poverty is by measuring consumption levels. The World Bank defines poverty as the inability to fulfill a certain level of consumption for basic needs, such as food or healthcare. Thus, proponents say, smokers deprive themselves of basic needs by spending money on cigarettes. Spending money on cigarettes is a waste indeed, but this argument only holds true if the counterfactual holds: that they would otherwise spend this money on basic needs. But would they?

Proponents also argue that the proposal serves as a disincentive to smokers so they would give up smoking in pursuing a free healthcare. It is a sort of punishment for smokers, albeit a weak and dishonest one.

The addictive property of nicotine has made efforts to encourage people to quit smoking far from easy. Most smokers fail in their attempts to stop. Many have struggled, sometimes for years, and succeeded, but they often relapse. In addition, successful cessation is often linked to increased access to assistance to quit smoking rather than preventing smokers from seeing doctors.

Not only is this punishment not evidence-based, it is also deceitful. It is like changing the rules of the game when the ball is already rolling. Where were we when these smokers took a puff on their first cigarettes? Did we tell them then they were going to lose their access to free healthcare?

Lastly, there is my favorite fairness argument — that it would be fair to place the burden of smoking-related illnesses on those individuals who smoke and relieve the rest of the society, the non-smokers, from paying for their illnesses. Smokers, indeed, are more susceptible to some diseases and are likely to use more healthcare services compared to non-smokers. This argument is correct, but only superficially.

In saying that an individual is held responsible for his/her actions, we are claiming that the action is completely voluntary and based on complete information of what such action would cause. In the case of smoking, is it fair for us to say this behavior is completely voluntary and deliberate?

Most smokers started smoking when they were young; some when they were just toddlers. I would argue that the initiation of smoking, for many, is not a voluntary decision made following a careful deliberation on complete information covering what health hazards smoking causes. In fact, most smokers hardly have complete information. The small warning box neither tells them how likely they are to suffer from those conditions nor warns them how cigarette smoking will affect their household finances.

The lack of information is aggravated by the aggressive cigarette sales promotions. Smoking role models have long been established — from the infamous Marlboro man to a successful architect. At schools, peer pressure plays an important part in smoking initiation. Worse still, our soccer league is named after a famous cigarette brand. So don’t we, society and the state, allow all this to happen and shouldn’t we be held responsible for these individuals’ smoking?

Fairness demands that we treat smokers and non-smokers equally. But we can’t be completely fair on smokers unless we can be certain that “the punishment fits the crime.” Smokers smoke differently and non-smokers suffer from diseases causally linked to smoking, too. How can we correctly quantify the contribution of smoking on the development of those diseases? Is banning smokers, let alone their families, from free healthcare a proportionate and fair punishment?

In sum, excluding smokers from free healthcare has no strong justification. It certainly has no prior evidence, or perhaps even hypothesis, that it would succeed to change smokers’ behavior.

I am a strong believer that smoking is evil, but I also believe that imprudent public health policy, such as this, will only see the most disenfranchised suffer further.

Moreover, by adopting such a policy we risk going too far. If smokers are banned from getting free healthcare services, shouldn’t we move on and ban patients from receiving treatment in severe head injury cases resulting from speeding collisions without a helmet or seat belt? What about diseases related to a lack of exercise or salt consumption?

As a nation, we ought to care about the poor, including those who smoke. Rather than further depriving these people of services they need the most, the state should proactively help them to quit smoking, for example by giving them access to smoking cessation programs.

After all, the state should be held responsible, at least partly, from failing to protect its citizens from being smokers in the first place.

The writer is a public health lecturer at Padjadjaran University School of Medicine, Bandung, and a doctoral degree candidate at the Harvard School of Public Health.