He was nearly 84. Married for over 53 years, he raised two children and adored two grandchildren. He was also a friend and a business owner. But in the medical world, he was often seen simply as a smoker. 

He started smoking as a teenager in the late 1950s, when it was the norm. In 1984, when I was 12 and he was 43, he quit—a noteworthy decision at a time when 43 percent of Canadian men smoked. 

Cigarettes were everywhere: at work, in restaurants, even on planes. Quitting wasn’t part of the conversation. But he did it for us, his family, and with strength from his faith, he never picked up a cigarette again.

In the 1990s, tobacco control groups like the Non-Smokers’ Rights Association, the Canadian Coalition for Smoking and Health and Physicians for a Smoke-Free Canada ramped up efforts to reduce smoking in Canada. Over the next two decades, smoking rates fell by 33 percent. 

This success was driven by graphic warning labels, steep tobacco taxes, widespread smoking bans, a full advertising ban and expanded cessation support. But perhaps the most powerful tool was denormalization, a campaign that reframed smoking as not only dangerous, but socially unacceptable. 

As public tolerance for smoking declined, people who smoked began to feel increasingly marginalized, not just for health reasons, but socially. In 2010, a qualitative study of 25 Vancouver residents who currently or formerly smoked illustrated the discomfort many felt. Participants described a sense of social exclusion as public spaces were increasingly dominated by non-smokers, and experienced profound stigma around their addiction. 

What I remember most is sitting with him in the ICU and hearing a nurse say, almost dismissively: “Well, what do you expect? He smoked.”

My dad had struggled with respiratory issues for years, partly due to significant asbestos exposure throughout his life as he worked on warships, in tanker rooms and as an electrician. 

Over Christmas 2023, he was struggling to breathe. Over the course of three emergency visits, he was repeatedly diagnosed with various lung-related conditions: pneumonia, fluid in the lungs and other respiratory issues. 

The assumption was always clear: He had smoked, therefore the problem had to be rooted in his lungs. But it wasn’t. 

It wasn’t until his fourth visit in 10 days that someone finally looked beyond his lungs, and that’s when they found the tumor in his windpipe. He was rushed into surgery and underwent an emergency tracheotomy. Remarkably, he recovered from the procedure within a week, and the cancer was successfully excised.

Yet what I remember most is sitting with him in the ICU and hearing a nurse say, almost dismissively: “Well, what do you expect? He smoked.”

This is what stigma looks like in our health care system. This is what happens when we teach an entire generation that smoking isn’t just unhealthy, but blameworthy. That those who smoked, no matter whether or when or why they stopped, brought it on themselves.

Today, most Canadians who smoke are older people who have tried to quit but not been able to do so. Yet 90 percent don’t know that vaping is significantly safer. Why? Because Canadian tobacco control leaders blur the line between nicotine and combustion. They often stay silent, but more often mislead Canadians about safer alternatives like vaping and nicotine pouches, equating them with cigarettes despite the absence of combustion.

This year, about 48,000 Canadians will die from smoking-related causes. I won’t know if my father will be counted. What I do know is that we must end the stigma. 

Youth smoking in our country is under 5 percent. For Canadians overall, the rate is 12 percent. Canada has a good chance to hit its goal of becoming a “smoke-free” country (prevalence under 5 percent) by 2035. But that chance will vanish if we don’t make significant changes to attitudes, and hold tobacco control entities accountable for the misinformation they are sharing about safer substitutes. We need to be honest about harm reduction, and part of that is treating people who still smoke and those who used to with dignity, not disregard.

Health equity matters. Empathy matters. My dad never deserved judgment. His lung specialist gave his lungs a clean bill of health earlier this year. But either way, he deserved care—and so do the millions of Canadians who still live in the shadow of shame because of attitudes toward their past or present nicotine use. 

Tobacco control leaders helped transform Canada’s smoking culture and reduce deaths. But they did so by generating stigma that should have no place in our society today. I’m calling on them to rise again, to support tobacco harm reduction and stop stigmatizing all forms of nicotine use. They can celebrate their success in reducing smoking rates, while also taking responsibility for the legacy of shame they created. They must stop repeating those mistakes with safer nicotine products. 

This year, about 48,000 Canadians will die from smoking-related causes. I won’t know if my father will be counted among that number. What I do know is that we must end the stigma. 

Photograph of the author’s father, Aristotelis Papaioannou, courtesy of Maria Papaioannoy 

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