Friday, January 21, 2011

Risks, Control, and Public Health

“…The ‘web’ of causation that is often constructed to show why individuals may choose to smoke draws attention to such factors as stress, lack of knowledge about side-effects of smoking, addiction to nicotine, low self-esteem, and low self-efficacy. While the sociocultural context is clearly important here, it is generally reduced to the individual level: a person feels stress and smokes to alleviate it, lacking the self-esteem and self-efficacy she or he requires to give it up. The questions of how ‘stress’ is generated, why that particular individual should be suffering from ‘stress’ in comparison to others, and the sources of that individual’s lack of self-esteem and self-efficacy are often glossed over for a focus upon ‘improving’ self-esteem and self-efficacy and alleviating stress, so that the individual may then give up smoking. Such individualistic understandings of smoking behavior tend to ignore or at the very least play down the whole panoply of broader sociocultural phenomena around smoking, including the cultural and symbolic meanings of smoking, the use of cigarettes as commodities to define the self, and the economics and politics of the production and marketing practices to do with cigarettes” (48).

The above news clip entitled “E-Cigarettes: Healthy Habit or New Hazard” from The Associated Press presents the phenomenon of the “e-cigarette.” These electronic pipes, manufactured by a Chinese company, serve as a possibly “healthy” alternative to the normal cigarette. Instead of smoke, they produce a fine nicotine spray that is quickly absorbed by the lungs. Therefore, one can have an e-cigarette around others without the concern of second-hand smoke. However, these facts do not prove to be universally accepted. While the product designer claims the e-cigarette to be a safe alternative to regular cigarettes and a way to kick the habit, the World Health Organization (WHO) remains concerned about the content of e-cigarettes and of long-term medical effects. Additionally, since they contain nicotine, e-cigarettes are still addictive, which seems to be in contrast with the overall goal of the product.

The mere existence of a cigarette alternative indicates an issue with normal cigarettes, with which Peterson and Lupton would surely agree. Classified as a “risky behavior,” cigarette smoking joins a wealth of other activities and life-style choices that public health labels as “risks” (23). Other “risk factors” include, but are not limited to, smoking, alcohol, diet, exercise, reproductive behavior, driving behavior, social relationships, the occupational environment, pollution, and the built environment (19).  The authors claim that “one of the key tasks of this expanding system of expert knowledge (public health) is to track down, calculate and eliminate the ‘risks’ that are seen to pervade all aspects of human life” (18). They acknowledge the social, cultural and political processes that shape risks and recognize that morality influences the interpretation of risk factors (18). Ultimately, the “calculation of risks” legitimates interventions based on an “expert assessment that an undesirable event may occur,” which helps them advance their goal of achieving health through intervention (19).

Later in Chapter 2, Peterson and Lupton discuss the epidemiology of risk. Though the term “risk” usually designates “something that can be given a numerical value,” in the case of public health the term mostly denotes danger (48). They also acknowledge that, in the realm of risk, epidemiology manipulates which outcomes and risk factors to focus on (47). These decisions are “surrounded by culturally defined moral problems in which power relations always have a central position” (47). Therefore, risk is a “sociocultural construct” informed by moralism with an emphasis on personal responsibility (48). Smoking cigarettes is no exception. The introductory block quote illustrates the framing of cigarette smoking in a complex socio-cultural and political context. The “web of causation” includes not only individualistic understandings of the behavior, but also the “broader sociocultural phenomena around smoking” (48).

Among these “sociocultural phenomena” lies the “use of cigarettes as commodities to define the self” (48). Therefore, cigarette smoking may constitute a part of a person’s identity, helping them form their sense of self. Relatedly, Peterson and Lupton discuss the constructions of “self” and “other” in epidemiological discourses, which tend to focus on the categorization of social groups as “normal” or “abnormal” (55). “As part of this process of drawing a dichotomy between ‘high risk’ or ‘unhealthy’ groups and ‘low risk’ or ‘healthy’ groups, fears about social order, death and disease may be projected by the latter onto the former” (55). Therefore, in trying to construct their identities, non-smokers may use commonly held moral assumptions about smokers to bolster their sense of self, while smokers may just be using smoking to help form their identity. Therefore, smoking and non-smoking and moral judgments regarding the habit all serve individuals in the fabrication of their identities.

Ultimately, the demand for e-cigarettes demonstrates Peterson and Lupton’s assertions that society is obsessed with notions of health to the point where they comply almost voluntarily with the principles and guidelines of public health. The authors stress the remarkable extent of “health-related concerns” in contemporary Western societies (1). Therefore, it logically follows that “by providing norms by which individuals are monitored and classified, and against which individuals may be measured, the emphasis of the new public health is upon persuading people to conform voluntarily to the goals of the state and other agencies,” including public health (12). Thus, in identifying smoking as a “risk factor,” public health attempts to dissuade people from smoking, and the demand for e-cigarettes proves their attempts to be successful and provides evidence for the control of public health on society. People conform voluntarily to public health standards because of their desire to achieve “health,” which may be a reason for them to transition from normal to e-cigarettes. 


Alan Peterson and Deborah Lupton. 1996. “The New Public Health: A New Morality?” and “Epidemiology: Governing by Numbers.” Pp. 1-60. IN The New Public Health: Health and Self in the Age of Risk. London: Sage Publications.

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