Health risks, health promotion and public health: sociological perspectives
1) Introduce public health and health promotion as an ideological project.
Public health
“The science and art of promoting and protecting health and well-being, preventing ill-
health and prolonging life through the organised efforts of society”. Faculty of Public Health,
2014
Public health is not about individual treatment, about managing the bigger picture.
Public health can be seen in different ways – sociological, seen in different ways.
‘old’ 19th century public health
• Sub branch of medicine; social medicine with a focus on social reform – housing,
sanitation, pollution, working conditions. Improving living conditions as this is what
was causing ill health
• Edwin Chadwick (1842) Sanitary Reforms of the Labouring Classes (20,000 copies
sold 2 weeks)
• Public Health Acts 1848; 1872 and 1875 – provisions about sanitation and pollution
etc.
• 1954 john snow cholera and the broad street pump – took handle off pump as many
people gathered here for water, was the cause of cholera.
The new public health.
70s/80s new public health – importance of environment AND lifestyles (sociologically
interesting) lifestyles made it more controversial – peoples lifestyles as a cause for
health inequalities.
‘Public Health is once again on the move. After 40 years of a narrow focus on
treatment as the answer to all health problems, first lifestyles and now the
environment are once again being taken seriously! … Many contemporary health
problems are therefore seen as being social rather than solely individual problems.’ –
John Ashton p. 113 (Ashton & Seymour, The ‘New’ Public Health 1988)
BUT
Critiques this…
‘With… the new public health, the distinction between healthy and unhealthy
populations totally dissolves since everything potentially is a source of ‘risk’ and
everyone can be seen to be ‘at risk’. – Alan Petersen p. 195 (Foucault, Health &
Medicine 1997)
AND
All about health being your own fault, when really there are more significant factors
and other contributing factors. Changing the individual rather than the environment.
‘Critics of the new public health have … emphasised the individualism, behaviourism,
consumerism and ‘victim-blaming’ associated with the lifestyle emphasis of health
promotion’
– Petersen p. 203
, 2) Illustrate this across 3 areas:
a) the emphasis on lifestyles as a key to health
critiques of the emphasis on lifestyle
• sees health as ‘super value’ (Crawford) = all that is good in the personal search for
‘wellbeing’. Everything is to do with health, health like a religion. Health above
everything else.
• Health as dividing practice and victim blaming: healthy self (exercises etc) versus
unhealthy other (e.g. AIDS – people with AIDS seen as partaking in unacceptable
behavior so had AIDS)
• Seeing health practices as individual security strategies = what you can control in a
world full of dangers (see later slides on Ulrich Beck) doing healthy behaviors to
control something in a world you cannot control
• Crawford again – constant awareness of the world around you as dangerous, up to
you to protect your health from these things, you are responsible for protection
from health consequences such as bad food or pollution
Paradox of health obsession…
The more we think of health as an individual thing we are responsible for, more
anxiety is felt to protect ourselves and control it.
Anxiety is exploited for commercial purposes – blood pressure monitor, heart rate
monitor, BMI calculator, self help books.
How emphasis on lifestyle exculpates industry
• Lets commercial factors off the hook
• Crawford 2006: corporations are happy to move blame to individuals rather than
face regulation – peoples fault that they eat too much fast food, not ours, should
balance it
• Herrick 2009: food companies shift blame from food to diet to sedentarism, sitting
too much, little exercise etc, shifts blame and scrutiny from their product.
• See controversy over PHE working with alcohol industry (see left)
• Also see controversy over ‘sugar tax’
2b) the new pro-active work of patienthood.
May, C. R., Eton, D. T., et al (2014) (coined the phrase) Rethinking the patient: using Burden
of Treatment Theory to understand the changing dynamics of illness.
BMC health services research 14(1), 281.
‘Health services face the challenge of growing populations with long-term and life-
limiting conditions, they have responded to this by delegating to sick people and
their networks routine work aimed at managing symptoms…
This is the new proactive work of patienthood for which patients are increasingly
accountable: founded on ideas about self-care, self-empowerment, and self-
actualization, …shifted from the clinic into the community. These place new
demands on sick people, which they may experience as burdens of treatment.’
1) Introduce public health and health promotion as an ideological project.
Public health
“The science and art of promoting and protecting health and well-being, preventing ill-
health and prolonging life through the organised efforts of society”. Faculty of Public Health,
2014
Public health is not about individual treatment, about managing the bigger picture.
Public health can be seen in different ways – sociological, seen in different ways.
‘old’ 19th century public health
• Sub branch of medicine; social medicine with a focus on social reform – housing,
sanitation, pollution, working conditions. Improving living conditions as this is what
was causing ill health
• Edwin Chadwick (1842) Sanitary Reforms of the Labouring Classes (20,000 copies
sold 2 weeks)
• Public Health Acts 1848; 1872 and 1875 – provisions about sanitation and pollution
etc.
• 1954 john snow cholera and the broad street pump – took handle off pump as many
people gathered here for water, was the cause of cholera.
The new public health.
70s/80s new public health – importance of environment AND lifestyles (sociologically
interesting) lifestyles made it more controversial – peoples lifestyles as a cause for
health inequalities.
‘Public Health is once again on the move. After 40 years of a narrow focus on
treatment as the answer to all health problems, first lifestyles and now the
environment are once again being taken seriously! … Many contemporary health
problems are therefore seen as being social rather than solely individual problems.’ –
John Ashton p. 113 (Ashton & Seymour, The ‘New’ Public Health 1988)
BUT
Critiques this…
‘With… the new public health, the distinction between healthy and unhealthy
populations totally dissolves since everything potentially is a source of ‘risk’ and
everyone can be seen to be ‘at risk’. – Alan Petersen p. 195 (Foucault, Health &
Medicine 1997)
AND
All about health being your own fault, when really there are more significant factors
and other contributing factors. Changing the individual rather than the environment.
‘Critics of the new public health have … emphasised the individualism, behaviourism,
consumerism and ‘victim-blaming’ associated with the lifestyle emphasis of health
promotion’
– Petersen p. 203
, 2) Illustrate this across 3 areas:
a) the emphasis on lifestyles as a key to health
critiques of the emphasis on lifestyle
• sees health as ‘super value’ (Crawford) = all that is good in the personal search for
‘wellbeing’. Everything is to do with health, health like a religion. Health above
everything else.
• Health as dividing practice and victim blaming: healthy self (exercises etc) versus
unhealthy other (e.g. AIDS – people with AIDS seen as partaking in unacceptable
behavior so had AIDS)
• Seeing health practices as individual security strategies = what you can control in a
world full of dangers (see later slides on Ulrich Beck) doing healthy behaviors to
control something in a world you cannot control
• Crawford again – constant awareness of the world around you as dangerous, up to
you to protect your health from these things, you are responsible for protection
from health consequences such as bad food or pollution
Paradox of health obsession…
The more we think of health as an individual thing we are responsible for, more
anxiety is felt to protect ourselves and control it.
Anxiety is exploited for commercial purposes – blood pressure monitor, heart rate
monitor, BMI calculator, self help books.
How emphasis on lifestyle exculpates industry
• Lets commercial factors off the hook
• Crawford 2006: corporations are happy to move blame to individuals rather than
face regulation – peoples fault that they eat too much fast food, not ours, should
balance it
• Herrick 2009: food companies shift blame from food to diet to sedentarism, sitting
too much, little exercise etc, shifts blame and scrutiny from their product.
• See controversy over PHE working with alcohol industry (see left)
• Also see controversy over ‘sugar tax’
2b) the new pro-active work of patienthood.
May, C. R., Eton, D. T., et al (2014) (coined the phrase) Rethinking the patient: using Burden
of Treatment Theory to understand the changing dynamics of illness.
BMC health services research 14(1), 281.
‘Health services face the challenge of growing populations with long-term and life-
limiting conditions, they have responded to this by delegating to sick people and
their networks routine work aimed at managing symptoms…
This is the new proactive work of patienthood for which patients are increasingly
accountable: founded on ideas about self-care, self-empowerment, and self-
actualization, …shifted from the clinic into the community. These place new
demands on sick people, which they may experience as burdens of treatment.’
