Theories of practice and public health understanding un healthy practices

Theories of practice and public health understanding un healthy practices


Critical Public Health




ISSN: 0958-1596 (Print) 1469-3682 (Online) Journal homepage: https://www.tandfonline.com/loi/ccph20




Theories of practice and public health:
understanding (un)healthy practices

Stanley Blue, Elizabeth Shove, Chris Carmona & Michael P. Kelly

To cite this article: Stanley Blue, Elizabeth Shove, Chris Carmona & Michael P. Kelly
(2016) Theories of practice and public health: understanding (un)healthy practices,
Critical Public Health, 26:1, 36-50, DOI: 10.1080/09581596.2014.980396
To link to this article: https://doi.org/10.1080/09581596.2014.980396




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, Theories of practice and public health understanding un
healthy practices

Critical Public Health, 2016
Vol. 26, No. 1, 36–50, http://dx.doi.org/10.1080/09581596.2014.980396




RESEARCH PAPER
Theories of practice and public health: understanding (un)healthy
practices
Stanley Bluea*, Elizabeth Shoveb, Chris Carmonac and Michael P. Kellyd
a
School of Social Sciences, Department of Sociology, University of Manchester, Manchester, UK;
b
DEMAND Centre/Department of Sociology, Lancaster University, Lancaster, UK; cCentre for
Public Health, NICE and Faculty of Medical and Human Sciences, University of Manchester,
Manchester, UK; dInstitute of Public Health, University of Cambridge, Cambridge, UK
(Received 27 March 2014; accepted 17 October 2014)

Psychological understandings and individualistic theories of human behaviour
and behaviour change have dominated both academic research and interven-
tions at the ‘coalface’ of public health. Meanwhile, efforts to understand per-
sistent inequalities in health point to structural factors, but fail to show
exactly how these translate into the daily lives (and hence health) of different
sectors of the population. In this paper, we suggest that social theories of
practice provide an alternative paradigm to both approaches, informing signifi-
cantly new ways of conceptualising and responding to some of the most
pressing contemporary challenges in public health. We introduce and discuss
the relevance of such an approach with reference to tobacco smoking, focus-
ing on the life course of smoking as a practice, rather than on the characteris-
tics of individual smokers or on broad social determinants of health. This
move forces us to consider the material and symbolic elements of which
smoking is comprised, and to follow the ways in which these elements have
changed over time. Some of these developments have to do with the relation
between smoking and other practices such as drinking alcohol, relaxing and
socialising. We suggest that intervening in the future of smoking depends, in
part, on understanding the nature of these alliances, and how sets of practices
co-evolve. We conclude by reflecting on the implications of taking social
practices as the central focus of public health policy, commenting on the bene-
fits of such a paradigmatic turn, and on the challenges that this presents for
established methods, policies and programmes.
Keywords: social practice; public health; behaviour change; smoking


Introduction: behaviour change paradigms in public health
The epidemics of non-communicable disease (NCD) resulting from smoking, alcohol
consumption, low levels of physical activity and obesity and the concurrent high rates
of type 2 diabetes, respiratory and cardiovascular diseases and cancer present consider-
able challenges to public health systems (Beaglehole et al., 2012; Horton, 2013;
Hosseinpoor et al., 2012; Lozano et al., 2012; United Nations General Assembly, 2011;
World Health Organization, 2012). Medicine can very precisely define the mechanisms
of the bio-pathogenesis involved in these diseases and the associated risk factors of
tobacco smoking, overconsumption of food and alcohol, and lack of physical activity.

*Corresponding author. Email:

© 2014 The Author(s). Published by Taylor & Francis.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License http://creativecom
mons.org/licenses/by/3.0/, which permits unrestricted use, distribution, and reproduction in any medium, provided the original
work is properly cited. The moral rights of the named author(s) have been asserted.