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Terms of Use Terms of Use The copyright of this thesis is owned by its author. Any reproduction, adaptation, distribution or dissemination of this thesis without express authorization is strictly prohibited. All rights reserved. BEYOND PUBLIC HEALTH: THE CULTURAL POLITICS OF TOBACCO CONTROL IN HONG KONG CHAN WAI YIN PHD LINGNAN UNIVERSITY 2009 BEYOND PUBLIC HEALTH: THE CULTURAL POLITICS OF TOBACCO CONTROL IN HONG KONG by CHAN Wai Yin A thesis submitted in partial fulfillment of the requirements for the Degree of Doctor of Philosophy in Cultural Studies Lingnan University 2009 ABSTRACT Beyond Public Health: The Cultural Politics of Tobacco Control in Hong Kong by CHAN Wai Yin Doctor of Philosophy This work provides cultural and political explanations on how and why cigarette smoking has increasingly become an object of intolerance and control in Hong Kong. Since the 1980s, the smoking population has been falling. Smoking behavior, sales and promotion of cigarette products have been under close surveillance by the government, medical experts and society at large. Cigarette smoking, as well as smokers, has increasingly been rejected and demonized in the public discourse. What are the conditions that make the growing intolerant discourses and practices against cigarette smoking possible and dominant? Why and how has the tobacco control campaign become prevalent as a governmentalist project, which is strong enough to tear down the alliance of tobacco industry giants? Why is tobacco singled out from other legal but harmful substances, such as alcohol, as an imperative object of intolerance and control? This work tackles these questions by adopting a Foucauldian discursive approach and the theory of articulation developed in cultural studies. By considering tobacco control as a historical and contextual practice, it traces the specific trajectory of tobacco control in Hong Kong, maps the cultural and political contexts that make it possible, and considers its consequence regarding the complex relationship among control, construction of risk, identity and freedom in society. CONTENTS LIST OF FIGURES v ACRONYMS AND ABBREVIATIONS vii ACKNOWLEDGEMENTS ix Chapter 1 INTRODUCTION 1 2 MAKING SENSE OF TOBACCO CONTROL IN HONG 30 KONG: THEORY AND METHODOLOGY Medicalization Critique 31 Foucauldian Perspective on Health and Medicine 34 Foucauldian Conception of Power and Governmentality 34 Risk and Governmentality 39 Application of Foucauldian Concepts to the Medical 48 Context New Public Health Critique 51 New Public Health Critique on Tobacco Control and its 57 Inadequacy Methodology 61 Discursive Approach 62 Theory of Articulation 70 3 THE DISCURSIVE FORMATION OF A GLOBAL 84 TOBACCO EPIDEMIC The Centrality of Epidemiology in the Smoking Issue: Linking 86 Cigarette Smoking with a Modern Epidemic of Lung Cancer Dissemination of Epidemiological Evidence to the Public 95 Before the 1980s: Cigarette Smoking as an Informed Choice 110 of Adults Since the 1980s: Cigarette Smoking as a Global Epidemic 122 Mounting Evidence and Warnings 124 i Emergence of a Global Tobacco Epidemic 126 Health Hazards of Cigarette Smoking as Commonsensical 133 Knowledge Spread of Smoking-related Health Problems, Diseases 149 and Deaths Spread of the Habit of Cigarette Smoking 162 Socioeconomic Implications of Cigarette Smoking 174 Pronouncement of a Global Tobacco Epidemic 179 Conclusion 187 4 CURBING THE TOBACCO EPIDEMIC 193 Identifying the Vectors of the Tobacco Epidemic 195 Blaming the Tobacco Industry 196 Blaming the Smokers 212 Mobilizing the Community 238 Calling on Responsible Medical Practitioners 239 Calling on a Responsible Government 242 Calling on Responsible Lawmakers 246 Calling for Corporate Responsibility 251 Calling for a Responsible Community 261 Legitimate Intolerance 263 Banning Smoking and Smokers in the Media 265 Banning Smoking and Smokers in Public Areas 271 No Smoking is Good for You and Me 285 Heavy Taxation 291 Tobacco Control as a Globalizing Movement 296 Conclusion 307 5 COMPARING THE PUBLIC DISCOURSES ON 311 CIGARETTE SMOKING AND ALCOHOL DRINKING Erosion of Alcohol Control Advocacy 313 Normalization of Alcohol 313 Medical Debate on the Health Benefits of Moderate 320 Drinking Liquor Industry’s Strategy: “Not in the Bottle but in the 322 Man” Abandonment of Alcohol Control 326 ii Public Discourse on the Benefits of Moderation 331 Prevalence of Alcohol Drinking in Hong Kong 339 Alcohol Drinking as a Social Recreational Activity 341 Alcohol as an Emblem of Class Identity 344 Delimiting Smoking and Drinking: Discrepancy between 359 Taxation Policies on Tobacco and Alcohol Alcoholism, Binge Drinking and Youth Drinking as 380 Under-recognized Problems Alcoholism and Binge Drinking 381 Youth Drinking 395 Public Order as an Object of Concern 404 Lan Kwai Fong Incident: From a Youth Drinking Issue to 404 A Lesson for Crowd Control Liquor License Mechanism and Criminalization of Public 414 Drunkenness as Measures of Order Maintenance Criminalization and Demonization of Drink-Driving: 417 Creating a Public Order Conclusion 443 6 CIVIC NEOLIBERAL POPULISM AS A MODE OF 449 GOVERNANCE IN HONG KONG Civic Neoliberalism as a Political Rationality 456 Populism as a Mode of Articulation 464 Tobacco Control in Hong Kong as a Civic Neoliberal 469 Populist Practice Civic Neoliberal Populism as a Mode of Governance 475 Good Government for the People 480 Economic Health and Growth as the Policy Priority 486 Building Up a Responsible Citizenry 489 Conclusion 504 Appendix 1 Chronology of Tobacco Control 521 2 Major Provisions of the Smoking (Public Health) Ordinance, 531 1982-2006 3 Tobacco Duty in Hong Kong, 1982-2010 537 4 Daily Cigarette Smokers as a Percentage of All Persons Aged 543 15 and Over, 1982-2008 (%) iii 5 Number of Daily Cigarette Smokers Among All Persons aged 545 15 and over, 1982-2008 (’000) 6 Daily Cigarette Smokers as a Percentage of All Persons by 547 Age, 1982-2008 (%) 7 Composition of Daily Cigarette Smokers by Age, 1982-2008 549 (%) 8 Number of Daily Cigarette Smokers by Age, 1982-2008 551 (’000) 9 Daily Female Cigarette Smokers as a Percentage of all 553 Female by Age, 1982-2008 (%) 10 Composition of Daily Female Cigarette Smokers by Age, 555 1982-2008 (%) 11 Number of Daily Female Cigarette Smokers by Age, 557 1982-2008 (’000) 12 Average Number of Cigarettes Smoked Per Day Among All 559 Persons Aged 15 and Over, 1982-2008 13 Number of Daily Cigarette Smokers by Whether Had Tried / 561 Wanted to Give Up Smoking, 1982-2008 (’000) 14 Sales of Alcohol Drinks by Sector: Total Volume, 1992-1996 563 15 Sales of Alcohol Drinks by Sector: Total Value, 1992-1996 565 16 Sales of Alcohol Drinks by Sector: Total Volume, 2001-2006 567 17 Sales of Alcoholic Drinks by Sector: % Total Volume 569 Growth, 2001-2006 18 Sales of Wine by Sector: Total Volume 2001-2006 571 19 Sales of Wine by Sector: % Total Volume Growth 2001-2006 573 20 Consumption of Alcohol Attributed to Driver’s Consumption 575 of Alcohol by Severity of Road Traffic Accident, 1991-2006 21 Number of Arrests for Drink Driving, 1998-2007 577 22 Prosecutions Against Drink Driving Arising from Road 579 Traffic Accidents, 1998-2007 BIBLIOGRAPHY 581 iv LIST OF FIGURES 3.1 Newspaper headline: “Just one puff cuts your life by minutes.” 100 3.2 Government anti-smoking poster: “Be considerate. Think before you 124 smoke.” 3.3 Government anti-smoking poster: The lung as an ashtray. 134 3.4 COSH TV commercial: “Smoking kills.” 139 3.5 Tobacco Control Office’s poster: “One equals two.” 152 3.6 Bai Xing magazine: The sudden death of Legislator Cheong 156 Kam-chuen. 3.7 Pictorial health warnings on cigarette packet. 160 3.8 South China Morning Post: The costs of smoking. 176 3.9 RTHK documentary Smoke Free Planet. 184 4.1 TIHK newspaper advertising campaign: “Advertising bans are wrong 201 for Hong Kong.” 4.2 Educators’ newspaper advertisement: “We want good TV programs, 203 but we want our next generation to be healthy even more.” 4.3 Guang Jiao Jing magazine: The smoker as a responsible victim. 214 4.4 Ming Pao Daily News: Smoking parents endanger their children. 216 4.5 The Sun: A smoker assaults a female hawker after being asked to stub 225 out his cigarette. 4.6 U-beat magazine: A smoking street kid. 230 4.7 Mr. Coconut: A clumsy and chained smoker from the mainland. 232 4.8 Ming Pao Daily News: Medical expert as a disinterested and 242 passionate campaigner against cigarette smoking. 4.9 Anti-smoking posters: Everyone is duty-bound to participate in the 263 tobacco control campaign. 4.10 No-smoking film From Ashes to Ashes: Leslie Cheung quits smoking. 270 4.11 Anti-smoking posters: Smokers should choose a healthful lifestyle for 285 their own sake. 4.12 Ming Pao Daily News: Quitter as a caring mother. 290 4.13 Ming Pao Daily News: The European Union plans to legislate a total 300 smoking ban. 5.1 Covers of Wine Now magazine. 351 5.2 Ming Pao Daily News: Professional sommelier and wine drinker. 352 5.3 Ming Pao Daily News: Liquor industry lobbies for an exemption of 371 alcohol duty. 5.4 Ming Pao Daily News: Drunken truck drivers endanger the Mainland 441 v and Hong Kong. 6.1 Keep Hong Kong Clean publicity: “Hong Kong is watching: 493 Cleanliness is a way of life” and “Beat Filth.” vi ACRONYMS AND ABBREVIATIONS ADPL Hong Kong Association For Democracy And People’s Livelihood BA Broadcasting Authority CDAC Community Drug Advisory Council CDO City District Offices CE Chief Executive CEPCG Catering Entertainment Premises Smoking Ban Regulations Concern Group COIAO Control of Obscene and Indecent Articles Ordinance
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