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Downloadable Symptomatic PUBLIC HEALTH AND THE RHETORIC OF PERSONAL RESPONSIBILITY by Monica (Mono) Brown B.A. (Hons.), University of Waterloo, 2005 M.A., The University of British Columbia, 2007 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY in THE FACULTY OF GRADUATE AND POSTDOCTORAL STUDIES (English) THE UNIVERSITY OF BRITISH COLUMBIA (Vancouver) April 2018 © Monica (Mono) Brown, 2018 ABSTRACT My dissertation examines the significance of public health messaging to perceptions of responsibility and risk. Central to this research is my view of public health campaigns as rhetorical texts—rhetoric being the art and study of persuasion—that employ discursive strategies of various kinds to achieve their aims. As rhetorical texts, public health campaigns provide a means of involving individuals in health promotion and disease prevention, which makes them a valuable resource amid growing concerns about rising healthcare costs worldwide. In four case studies, on hand hygiene, vaccination, antibiotic use, and “epidemic” obesity, I illuminate the persuasive means through which public health comes to be understood as, in the first instance, a matter of personal responsibility. Given that the rhetoric of personal responsibility places more of the onus for health on individuals than on systems, this rhetoric has long been criticized in health contexts as a form of “victim blaming.” Appeals to personal responsibility, for example, ignore the influence of context on health status. These appeals also induce cooperation among individuals by triggering feelings of anxiety, stigma, and blame. Some public health scholars celebrate these effects as essential to public health; I stress their potential to impede a society’s capacity to cope with infection. Throughout, I examine the relationship of the rhetoric of personal responsibility to neoliberalization—especially its advantages for the private sector, some of which come at the expense of public health. A political-economic theory, neoliberalism prioritizes privatization, deregulation, reduced spending on social welfare, and minimal government interference in the private sector. ii In each of my chapters, I critique public health’s neoliberalization by documenting consequences or conflicts of interest arising from the rhetoric of personal responsibility. One such conflict is the opportunity to profit from altered perceptions of risk and responsibility, an effect I demonstrate most emphatically in my chapters on hand hygiene and “epidemic” obesity. A rhetoric of personal responsibility also distracts from the reality that some problems—for example, antibiotic-resistant infections (ARIs) and declining vaccination rates—necessitate both societal and individual change. iii LAY SUMMARY My dissertation examines the use of public health messaging to involve individuals in maintaining public health. In it, I ask, “How does public health become a matter of personal responsibility? What are the consequences of premising public health on personal responsibility?” In four case studies, on hand hygiene, vaccination, antibiotic-use, and “epidemic” obesity, I illuminate the strategies used within public health to prioritize behaviour change over government regulation or support. While personal responsibility is seen as both necessary and beneficial to the work of preventing infection, I underscore its limits as an approach to public health. The emphasis on personal responsibility, for example, introduces into public health potential conflicts of interest, such as the increased opportunity to profit from altered perceptions of risk. A model of public health premised on personal responsibility is also too limited to address problems that necessitate both societal and individual change. iv PREFACE This dissertation is original, independent work by the author, Monica (Mono) Brown. A version of Chapter One has been published. “‘Don’t Be the Fifth Guy’: Risk, Responsibility, and the Rhetoric of Handwashing Campaigns.” Journal of Medical Humanities, 29 August 2017, https://doi.org/10.1007/s10912-017-9470-4. Parts of Chapter Four have also been published. “Appropriating Genre, ‘Taking Action’ Against Obesity: The Rhetorical Work of Digital Public Genres.” Genre and the Performance of Publics, edited by Anis Bawarshi and Mary Jo Reiff. Utah State University Press, 2016, pp. 201-218. v TABLE OF CONTENTS ABSTRACT ............................................................................................................................ ii LAY SUMMARY .................................................................................................................. iv PREFACE .................................................................................................................................v TABLE OF CONTENTS ....................................................................................................... vi LIST OF FIGURES .............................................................................................................. viii LIST OF ACRONYMS .......................................................................................................... ix ACKNOWLEDGEMENTS ......................................................................................................x INTRODUCTION ....................................................................................................................1 Neoliberalism, “Self-Imposed Risks,” and the Rhetoric of Personal Responsibility.. 3 Public Health Messaging: Risk, Responsibility, and Constitutive Rhetoric ..............10 Outline of Chapters .....................................................................................................13 CHAPTER ONE: Cultivating Personal Responsibility by Promoting Hand Hygiene ...........18 The Turn to Hand Hygiene Promotion in the Era of Emerging Diseases ................. 22 Handwashing Campaigns and the Rhetoric of Personal Responsibility ................... 30 Don’t Be the “Fifth Guy”: Risk and Responsibility in Public .................................. 42 Personal Responsibility and Shared Perceptions of Infection Risk .......................... 46 The Limits of Personal Responsibility for Infection Risk ........................................ 48 CHAPTER TWO: “Separating Fact from Myth” ...................................................................52 Anti-Vaccination Activism .........................................................................................58 MMR-Autism: False Balance and the Need to Defend Vaccine Science ..................64 Boundary Work in Vaccine Messaging ......................................................................71 CHAPTER THREE: Moralizing Antibiotic Use ....................................................................83 Antibiotic “Wonder Drugs” and the Problem of the “Ignorant Man” ........................88 “No Antibiotics Please”: Discourses of Dependency and Demand ............................93 “Z is for . Zithromax” ...........................................................................................107 CHAPTER FOUR: Responsibilizing Citizens Amid “Epidemic” Obesity ..........................117 Epidemic Obesity, Stigma, and the Rhetoric of Personal Responsibility .................122 The U.S. CDC’s “Success Stories”: Cultivating Fitness Amid Epidemic Obesity ..134 “Taking Action” Against Epidemic Obesity via Public-Private Partnerships ..........143 Profiting from the Rhetoric of Personal Responsibility ...........................................152 CONCLUSION .....................................................................................................................153 Prioritizing Individual over Systemic Factors Shaping Health Status ......................155 vi Private Sector Advantages at Public Health’s Expense ............................................158 BIBLIOGRAPHY .................................................................................................................162 vii LIST OF FIGURES Figure 1: Yale Emergency Management Handwashing Poster ............................................. 36 viii LIST OF ACRONYMS AIDS Acquired Immune Deficiency Syndrome ALSEIB State Employees’ Insurance Board of Alabama ARI Antibiotic-Resistant Infection AMA The American Medical Association ASM American Society for Microbiology BCCDC British Columbia Centre for Disease Control BMI Body Mass Index CBC Canadian Broadcasting Corporation CDC The United States Centers for Disease Control and Prevention DPT Diphtheria, Pertussis, and Tetanus DTCA Direct-to-Consumer Advertising PPP Public-Private Partnership PPPHW Public-Private Partnership for Handwashing with Soap HAI Healthcare-Associated Infection HBO Home Box Office HHS The United States Department of Health and Human Services HIV Human Immunodeficiency Virus ILI Influenza-Like Illness IOM Institute of Medicine JAMA Journal of the American Medical Association MMR Measles, Mumps, and Rubella MRSA Methicillin-Resistant Staphylococcus Aureus NAMCS National Ambulatory Medical Care Survey NIH National Institutes of Health NVIC National Vaccine Information Center PAwS Public Awareness of Science PEST Public Engagement with Science and Technology PSA Public Service Announcement PUS Public Understanding of Science SAGE Strategic Advisory Group of Experts SARS Severe Acute Respiratory Syndrome STI Sexually-Transmitted Infection STS Science and Technology Studies WHO The World Health Organization ix ACKNOWLEDGEMENTS A project of this length takes
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