The sociology of health promotion Over the last decade the promotion of health has become a central feature of health policy at local, national and international levels, forming part of global health initiatives such as those endorsed by the World Health Organisation. At the same time a concern with ‘healthy living’ has become a preoccupation for many people. The Sociology of Health Promotion responds by offering the first critical sociological account of these developments and locates them within a set of wider socio-cultural changes associated with late modernism. Drawing upon the work of Foucault, Beck, Giddens, Featherstone and others the book presents a theoretical as well as empirical examination of health promotion. The Sociology of Health Promotion offers analyses of contemporary public health policy, lifestyle, consumption, risk and health. It also examines socio-political critiques of health promotion and reflects upon their implications for policy and practice. Substantive topics covered include: the institutional emergence of health promotion at both global and national levels, accidents and the risk society, smoking, HIV/AIDS, ageing, the body, and health-related consumption. A key theme of the collection is that health promotion is emblematic of wider sociocultural changes. Changes such as the demise of institutional forms of welfare and social control, a blurring of ‘expert’ and lay knowledge, a heightened collective perception of uncontainable risks, and a shift to a consumer- rather than producer-driven economy. This collection will be invaluable reading for students and social scientists with an interest in health and health policy, health promotors, public health doctors and practitioners engaging in critical reflection upon their professional activities. Robin Bunton is Senior Lecturer in Social Policy at the University of Teesside, Sarah Nettleton is Lecturer in Social Policy at the University of York, and Roger Burrows is Reader in Sociology at the University of Teesside. The sociology of health promotion Critical analyses of consumption, lifestyle and risk Edited by Robin Bunton, Sarah Nettleton and Roger Burrows London and New York First published 1995 by Routledge 11 New Fetter Lane, London EC4P 4EE Routledge is an imprint of the Taylor & Francis Group This edition published in the Taylor & Francis e-Library, 2005. “To purchase your own copy of this or any of Taylor & Francis or Routledge’s collection of thousands of eBooks please go to www.eBookstore.tandf.co.uk.” Simultaneously published in the USA and Canada by Routledge 29 West 35th Street, New York, NY 10001 © 1995 Robin Bunton, Sarah Nettleton and Roger Burrows, selection and editoiral matter; individual chapters, the contributors All rights reserved. No part of this book may be reprinted or reproduced or utilized in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data A catalogue record for this book is available from the Library of Congress ISBN 0-203-42949-4 Master e-book ISBN ISBN 0-203-73773-3 (Adobe eReader Format) ISBN 0-415-11646-5 (hbk) ISBN 0-415-11647-3 (pbk) Contents List of illustrations vi Notes on contributors vii Acknowledgements ix 1 Sociology and health promotion: health, risk and 1 consumption under late modernism Roger Burrows, Sarah Nettleton and Robin Bunton Part I The institutional context of health promotion 2 Health promotion: rhetoric and reality 11 Richard Parish 3 From Alma Ata to Asda—and beyond: a commentary on 23 the transition in health promotion services in primary care from commodity to control Laurann Yen Part II Socio-political critiques of health promotion 4 Sociological critiques of health promotion 39 Sarah Nettleton and Robin Bunton 5 Feminist critiques of health promotion 57 Norma Daykin and Jennie Naidoo 6 Developing anti-racist health promotion strategies 69 Jenny Douglas 7 The modern and the postmodern in health promotion 77 Michael P.Kelly and Bruce Charlton 8 The baby and the bath water: examining socio-cultural 91 and free-market critiques of health promotion Charlie Davison and George Davey Smith Part III Knowledge, risk and health promotion v 9 The development of a scientific fact: the case of passive 103 smoking Peter Jackson 10 Accidents and the risk society: some problems with 115 prevention Peter Jackson 11 Chance and modernity: accidents as a public health 133 problem Lindsay Prior 12 ‘London dentist in HIV scare’: HIV and dentistry in 145 popular discourse Nicki Thorogood Part IV Health promotion, consumption and lifestyle 13 In the name of health 159 Barry Glassner 14 Positive ageing: what is the message? 175 Mike Hepworth 15 Health and lifestyle: a critical mess? Notes on the 189 dedifferentiation of health Martin O’Brien 16 Consumption and health in the ‘epidemiological’ clinic of 203 late modern medicine Robin Bunton and Roger Burrows References 219 Name index 241 Subject index 247 Illustrations FIGURES 4.1 Wheelchair posters 43 5.1 Models of health promotion 58 10.1 Live a little longer 119 11.1 Deaths from road accidents and homicides in Northern Ireland 142 1968–91 16.1 Some contrasts between ‘old’ and ‘new’ health care systems 204 16.2 How to smoke 214 TABLES 4.1 Social policy and sociological analyses ‘for’ and ‘of’ health 40 promotion 4.2 Critiques of health promotion and the foci of health promotion 48 8.1 Approaches to two ‘basics’ of public health 97 8.2 Reactions to two ‘defining moments’ of 1993 98 11.1 Numbers of accidents reported by 51,080 respondents for a three- 135 month period 11.2 Proportions of male and female respondents reporting an accident 138 during the three months before interview 11.3 Proportions of manual (Social Class I, II, IIIM) and non-manual 138 (Social Class IIINM, IV, V) respondents reportingan accident during the three months before interview 11.4 Proportions of respondents reporting an accident during the three 139 months before interview by age group 16.1 Drink most frequently taken by socioeconomic group of the head of 212 household by gender for those aged 18 to 60 16.2 Percentage of smokers who smoke selected brands of cigarette by 213 socio-economic group Contributors Robin Bunton is Senior Lecturer in Social Policy in the School of Social Science at the University of Teesside and works as a member of the Centre for the Study of Adult Life (C-SAL) at the University. Roger Burrows is Assistant Director of the Centre for Housing Policy at the University of York. Bruce Charlton is a Lecturer in the Department of Psychology at the University of Newcastle upon Tyne. George Davey Smith is Professor of Clinical Epidemiology at the University of Bristol. Charlie Davison is a Lecturer in Sociology at the University of Essex. Norma Daykin is a Senior Lecturer in Social Policy at the Faculty of Health and Social Care at the University of the West of England, Bristol. Jenny Douglas is a Lecturer in Health Education at the University of Birmingham. Barry Glassner is Professor of Sociology at the University of Southern California. Judith Green is a Senior Lecturer in Sociology at South Bank University in London. Mike Hepworth is Reader in the Department of Sociology at the University of Aberdeen. Peter Jackson is a Researcher at the Centre for the Study of Adult Life (C- SAL) at the University of Teesside. Michael P.Kelly is Professor of Social Sciences and Head of the School of Social Science at the University of Greenwich in London. Jennie Naidoo works in the Faculty of Health and Social Care at the University of the West of England, Bristol. Sarah Nettleton is a Lecturer in the Department of Social Policy and Social Work at the University of York. Martin O’Brien is a Lecturer in the Department of Sociology at the University of Surrey. Richard Parish is Chief Executive of Humberside College of Health and Honorary Senior Fellow at the University of Hull. viii Lindsay Prior is a Senior Lecturer in Social Research Methods at the University of Wales, Cardiff. Nicki Thorogood is a Lecturer in Sociology, Dental Public Health Unit, Guy’s Dental School, United Medical and Dental Schools in London. Laurann Yen is Director, Primary Health Care, Tower Hamlets Healthcare Trust. Acknowledgements This volume presents chapters the bulk of which are substantially revised versions of papers that were first presented at a conference—Towards a Sociology of Health Promotion and the New Public Health—organised by the three editors at the University of Teesside under the auspices of the Centre for the Study of Adult Life (C-SAL) in September 1993. The book is the second to be derived from Teesside conferences concerned with the sociology of social and public policy and follows the earlier Towards a Post-Fordist Welfare State? (Routledge, 1994) edited by Roger Burrows and Brian Loader. Thanks are due to all participants at the conference for making it such a stimulating affair, to Lesley Jones, and to colleagues from Teesside, especially Steven Muncer, Kate Giilen, Brian Loader and Mike Featherstone for their support, good humour and interest in our work over the last few years. Special thanks should also go to Andrea Robinson, Elaine Hodgkinson and Ted Glover for their administrative support during a particularly difficult period in the early life of the School of Human Studies at Teesside. This volume is dedicated to Jack Nettleton Burrows who was born in the month before it was completed. Roger Burrows, Sarah Nettleton and Robin Bunton York October 1994 x Chapter 1 Sociology and health promotion Health, risk and consumption under late modernism Roger Burrows, Sarah Nettleton and Robin Bunton INTRODUCTION During the last few decades inordinate attention has been paid to the promotion of ‘healthy’ living.