Is imposing risk awareness cultural imperialism?
Section snippets
The role of epidemiology
As the prestigious, basic health discipline, epidemiology is the paramount supplier of facts, premises and “bases of action” for preventive medicine and health promotion. Through population registers, health surveillance programs and institutions epidemiology also enjoys a powerful attachment to health politics and the health bureaucracies in most industrialised countries. Epidemiology and epidemiologists therefore have a responsibility not only for the quality and soundness of their risk
The “risk epidemic”
In the industrialised world, the value of, and preoccupation with, health is seemingly greater than ever. Disclosure to the public of new hazards and risks from epidemiological research and public surveillance bodies, has become almost an every-day phenomenon.
The Norwegian psychologist Skolbekken has convincingly shown that what he has called the “risk epidemic” has its roots in scientific medical journals (Skolbekken, 1995). By searching Medline he demonstrated that there has been an explosive
Side effects of the risk epidemic
Epidemiologists and health promoters have to a great extent overlooked the possibility of harmful side effects of increased risk and health awareness. Despite strong warnings (Illich, 1976; Haynes et al., 1978; Crawford, 1980; Barsky, 1988) the flow of information on new risks to everyday life continues (Feinstein, 1988) and despite magic formulae such as “positive health” and “self empowerment” (Tones, 1986), fear of disease continues to be the most effective tool for life style changes. In
Risk, uncertainty and the expanded health concept
A healthy life-style has become in our language almost synonymous with a life-style characterised by risk evasion. This is in good correspondence with a minimalistic health concept where health denotes absence of disease and death (Boorse, 1977). It is, for instance, no reason to question the relation between a healthier life-style and the declining morbidity and mortality of coronary heart disease in most western countries. However, most prevailing definitions of health, generally endorsed by
Changes in health culture and life perspective
Existence in the Western world has never been safer. We enjoy longer life expectancy than ever before. The threats from war and unpredictable natural forces like plague, famine, heat, frost and disasters are remote. We seem close to mastering the universe and the daily struggle for food and shelter has vanished.
Our life is increasingly controlled, protected and predictable. We are planning and arranging our education, our economy, our family size, our children's birth date and our future, and
Public health, epidemiology and social class
The affiliation between the public health movement and middle class morality is certainly not new (Lupton, 1995). Although not at all altruistic, the focus in earlier days on sewage, overcrowding, better housing conditions, water supply and food hygiene eventually led to improved social conditions for the underprivileged working class. In its contemporary appearance, with the skewed focus on individual responsibility and self control, it takes the form of a class struggle where the weaker part
Values, culture and social class
There is no way that a further change towards the new risk culture can be imposed without unexpected and unwanted side effects. The paradox of health, with risk awareness, medicalisation, and decreased subjective health may even not be the most serious consequence. Traditionally, a prospective life perspective with the struggle for life-control, prudence, self-control and renunciation are closely associated with Protestant ethics and middle class values (Weber, 1973). Lower social classes, on
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