Marketing Health —— Smoking and the Discourse of Public Health in Britain, 1945-2000

----- 健康推广：吸烟与英国公共健康论文1945-2000

ISBN: 9780199260300 出版年：2007 页码：359 Berridge, Virginia Oxford University Press

The post war history of public health and the role of smoking within that history epitomises the tensions which surround taking health to the public .Public health history has concentrated on the nineteenth century sanitary period or on the years before the Second World War. It has concentrated on the environmental advances, or on the professional and occupational history of public health as an activity. This book has a different focus : it deals with the change in the outlook of public health post war. From a focus on services, on vaccination, on dealing with health issues at the local level, public health developed a new discourse. Focussing on chronic disease through the use of the tools of epidemiology, public health reoriented itself round the concept of’ risk’ and targeted individual behaviour. The mass media and centralised campaigning directed at the whole population replaced local campaigns. Politicians changed their mind about speaking directly to the public on health matters. Their early worries about the ‘nanny state’ gave place to a desire to inculcate new norms of behaviour. Debates took place within public health about how change was to be achieved. The book identifies, using smoking as its model, debates between those believing in ‘systematic gradualism’ and those who advocated a more coercive approach. Such debates necessarily brought into play tensions over the relationships between public health and industrial interests. Health campaigning by new style pressure groups like ASH, which were part state funded, was an important motive force behind the change. In the 1980s and 1990s, public health changed again. Passive smoking and HIV/AIDS brought environmental concerns back into public health whence they had disappeared after the 1950s. And the ‘ rise of addiction’ for smoking demonstrated the power of pharmaceutical interests to define a new’ pharmaceutical public health’ in which treatment and ‘ magic bullets’ were also tactics for prevention. In the early 21st century, public health was play to complex tensions and conflicting impetuses. This book shows that those tensions were nothing new and outlines their development over the last half century.