Mikko Jauho

Lay Understandings of Functional Foods as Hybrids of Food and Medicine

Abstract This article examines the lay appropriation of so-called functional foods that are marketed to enhance health and well-being and/or to reduce the risk of disease. Previous research has shown that consumers are skeptical of functional foods and inclined to contrast them with natural and non-technological foods. We argue that taking into account the hybrid nature of functional foods at the borderline between food and medicine provides a useful starting point for an analysis of lay appropriation, i.e. understanding and adoption of the new products. We first present results from earlier studies on lay conceptions of healthy eating and of medicines, and then analyze the role of these in the lay appropriation of functional foods. In this analysis, we make use of findings from both our own studies and those of other researchers, and give consumers a voice by presenting quotations from a qualitative study carried out in Finland in 2004. We claim that the food–medicine dichotomy can in many respects explain the ways in which consumers conceptualize functional foods and adopt them in their daily eating.

The mutual shaping of life insurance and medicine in Finland.

This article examines the mutual shaping of medicine and private life insurance in Finland before the Second World War. Based on historical texts and archival material, it shows the important effects that the involvement of medicine in client selection for life insurance companies had on medical knowledge and practice. The analysis focuses on the tensions between the main actors in life insurance underwriting – candidates, insurance agents, examining physicians and the central office – as well as the medical examination as the key site of these tensions. The article shows how the introduction of a set of procedural and technical innovations reshaped the medical examination and helped to stabilize the fraught network of life insurance underwriting. These innovations re-scripted medical work. They stressed objective measurable knowledge over the personal skill and clinical acumen of the examining physician, propagated the physical examination and the use of diagnostic technologies and vital standards, multiplied medicine’s administrative tasks, and contributed to the introduction of a risk factor approach to medicine. Moreover, the social organization of life insurance promoted the spread of these objects, practices and tasks to other fields of medicine. The case displays how medical innovations are developed through the situated interplay of multiple actors that cuts across the science–society boundary.

Demarcating Social Practices: The Case of Weight Management

The concept of weight management has gained currency in present political and social discourses on weight and health, organizing the various efforts to fight obesity and to assist individuals in controlling their weight. In this paper, we ask whether weight management is becoming rooted also in the everyday life of individuals. Adopting a practice-theoretical approach we study whether weight management constitutes an intelligible and distinct entity to people problematizing their weight. By analysing data generated by focus group discussions with Finnish consumers we investigate the ways in which people understand the concept of weight management, what kinds of techniques they use in order to manage their weight, and what kind of emotional and normative positions they take with respect to weight management. We analyse weight management in relation to eating, but acknowledge the role of another practices, such as exercising. We conclude that weight management is not a clearly defined entity, but located at the intersection of more established practices, healthy eating and slimming. We end our article by discussing the policy-implications of our findings.

‘Give people work, and the blood pressure will sink’: lay engagement with cardiovascular risk factors in North Karelia in the 1970s

In high-income countries such as Finland, personal healthcare is organised around the management of lifestyle risks and minimisation of such risks forms a key part of public health policy. While the scientific development of the lifestyle risk model has been thoroughly studied, there has been less research on the history of popular experiences of the model. In this article, I examine lay people’s response to a pioneering heart disease prevention programme in north-eastern Finland in the 1970s, the North Karelia Project, which promoted the lifestyle risk model. I use archival data from early 1970s that recorded the project interactions with the local population and their reactions to the project. I show that although local residents in North Karelia responded positively to the project, they did not necessarily subscribe to its preventive and risk minimising objectives. In an area of limited health resources, the project provided local residents with access to medical expertise. Local reactions indicated a clash of a cultural notion of illness embedded in the social life-world of Karelians with a specific rationality of government emphasising individual responsibility vis-à-vis heart conditions. Local residents who were critical of the public health risk model tended to minimise the role of lifestyle risk factors in cardiovascular disease causation or subsumed these factors into a more encompassing explanation that stressed the effects of the on-going structural social change in the area, highlighting the sense of loss caused by the waning of traditional small farm existence and their anxiety about the resulting economic and social insecurity.

Symptoms, signs, and risk factors: Epidemiological reasoning in coronary heart disease and depression management

In current mental health care psychiatric conditions are defined as compilations of symptoms. These symptom-based disease categories have been severely criticised as contingent and boundless, facilitating the rise to epidemic proportions of such conditions as depression. In this article we look beyond symptoms and stress the role of epidemiology in explaining the current situation. By analysing the parallel development of cardiovascular disease and depression management in Finland, we argue, firstly, that current mental health care shares with the medicine of chronic somatic conditions an attachment to risk factor epidemiology, which accentuates risk and prevention in disease management. However, secondly, due to the symptom-based definitions of psychiatric conditions, depression management cannot differentiate properly between symptoms, signs and risk factors such as, for example, cardiovascular medicine, but treats symptoms as signs or risk factors in contexts of treatment and prevention. Consequently, minor at-risk conditions have become difficult to separate from proper cases of depression.

Contesting lifestyle risk and gendering coronary candidacy: lay epidemiology of heart disease in Finland in the 1970s

This study addresses two issues currently under critical discussion in the epidemiology of cardiovascular diseases (CVD), the relative neglect of women and the individualised nature of key risk factors. It focuses on the North Karelia project (NKP), a community programme aimed at coronary heart disease (CHD) prevention in a predominantly rural Finnish region in the early 1970s, that is, during a period when the epidemiological understanding of CVD still was relatively new and actively promoted. Adopting the notions of lay epidemiology and coronary candidacy, culturally mediated explanatory models lay people use to assess who is likely to develop heart disease and why, the study shows that locals targeted by the project critically engaged with both of these bias. Based on the rich materials resulting from project activities the study shows, first, how many locals subsumed the individualised and lifestyle-based approach to CHD prevention promoted by NKP under a more general framework emphasising the health effects of ongoing structural changes in the area, and second, how women constructed themselves as viable coronary candidates. The case supports the position in the current discussions on lay expertise that wants to integrate lay experiences more firmly into epidemiological studies and public health.