Suzanne Fraser

‘It’s Your Life!’: Injecting Drug Users, Individual Responsibility and Hepatitis C Prevention

Health promotion materials on hepatitis C prevention and safe injecting enjoin injecting drug users to produce ethical selves through relatively rigid social and hygiene-related conduct. This article examines a sample of safe injecting and hepatitis C prevention health promotion materials, and interview data gathered from injecting drug users, to consider the ways in which the notion of individual responsibility functions within them. I argue that the primacy of the individual in western culture is indeed reflected in hepatitis C and safe injecting materials and, that for a range of reasons, injecting drug users also make use of notions of individual responsibility. The article concludes by considering the social and health implications of this individualist approach to injecting drug use and health promotion, and by suggesting ways in which effective materials which do not focus solely on the individual can be created.

Framing the mother: childhood obesity, maternal responsibility and care

Currently in developed nations, childhood obesity is generating widespread concern and prompting social and institutional responses. Obesity is constructed as a broad public health crisis, but individuals are constructed as responsible for their own bodies and body sizes within this crisis. We are particularly interested in two aspects that focus on women as central to this phenomenon; the first is the imputation of maternal responsibility for the weight of children and the second is the role that specific fears about flesh and womens bodies play in how childhood obesity is represented. We analyse media representations of childhood obesity in Australia and draw out the discourses of maternal responsibility and the intertwining of mothers and childrens bodies. We frame the childhood obesity crisis within a broader discussion of women, care and responsibility, suggesting that childhood obesity offers another embodied location to reinforce and extend womens roles and responsibilities as mothers, in response to changing patterns of work and care.

‘Spoiled identity’ in hepatitis C infection: The binary logic of despair

Hepatitis C is a potentially debilitating disease of the liver, the impact of and prognosis for which vary significantly from person to person. Although the health consequences of contracting hepatitis C are extremely diverse, becoming infected with the disease is sometimes experienced in terms of an absolute shift from healthy to sick, clean to contaminated, good to bad. In this paper, we use interview material derived from a study on hepatitis C and blood awareness to look at one rarely discussed response to diagnosis with hepatitis C: a sense of despair and absolute contamination, leading to a belief that contraction of other blood-borne viruses is of no consequence. By considering the effects of hepatitis C diagnosis in light of Goffmans theory of stigma, and by linking stigmatization to the binary logic common to thinking about infection, health and identity, we offer a starting point for designing health-promotion materials that minimize despairing responses to infection.

Healthy living and citizenship: an overview

The effort to achieve ‘healthy living’ or adopt a ‘healthy lifestyle’ has become a predominant concern of our time. A perusal of websites (such as those quoted above), daily news articles, public health journals and popular magazines reveals a bewildering array of pertinent research evidence and advice. Directives such as those above, calling on individuals to ‘take responsibility’ and make ‘smart choices’ in relation to diet, exercise, emotional wellness and so on, have become a common feature of the discourses of health in many societies. Although it is especially pervasive in contemporary Western societies, this emphasis on healthy living is neither new nor unique to these societies. As early as the fifth century, one can find a substantial body of Greek literature focusing on the preservation and restoration of health, including prescriptions about diet, exercise, bathing and other regular habits. The Hippocratic treatise, On Regimen, offered detailed norms about ‘correct living’ with a view to health, with many prescriptions concerning self-control (Wilson 2006, p. 337). In more recent times, this concern has at times reached fever pitch, perhaps most famously in Germany during the 1930s and 1940s when the Nazi Party sought to improve the health of German citizens through promoting low-fat, high fibre foods, and encouraging a reduced intake of tobacco, alcohol and coffee and an increased intake of natural foods (Proctor 1999). However, over the past three decades, concern about healthy living and the best means to achieve it would seem to have reached a new, consistently high level in many societies. This special issue focuses on the imperatives surrounding ‘healthy living’ and their personal, social and policy implications. The issue includes a number of papers drawn from an event, ‘Healthy living and citizenship’, attended by social scientists and philosophers from the UK, Europe and Australia and held at Monash University’s Prato Campus in Italy, in June 2009. Hosted by members of the Health, Wellbeing and Social Change research cluster, based in the School of Political and Social Inquiry at Monash University, the event sought to explore the meanings of health and wellbeing in light of the changing relationship between citizens and the

Cosmetic surgery, gender and culture

Inevitably, reading is one of the requirements to be undergone. To improve the performance and quality, someone needs to have something new every day. It will suggest you to have more inspirations, then. However, the needs of inspirations will make you searching for some sources. Even from the other people experience, internet, and many books. Books and internet are the recommended media to help you improving your quality and performance.

Valuing methadone takeaway doses: The contribution of service-user perspectives to policy and practice

Unlike health policy in the United Kingdom, Australian health policy does not provide a strong endorsement for the involvement of service users in the design, delivery and evaluation of drug treatment services. There has been no research into service-users’ views on the contentious issue of methadone takeaway doses. This study explores the value of takeaway doses from service-users’ perspectives and highlights the contributions that service-user involvement can make to further drug treatment planning, delivery and evaluation. Twenty-five methadone clients were interviewed about the value of methadone takeaway doses. Benefits cited by participants included convenience, less travel and lower costs, protection of confidentiality and less restriction on employment as well as less tangible issues related to feelings of ‘normality’ and flexibility in daily life patterns. Feeling trusted as a methadone client was also an important result of accessing takeaway doses. The inclusion of service-user perspectives is important for ensuring that services are not wrongly targeted and that evaluations of those services do not underestimate or misrepresent their value to clients. This is particularly important in policy around illicit drug use where public and political opinion is often a key driver in decision making.

Producing the “Problem” of Addiction in Drug Treatment

In this article, we argue that the “problem” of addiction emerges as an effect of treatment policy and practice as well as a precursor to it. We draw on the work of Marrati to analyze interviews with policy makers and practitioners in Australia. The interviews suggest that the episode-of-care system governing service activity, outcomes, and funding relies on certain notions of addiction and treatment that compel service providers to designate service users as addicts to receive funding. This has a range of effects, not least that in acquiring the label of “addict,” service users enter into bureaucratic and epidemiological systems aimed at quantifying addiction. Rather than treating pre-existing addicts, the system produces “addicts” as an effect of policy imperatives. Because addiction comes to be produced by the very system designed to treat it, the scale of the problem appears to be growing rather than shrinking.

Public opinion on needle and syringe programmes: Avoiding assumptions for policy and practice

Despite evidence for their effectiveness, harm reduction services such as needle and syringe programmes (NSPs) are highly vulnerable to perceptions of community disapproval. This paper reviews Australian research on community attitudes to harm reduction services and its impact on research, policy and practice. The literature on community attitudes to NSPs in Australia comprises a small number of representative national samples and surveys of local communities affected by specific services. Despite these extremely limited data, negative community attitudes are often cited by policy-makers and health professionals as a primary constraint on policy-making. The main finding of this literature review is that community perceptions of NSPs are largely positive. Also, support for NSPs was not synonymous with condoning drug use. The failure of policy-makers and politicians to recognise positive community attitudes to NSPs has led in some instances to hasty political responses to adverse media reports, including the closure of services. This literature review showing positive community attitudes to harm reduction services should embolden researchers, practitioners and policy-makers to challenge such reactionary responses. Further, this evidence should be used in countering negative publicity surrounding these services.

The Agent Within: Agency Repertoires in Medical Discourse on Cosmetic Surgery

The question of agency is addressed regularly in feminist discussions of cosmetic surgery. Some feminist work, such as Germaine Greer’s recent book, The Whole Woman, offers an account of cosmetic surgery that leans heavily towards a construction of women as victims. Other studies, such as Kathy Davis’s important Reshaping the Female Body, focus on women as agents. Despite these differences, all of these works share a conception of agency as inhering in the individual. The same conception informs many medical texts on cosmetic surgery. In this article, notions of agency will be traced through a broad sample of medical texts on cosmetic surgery to consider what they reveal about the contexts in which medical understandings of gender are articulated, and how they bear on the development of gender and of cosmetic surgery as a medical field. The approach differs from other feminist accounts in that no attempt is made to arbitrate on whether those who undergo cosmetic surgery are more accurately described as agents or victims. Rather, it treats the common reflex to ascribe these judgements as the object of study. Medical, scientific and ‘popular medical’ writing on cosmetic surgery is overwhelming in volume. Almost all of it posits women as the primary subject of cosmetic surgery. In analysing medical discourse on cosmetic surgery, it is necessary to begin by defining what might constitute ‘medical discourse’. Medical writing in this field includes articles in general medical, plastic surgery and cosmetic surgery journals, textbooks, publications aimed at a lay readership and advertising material for cosmetic surgery clinics and procedures. In selecting material for this article, I have used mostly Australian sources, but the field is largely international, and in order to address this, I have also included some material from overseas. The examples I use draw on brochures as well as prestigious international journals, on books written to inform the public about breast implants, as well as textbooks on plastic surgery. Because cosmetic surgery is a highly commercialised form of medical treatment, medical texts on the subject range in tone from technical to informal and chatty, according to their intended audience. For potential cosmetic surgery participants, distinguishing between sound medical advice and sales material can prove difficult. Like all science, medical research presents itself as value-free. However, the status of cosmetic surgery as a commercial enterprise impacts heavily on its claim to impartiality. Of course, the issue of scientific impartiality and objectivity is central to this article. Medical understandings of sex and gender underpin the development and sale of cosmetic procedures and, as such, they constitute a central organising feature of the development of cosmetic surgery as a medical specialty itself.

Between provisioning and consuming?: Children, mothers and ‘childhood obesity’

Abstract Contemporary Western societies focus considerable policy and media attention on the ‘epidemic of childhood obesity’. In this paper we examine the mobilisation of notions of responsibility and consumption in these discussions, and consider the implications they have for women as mothers. In particular, we are interested to explore the potential conflicts mothers face as care providers and nurturers when responsible care is framed as withholding or managing the food consumption of children. We argue that the competing discursive frameworks around mothers’ food provision invite further theorisation that explicitly addresses nourishment and consumption as elements of maternal practice and care. We draw on the work of Neysmith and Reitsma-Street (2005) regarding ‘provisioning’ to undertake a critical examination of the discourses in the ‘childhood obesity’ epidemic, with particular attention to Australian media and policy discussions. According to Neysmith and Reitsma-Street, mothers are central to social ‘provisioning’, that is, the labour that secures the necessities of life. This provisioning framework captures paid market work and unpaid caring labour, policy settings and social locations, allowing for a rich conceptualisation of the conditions mothers negotiate as they provide for their children. Taking up the possibilities of this framework, we argue that, insofar as health risks and responsibilities are largely individualised, mothering is framed as primarily about giving, and childhood obesity is considered a disease of affluence and over-consumption, imperatives for maternal provisioning and nurture are potentially in conflict with critiques of consumption and excess.