This article focuses upon longstanding controversy surrounding the health impact of air pollution from steel and chemical industries in the conurbation of Teesside, in Northeast England. Drawing on ...Ulrich Beck's analysis of risk, it presents a commentary on the ways in which epidemiological findings are incorporated or marginalised in conflicting public health narratives in Teesside, taking recent epidemiological research on mortality patterns for detailed scrutiny. I argue that where public health issues are contentious and politicised, inconclusiveness in such research plays a significant part in sustaining a “narrative of reassurance” about the possible health or environmental costs of living close to industrial operations.
This article examines popular understandings of diabetes, and conflicts and ambiguities in the management of diabetes care, in two areas of Cameroon. Conducted over a two-year period, comparative ...ethnography in Yaoundé and Bafut started in four diabetes clinics (two in each place). From there it extended outwards, first to the homes of patients with diabetes, and then on to a number of indigenous healers consulted by patients or their families. We explore here the tension between clinic-based demands for patients' ‘compliance’ with treatment guidelines, including repeated strictures against resorting to ‘traditional’ medicine, and patients' own willingness to alternate between biomedicine and indigenous practitioners, a process in which they subject the claims of both to a kind of pragmatic evaluation. The continuing importance of indigenous healing practices, and explanations for diabetes in terms of ancestral intervention or witchcraft, are considered in the light of recent anthropological debate about the ‘modernity of witchcraft’ in Africa. Cet article examine les interprétations populaires du diabète, ainsi que les conflits et les ambiguïtés dans la gestion du traitement du diabète dans deux régions du Cameroun. L'ethnographie comparative menée sur une période de deux ans à Yaoundé et Bafut a commencé dans quatre cliniques du diabète (deux dans chaque ville). L’étude s'est ensuite élargie au domicile des patients diabétiques, puis à un certain nombre de guérisseurs indigènes consultés par les patients ou leur famille. L'article explore les tensions entre d'une part les exigences des cliniques en matière d'observance de traitement par les patients (y compris des critiques sévères répétées contre le recours à la médecine « traditionnelle ») et, d'autre part, la volonté des patients d'alterner entre praticiens de la biomédecine et praticiens indigènes, un processus dans lequel ils soumettent les prétentions des uns et des autres à une sorte d’évaluation pragmatique. L'importance persistante des pratiques de guérison indigènes, et les explications du diabète en termes d'intervention ancestrale ou de sorcellerie, sont étudiées à la lumière du débat anthropologique récent sur la « modernité de la sorcellerie » en Afrique.
This paper is about the power to represent. 'Who speaks for Teesside?' about air pollution - whose voice gets heard about the sources, pathways and consequences of pollution. Around such apparently ...technical issues arises a kind of political morality tale that leads to questions of security and insecurity, accountability and trust. Industry and local government in Teesside may no longer have things their own way; but they have been tenacious in resisting what they consider to be unhelpful claims or assumptions about pollution and its impact, and there are strong reasons why they are able to claim that they present the authoritative account of Teesside's air quality. In conclusion some changes to the context in which industrial pollution comes to the fore as a public issue are reviewed: debate around diversification of Teesside's economy; the impact of environmental campaigns; and certain paradoxes of developments in air quality monitoring.
This paper presents evidence from research into health system challenges of cardiovascular disease (CVD) and diabetes in four Eastern Mediterranean countries: the occupied Palestinian territory, ...Syria, Tunisia and Turkey. We address two questions. How has the health system in each country been conceptualised and organised to manage the provision of care for those with CVD or diabetes? And what were key concerns about the institutional ability to address this challenge? Research took place from 2009 to 2010, shortly before the political upheavals in the region, and notably in Syria and Tunisia. Data collection involved a review of key documents, interviews with key informants and brief data collection in clinics. In analysing the data, we adopted the analytical schema proposed by Walt and Gilson, distinguishing content, actors, context and process. Key findings from each country highlighted concerns about fragmented provision and a lack of coordination. Specific concerns included: the lack of patient referral pathways, functioning health information systems and investment in staff. Regarding issues underlying these 'visible' problems in managing these diseases, we highlight implications of the wider systemic pressure for reform of health-sector finance in each country, based on neoliberal models.
This article examines the relationship between trust and risk in one of the centres of the global chemical industry, Ludwigshafen in Germany. A single industry town associated for 150 years with ...BASF, the dominant outlook among those living or working there has been one of trust, confidence and pride in the corporation which has 'put the town on the map'. Yet beneath the surface, subtle shifts in public assumptions and expectations about BASF and the town's chemical industry are now occurring. We describe the parameters of public reflection about trust and risk, analyse how characterizations of BASF are changing, and consider how far recent writing on trust helps in understanding its salience in this particular industrial town.
This article examines the centrality of 'safety' in Grangemouth's recent politics. Scotland's main petrochemical center is a town dominated for well over fifty years by a major BP complex. In a ...context of extensive redundancies at BP, new insecurities surrounding the future of the company's Grangemouth site, and a series of recent accidents, as well as controversy over planning applications from other chemical companies, the town has been pushed into unusually searching questioning about both safety and economic security. This article explores the different lines of reasoning and rationalization on risk, safety, and the future advanced by regulators, BP, and residents and their political representatives. We emphasize how important the familiarity of petrochemical technology has been in public responses to the question of safety, in contrast to many environmental risk controversies. And we argue that safety has provided a focus for social, moral, economic, and political perspectives on the town's present circumstances and future prospects to be played out.
Abstract Objective: To identify relative and absolute changes in mortality in the Northern region of England between 1981 and 1991. Design: 1981 and 1991 census data were used to rank 678 wards on an ...index of material deprivation composed of four variables (unemployment, car ownership, housing tenure, household over-crowding). Standardised mortality ratios (all causes) were calculated for various periods between 1981 and 1991 and for different age categories. Setting: Counties of Cleveland, Cumbria, Durham, Northumberland, and Tyne and Wear. Results: During 1981-91 mortality differentials widened between the most affluent and deprived fifths of wards in all age categories under 75 years. The decline in the relative position of the poorest areas was particularly great, and there was no narrowing of inequalities across the remainder of the socioeconomic spectrum. In absolute terms, there were improvements in mortality in all age categories in the most affluent areas. In the poorest areas improvements in the 55-64 age group were balanced by increased mortality among men aged 15-44, a slight rise among women aged 65-74, and static rates among men aged 45-54. Conclusions: These results re-emphasise the case for linking mortality patterns with material conditions rather than individual behaviour.
This study assesses whether deprived populations living close to industry experience greater mortality from lung cancer than populations with comparable socioeconomic characteristics living farther ...away. Mortality data, census data, a postal survey of living circumstances, historic and contemporary data on air quality and a historic land-use survey were used. Analysis was based on two conurbations in England, Teesside and Sunderland. Housing estates in Teesside were selected based on socioeconomic criteria and distinguished by proximity to steel and chemical industries; they were grouped into three zones: near (A), intermediate (B), and farther (C), with a single zone in Sunderland. We included 14,962 deaths in 27 estates. Standardized mortality ratios (SMR) for lung cancer International Classification of Diseases #9 (ICD-9) 162 and cancers other than lung (ICD-9 140-239, excluding 162), and sex ratios were calculated. Mortality from lung cancer was well above national levels in all zones. For men, a weak gradient corresponding with proximity to industry at younger ages reversed at older ages. In women 0-64 years of age, stronger gradients in lung cancer mortality corresponded with proximity to industry across zones A, B, and C (SMR = 393, 251, 242, respectively). Overall rates in Teesside were higher than Sunderland rates for women aged 0-64 years (SMR = 287 vs. 185) and 65-74 years (SMR = 190 vs. 157). The association between raised lung cancer mortality and proximity to industry in women under 75 years of age could not be explained by smoking, occupation, socioeconomic factors, or artifact. Explanations for differences between men and women may include gender-specific occupational experiences and smoking patterns. Our judgment is that the observed gradient in women points to a role for industrial air pollution.
This paper analyses the emergence of recent activism in Grangemouth, Scotland's major petrochemical centre and an important BP site since 1924. Today this is a town in crisis. In a mood of growing ...pessimism and distrust, public doubts about the economic security and environmental safety of the town have provoked increasingly vocal local opposition to planning applications which would extend activity in chemicals while economic diversification is denied. The analysis starts by examining local interpretations of the new activism. The authors then move on to consider three alternative explanatory approaches: Douglas's analysis of 'risk positions'; the emerging 'environmental justice' perspective; and the distinction between 'siting' and 'exposure' in environmental controversies. All have explanatory limitations in this context, as public risk concerns are subsumed within rapidly changing judgements about the town's future prospects.
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