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Drinking Smoke

The Tobacco Syndemic in Oceania

Mac Marshall

Publication Year: 2013

Tobacco kills five million people every year and that number is expected to double by the year 2020. Despite its enormous toll on human health, tobacco has been largely neglected by anthropologists. Drinking Smoke combines an exhaustive search of historical materials on the introduction and spread of tobacco in the Pacific with extensive anthropological accounts of the ways Islanders have incorporated this substance into their lives. The author uses a relatively new concept called a syndemic—the synergistic interaction of two or more afflictions contributing to a greater burden of disease in a population—to focus at once on the health of a community, political and economic structures, and the wider physical and social environment and ultimately provide an in-depth analysis of smoking’s negative health impact in Oceania.

In Drinking Smoke the idea of a syndemic is applied to the current health crisis in the Pacific, where the number of deaths from coronary heart disease, cancer, diabetes, and chronic obstructive pulmonary disease continues to rise, and the case is made that smoking tobacco in the form of industrially manufactured cigarettes is the keystone of the contemporary syndemic in Oceania. The author shows how tobacco consumption (particularly cigarette smoking after World War II) has become the central interstitial element of a syndemic that produces most of the morbidity and mortality Pacific Islanders suffer. This syndemic is made up of a bundle of diseases and conditions, a set of historical circumstances and events, and social and health inequities most easily summed up as “poverty.” He calls this the tobacco syndemic and argues that smoking is the crucial behavior—the “glue”—holding all of these diseases and conditions together.

Drinking Smoke is the first book-length examination of the damaging tobacco syndemic in a specific world region. It is a must-read for scholars and students of anthropology, Pacific studies, history, and economic globalization, as well as for public health practitioners and those working in allied health fields. More broadly the book will appeal to anyone concerned with disease interaction, the social context of disease production, and the full health consequences of the global promotional efforts of Big Tobacco.

Mac Marshall is emeritus professor of anthropology and community and behavioral health at the University of Iowa.

Published by: University of Hawai'i Press

Title Page, Copyright, Dedication, Quote

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pp. i-vi


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pp. vii-viii

List of Illustrations

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pp. ix-x

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pp. xi-xii

...Forty years ago when I began to research the history of alcoholic beverages in Micronesia, I kept running across numerous references to tobacco consumption in ways that predated the rise of modern cigarettes. Although tobacco was not my primary focus back then I routinely recorded this information for possible future use. I mentioned bits of this historical material...

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pp. xiii-xiv

...A book such as this owes a scholarly debt to the many people who have mentioned tobacco in their written work, whether but a short passing reference or a more detailed focus on smoking or chewing. Others have assisted my project by sharing unpublished material, pointing me toward sources of which I was unaware, or responding to questions I posed on ASAOnet...


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pp. xv-xvi

Situating Tobacco Chronologically vis-à-vis Oceania

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pp. xvii-xx

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Part One: The History, Economy, and Ethnography of Tobacco in Oceania

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pp. 1-4

...of the relationship between anthropology and history. Kroeber made the point many years ago that anthropology “stands with one foot in the field of the undoubted sciences; with the other squarely in history” (1935, 568), and this continues to hold true today. In that influential article Kroeber argued that both sound history and sound anthropology are concerned with finding patterns. For Kroeber, a pattern...

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1. Introduction and Historical Background

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pp. 5-21

...This book examines the history, ethnography, and medical anthropology of tobacco in the world region known as Oceania or the Pacific Islands. Part one draws together historical material on the introduction and spread of tobacco in Island Oceania and explores the ways Islanders have incorporated tobacco into their lives as reported by ethnographers. In part two, attention...

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2. Tobacco as a Comestible

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pp. 22-43

...At first blush, this expression—“tobacco is my mother’s milk”—may seem odd or even nonsensical. But I believe it encodes several important truths about the place of and the uses for tobacco, not just for a few old women on Sabarl, but also for men and women of all ages in much of Oceania. To equate tobacco with mother’s milk is to emphasize several things at...

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3. Pipe Dreams

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pp. 44-61

...Europeans mostly consumed tobacco by smoking it. Both Goodman (1993) and Gately (2001) contend that in the British Isles and northern Europe (and their corresponding colonies across the Atlantic), pipes were adopted as a consequence of having encountered New World peoples who smoked pipes. Likewise, they argue that the Spaniards and possibly the Portuguese and residents...

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4. Tobacco in Indigenous Trade

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pp. 62-78

...When colonizing Europeans first ventured ashore on New Guinea in substantial numbers, they encountered tobacco being grown and smoked in many different places. This led to the erroneous idea that a species of tobacco must have been indigenous to the island, and a mini-academic controversy swirled around this subject for a number of years (e.g., Haddon 1931; Laufer...

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5. Tobacco as an Object of Exchange between Islanders and Foreigners

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pp. 79-100

...Several historians have remarked that tobacco afforded traders a “perfect” exchange commodity: it was addictive, it was used up quickly, and it was often in short supply even if grown locally. As a drug food, tobacco served as both an inducer and an enhancer of trade (Jankowiak and Bradburd 1996). As an inducer, tobacco encouraged Islanders to give traders goods or labor...

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6. From Tobacco Trade to Tobacco Production

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pp. 101-117

...Until 1884 nearly all cigarettes were hand-rolled, and cigarettes were far less popular anywhere in the world than alternative means of taking tobacco: smoking pipes or cigars, snuffing, and chewing. But in April 1884 in Durham, North Carolina, James “Buck” Duke’s relatively small tobacco company1 altered the tobacco landscape forever by partnering with the inventor of the first machine that could manufacture ready-made cigarettes...

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7. Death, Taxes, and Tobacco Control

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pp. 118-140

...As we will see in subsequent chapters, tobacco has become a major cause of death and disability in Pacific Island countries and territories (PICTs), especially over the past century, as industrially manufactured cigarettes have captured an ever greater number of smokers. According to the World Health Organization’s Western Pacific Regional Office (WHO-WPRO), diseases...

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Part Two: The Medical Anthropology of Tobacco in Oceania

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pp. 141-144

...yet until now our primary focus has been on the history and ethnography of tobacco in the Pacific Islands. We have reviewed when and how tobacco reached different island groups, the various ways it was consumed, and by whom. We have seen the many ways this drug food was incorporated into Pacific sociocultural systems and the ways it became an important item of exchange in traditional trading networks. We have reviewed tobacco’s role...

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8. Aotearoa: “Land of the Long White Smoke Cloud”: Pacific Smoke Inhalation Case Study Number 1

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pp. 145-163

...This chapter is the first of three “case studies” that chronicle and examine the effects of tobacco use—primarily cigarette smoking—on the health and socioeconomic well-being of Pacific Islanders in three different locations. Selection of these cases has been dictated to some extent by the availability of relevant information. The first and third cases analyze the situation for Fourth World peoples, that is, indigenous Polynesian Islanders submerged...

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9. U.S. Associated Micronesia: Pacific Smoke Inhalation Case Study Number 2

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pp. 164-178

...This second case study is of a different sort than the preceding one. In the former instance our attention was focused on two so-called minority ethnic groups1 in a dominant settler society that is a developed and relatively wealthy country. In U.S. Associated Micronesia—henceforth for ease of reference to be called Micronesia2—we encounter a mix of political entities and...

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10. Native Hawaiians: Kanaka Maoli: Pacific Smoke Inhalation Case Study Number 3

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pp. 179-190

...This final case study of the negative health effects of smoking is focused on “Native Hawaiians,” also called Kānaka Maoli. They will be referred to below as Native Hawaiians since most of the published literature uses this designation. The indigenous Polynesian inhabitants of the Hawaiian archipelago were believed to have numbered about 300,000 at the time Captain...

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11. Tobaccosis: The Tobacco Syndemic

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pp. 191-224

...As we launch into a full description and analysis of the tobacco syndemic in this final chapter, a few reminders about syndemics are in order. Please keep in mind that a syndemic is a complex, interrelated, multivariate phenomenon made up of both biological and sociocultural parts. The syndemic lies in the intertwining of these various parts and the ways their...


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pp. 225-246

References Cited

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pp. 247-284


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pp. 285-292

Back Cover

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p. 314-314

E-ISBN-13: 9780824837969
Print-ISBN-13: 9780824836856

Publication Year: 2013