Drinking Smoke: The Tobacco Syndemic in Oceania

Part Two: The Medical Anthropology of Tobacco in Oceania

141 Part Two The Medical Anthropology of Tobacco in Oceania The subtitle to this book is The Tobacco Syndemic in Oceania, and 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 as commodity money and its significance in economic and social relations between Islanders and foreigners, including soldiers from both sides during the Second World War. We have investigated the post–World War II penetration of Pacific markets by transnational corporations making and selling industrially manufactured cigarettes and how this development led to a major change in the method of smoking. Tobacco consumption in Oceania is now overwhelmingly the smoking of cigarettes made and marketed by the tobacco transnationals. And finally, we have looked at tobacco products as a source of government revenue for Pacific countries, and then at a few of the efforts at tobacco control, both government-sponsored programs and church-related and local community decisions. Now, at the beginning of chapter 8, we have reached a transition point. From this point onward in the book our emphasis will shift from history and ethnography to medical anthropology and information gleaned from a variety of health-related disciplines . Chapters 8, 9, and 10 outline the nature and complexity of the range of literature concerning smoking and health in three different Pacific locales. 142 Part Two In conclusion, chapter 11 is devoted to a full explication and discussion of the tobacco syndemic writ large. The idea of a syndemic was introduced briefly in chapter 1, and it is now appropriate to explore this relatively new notion in a bit more detail before proceeding. In the early to mid-1990s Merrill Singer sought a way “to rethink the public health and social scientific understanding of disease so that it focused attention on the multifaceted interactions that occur among the health of a community, political and economic structures, and the encompassing physical and social environment” (2009, xiii). In many respects this was a classically anthropological quest for a holistic perspective on health and disease. The hope was to examine these in light of the political economy (what has come to be known as critical medical anthropology ) and the biocultural nature of human existence (what is known as biocultural medical anthropology). Eventually, Singer defined a syndemic as “the concentration and deleterious interaction of two or more diseases or other health conditions in a population, especially as a consequence of social inequity and the unjust exercise of power” (ibid., xv). There are several parts of this definition that bear scrutiny for what is to follow in this book. First, note that a syndemic concerns disease interactions. Second, note that a syndemic looks at populations rather than individuals. And third, following in an anthropological tradition, note that a syndemic takes account of inequalities and power differentials in human communities. Indeed, this last item—the untoward social conditions that foster disease clustering—is meant to alter our understanding of what disease is. From the perspective of syndemic theory, diseases are biosocial phenomena and not simply biological ailments that afflict individual human bodies, brought on by germs, viruses, poor diet, substance abuse, and the like. This reflects a fundamental medical anthropological understanding. A syndemic approach to disease “examines both disease concentrations (that is, multiple, coterminous diseases and disorders affecting individuals and groups) and disease interactions (that is, the ways in which the presence of one disease or disorder enhances the health consequences of other diseases and disorders, paving the way...for new infection or enhanced lethality)” (ibid., 20–21). This set of intertwined and interacting health problems occurs “in a context of noxious social and physical conditions” that may have a considerable effect on “the overall disease burden and health status of a population ” (ibid., xiv). One of Singer’s goals in Introduction to Syndemics is to draw attention to the complex linkages among social and health disparities, and the multiple ways that diseases cluster, interact, and potentiate each other. In this regard he notes that The Medical Anthropology of Tobacco 143 in the human world disease develops within and...