Academic Exchange How
did you get interested in addiction?
Peter Brown I did a project two years ago on
the relationship of culture and mens health and obesity. In
developed countries, theres a serious mortality gap. At least
in term of years of life, women do better than men. For example,
in the U.S., retired white men are the highest risk group for suicidehigher
even than teenagers. This mortality gap relates, in part, to male
privilege in terms of access to consumer goods. Many males use their
privileged status to buy alcohol and cigarettes, things that harm
their health. Then I did a project with the School of Public Health
and Grady Hospital on untreated tuberculosis and treatment compliance
with HIV. Most of the men with active tuberculosis were hiv positive
due to drug use. So I began to see that tb was also a problem of
addiction. The underlying issues again were social and had to do
with addiction and inequality.
Theres a tremendous opportunity in recognizing the sociological
and cultural factors underlying addiction, because its related
to a whole host of other markers of ill health. The overall culture
of science and medicine, though, tends to see this social stuff
as noise and focus on technological solutions.
is the cultural ecological model that you use in your study
is a standard model in medical anthropological theory. Health can
be seen as a marker of social processes that present particular
threats to the individual. Humans have a dual system of inheritancegenetic
and cultural. And though humans adapt genetically, cultural evolution
is much faster and more important in understanding human behavior.
Basically, cultural ecology describes the interactions among cultural
systems and the local environment: human interactions, economic
ones, settlement patterns, belief systems, and behaviors. Diseases,
including addiction, are simply part of the environment.
What is the relationship between inequality and addiction?
societies that are more egalitarian in income structureones
with less inequalityhave better overall population health.
Societies with more social cohesion have better health; the buzzword
these days is social capital. But its very complicated.
Even in relatively rich societies that have good access to health
care, like Britain, there is this huge gap between the health of
the rich and poor. My guess is that it has a lot to do with peoples
perceptions of personal success or failure. In some ways the American
dream sets up false expectations.
Sweden is interesting because it has a high level of general health
markers and a high percentage of cigarette smokers. This suggests
that smoking is not a one-to-one correlation with cancer. Swedes
probably smoke less and do other healthy things more frequently.
Theyre not stressed out and chain smoking. They have more
socially fulfilling lives.
Does treating addicts with medicinal drugs just change who profits
from addiction in our society, from black market dealers and the
prison industry to doctors and the pharmaceutical industry?
one hand, that cynical view has some merit. On the other hand, state
regulation has benefitson the quality of the legal drug, for
example. The Soviet Union has a terrible problem right now with
alcohol abuselots of death from alcohol poisoning and adulterated
vodka, black-market vodka. It may be
that in places where its less of a black-market problem, people
can manage their addictions in a healthier way.
Part of my other interest is in Italian studies. Ive been
studying Mafia culture in Sicily. Id much rather these exorbitant
profits be made by the white collar gangsters, the pharmaceutical
companies, than by organized crime. Ultimately, there will be health
benefits. And if you know who is profiting, you can ask: are there
limits to what profitability should be? And at what point do we
have a public health disaster that makes us think about the ethics
of profiting from human misery?
The drug companies have a public face and can be shamed. And theyre
generally good people who want to improve peoples health.
The Mafia doesnt want
to do that. Cigarette companies dont want to do that. I think
there may be real opportunities now if people realize that the War
on Drugs using a military battle plan against drug supply
has failed. But Im not sure policy makers really understand
that or that Americans are as embarrassed as they should be about
the complete social failure reflected in our high rate of incarceration.
is something dreadfully wrong in a society that has such a high
percentage of people who are in prison and kids growing up with
the expectation that at some point they will be in prison.
Brown is a medical anthropologist.