issue 198 - August 1989
A smouldering problem
Blaming the victim is a popular sport. Individuals, whether unemployed or seriously
ill with cancer, are held responsible. Peter Laurie explains how this personal
focus distorts the politics of cancer prevention.
My mother died of cancer, as did her mother and grandmother. I know only too well the seriousness of a disease that will touch one in three of us and kill one in five. But looking through the pamphlets and policy papers on the subject, I feel they are fundamentally misleading - both about the causes of cancer and what we can do about it.
The most striking thing about cancer prevention and research in Western countries is the tendency to single out individual habits. Smoking or unhealthy diets are blamed, while social and environmental factors that help fuel cancer are downplayed. This is nothing new: it's why health activists coined the term 'blaming the victim' a decade ago.
Today this approach is becoming the norm as the welfare state searches for ways to pass the costs of health care back to the individual.
'Lifestyle need a bit of a change?', asks a recent pamphlet produced by the Canadian Cancer Society. 'Gain control of your body, mind and spirit.' The implication is clear: you chose it; you change it. Despite the holistic overtones, this approach is rooted squarely in the traditional clinical model of medicine, which seeks the causes of disease in the pathology of the individual body rather than in the social context.
There is a lot at stake in this emphasis on individual causes and solutions. For one thing, it ensures that an overwhelming proportion of the money raised to fight cancer goes into research while little is set aside for public education. In Canada, for instance, over half of the $64 million raised last year by the Canadian Cancer Society was allotted to research; a mere 17 per cent was spent on education.
This shift in responsibility to the individual obscures the many environmental hazards that are anything but a matter of individual choice. One study estimates that nearly 90 per cent of the carcinogens we're exposed to outside work (like polychlorinated biphenyls (PCBs) and dioxins) come from toxic chemicals that have seeped into the food chain. And, of course, such additives don't appear on food labels.
'You can tell if an orange has been dyed, but you can't tell if a glass of milk has PCBs in it,' says Linda Pim. author of two books on food additives. 'In this area, the consumer has absolutely no control.'
The scientific jury is still out on the precise connections between environmental contaminants and cancer rates. During the 1970s the 'carcinogen of the week' phenomenon in the mainstream media only served to confuse the issue. As a result, health activists have more than once been accused of 'cancerphobia'. Establishment cancer institutes like the American Cancer Society tend to adopt a 'look the other way' attitude to pollution, rather than taking controversial positions that might offend the pillars of corporate society.
The victim-blaming syndrome has also spilled over into the factory. There are some fairly bizarre examples. In 1970, for instance, two giant chemical companies, Dow and Du Pont, quietly began routine 'genetic screening' on employees and job applicants in order to determine their vulnerability to hazardous chemicals. According to company doctors, the tests were intended to screen out individuals with 'defective' genes. The assumption was that if you got ill on the job, it was 'your' genes and not 'their' chemicals that were at fault.
Thankfully, most cancer organizations and government agencies have come to recognize the links between cancer and the use of chemicals at work - especially the multiplier effects that exist between work and smoking. For instance, it is accepted that asbestos workers who smoke cigarettes are 90 times more likely to contract lung cancer than if they neither worked with asbestos nor smoked. As one epidemiologist puts it: 'Does smoking kill workers or does working kill smokers?'
But what about smoking, you might ask? Don't individuals bear some responsibility for the choices they make?
Of course they do, but such choices are never made in a vacuum. Unfortunately, the way in which the word 'lifestyle' is repeatedly invoked in most cancer prevention literature obscures this. According to Vicente Navarro. Professor of Health and Social Policy at Johns Hopkins Medical School in Baltimore, 'the idea of "lifestyle" assumes that you have control over your own life, which is only true to a certain degree.'
Life isn't a level playing field. Our world is stratified into social classes and talk of 'lifestyle' only serves to mystify the reasons why cancer tends to strike working people most often.
Consider a 1988 report by the American Council on Science and Health called Cancer in the United States: Is There An Epidemic? The report's purpose is to placate fears about cancer, but in its midst is the surprising admission that 'there is a cancer epidemic among blacks compared to other subgroups of the population.'
The logical question is 'Why?' The report points to 'the risks associated with diet and smoking as well as other aspects of lifestyle.' But that's it. No mention that blacks are far more likely than whites to work in high-risk occupations, nor that the proportion of blacks living below the poverty line is four times that of whites.
However, many studies do show a relationship between socioeconomic status and smoking. One reason for increased smoking, says Navarro, is stress at work, a factor that victim-blaming largely ignores. 'How do you tell a worker to change his lifestyle without changing his job?', asks Navarro.
According to a recent article in the American Journal of Public Health, anti-smoking literature is pitched at too high a literacy level to be useful to those who need it most. One exception is Australia, where well-funded and carefully-targeted media campaigns have resulted in a drop in smoking by all classes.
While most anti-smoking literature is aimed at convincing individuals to screw up their courage and quit, cigarette companies continue to pour billions into advertising - an estimated $2.5 billion a year by US companies alone. With that kind of market clout real change will never occur without collective action. But according to David Sweanor of the Canadian Non-Smokers' Rights Association, 'health and welfare organizations in most industrialized countries are nowhere in terms of political action to combat the tobacco industry.'
Still, there have been gains. Cigarette advertising is now banned in Sweden, Canada and Nigeria. And groups like the British Medical Association are beginning to play an advocacy role on a variety of cancer issues. In Australia, a militant group called BUGA-UP decided to take matters a little further: defacing tobacco billboards with their own caustic anti-smoking message. (The acronym stands for Billboard Utilizing Graffitists Against Unhealthy Promotions.) And the Scandinavian countries have long been praised by health activists for their recognition of the links between health and social conditions.
Unfortunately, the current climate of fiscal restraint in Western countries has sparked a new round of victim-blaming - hidden as part of a campaign to de-institutionalize health care. 'In times of crisis,' says Vicente Navarro, 'the line is always "don't ask what the government can do for you, but what you can do for yourself."'
Collective intervention is needed to prevent cancer. But first we need to recognize the biggest barrier to joint action. All of us will have to challenge the deeply-ingrained notion that the personal habits and behaviour of individuals are the main cause of the disease.
Peter Laurie is a freelance writer based in Toronto.