May/June 2010 Issue • Volume 38 • Issue 5

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ASA Forum for Public Discussion and Debate

First-rate Sociology or
Second-hand Epidemiology?

I read with much interest the Executive Officer column in the March 2010 Footnotes (p. 2) by Dr. Sally T. Hillsman, titled "Social Science Speaks, ‘NIH Listens’ and Acts." Unfortunately there is very little sociology in the ASA-submitted question to the NIH Director. Let me quote a passage from the text: "[Epidemiological] research shows that about 50 percent of premature deaths in the United States are directly [in fact indirectly, due to spurious correlations] attributable to social and behavioral determinants (e.g., health-care disparities, personal life choices regarding exercise, tobacco smoking, alcohol use, environmental effects on obesity)." (The words in brackets and italics are mine).

The italicized words deserve brief comments: First, the use of "determinants" as a sociological concept—or rather, "determinants in the last analysis"—comes from the Marxist views about the impact of the social relations of production. The use of "social determinants of health" has been uncritically adopted by the epidemiological literature, as if any statistically significant "factor" could determine all health standards. Second, I recall that the risks of a "personal life choice" of smoking were cautiously classified by epidemiologists years ago according to different levels of addiction (i.e., light versus heavy smokers). This is a topic still open to sociological debate. It is time the voice of sociology should be heard in the debate on smoking bans.

Let me recall the statement on the "personal life [choice] regarding tobacco smoking" to make my point clearer. What is at stake here is not compulsive, chain-smoking addiction (nor binge drinking, by the same token), but the extremely low levels of smoke in public spaces like airports, restaurants or pubs, which were targeted as health-hazardous places by the anti-smoking epidemiology circles. However, well-ventilated areas properly set or designed by technical standards will not pose a health hazard to non-smoking areas. Smoking and non-smoking areas should not have been eliminated in the United States and other countries by "medical police" regulations. Let us recall one of social science’s strongest moral imperatives, stressed by outstanding public sociologists Erving Goffman and C. Wright Mills. Both strived to show how institutions, organizations, social programs and social contexts confront individuals and their "out-group alignments" with stigma, spoiled identities, and deteriorated self images. Smokers are now considered second-class citizens, ostracized from spaces of recreation and sociability. Sociologists cannot stand silent in the face of social exclusion and the excesses of a stigmatizing health culture. Let sociologists and ASA confront the most damaging evils in the United States: The issues of gun rights and their advocates; the networks of crime disseminated by the narco-traffic. Epidemiology also takes a hegemonic role in lieu of sociology in Brazil, where anti-smoking laws and easy-to-ban citizens attract heavy-handed public authorities, in a time when the use of narcotics, the illegal dissemination of firearms, urban violence, and crime spread unchecked throughout Latin America.

It is absolutely necessary that the ASA voices the nation’s most urgent concerns, as Hillsman sought to address at the end of Francis S. Collins´ Press Club speech. ASA should be congratulated for this effort. However, I suggest that sociologists in this country must regain a critical voice in the public health arena, a task that requires a displacement of the "epidemiological risks" rhetoric and a strong attempt to curb its hegemony in sociology circles. I would suggest that a second-hand epidemiology discourse, that plagues medical sociology and the sociology of health in recent years, is much more to blame than "second-hand" smoking—a polemic concept that won’t hold water, but instead leaks its scientific aura from all sides.

Luiz A. Castro-Santos, Institute of Social Medicine, State University of Rio de Janeiro, or

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