In the past few weeks, stories have been circulating on the Hungarian Internet about women disappearing in Chinese shops  and being discovered dead or drugged by relatives in a secret room, either with organs already taken out or in preparation for the harvesting. The women (always women, rescued by a male relative who is a friend of a friend of the author) invariably have their heads shaved (even if it is a kidney that is missing). I have been getting these emails from a friend who gets them from her university classmates, with comments like “Well, if this is true!…” ”I don’t know if it’s true but I’ll forward it”.

The people waking up in a bathtub full of ice with a kidney missing are one of the most popular recent urban myths — so much so that they have figured in well-known anthropological writing, for example by Nancy Scheper-Hughes. But these stories tend to come from exotic foreign lands. Here, however, we have a cross-breed of the story with domestic xenophobia, so that the exotic locale is transported to our midst.

Chinese shops are a ubiquitous phenomenon in Hungary and some other Eastern European countries. They sell cheap clothes and shoes, and in some villages are the only provider of such goods — to some extent heirs of the pre-war Jewish shopkeeper. It is perhaps not far-fetched to see in the organ-harvesting Chinese the updated embodiment of the Jewish blood libel (the use of Gentile children’s blood  in preparing matzoh for passover).

Hungary consistently gets the highest scores in European surveys of xenophobia.

In three days, I will be part of a festive roundtable  in Budapest celebrating “Diversity in the united city.”

If this post doesn’t attract the spam bots, I don’t know what will…

Recently I saw an article in the Herald’s “Strange but True” section — where I do all my trolling for topical anthropology blog posts — about a Saudi guy who had paid $US50,000 for a solid 18-carat gold, diamond and ruby encrusted, penis enlarger. The subeditors had a field day with that one: “Saudi pays stiff price for sex toy” reads the headline.

I was immediately struck by the resonances with Lisa’s work about attitudes towards Viagra and other erectile dysfunction drugs in the Middle East.  Amongst other things Lisa noted differing cultural attitudes towards the drugs: while the men around the department here at Macquarie associated Viagra usage with a lack (we tended to laugh and claim “we don’t need it” when she jokingly offered it to us),  it has all sorts of positive associations for Egyptian men.  She noted that Egyptian men give each other Viagra as gifts without, presumably, any implication of a lack of virility, and that there are a number of food dishes trading on the “Viagra” name.

I sent the article to Lisa, noting the parallels with her research, and wrote a little riff about it.  Lisa liked it and thought I should post it to CM. So, despite my reservations, here it is:

When I saw the article (besides having a good chuckle) I was immediately reminded of the Viagra meals and gift giving you talked about back then — public, or at least shared, celebrations of virility rather than signs of inadequacy.  I thought, what a contrast between the shameful $400 penis enlarger, kept in a draw next to the bed and used in secret, and this ostentatious, ruby-encrusted monument to one’s cock.  It wasn’t just that this thing was so much more expensive than usual, but that its symbolic value is the opposite of what we’d expect; it was being treated like a luxury good or status symbol rather than a pseudo-medical apparatus designed to correct a problem.  I wonder if its given pride of place in the bedroom — maybe in a nice glass cabinet above the bed?

It’s funny, isn’t it?  The usual, Freudian, way we think about phallic symbols is as attempts to compensate for a lack, but the symbolism is always repressed and therefore indirect, concealed, at least to the “owner”.  The bloke just thinks his shiny new red sports car is really cool; the rest of us just look at each other knowingly and wiggle our pinkies.  And then there’s this Saudi guy, who doesn’t bother with sublimating this symbol into some other form; it’s out there, standing (literally) for what it is.  “Yes, this represents my desire for a larger penis.  Who wouldn’t want to have a larger penis?”    Sometimes a penis enlarger is just a penis enlarger.

The logic would seem not to be that of a compensation for a lack. Rather, when it comes to virility, more is always better.

– Jovan Maud

Let me break my long silence with a quick announcement for a conference.  The ANU is hosting a symposium and short course on the subject of cultural epidemiology.  Seems like and event that would be of interest to readers of this blog.  Here are the details:

*Culture Matters for Health: Exploring cultural epidemiology & related
approaches in a symposium and short course.*

26-29 October, University House The Australian National University,
Canberra.

According to the 19th centure anthropologist and doctor, Rudolph
Virchow, ‘disease is a disturbance of culture’. Over the past 150 years,
cultural epidemiology has evolved as a hybrid or sub-discipline with a
body of work and research approaches that resonate with Virchow’s
proposition.

*Scoping cultural epidemiology in the Antipodes – a symposium.*
Through the presentation of brief papers and posters over one and a half
days, the symposium will explore the inter-relationships between
culture, health and illness.

*Cultural Epidemiology short course*
This two day course introduces students to the emerging discipline of
cultural epidemiology, defining what it is and how it might be
undertaken. It focuses on employing cultural theories, concepts and
related methods to the health of populations and sub-populations.

Speakers include:
Professor Sandy Gifford, Director, Refugee Health research Centre,
School of Social Sciences, LaTrobe University
Professor Claude Fischler, Director, Centre National de la Recherche
Scientific, Paris
Associate Professor Julir Park, Associate Professor of Anthropology,
University of Auckland
Professor Tony Blakely, Director of the Health Inequalities Research
programme, University of Otago,
Dr Maggie Walter, School of Sociology, University of Tasmania
Jill Guthrie, Australian Institute of Aboriginal and Torres Strait
Islander Studies.

For more information and to register go to:
<http://nceph.anu.edu.au/Short_Courses/CulturalEpi/index.php>

*Register early to be guaranteed a place – strictly a limited number
available!*

Yesterday I had a chance of observing organisational space in a Sydney hospital as I joined a UTS Centre for Health Communication group. Rick Iedema and his staff do wonderful ethnographic research in hospitals filming professional collaboration around patient care. Yesterday’s topic was the designed spatial settings in hospital. In our group was apart from the UTS researchers also hospital staff and the architect of the visited spaces. Completely dressed up as hospital employees we were able to visit the different surgery and recovery rooms. One of the staff members washed her hands when entering a new room. When I asked her about that she told me that all the doctors were obliged to wash their hands when going from one patient to another in order to prevent the spread of diseases. For many years academic articles have been written, she told me, to show the neg correlation between handwashing and disease spreading. However, still only 15% of the male doctors did wash their hands. Therefore, she saw herself as a role model to show others that handwashing should be done every time. Articles, information, stickers, and role model however had not helped to increase the handwashing rituals of male doctors. ‘It is behavioural,’ she said. I told her that ethnographic study would probable show that hand washing was perceived as to be in the female domain by male doctors. That handwashing, in contrast to scrubbing of surgeons, is not in the professional domain of doctors. Interventions to increase the handwashing should therefore be based upon changing the meaning of handwashing in the professional culture. This is where interests of contemporary businesses and organisations such as this Sydney hospital have interests in anthropologists and their methods. The detailed accounts of what really happen at the work floor of a, for example, hospital makes professionals aware of their own action. Helping with their reflection on action in order to increase their reflection in action (Schön).

There are many rituals in hospitals that are questioned by researchers but that are exercised by practitioners. The Amsterdam Academic Centre had a campain last year to recruit nurses who where asked to get rid of unnessasary rituals by showing a picture of a Ladakhi oracle acting a cleaning ritual with a patient. In my anthropological fieldwork in the early 1990s I encountered many rituals among the Ladakhi shamans in the upper Indus valley in Northern India. This Tibetan Buddhist community has male (llhamo’s) and female (llapa’s) village oracles and eight monastery oracles. The oracle is perceived as the possessor of power and the linking between the human and the spiritual world. By virtue of calling and training the oracle is able to restore the disturbed relation between patients and the supernatural forces that have brought disorder (Miller 1997). The power is not exclusively attached to the person of the oracle. It is the relation between the oracle and his patients that generates the power (Taussig 1987). The shaman and his audience construct a joint interrogation of their ideological environment. Shamans employ their power in public rituals for the benefit of the community or individuals. And there is why the rituals in the Sydney hospital are so difficult to get rid of as the are part of a larger construction of healing.

Call for papers – Medische Antropologie, Dutch journal of medical anthropology – “Beauty and Health”
Please submit papers to Alex Edmonds at a.b.edmonds@uva.nl by January 30

Beauty and health. In most societies beauty can be seen as a sign of health, presenting the body as the materialization of wealth and power. But as anthropologists we are also familiar with an astonishing range of aesthetic ideals and body modification procedures that are violent and harmful to the body. The Western beauty ideal of a slim and youthful body leads to practices that carry their own health risks, ranging from severe dieting to cosmetic surgery. And then there is the growing importance of the ‘aesthetic of health’, the idea that the continuous improvement of the body is possible and desirable. Beauty can be both a sign of health and an invitation to endanger it. ‘Beauty and health’ in its many varieties, is a theme that prompts reflection from several focus points, not only anthropological, but also psychological, medical, sociobiological and historical.

I have been working on an ethics teaching module and just came across this December 2007 editorial in the NY Times by Atul Gawande. Medical anthropologists might have encountered Gawande through his articles for the New Yorker or for his book of collected essays, Complications: A Surgeon’s Notes on an Imperfect Science — which I think is great material to assign to undergraduates in an introductory medical anthropology class. Gawande has an anthropological appreciation for the technological, social, cultural, political, and organizational forces that shape science and medicine. Plus his writing is punchy, dramatic, and neatly wrapped up with concise morals-to-the-story that makes it easy to digest for students who are new to anthropology’s way of complicating everything, especially neat morals-to-the-story.

Still, Gawande is a doctor, not an anthropologist, and I thought it was mostly anthropologists (plus our social science relatives who also do ethnographic research) who chafe at the way ethics oversight developed to regulate biomedical research has crept over to the social sciences. We can all agree that ethical research is a good goal in either domain, but anthropologists are acutely aware (in a way that sometimes IRBs / ethics committees aren’t!) that there are very different research ethics issues at stake depending on whether you’re testing a new drug or doing ethnographic fieldwork.

But in his NY Times article, Gawande shows us a conflict where medicine chafed at the way ethics regulation originally developed for biomedical research crept into applied research on the social organization of medicine.

Here’s an excerpt:

A year ago, researchers at Johns Hopkins University published the results of a program that instituted in nearly every intensive care unit in Michigan a simple five-step checklist designed to prevent certain hospital infections. It reminds doctors to make sure, for example, that before putting large intravenous lines into patients, they actually wash their hands and don a sterile gown and gloves.

The results were stunning. Within three months, the rate of bloodstream infections from these I.V. lines fell by two-thirds. The average I.C.U. cut its infection rate from 4 percent to zero. Over 18 months, the program saved more than 1,500 lives and nearly $200 million.

Yet this past month, the Office for Human Research Protections shut the program down. The agency issued notice to the researchers and the Michigan Health and Hospital Association that, by introducing a checklist and tracking the results without written, informed consent from each patient and health-care provider, they had violated scientific ethics regulations. Johns Hopkins had to halt not only the program in Michigan but also its plans to extend it to hospitals in New Jersey and Rhode Island.

The government’s decision was bizarre and dangerous. But there was a certain blinkered logic to it, which went like this: A checklist is an alteration in medical care no less than an experimental drug is.

Gawande’s editorial was accompanied by objections from major journals and medical associations including the New England Journal of Medicine and led to a letter-writing campaign to Congress.

The case highlights the perversity that we sometimes find in ethics oversight. Research ethics codes, of course, were developed in the wake of the Nuremberg trials that prosecuted the Nazi doctors who performed grotesque experiments on live prisoners. The Nuremberg Code was the first international code of research ethics. It mandated that research involving human beings must follow 10 basic directives, including:

1. voluntary, informed consent from research participants;
2. no coercion to participate in research;
3. only properly trained scientists should carry out research;
4. any risks must be outweighed by the humanitarian benefits of the research;
5. research should be designed to minimize risk and suffering
6. participants can end the experiment at any time, and researchers must stop the research if it becomes apparent that the outcomes are clearly harmful.

Later elaborations of the code have tweaked those basic directives — for example, the Helsinki Declaration allows for proxy consent — but the basic calculus of benefits outweighing risks has guided all subsequent elaborations of research ethics codes (and not without considerable debate about what constitutes an appropriate risk-benefit calculation). And yet as so many have noted, the application of ethics oversight has often focused on the letter, rather than the spirit, of the law, with painful attention to bureaucratic detail. In the Johns Hopkins case, Gawande was essentially pointing out that the humanitarian benefits to this research far outweigh the fact that consent wasn’t obtained from the doctors and patients being ’studied.’

The OHRP ruling was soon overturned, but not on the grounds of that risk-benefit calculus.  Rather, the revised ruling hinged on definitions of whether the Johns Hopkins project counted as research or quality control.

[See the American Nurses Association website for a good (well referenced and linked) summary of how the whole story played out.]

–L.L. Wynn

The US National Association of Practicing Anthropologists has just released a call for papers on the subject of the global food crisis.  Here are the details:

Global Food Crisis: Perspectives from Practicing and Applied Anthropologists
Sponsor: NAPA Bulletin, National Association for the Practice of Anthropology (NAPA)
Contact Information:

David A. Himmelgreen
Department of Anthropology, University of South Florida
4202 E. Fowler Ave, SOC 107
Tampa FL 33620
Email: dhimmelg [at] cas.usf.edu

Description

The NAPA Bulletin welcomes submissions for a thematic issue on “Global Food Crisis: Perspectives from Practicing and Applied Anthropologists,” to be tentatively published in Spring 2010. NAPA Bulletin is the official publication for the National Association for the Practice of Anthropology (NAPA), a section of the American Anthropological Association. Recently, a convergence of events including environmental threats (e.g., floods, droughts, frosts) and cost of fuel in the United States and around the globe has resulted in skyrocketing food prices throughout the world, leading to a global food crisis not seen in decades. The ensuing threats of hunger and food insecurity have caused civil strife and political instability in dozens of developing countries. In the United States and other industrialized countries, rising food prices has further eroded the buying capacity of consumers and threatened the ability of families to access nutritious food in sufficient quantity. While the increase in food prices have been felt by most Americans regardless of socio-economic status, low income families have been the most drastically affected. The effect of this trend in rising prices on food security is clearly seen by increases in the use of soup kitchens in majority of the major U.S. cities. This proposed NAPA volume will bring contributions from both practicing and applied anthropologists to examine how rising food prices are affecting peoples’ food choices, to discuss the way international and domestic food and energy policies are exacerbating the problem of hunger and food insecurity in both developing and industrialized nations, and to provide recommendation for addressing the global food crisis in the coming years. This CFP invites practicing and applied anthropologists and other social scientists with expertise in aspects of agriculture and food, especially as they relate to global food policies, structural adjustment programs, and the development of food assistance initiatives either within or outside the United States to contribute full-length articles (approximately 7,500 wordsto this proposed volume.

Please submit a 250 word abstract and 150 word biographical sketch to David Himmelgreen , no later than November 1, 2008.

Several articles have appeared in today’s The Australian regarding the Northern Territory intervention, and on indigenous health and welfare more generally.  Of most interest to me was a report on calls to soften some aspects of the new government regime.  The article notes that while there have been some reported positive outcomes of the new paternalism in the NT, such as an increase in the amount of fresh food being eaten.  I’ve heard anecdotal evidence from an anthro working in Arnhem Land that the quarantining of welfare payments and the introduction of stamps for certain products has certainly had an effect on consumption patterns.  For example, kids are claiming “not to like” lollies anymore but to prefer fruit-based snacks like Roll-ups because the latter can be bought with stamps.  This allows them to continue to spend their free cash on cigarettes and other products not covered by the stamps.  It would seem that the new system has introduced new hierarchies of need where people have to make choices about which pleasures to keep and which to modify.  This is all interesting stuff and it would be great to see more reporting by anthropologists about what they’re seeing in the communities that they work with. All contributions are welcome and we are happy to reproduce them on this blog.

One area on which the Intervention doesn’t seem to be having an impact, and might even be making matters worse in some ways, is child welfare and the prevention of abuse.  This was of course the issue that prompted the Intervention in the first place.  According to a report by the Secretariat of National Aboriginal and Islander Child Care,

“A major unintended consequence of the NT intervention has been to stall and delay the necessary reform of the child protection systems (and) care needed to support children at risk of abuse and neglect,” the secretariat says in its submission.

“It has not uncovered the abuse of children or resulted in any significant change in child abuse notifications.

“Ironically, the intervention seems to have swept to one side the very issues that precipitated it in the first place.”

Other related articles in today’s Oz are as follows:

Call to lock in indigenous health gains
http://www.theaustralian.news.com.au/story/0,25197,24422991-5013172,00.html

Action, not words, needed to close gap on indigenous health
http://www.theaustralian.news.com.au/story/0,25197,24422990-5013172,00.html

I am happy to present this guest post by ANU PhD Student Bree Blakeman and environmental economist, Dr Nanni Concu.  This article deals with a number of themes that we have focused on at CM: the concept of culture and how it is applied in real life contexts, engaged anthropological commentary on current events, and the specific issue of the government Intervention into Aboriginal communities in the Northern Territory.  The article provides some considered observations grounded in ethnographic research which, I think, serve to challenge the usual terms of the debate about the Intervention.  Hopefully this will provoke new discussion on what remains an important, and unresolved, issue.

Jovan

There is a sense of the uncanny following contemporary Indigenous policy debates while living in a remote Indigenous Homeland. For the last twelve months we’ve done just this, discussing the varying issues with our adoptive family. At first instance we thought this feeling of discomfort arose from the glaring power differential: listening to people thousands of kilometres away make decisions about the lives of our family in a language largely unintelligible to them, in a forum out of their reach. However, in the course of our life on the Homeland, it struck us that it is something more pervasive and, arguably, a lot more sinister. It is as if the life of our family – their everyday lives, responsibilities, values and goals – are being effaced. Through a pervasive rhetorical device – an implied cultura nullius – these debates effectively negate the life of those they then claim they must act to save.

Debates about remote Indigenous communities, with very few exceptions, are crafted with a discourse of negation: people on the ‘margins’ of society, on the ‘margins’ of the economy with ‘little or no education’ who are nothing more than exiled economic citizens. The implication is clear as Helen Hughes said recently – Indigenous people can’t read, they can’t write, they don’t have skills, [and seasonal fruit picking] is about the only thing they can do! Their communities are rendered as socio-economic vacuums in our thriving settler State. When the debate is cast in these terms, one can understand the sense of urgency to educate Indigenous people, ‘skill’ them up and make them ‘job ready’ so we can break down, in Marcia Langton’s words, ‘the apartheid system of employment’. They are waiting for us to fill them out and colour them in with education and skills, to bring them into the real world and the real economy.

However, one feels entirely unconvinced living in a vibrant remote Yolngu* community – one of around a thousand on the 1.5 million sq km of Indigenous owned land – listening to these debates and the assumed negation, or cultura nullius. Considered time in these communities will reveal very little ‘missing’ or ‘lacking’ in the social fabric. If anything, it is the visiting Balanda, or white person, who feels on the margins, lacking in language, education and practical skills. There are often more than five languages spoken in any one Homeland, a great source of amusement as kin show off their skilled and often uproarious word play. Days are spent in the breast of kin and country, hunting and gathering food to compliment shop bought products, collecting bark and pandanus for painting and weaving (which later adorn the walls and shelves in local and international art centres), and plugging in a few hours of CDEP work – mowing lawns, fencing, gardening etc. – to ensure their fortnightly pay. The evenings are spent catching up with the latest gossip and sharing in music, dance and food.

Longer yearly cycles show a rhythm of movement between one’s primary Homeland, trips to town for reinforcements, and movement between other communities and centres ‘following ceremonies’, and maintaining socio-ceremonial networks that hold the wider Yolngu community together. Underlying these everyday activities is the ever present satisfaction in the knowledge they are fulfilling their most fundamental and rewarding responsibilities: looking after kin and country, and in doing so ‘following in the footsteps of the ancestors’ and ‘holding’ Yolngu law, two sayings that one hears all the time in the Homelands.

These communities are not socio-cultural vacuums and are not on the margins of anything. They are the centre of Yolngu lives and are filled with knowledge, skill and value that, though very different, are not exclusive to those of the encompassing settler State. From a Yolngu point of view these communities are ‘promised lands’ of unquestionable value as part of wider socio-ceremonial networks that make up the Yolngu cosmological and social world. Traditional owners or custodians of each community proudly refer to themselves as ‘lukumankamirri Yolngu’, which roughly translates as the people who have their feet ‘stamped’ in the white clay of the land.

It is true that many people on the Homelands speak little English and do not meet National education benchmarks, but these are not primary indicators of social skill, status or value in Yolngu communities. Yolngu, by in large, have a very different education and a very different skill set that is much more diversified than ours in many cases. These knowledge or skill sets are perfectly suited to the tasks most Yolngu dedicate their time and lives to, which make them successful, happy and valued members in their wide social networks.

The argument that is often used to dismiss the portrait above, as Langton recently countered, is that Yolngu are an ‘exception’ and a geographically confined exception at that, and should therefore be subordinated to the national debate about CDEP (where most Indigenous people are exiled economic citizens waiting for us to bring them in?). Well, it is true that Yolngu are somewhat unique. They had a very late contact history, and many were never moved off their land. They still speak their languages, hold and practice their ceremony and live on land they own. But should this alleged ‘exception’ be dismissed and these communities be mainstreamed? Should the knowledge, skill and value in these communities be subordinated and effaced by a singular market value? What does it mean to talk and act as if this culture and life doesn’t exist?

As the legal escamotage of terra nullius denied the existence of Indigenous land tenure, opening up land and resources to European settlers, so cultura nullius is being used to justify government and market policy efforts to overlay our own, often foreign values and visions, on those that are rhetorically effaced and trade-off one cultural body of knowledge, skills, practices and values for another. We are not filling up or colouring in exiled citizens with no education or skills who are waiting on the margins of society for us to ‘bring them in.’ The pretence of a socio-cultural vacuum is functional to avoid the moral nuisances that arise when we address cultural diversity with mainstreaming and resocialisation. Policy pundits can no longer act in bad faith upon a false premise of ‘cultura nullius’. We have to ask ourselves how morally sound such policies are.

The merit of CDEP in the full colour version of life on the Homelands in North East Arnhem Land is that it accommodates and even compliments Yolngu cultural responsibilities, priorities and values while delivering basic services to remote communities at low cost to the Government. CDEP gives Yolngu the opportunity to balance often conflicting systems of value and allows them to choose how far they wish to move between the two. It offers a flexible system that allows communities to fulfil basic responsibilities to both kin and government on their own country, and largely on their own terms. A more coercive policy will inevitably bring the two systems of value into direct competition.

Yolngu are acutely aware of this pressure, as my adoptive sister (who is an enthusiastic CDEP worker) stated when discussing the recent CDEP debate and the pressure for Yolngu to move into labour market centres “if they stop CDEP we will not leave. We will still stay here on our country. We were not born with money, we were born with culture. It is indeed this way. The money is not sacred for us. That is Balanda madayin [white people’s sacred endowment]. This is how I feel. Money is not our madayin. We will stay here.” As history has proven, Yolngu are more than resilient. They will not disregard values at the heart of their culture and identity and it will be a sad day when Government policy measures suggest they do, without even acknowledging the trade off they are asking these people to make.

Acknowledging the richness and diversity in Indigenous Australia will make policy debates a lot more complex, but to act otherwise is both morally and politically dishonest.

Bree Blakeman is a PhD student of anthropology at the Australian National University, and long term resident of Yolngu Homelands.

Dr. Nanni Concu is an environmental economist at Charles Darwin University and Dhimurru Aboriginal Corporation.

*The above discussion is confined to Yolngu country (stretching from Maningrida in the West to Blue Mud Bay in the South East) because this is the area with which the authors are most familiar.

The New York Times has run a story about Val Curtis, an anthropologist who directs the Hygiene Center at the London School of Hygiene & Tropical Medicine: Warning: Habits May Be Good for You by Charles Duhigg. The story discusses how Curtis turned to consumer goods manufacturers like Procter and Gamble and Unilever in her attempts to persuade people in the developing world to wash their hands habitually with soap. Although seemingly innocuous, illnesses carried on the hands that might be prevented by simply washing them often lead to diarrhea, one of the leading killers of children in the developing world.

The marketing divisions of these corporate behemoths had abundant experience insinuating themselves into the everyday habits of consumers, helping us to feel ‘dirty’ if we don’t brush our teeth multiple times each day or that we are inadequate if sweat shows in the armpits of our t-shirts. As Curtis explained:

There are fundamental public health problems, like hand washing with soap, that remain killers only because we can’t figure out how to change people’s habits…. We wanted to learn from private industry how to create new behaviors that happen automatically.

Curtis looked at the ways in which advertisers try to establish cuing behaviour for habits, such as associating being with friends with having a beer or having a Snickers bar when one is a bit spacey in the middle of the afternoon. If the advertising works, the relatively common cue starts to provoke people to think about the product (even if the product is a dubious ‘cure’ for a manufactured ‘problem’).

Dr. Curtis’ problem was that people were not cued to wash their hands with soap after going to the bathroom. As the article explains:

To teach hand washing, about seven years ago Dr. Curtis persuaded Procter & Gamble, Colgate-Palmolive and Unilever to join an initiative called the Global Public-Private Partnership for Handwashing With Soap. The group’s goal was to double the hand-washing rate in Ghana, a West African nation where almost every home contains a soap bar but only 4 percent of adults regularly lather up after using the toilet.

Studies showed that Ghanaians used soap when they felt there hands were dirty, such as after traveling about in the city or cooking with oil, but they didn’t have those associations with going to the bathroom (oh, don’t get all shocked and incredulous — studies of Westerners show that less than half wash their hands before leaving public restrooms). Because modern commodes were such an improvement upon previous facilities, many Ghanaians actually considered them to be quite clean and sanitary, which they are relative to other sorts of solutions to human waste problems.

The campaign resulted in commercials aimed at creating a sense of ‘disgust’ or ‘unseemliness’ about leaving a bathroom without washing one’s hands with soap; they used ‘ads showing mothers and children walking out of bathrooms with a glowing purple pigment on their hands that contaminated everything they touched.’ The article discusses how other public health campaigns, such as HIV infection prevention and anti-smoking campaigns, are adopting a focus on habit formation and using methods that focus less on health concerns than on creating habitual associations.

I get a bit of ethical vertigo in the article as we jump back and forth from discussions of public health campaigns and the marketing of ever-increasing amounts of self consciousness in order to flog new ‘necessities’ like mouth wash and hand sanitizer. A ‘consumer psychologist’ for Procter & Gamble rather glibly announces that her firms’ attempts to create ‘positive habits’ are ‘a huge part of improving our consumers’ lives,’ nevermind that the Cincinnati-based Fortune 500 company markets a few products that likely only improve consumers’ lives after they have developed phobias about the way they smell, the colour of their teeth, or the presence of hair on their bodies in particular places. Christina Aguielera fragrance and ‘Born Blonde’ hair colour, anti-wrinkle creams and teeth-whitening strips seem to be a bit of a stretch in the ‘life improvement’ department.

The companies’ representatives are pretty clear about the need to produce new ‘needs’: one of the P&G psychologists says, ‘For most of our history, we’ve sold newer and better products for habits that already existed…. But about a decade ago, we realized we needed to create new products. So we began thinking about how to create habits for products that had never existed before.’ They turned to emerging research on habit formation in order to learn how to manufacture new ‘needs’ in people’s lives.

One of the better examples that the New York Times article uses as illustration is Febreze, a P&G product first advertised as being useful for getting the smell of smoke out of your clothes after a late night at the local watering hole or for making a stinky room smell passable. Febreze was a big hit in my college dorm immediately prior to parents’ weekend as it was also useful for removing the smells of certain burning substances from the curtains and linens.

Because consumers didn’t need to remove terrible smells often enough (how much of the stuff can you flog to college students in need of hiding incriminating odors?), P&G couldn’t sell enough Febreze. So they repositioned the product, convincing homemakers that a spritz with artificial aromas was the perfect end to a housecleaning activity. As the company psychologist says, ‘It’s the icing that shows you did a good job’ — as meaningless an empty signifier of ‘job done’ as folding the end of toilet paper into a triangle.

North American consumers alone engaged in this habit to the tune of $650 million last year alone. No, I’m not kidding — $650 million on Febreze. I’m just reminded of a girl in my freshman dorm using it on her long hair to try to remove the malodorous aftermath of a serious bender.

The article is fascinating; first, there’s the reincorporation of ideas originally taken from social science research (or psychology) and developed in marketing back into the applied social sciences. Second, there’s the marketers pretty much laying out how they seek to manipulate and produce human needs through a kind of symbolic association, linking their products to sometimes only loosely related recurring events. Third, there’s a fascinating discussion of the habitual basis of much of human behaviour, especially consumption. Worth checking out on many levels.

Credit: Graphic from http://www.1st-in-handwashing.com/hand_procedure_washing.html