National Institute for Health and Welfare, Department of Alcohol, Drugs and Addiction, Mannerheimintie 164a, P.O. Box 30, FI-00271 Helsinki, Finland.
Soc Sci Med. 2013 Dec;98:253-9. doi: 10.1016/j.socscimed.2013.10.002. Epub 2013 Oct 10.
Smoking was once defined as an appropriate recreational substance or life comfort, but is now understood as a serious health risk and a public health problem important enough to be controlled by society. In this article the changed social position and development of tobacco regulations in Finland are studied from a perspective of social constructionism. The emergence of recent tobacco controls can be seen as a process whereby tobacco came to be defined as a social problem. I will argue that there were three primary definitions which played a decisive role in this process. Put in historical order, these three definitions contained (1) claims about harms to smokers, (2) claims about harms to others, and (3) claims about tobacco as a highly addictive drug. These conceptions together drove a complementary and mutually reinforcing re-conception of tobacco harms. Consequently, the emergence of these definitions led to the founding of new institutions, practices, and treatments. The leading value in the claim-making process was public health, which transferred the state's interest away from fiscal revenues towards lowering the costs caused by tobacco diseases. Correspondingly, medical science and medical doctors gained a position as the leading authority in the defining the tobacco issue. The latest conceptual innovation is the idea of a tobacco-free Finland by 2040, representing a strategy of 'de-normalising' tobacco use. The reversal in the social and cultural position of tobacco, which in Finland went from one extreme to another, was not based on pressure created by any wider social movements or organised tobacco-specific citizens groups, as in some other countries, but rather by a state health administration supported by a relatively small network of tobacco control advocates.
吸烟曾经被定义为一种适当的娱乐性物质或生活舒适品,但现在被认为是一种严重的健康风险,也是一个足以引起社会关注的公共卫生问题。本文从社会建构主义的角度研究了芬兰社会对烟草的定位变化和法规发展。可以看出,最近的烟草控制措施的出现是一个将烟草定义为社会问题的过程。我认为,在这个过程中,有三个主要的定义起了决定性作用。按历史顺序排列,这三个定义包含(1)吸烟对吸烟者的危害的说法,(2)吸烟对他人的危害的说法,以及(3)吸烟是一种高度成瘾性药物的说法。这些观念共同推动了对烟草危害的互补和相互强化的重新认识。因此,这些定义的出现导致了新的机构、实践和治疗方法的出现。在主张过程中起主导作用的是公共卫生,它将国家的利益从财政收入转移到降低烟草疾病造成的成本上。相应地,医学科学和医生在定义烟草问题方面获得了主导地位。最新的概念创新是到 2040 年实现芬兰无烟的想法,代表了一种“使吸烟正常化”的策略。在芬兰,烟草的社会和文化定位发生了从一个极端到另一个极端的逆转,这不是基于任何更广泛的社会运动或有组织的特定烟草公民团体所创造的压力,而是基于一个得到相对较小的烟草控制倡导者网络支持的国家卫生管理部门。