TENSIONS WITHIN CALIFORNIA TOBACCO CONTROL IN THE 1990s: Health Movements, State Initiatives, and Community Mobilization

摘要

Our society intends to reach all communities equitably, but minority populations are not being served by policies and programs, nor are their needs being addressed by research (Montes et al., 1995). The biggest problem is that we don't contact the people who we are going to change. They have no idea that they have a problem and most of the time they don't even care [Health professional cited by Grace (1991)]. The last quarter of the twentieth century marked the triumph of market-based neo-liberal policy agendas that have stressed the benefits of globalization, the reduction and privatization of state services, the introduction of corporate management and marketing techniques into the public and non-profit sectors and the recruitment of citizens as responsible community members (Barry et al., 1996; Dean, 1999; Rose, 1999). In this essay I will broach the question of the power and limits of the deployment of these new market logics in the arena of public health by exploring the tensions that arise in democratic projects of ensuring a healthy environment for increasingly diverse populations. I will focus especially on the contradictions that surface in the formulation and realization of these democratic goals through recourse to concepts derived from the community empowerment movement, social marketing tools developed by private sector firms, and state-sponsored research and policy bureaucracies.