Health, Risk and Society: six years on

Abstract

In this editorial the Founding Editor of Health, Risk and Society reflects on the aims of the journal and the extent to which they have been achieved in first five volumes of the journal. The editorial looks forward to the opportunities offered by the expansion of the journal to four issues per year and the ways in which aims of the journal can be developed to include such issues as risk production and construction and to provide more sophisticate theoretical insights into the relationship between risk, health and society.

Keywords:

• risk
• new risks
• risk communication
• risk policy
• risk theory

In March 1999, the inaugural editorial (Alaszewski and Manthorpe 1999) outlined the rationale for launching Health, Risk and Society. Having survived and thrived over the last 5 years and as Health, Risk and Society moves from three to four issues a year, it is time to reflect on what Health, Risk and Society has achieved and how it can develop over the next 5 years.

The initial aims of Health, Risk and Society were to develop the theoretical and empirical understanding of the ways in which health risks are assessed, communicated, taken and managed. We have expanded these to include the study of the social processes involved in the construction and production of risk. In the inaugural issue, Green (1999) explored the ways in which public health had reconstructed accidental death and injury as type of health risk which experts could and should be identify and manage. In subsequent issues, a variety of articles have explored the ways in which societal institutions amplify or ameliorate health risks. For example Barnett and Breakwell (2003) examined the events around the 1995 oral contraceptive ‘pill scare’ identifying a hazard sequence in which risks were initially amplified by regulatory agencies, pressure groups and the media and subsequently normalised. Rothstein (2003) in his analysis of the institutional factors that shape health and safety inspectors perceptions of risk, focussed on the institutional processes that served to diminish perceptions or awareness of safety risk and/or the importance of associated regulations. Burgess's (2002) paper on national responses to the perceived risk from mobile phone masts provided an interesting international perspective on risk construction. As he convincingly demonstrated different states responded to the risks associated with the electromagnetic emissions of mobile phone masts in very different ways. While in some states there was little evidence of a regulatory response to risk, especially the Scandinavian states, in others such as Italy, institutions used ‘precautionary’ approach to justify regulation of the risks associated with this new technology.

Established or ‘old’ health risks continue to attract attention. For example in the special issue on Risk, Health and Globalisation, Prothero (2001) considered the ways in which an infectious disease, malaria, has re-emerged as a major health threat following the social changes associated with globalisation and population movements. However a major focus has been on new and emerging health risks. This interest is evident in two of the special issues. In the first volume, Cunningham-Burley and Kerr (1999) brought together a collection of papers that critically analysed the ways in which New Genetics influenced perceptions and management of health risk. In Volume 4 Webster (2002), Director of the Economic and Social Research Council's Programme on Innovative Health Technologies edited a special issue which drew on the Programme to explore the ways in which risk was calculated, interpreted and regulated. The study of these ‘new’ risks brings together work from a variety of disciplines. Papers grounded in the detailed sociological study of interactions provide important insights into the ways in which risk interactions and discourses are structured and managed. For example Hallowell (1999) uses observational data to explore the ways in which clinicians selectively presented different risk management choices to women at-risk of hereditary breast and ovarian cancer. Other established disciplines such as legal studies and ethics also provide important insight. For example, Laurie (1999) explored the complex legal issues associated reconciling the competing claims to genetic information between family members, insurers and employers which have been be created by new technologies. Almond (2000) used ethics to examine issues created by the commodification of animals created by genetic engineering and the patenting of life-forms. While ‘new’ risks attract considerable policy and media interests and can be linked to sociological debates about ‘risk society’, it is important that ‘old’ risks are not neglected. In this context, the special issue on risk and mental health which Bob Heyman is planning for this volume, is particularly welcome. We have published papers on risk and mental health, for example Holmes and Warelow (1999) paper on the psychiatrising of every-day life and Ryan's (2000) study of the risk management strategies of mental health service users. Given current anxieties about the risks associated with mental illness and the dangers that such anxieties will feed repressive regulation (see for example Alaszewski 2003) it is timely to have a more substantial collection of articles on these issues.

The articles published in the first five volumes of Health, Risk and Society have reflected public and government interest in health risks. Policy concerns have been reflected in articles on risk communication and risk regulation. For example in our first issue Sir Kenneth Calman, then Chief Medical Officer, and his colleagues in the UK's Department of Health (Calman, Bennett and Coles, 1999) reviewed current evidence on effective risk management emphasising the importance of communication and regulation. While we have published work on national regulation, for example Hood et al. (1999), given the globalisation of risk, we have also published work on transnational risk regulation including articles by Tait and Bruce (2001) on the transboundary regulation of pesticides and genetically modified food, and by Abraham and Reed (2001). Recent articles reflect developing interest in trust and risk following a series of ‘Man-Made Disasters’ such as BSE or ‘mad cow disease’ (Gherardi 1999). For example Issue 3 of Volume 5 includes a number of articles which explored trust issues. Dibben and Lean (2003) explored the importance of the development of trust in achieving compliance in the management of chronic disease. Frewer and Miles (2003) examined the psychological determinants of trust and their implications for the communications about food risks. Hobson-West (2003) explored the MMR vaccination controversy in the UK and critically reviewed the assumptions which underpin the current UK's government response to increase vaccination resistance, e.g., that providing more information about the risks will improve take-up.

There is always the danger that issues which concern policy makers, will dominate the research agenda. Therefore we have been keen to publish articles that are critical of current policy and provide an insight into the ways in which individuals perceive and manage risk. Coleman's (2002) review of the evidence base for interventions designed to reduce teenage pregnancy provided an effective critique of current approaches which tend to focus on one risk behaviour and provided a coherent case for addressing a combination of risky behaviours within their individual and social contexts. If governments want to change ‘risky’ behaviours they need to have a firmer grasp of the social processes that shape such behaviours. Ruston and Clayton (2002) explored the ways in which women assessed their risk of coronary heart disease. They identified a series of risk assessment strategies which women, even those who had a history of coronary heart disease distanced themselves from its risk. While empirical studies are important and form the bulk of the articles published in Health, Risk and Society, it is important not only that these articles effectively and critically theorise risk but that the Journal allocated space for effective discussion of theoretical issues. Editorials and commentary articles provide just such opportunities. Taylor-Gooby (2002) who currently directs the Economic and Social Research Council's Social Contexts and Responses to Risk priority network, used his editorial to argue the case that the concepts of ‘framing’ and ‘discourse’ provide the basis for interdisciplinary work on risk. In an interesting innovation Srikant Sarangi and Christopher Candlin who edited a special issue which explored the utility of discourse analysis invited Greg Myers and Tom Horlick-Jones to provide commentaries as concluding articles to the issue. Myers (2003) drew on the Goffman's work to explore the relevance of ‘face-work’ and ‘framing’ noting that ‘professional who engage in risk talk cannot just convey relevant information, but must consider how the participants present themselves, and what different frames might emerge in the course of interaction (p. 215). Horlick-Jones (2003) used two approaches derived from social theory—reflexive modernisation and governmentality—to explore the specific features of the interaction reported in the special issues. He found both too generalised and identified the need for concepts that capture the situationally-specific nature of interactions such as practical reasoning.

It is clear that Health, Risk and Society plays an important role in risk studies. It has attracted a range of articles that provide important insight into the ways in which risk is structured, communicated and managed in contemporary society. With the move to four issues a year there is an opportunity to build on the firm foundations of the first five volumes.