A harmful cultural practice

How a state shifts blame for the popularity of tobacco

In recent years, with the ever-growing tobacco industry, an interesting phenomenon has been brought to attention in China. According to studies, 55 percent of Chinese doctors, ironically regarded as the stalwarts of good health, are smokers. China’s doctors not only smoke cigarettes but are also pilloried as furtively promoting tobacco induced morbidity. In China, cigarettes kill over a million citizens a year and if present trends hold, between now and 2050, the countries annual death toll from tobacco will jump as much as 300 percent. Executives of state regimes and key international organizations have been pursuing a dual track regarding tobacco in the past three decades or more: (a) a longstanding strategy of using tobacco sales as a front for economic development and pre-eminence (b) maintaining their legitimacy by increasing striving to regulate tobacco in the face of empirical evidence that it is highly toxic.

Mathew Kohrman in his essay, “Smoking among Doctors” draws attention to the manner in which bio-politics and Chinese cultural ideas of masculinity shape the practice of smoking amongst surgeons. Tobacco production and sales in China have been an emblem of economic development and the government has ‘centred on regulating’ its harm instead of expunging it from society. The idea that smoking is unhealthy is ‘normalised’ by the government and media and physicians are presented as dispersers of health. The shift of the blame onto the doctors is in accordance with the eminent French philosopher, Michel Foucault’s idea that “governments have multilayered modes of authority making to techniques” for establishing control over people as the focus is shifted from the powerful institutions of the state and the cigarette manufacturing industry to the medical community. Social factors such as the pressure to enact one’s masculinity have eased the processes of ‘governmentality’ into creating and ‘problematizing’ the behaviour of physicians with regards to smoking.

The medical environment is mostly dominated by men who are like most other people will not ‘exclude a behaviour’ solely on the basis of scientific rationality. The cigarette has been advertised as a symbol of manhood and the same gendered notions operate in forming its role among physicians. Smoking develops bonds between doctors who share the practice and keeps the medical departments working as units defined by gender, class and similar habits. Offering a cigarette or ‘fayan’ is a very important feature of ‘male performativity’ in Chinese culture and it is symbolic of the socialization process in the male dominated field of surgery as well. In most settings, whenever men encounter one another and wish to engage in dialogue, it is expected that one or more will pull out a pack of cigarettes and offer a smoke to all men immediately present, with special attention given to a participant’s social status and understood quality/cultural coding of the cigarette offered. The image of important members of the Chinese government ‘with lit cigarettes in their hands managing the nation’s future’ posits smoking as a crucial embodiment of masculinity adopted and sanctioned by the state.

In his ‘Problematisation’ discourse it becomes apparent that powerful institutions such as the mass media and state use their authority to shift the focus of the national problem of smoking to ‘individual failure’ of doctors. Institutions consciously ignore socialization, the tobacco marketing industry and the failure of the government to eradicate smoking and disperse knowledge/facts in a manner that is the most suitable for them. Foucault’s notion of the ‘relationship of the self to the self’ is echoed as sense of fatalism and low self-worth is induced by techniques of individual accountability that even disregard the lack of a support system for people who want to give up smoking in China.

Significant social factors in Chinese society such as defined masculinity and the connotations of smoking, class, and economics lead to the prevalence of smoking amongst doctors. However, the same institutions that promote these ideals seek to curb the practice by conveniently shifting the blame onto the individual as opposed to holding the system accountable.

The writer is a staff member of Pakistan Today and holds a degree from Mount Holyoke College.