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This presentation was given at the Sustainable Consumption Institute at the University of Manchester on September 1st, 2014. Understanding health through social practices: performance and materiality in everyday life The social context is recognised as playing an important role in understanding and improving health outcomes as evidenced by international recognition of the social determinants of health. However, although this recognition has guided the way health promotion is addressed globally, the aim of the Ottawa Charter to create health for all by the year 2000 has not been achieved. Further, in post-industrial societies it is now evident that existing health promotion approaches have not averted large scale health problems such as obesity. This presentation will delve into contemporary theories of social practice as used in consumption and sustainability research to provide an alternative, and more contextualised means, of understanding and explaining human action in relation to health and wellbeing. To progress incorporating social theory into health, researchers have used Giddens’ and Bourdieu’s conceptualisations of ‘social practice’ to understand relationships between agency, structure and health. However, social practice theory(ies) have more to offer than has currently been capitalised upon. The paper will reconsider how health can be understood and interpreted by drawing on theories of social practice as developed by Theodore Schatzki, Andreas Reckwitz and Elizabeth Shove among others. Two key observations are made. First, the latest formulations of social practice theory distinguish moments of practice performance from practices as persistent entities across time and space, allowing for empirical application and explanation of practice histories and future trajectories. Second, they emphasise the materiality of everyday life, foregrounding things, technologies and other non-humans which cannot be ignored in a technologically-dependent social world. By using practices as the entity of enquiry rather than the behaviours of individuals, and by exploring these and other aspects of health and wellbeing as socio-technical phenomena, the paper expands how health can be understood and highlights what future health promotion might entail for understanding and addressing current problems.
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Understanding health through social practices: performance and materiality in everyday lifeSCI Seminar Series, 1st September 2014
Dr Cecily MallerCentre for Urban ResearchBeyond Behaviour Change Research GroupRMIT University, Melbourne
www.rmit.edu.au/research/urban/beyondbehaviour
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Aim and introduction
• Changing lifestyles to achieve better outcomes for health or sustainability is complex – efforts to date have mixed success
• Health promotion—and behaviour change for sustainability—critiqued for:
–supporting neoliberal agendas
–treating structure and agency independently
–placing responsibility on individuals
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• Aimed to create ‘health for all’ by 2000
• Prerequisites of health:
–peace
–shelter
–education
–food
–income
–a stable eco-system
–sustainable resources
–social justice, equity
The Ottawa Charter for Health Promotion
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Background
• Health promotion aims to create health through changing social, economic and environmental conditions (structural)
• Strengthening the skills of individuals (behavioural)
• Can overlook how health is created and experienced on an everyday basis …
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My aim is to draw on theories of social practice to consider how health can be re-conceptualised and understood
“The health promotion movement has the possibility of re-inventing itself in the twenty-first century”
If as Baum (2008, p. 464) says:
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Some guiding questions
1. What new ways of thinking about and understanding health might assist HP in achieving ‘health for all’?
2. How can we better address the socio-technical dimensions of how health is lived and experienced everyday?
3. What might new (socio-technical) directions for HP look like?
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Theories of social practice
• Sociological theories of social practice are at the cutting edge of sustainability and consumption research
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The practice of eating breakfast
Skillshow to source/shop for/ store/prepare/cook/eat/share breakfast food
Meanings What to eat for breakfast, when, with whom, where, why
MaterialsFood/ingredients,
condiments, shops, recipes, kitchens,
appliances, utensils, crockery etc.
(Maller in press adapted from Shove et al. 2012; )
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Two key features of social practice theories…
1. They incorporate the role of technologies and things in daily life, focusing on socio-technical relations rather than the purely social
Recognise the agency of materials, objects in construction of everyday life: the things that co-constitute practices (Schatzki 2010; Reckwitz 2002a)
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2. Practices are recognised as discrete entities with particular histories and future trajectories
—Entities are distinguished from moments of observable performance
(Perfo
rmance
)
Spurling et al 2013 http://www.sprg.ac.uk/projects-fellowships/theoretical-development-and-integration/interventions-in-practice---sprg-report (accessed 11/10/13)
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Using SPTs in empirical research
—Selandra Rise ... a healthy and engaged community
• Master planned estate designed to try and improve residents’ health and wellbeing
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BMI: High overweight and obesity ratesMore men are affected but women’s rates of overweight/ obesity are higher than City of Casey/Australian population
Just over half sufficiently active
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Few work close to Selandra Rise
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Nearly 1/5 of residents eat take away food 3 to 10 - or more - times per week
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On moving to Selandra Rise residents are finding it more difficult to get to and from shops to buy food
If we don’t have milk we have to drive…we thought … we’d be able to sort of get everywhere without driving.
Lucy
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More Selandra Rise households own multiple cars than those yet to move to the estate
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Selandra Rise residents are significantly less satisfied with….
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Practices do not exist in isolation: they are ‘materially interwoven’ with some practices…
And are in competition with others
“Travel time to and from work is the biggest challenge everyday.”
Survey participant
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Moving from ‘behaviours’ to ‘practices’
• Applying social practice theory to research on health means health and wellbeing are outcomes of participating in a set of social practices
–rather than the result of individual behaviours and/or external structural factors and context
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• Healthy and unhealthy behaviours do not directly translate as social practices
‒e.g. smoking, drinking not necessarily practices in themselves
‒Instead they are part of practices, e.g. going out with friends, seeing a band
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• Classifying practices as healthy/unhealthy:
–Potentially excludes some practices that have health outcomes, e.g. driving, doing housework
–Perpetuates unhelpful binaries of ‘good’ and ‘bad’
Every practice could be said to have health outcomes
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New (socio-technical) directions for HP?
• Reframe existing HP programs and policy to target social practices
• Encourage new combinations of elements or replace existing ones
–e.g. shift meanings, create new skills, recognise agency of materials
• Recognise relationships between practices: competition, cooperation, symbiosis (Shove & Pantzar 2005)
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• Some existing HP programs emanate a social practice approach
–E.g. Stephanie Alexander kitchen garden program: practices of growing, harvesting, preparing, and sharing fresh food
Source: http://www.kitchengardenfoundation.org.au/join-the-program/program-funders/queensland-program (accessed 22/11/13)
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Conclusion
• Social practices mesh well with HP:
–Acknowledges both structure and agency
–Looks beyond ‘health’ policy to all policy sectors
–Works upstream
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Conclusion
• Social practices could help HP:
–Move away from structure/agency binaries
–Incorporate materialities/technologies in daily life
–Delve further into complexity
–Get closer to achieving the aims of the Ottawa Charter?
–Connect with sustainability and consumption
Acknowledgement: Funding for this research is generously provided by The Victorian Health Promotion Foundation through a Research Practice Fellowship, 2010-2015
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