IS IMPOSING RISK AWARENESS CULTURAL IMPERIALISM

Epidemiology is the main supplier of ''bases of action'' for preventiv e medicine and health promotion. Epidemiology and epidemiologists ther efore have a responsibility not only for the quality and soundness of the risk estimates they deliver and for the way they are interpreted a nd used, but also for their consequences. In the industrialised world, the value of, and fascination with health is greater than ever, and t he revelation from epidemiological research of new hazards and risks, conveyed to the public by the media, has become almost an every-day ph enomenon. This ''risk epidemic'' in the modern media is paralleled in professional medical journals. It is in general endorsed by health pro moters as a necessary foundation for increased health awareness and a desirable impetus for people to take responsibility for their own heal th through behavioural changes. Epidemiologists and health promoters, however, have in general not taken the possible side effects of increa sed risk awareness seriously enough. By increasing anxiety regarding d isease, accidents and other adverse events, the risk epidemic enhances both health care dependence and health care consumption. More profoun dly, and perhaps even more seriously, it changes the way people think about health, disease and death - and ultimately and at least potentia lly, their perspective on life more generally. The message from the od ds ratios from epidemiological research advocates a rationalistic, ind ividualistic, prospective life perspective where maximising control an d minimising uncertainty is seen as a superior goal. The inconsistency between applying an expanded health concept, comprising elements of c oping, seif-realisation and psyche-physical functioning, and imposing intolerance to risk and uncertainty, is regularly overlooked. Acceptan ce and tolerance of risk and uncertainty, which are inherent elements of human life, is a prerequisite for coping and self-realisation. A fu rther shift away from traditional working-class values like sociabilit y, sharing, conviviality and tolerance can not be imposed without unwa nted side effects on culture and human interaction. The moral and coer cive crusade for increased risk awareness and purity in life style can too readily take on the form of cultural imperialism towards conformi ty. Epidemiologists and the health care movement in general have a man date to fight disease and premature death; they have no explicit manda te to change culture. (C) 1998 Elsevier Science Ltd. All rights reserv ed.