The basis of Pleasure Consuming Medicine is a contemporary distinction between the institution of health and medicine and, on the other hand, commodified forms of health and medicine. These two entities or institutions, Race argues, were separated from one another during the course of the twentieth century via a process of institutionalisation, licensing and authorisation. The institution of health has been defined as objective, disinterested and focused solely on the promotion of good health. The commercial business of health consumerism, on the other hand, has been represented as self-interested, focused on consumption rather than health and as quackery.
Race argues that institutional health insists on defining its role in terms of a return of a “normal” state - as recuperative. This can be seen in the way that health promotion strategies focus on the negative implications of ostensibly unhealthy practices. Poor or negative health behaviours are defined as an aberration from a right, proper or better path. These behaviours therefore need to be corrected. This logic can be seen in almost all tobacco cessation interventions. This contrasts with a commercial approach to the promotion (or marketing) of health. At a basic level, you won’t see Diet Coke (for example) specifically invoking health concerns about obesity- even though these concerns might inform its corporate marketing strategies. Rather, these healthy products are marketed in terms of gendered and cultural norms about style, pleasure and performance.
Race argues that this distinction between institutional and commercial health is unsustainable. He is especially interested in politicising the “normal” or healthy body that underlies institutional health’s claim to distinction (its sense of objectivity or disinterestedness). His work places seemingly objective institutional forms of health and drug consumption next to commercial or self-interested forms of health and drug consumption.
More specifically, Race advocates an emphasis on pleasure as the basis of health and health promotion. The rationale for this is Foucault’s suggestion that pleasure is “less caught up in the whole apparatus that extracts a truth-value from embodied experience” It is capable of considering “different practices and conceptions of responsibility” and more open to “historical construction, practical variation and creative experimentation.” (pp. viii-xi).
Race’s book is principally concerned with the lessons that can be learned from the response to the AIDs epidemic. What is the nature of this response? Race talks about the importance of the kinds of “pleasures”, imagination and “fantasies” that animated the gay “community” in Sydney in the 1990s (p.22). These pleasures and fantasies can be defined, in part, through an analysis of the gay dance party, with its origins in the disco movement in New York in the 1970s.
What, in turn, are the implications of this emphasis for health and health promotion initiatives? In a consideration of an event entitled the Wheel of Misfortune, set up to provide “clear and accessible information around [AIDS] treatment side effects”, “part educative intervention, part peer support, and part good night out” (p. 128), Race talks about the importance of style and, more specifically, camp (pp. 132-33). “This embodied style”, Race writes, “has been actively and usefully deployed to throw these matters up for public consideration, elaboration and concern” (135). This emphasis on style can be understood in terms of the work of Bourdieu and which has been applied to the “embodied character of cultural discrimination” which is apparent in popular music tastes (for example) (pp 150-1). The emphasis on style remains important whether or not that style is condoned by normative morals and norms.
As a critical analysis of contemporary public health policies, Races book is a tour de force. Given the wide range of analytical tools it brings to bear on its subject, the book should be high on the reading list of all in critical public health (or “counterpublic health”). The broad scope of Race’s focus can be confusing. In the first few pages of the book he defines the object of his critique as “medical subjectivity”, “medical rationality”, “medical authority”, “the medical sphere”, “the scene of health and medicine”, “the current biomedical context”, the “sociomedical” and “drug regimes”. The use of these inter-related terms is very difficult to follow. Nevertheless, it does not detract from (and may even contribute to) the suggestive power of the book.
Ultimately, Race’s book is a challenge and provocation. It highlights the fact that health is a contested term. Different entities - ranging from the institution of health to the pharmaceutical industry, to entrepreneurs working in the market for health, and beyond - invoke health in differing ways. The book suggests that institutional health, despite its claims to moral authority, might not always have the best or only answers. It suggests the need for these different and at-times opposing parties to sit around the same table and to share ideas. Finally, The book has practical and important implications for health promotion through its focus on the “situated nature of serious harms”, “particular embodied styles”, “collective subjectivities” and, specifically, the “articulation of pleasure” (p. 154-60).