T h e Relative Impo r ta n ce o f Hea lth Dete rmin ants 107
T h e Sear c h fo r a Cau sa l Explan a t io n : Jason's Story 108
Pr itna ry a n d Secon da ry Deter n1i n a nts 110
Es ti111 ating th e Hea lth Be n efits o f Major Dete rm in an ts Il l
T h e Dete rm in a nts o f Good Healt h a n d 111 Hea lth 112
Chapte r Su111mary 115
Stud y Q u estio n s 117
Reco n1n1ended Read ings 117
Reco n1n1ended vVebs ites 118
Reco n1n1ended A u d iovisua l Sou rces 118
5 Ad dressing Sources of Inequa lity a nd Health D ispa r ities:
Socia l Class 119
Und e rs ta nd ing Social In e qu al ity 119
Socia l De ter n1in a n ts o f Healt h Disparit ies : l nc0111 e, Occupatio n , and
Educa t io n 121
T h e Socia l G r ad ie nt a nd H ea lth 126
l nc0111 e In equa li ty a nd Popu latio n H ea lth : T h e O n goi ng Debate 13 1
Expl anat io n s of the Socia l Gradie n t in Healt h 134
Ma teriali st a nd Neo -111ateria list Expla n atio n s 134
C ultu ra l Beh aviou ra l Expla n a tions 135
Psyc hosocia l Explana t ions 137
Toward a n l nter sect iona l T h eo ry o f H ea lth and So ci al C lass 139
Re duci n g Socia l Class Disparities in Healt h: ls It Poss ible to Close the Gap? 140
Chapte r Su111mary 143
Stud y Q u est io n s 144
Reco n1n1ended Read ings 144
Reco n1n1ended vVebs ites 144
Reco n1n1ended A u d iovisua l Sou rces 144
6 Ad dressing Sources of Inequa lity a nd Health D ispa r ities:
Gender 145
Hea lth a nd Ge nder 145
Ge nder D iffe re n ces i n Healt h 147
Wo n1en Li ve Lo n ger Than Men 147
T h e Ge nders Di ffer in Major Cau ses o f Death 149
Wo n1en Are Diag n osed as Suffe ri ng fro m Mo re Il l Health Tha n Me n 150
Wo n1en Mak e More Freque n t Use of Forn1al Health Care Tha n Men 151
s
Gender D iffe re n ces i n th e Social De tern1 i nants of Hea lth 153
Expl anat io n s of Gend er Di ffe re n ces i n Health an d Jll ness 155
T h e Ro le Accu 111 ul a t ion H ypo t hesis 157
T h e Ro le St rai n Hy p othesis 157
T h e Socia l Accep tability H ypo th esis 158
T h e Ris k-Tak ing H y p o t hes is 159
T h e Nu rt u rant Hypoth esis 162
Toward a n l nter sect ional T h eory of H ea lth and Gend e r 163
Chapter Su111mary 164
Stu dy Q u estio n s 165
Reco n1 n1ended Read in gs 165
Reco m n1ended vVeb s ites 165
7 Addressing Sources of Inequa lity and Health D ispar ities: Ethnicity and the Life Course 166
Health an d Et hn icity 166
Ethn ic D iffe rences in Healt h 168
A b o rigin al Peoples H ave Poore r Heath Outc0111es Due to So ci al Exclus ion 169
T h e Healthy -lm n1ig rant Effect De teriorates over Titue 173
Ethn ic D iffe rences in t he Pe rceptio n a n d Un d erst a nd in g o f Syn1p to m s 175
Ethn ic D iffe rences in Healt h- Ca re Beh aviou r 176
Ethn ic D iffe rences in t he Social De te n n i na n ts of H ea lt h 178
Expl anat io n s of Et h n ic Di ffe rences in Healt h and I llness 180
Bio logical Deten u in ist Expla n a ti o n s 180
Socioeconon1ic Explan a t ions 182
Cu ltu ra l Beh aviou ra l Expla n a tions 182
Toward a n l nter sect ional T h eo ry o f Hea lth and Eth nicity 183
Health a nd the Life Cou rse 184
T h e Li fe Cou rse a n d t h e Socia l Grad ient in Hea lth 189
Li fe Cou rse D iffere n ces in th e Socia l De tern1 i nants of Hea lth 189
Toward a n l nter sect ional T h eo ry o f Hea lth and the Life Course 191
Chapter Su111 m ary 192
Stud y Q u est io n s 194
Reco n1n1ended Read i ngs 194
Reco n1n1ended vVeb s ites 194
Reco n1n1ended Aud iovisua l Sources 194
8 Unravelling the Mystery of Healt h : An lntersectional Model 195
l ntersectio n a lity a nd H ealth D is p arities 195
Lifes ty le Behaviou rs a n d H ealth 198
Individualized Health Pron1otion 20 I
The Individualization of Health Lifestyles 203
Health Lifestyles or Health Behaviours? 209
Theo ri zing the lntersectionality of Hea lth 213
Health Lifestyles and the Structure-Agency Issue 214
P ierre Bourdieu and a Relational Theory of Health Lifestyles 2 17
An lntersectional Model of Hea lth and Hea lth Lifestyles 223
Chapter Su1nmary 227
Study Questions 229
Recon1n1ended Readings 229
Recon1n1ended Audiovisua l Sou rces 229
9 Discover ing the Hidden Dept hs of Heal th Care: Lay Be li efs, Socia l
S u p p ort, a n d Informal Care 233
The Iceberg of Hea lth Care 233
Hidden Components of the Hea lth -Ca re Syste1n 234
Lay Explanatory Bel iefs about Health Maintenance and Ill ness
Manage1nent 236
Popular and Professional Concept ions of Health and Illness 246
Self-Care Beliefs and Behaviour 249
Social Support, Helping Networks, and Hea lth 258
Info r ma l Care and Illness as Embodied Experience: Making Sense of Sickness and Maintain ing a Healthy Self-Identity 263
A Narrative Account: T he Meaning and Management of Pain 264
Chronic Il lness Work 268
Chapter Su1nmary 270
Study Questions 272
Recon1n1ended Readings 272
Recon1n1ended vVebs ites 272
10 Med ical izi ng Be ings an d Bo d ies: T h e Link be t ween
Pop u lat ion Health a n d Biomedical Ca r e 273
The Origins of the Bion1edical Model 275
Bedside Medicine 275
Hospital Medicine 277
Laborato ry Medicine 279
Basic Ideas of the Bion1edical Model 280
Mind-Body Dua l ism 281
Physical Reductionis1n 282
Specific Et io logy 282
T h e Machin e Metaphor 283
T h erapeut ic Focus on In dividualized Regitnen and Control 286
Medica l Don1ina n ce of t h e Health-Ca re System 288
Medica lizing Beings and Bodies 291
Explanat ions for Med icalization 293
Chapter Su1nmary 309
Study Question s 311
Recomn1ended Readings 311
Recomn1ended vVebs ites 311
Recon1n1ended Audiovisua l Sources 311
11 Mov ing beyond Biomedicine: Medical Plura lism 312
T h e Socia l Construction of Hea li ng: A Sociologica l Perspective on Med ica l Plu ra lisn1 3 13
T h e Histo rica l Pers istence of Med ica l P lura lism 315
Avoid ing the 'Stereotypes o f Ma rginal ity' in Social S tu d ies o f Alternat ive Med ic ine 3 17
Labell ing Alternat ive Med icine 318
T hree Streams ofCon1ple1nenta ry Alter n at ive Medicine Research 319
Explanat ions for th e Reviva l of Medical Pluralism 32 1
T h e Den1ographic Trans ition and Popu latio n Agi n g 321
Dissa t isfaction with Biomedicine 322
T h e Post1nodern Cond ition 322
Individualizatio n and Con stune rism 322
Crossing Cu ltures in Pursuit of Hea lth and We llness: Choosing Heal ing Practices 323
T h e Deve lopment of Cu ltural Diversity and Mu lticu ltu ral ism 325
Medica l Consun1eris111, the Marke t in g of Eth n ic ity, and Revi val of Med ica l Plu ralisn1 326
Integrative Medicine: Pr ospects for a New Med icine 329
Chap ter Su1nma ry 332
Study Questio n s 334
Recomn1ended Readings 334
Recomn1ended vVebs ites 334
Recon1n1ended Aud iovisual Sources 334
12 Ac h iev ing Healthy Futures 335
Toward a Soc io logical Understan ding o f Hea lthy Societies and Healthy People 335
Studying Health: Alternative Socio logical Paradigtns 336
Deve lop ing an l ntersectional Model of Healt h 337
Measurin g t h e Di n1en s io n s of Hea lt h: A M ixed -Me t ho d s Ap proach 337
Socia l De ter n1i nants of Healt h : Reflect io n s on vVhat We H ave Lea r ned 339
Str uc t u ra l a n d Per sona l Dete r min a nts o f H ealth 339
Sou rces of Socia l Inequality and H ea lt h Dispa rit ies: I ntersection s of Class, Gen d er, Et hn icity, and Age 340
Adopt ing a Li fe Cou rse Persp ect ive on th e P u rsu it of Healt h and Wellness 341
Life C h a n ces a n d Health C h o ices: The Str u cture -Agency Q u estion 342
Shared Respon sib ility fo r Ma k i ng Societies and People Hea lt hy 342
Person al Resp onsibility: lnfon nal Ca re and Healt h 343
Pro fess ional Respon s ib ility: Forn1al Ca re a n d Health 344
P ublic Responsi b il ity: The Govern a n ce o f H ealth 344
Healt h Po licy In it iatives: Lalond e and Beyond 346
T h e Ongoing Pursuit of Health a n d vVellness: Some Un a n swe red Quest io n s 350
How Does the Vis ion of a Health y Socie ty Differ fr 0111 th e Reality of Healt h - Ca re Reforn1? 351
l s It Possible to Re d ress Socia l I nequalities in H ealth? 353
Why l s It So Diffi cu lt to hnplement Health y P ubl ic Policy? 357
l s Well n ess Always Good for You r Hea lt h? 359
What Is Requ ired to Ren1ake t he Medica lized Soc iety into a Salutogen ic Society? 362
Study Question s 365
Recommended Readi n gs 365
Recon1n1ended vVebs ites 365
Glossary 366 References 373 Index 397
Pr eface
Our culture is preoccupied with pursuing heal th and wellness. Think, for example, how prominent ' health' is in our everyday language: healthy li ving, healthy eating, healthy environments, healthy arguments, healthy acti vity, healthy buildings, hea lthy re lationships, healthy workplaces, hea lthy bodies, hea l thy k ids, healthy commun it ies, healthy recipes, hea lthy minds, healthy agi ng, healthy schools, heal thy familie.s, hea lthy weight, healthy balance, healthy habits, healthy beginn i ngs, hea l thy endings. We use the term 'health ' to refer to these and many mor e aspects of everyday l ife. We r outine ly greet people with the fam i liar 'Hi. How are you? ' inquiring about their health status. The ma r ketpl ace is crowded with products and serv ices pr omisi ng more hea lth and higher levels of wellness.
Governments try to fu r ther ra ise heal th consciousness in order to get indiv iduals to behave in ways that will promote personal health and avoid potential health r isks. Healthy living is synonymous wi th desi re, virtue, vi tali ty, beauty, and goodness. ' If you have you r health, you have everything', the saying goes. Health per vades our wellness-oriented culture. De.spite i ts universali ty, hea lth is also intensely personal-seemingl y a private matter and a pe r sonal va lue. vVe closely safegua r d info r mat ion regarding hea l th, ca r efully conside r ing to whom we should d isclose our health concerns. Med ical records are subject to some of society's st r ictest p r ivacy laws. Additionally, like all th i ngs of va lue in our culture, health is unequally distributed within society, as are the conditions necessary for wellness. Not everyone is healthy or has equitabl e access to the resource.s that make people well. We a r e left wonder ing whether it is possi ble to address social i nequalities i n health.
Too often, the vision of achieving healthy futures gives way to never-ending debates focused on reform i ng the formal health-ca r e system, repai r ing medicare, and consuming health care rather than p r oducing population heal th . The dominance of biomedici ne leads to medicalizing beings and bodies, wh i le the goal of making people hea l thy gets lost amidst anxiety over the threat and treatment of ill ne.ss. Some people try moving beyond biomed icine by usi ng complementary and alternative forms of health care. It is easy to conclude that health is both public and p r ivate. It is everywhere in ou r culture, and yet not all members of our society share i t equally. The pu r suit of hea l th and wellness tru ly seems a mystery that leaves us unce r tain as to whether it is possible to make societ ies and people healthy.
By apply i ng the sociological i magi nat ion, th is book wi ll unravel the myster ies surrounding the pu r suit of health and wellness. Health and illness are related concepts, wi th health often unde r stood as merely the absence of d isease. Standard appr oaches to understandi ng health in ter ms of i llness a r e li m i ted by focusing on the d i stri bution of disease and the consumption of medical products and forma l heal th-care services. Rather than focusing on p r oducing health, these approaches concentrate on disease and death rates and consuming health ca r e provided by medica l pract i tioners (e.g., doctors) and inst i tutions (e.g., hospitals) . However, th is book shows that sickne.ss is only the t ip of the iceberg when it comes to studying health ! Researchers often overlook h idden depths of health ca r e
Preface and contri butions that lay beliefs, social support, and informal care make to the pursu i t of health and wellness. As a r e.suit, we know mor e about what makes us sick than we do about what makes us healthy. Th is book adopts an alter native perspective, consistent wi th a shift in hea lth sociol ogy, and concentrates on explo r ing facto r s that shape health and wellness. The focus is explicitly on health rather than illness. We will d iscover both the st r uctural and personal factors that cont r ibute to pu r suing health and wellness wh ile l earning about the i mpo r tance of healthy societies for hea lthy peopl e.
No single theory or associ ated methodology is abl e to completely unrave l the mystery of health i n all of its d imensions. Due to the multi-dimensional nature of health, this book consider s major theoretical paradigms used by sociologists for under standing hea lth and makes a case fo r adopt i ng an eclectic approach using mixed methods to measure the d i mensions of health. Extensive cover age is given to the l atest r esearch perspect ives on health, including i nter sectiona l analysis and a li fe course per spective. Detailed and upto-date infor mation is prov ided on socia l determinants of health and how society shapes the health of both popul ati ons and i ndi viduals. vVe p r e.sent the latest ev idence from i nternational and Canadian health r e.sea r cher s on factors that affect health. An intersect ional model of heal th is outlined to gu i de future research. Most impor tantly, this book is wr i tten i n straightforwa r d, easy-to-read language, wi th student-friend ly sociolog ical analyses of engagi ng curr ent events re lating to the pursuit of hea lth and wellness. Each chapter summarizes resea r ch in a manner that allows an undergraduate student to understand the majo r issues. It critically evaluates the exist i ng body of knowledge and identifies gaps as well as i mplications fo r future r esearch. Chapter s conclude with a brief summa r y of the ma i n points raised in the discussion, sample study quest ions, suggest ions for further read i ng, and Inter net resources. Throughout the text, biographic content boxes pe r sonalize the insights of some of the most r enowned scholars of health, med icine, and the body. Afte r read i ng this book, you wi ll understand that it is possible to create healthy societies and healthy peopl e, and you will gain a better appr eciation of factors that shape your pu rsu i t of heal th and wellness!
Acknowledgements
We would like to acknowledge the Oxfo r d Un iversity Pr ess staff who have contri buted i n different ways to this book, includ i ng Al an Mulder, Sales and Editor ial Representative; Katherine Skene, Supervisi ng Acqu isitions Edito r ; Nancy Rei lly, Acqu isitions Edi tor; and Jodi Lewchuk, Super vis ing Deve lopmental Editor. vVe are particularly gr ateful to Nancy Rei lly fo r her enthusiastic response to the initial book proposal and to Jod i Lewchuk for her ski llful gu idance and invaluable suppor t during the wri ting phase. We also sincerely appr eciate the insightful and instructive comments that we r eceived from the r ev iewers. It has been a very positi ve and r ewa r d i ng exper ience wor king with you all.
I n add i t ion, we would li ke to acknowledge the financial support p r ovided by the Faculty of Graduate Studies at the Universi ty of Man i toba for the graduate students i n the Department of Sociology who assisted us by carry i ng out liter ature searches and finalizing the list of refe r ences cited in the book.
To Maxine, for constantly provid i ng food for thought. Your unconditiona l love and suppor t make all things possible
To Kevin, Sheryl, Justin, and Hayden, and to Nicole, Dave, and Jordan fo r the many ways that you have en r iched my li fe.
To vVally, my best fr iend and father, whose own pursuit of health and wellness has taught me so much.
To Annette, my aunt and ma i n prov ider of social support in all its forms
To Rayanne, the healthiest influence in my li fe.
C.J.F.
A.S.
PURSUING HEALTH AND WELLNESS
Understanding Hea lth and Wellness Sociolog ica lly
Part I, Under standing Hea lth and 'vVellness Sociologically, contains th r ee chapters. Chapter I, Introducing Health Sociology, begins with a discussion of the mystery of good hea lth and the impor tance of r ecogniz ing that health is a social constr uct. The concept of health consciousness is then introduced, and an effort is made to clari fy the dist i nction between produci ng hea lth and consum i ng health ca r e. Th is i ntroductory discussion is followed by a brief r eview of the origins of medical sociology and the factors that contr ibuted to the convergence of sociol ogy and medici ne. After out lin i ng the scope of early medical sociology, the focus sh i fts to the transition from medical to health sociology and the development of hea lth sociology in Canada. The first chapter concludes by emphasizing the need for a more theoretically o r iented sociologica l approach to under standing the pursu i t of health and we llness.
Chapter 2, Apply i ng the Sociologica l Imaginat ion to Hea lth, Illness , and the Body, p r ovides a d iscussion of alternative sociologi cal pa r ad igms for studying health, i llness, and the body. After summarizi ng t r aditional theoretical pe r spect ives ( i.e., health and illness as viewed from structu r al functiona list, conflict, and interactionist paradi gms), th is chapter i ncludes a discussion of fem i n ist social theo r y and health and i llness as gender ed experiences. The chapte r concludes by reviewing the contemporary sociology of the body pa r adigm, which h ighlights the i mpo r tance of understand i ng health and i llness as embodied cultu r a l facts.
Chapter 3, Measuri ng the Dimensions of Health, addresses the need for a better unde r standing of the relat ionship between meaning and measu r ement, the distinction between good hea lth (we llness) and i ll health (s ickness), and the process of hea lth status designation. The multi-dimensiona l nature of health is emphasized, and challenges facing popu lation health assessment are outl ined, including d i fficulties invol ved i n measuring both ill health ( the t r ad i t ional approach) and good health (t he positive aspects of heal th and we ll -bei ng). The salutogenic model of health is int r oduced as a conceptual framework fo r studying salutary facto r s that protect and promote good health. The chapter clari fies the d i fference between health inputs, health status, and heal th outcomes, and then rev i ews the advantages and disadvantages of a number of i nd icators typically used in measu r ing the health status of Canad i ans. Chapte r 3 ends with a call for a m i xed-methods appr oach to measur i ng the good health dimension of wellness (a nd the ill heal th dimension of sickness), combi ning standa r d quantitat ive methods, such as population health surveys, with more qua litative methods, such as nar r at ive accounts and health diary studies.
Introducing Health Sociology
Learn ing Objectives
In th is chapter, st udent s will be in trodu ced to a so cio logica l pe rspe ctive on hea lth and will gain a b etter u nderstan d ing of
• healt h as a 'so cial const ruct io n';
• t he d iffe rence bet ween a sociolo g ical unde rstandi ng of hea lth a nd wellness a nd one based on 'biolog ical det e rminis m';
• t he cu lt ural bases of 'health conscio u sness';
• t he sco pe of trad it iona l me d ical so cio logy a nd effort s to trans form the fi e ld into healt h sociolo g y; a nd
• t he d eve lopment of hea lt h socio lo g y in Ca nada.
Intr oduct io n: The Mystery of Good H ea lth
Have you ever wondered how it is possible fo r anyone to stay healthy? vVhen we a r e young, we a r e typically exposed to 'normal' childhood diseases such as chicken pox. As ch i ldren and adults we continuall y face the threat of contagious i llnesses that a r e 'go ing a r ound'. For example, i n our daily lives we routinel y encounter people who have 'common' cold symptoms, such as d i fficu lty breath i ng or sor e throats. Plus, there is the annual challenge of the flu season. T he olde r we get, the more li kely we a r e to have to deal with the increasi ng prevalence of ch r onic cond itions such as arth r itis o r hypertension ( h igh blood p r essure). Today we r out i nely hear about the potential threat of pandemics such as Acquired Immunodeficiency Syndrome (A IDS ) , Sever e Acute Respiratory Syndrome (SARS) , and HIN! influenza. Fi nally, we are lea r n i ng more about how threats to the environment are also threats to human hea lth. Despite all the r isks, most people manage to stay well and lead healthy and p r oductive lives.
vVhat types of factors contri bute to good health? How do peop le manage to p r otect their health and stay well? As Antonovsky consistently a r gued (1996, 1987, 1979), health r esearchers need to focus attention on finding answers to these quest ions i f they hope to be able to unravel what he descr ibed as the mystery of good health. At present, we know a g r eat deal about what makes us sick (as i llustrated by the cartoon below), but, in cont r ast, we have a very li m i ted understanding of what keeps us we ll. T he types of risk factors that contr ibute to ill heal th are quite fami li ar to us (e .g., cigarettes and fast food), but the ' ver y r a r e condition of good health • is st i ll somewhat a myste r y!
~ou \.\ive Very r.ll'e concl.i.tion. we call "{;;tool> "EALT1t" C-i~arett.es G ra~t .{:,oJ. shoul.l. take c are o~ il fairl1.1 cr,w~kl~ & we'll see 1:1«>tt ~(!;a1n in. ~nc. m.ontlt.~.
Antonovsky (1979 ) introduced a sa l u t ogeni c model of h e alth i n an effo r t to direct our attention from i ll health to the salutary facto r s that p r otect or enhance good heal th. H is intention was to formulate an approach that would contribute to an i mproved understand i ng of the ' or igins' of good health and the social conditions that fac i li tate health-protect i ve behaviours
By focus ing on hea lth i nstead of i llness, Antonovsky was hopeful that the sa lutogen ic model would p r ovide a gu ide for identifying and understandi ng the factors that make populat ions healthy. We w i ll examine the features of this model mo r e closely later i n the book when we discuss the determ i nants of good heal th versus ill hea lth ( Chapter 4, Making People Heal thy: Genera l Determinants of Health and 'vVellness) For the present, i t is suffici ent to acknowledge the influence of the salutogenic model on the approach adopted i n this book for exploring the meaning of good health and the soci al facto r s that contribute to the successful pursu i t of health and wellness.
The pr i ma r y purpose of this book is to provide a cr itical sociologica l framework for understand i ng the hea lth and hea lth-care behaviour of Canadians. Fi rst and foremost, th is book will focus explicitly on health rather than illness. Traditionally, medical sociol ogy focused primar i ly on the d istribution of disease , the organization of fo r mal medical se r v ices, and the rol e of med i cal pract i t ioners ( e.g. , doctors ) and i nst itutions ( e.g., hospitals) in caring for illness. Wh i le acknowledg i ng the trad itiona l med ica l sociology approach, we will shift our thinking about hea lth and i llness to a health soc iology perspective, considering not on ly ou r efforts to ma i ntain ' health ' but also the mo r e general pu r su i t of 'wellness' Drawing on the sci entific literature ava i lable, i t seems that while the two terms are somet i mes used interchangeabl y, the concept of wellness is much broader than hea lth and actually subsumes good health. For example, Br uhn and colleagues ( 1977: 2 10) argue that wh i le the mean i ngs of good hea lth and wellness differ, it is important to rea li ze that ' good health is a cont i nua l process that can evol ve i nto wellness.' In other words , good health is a necessary, but not a sufficient, cond i tion to attain wellness. Well ness is an i nclusi ve concept that incorporates not only good health but also quality of l i fe and sat i sfact i on with general liv i ng cond i tions ( Evans and Stoddart, 1990). I n other words, by providing a cr it i cal ana lysis i nformed by soci ol ogical theory and research, this book will help you understand the factors that shape the hea lth and wellness of Canad i ans.
H ealt h as a Social Cons t r ucti o n
'No social study that does not corne back to the problerns of biography, ofhistory and of their intersections within a society has co111pleted its intellectual journey.'
C. Wright MiUs, The Sociologica/ /111ngi11ntio11, 1959
This quotat ion is from the sociologist C. Wri ght Mills, who wrote a ve r y i mpo r tant book in which he expla i ned that the task and promise of sociology are to understand the dual process wherein society affects i ndi vidual behaviour that, in turn, in its totality affects society. The task of social science is to understand how the object ive structu r es of society (e .g., socia l r ol es, nor ms, i nst i tutions) influence individual, subject ive behaviour (e g., personal health-care behaviou r), and, in tu r n, how the totality of social behav iour serves to reproduce the rea li ty that is society. One place to begin our introduct ion to heal th sociology is by looki ng at how sociologists follow M i lls' advice to define and understand health. I n th is effort, we will contrast the sociological unde r standing of health and wellness with other unde r standings, some of which a r e popul ar in ou r culture.
Though most peopl e have some idea about what it means to be in good hea lth, heal th is not as st r a i ghtfor wa r d a concept to unde r stand as it may appear. Usually, it is not unt il sickness intrudes into a person's li fe that health and its i mpo r tance become clea r to the unfortunate sufferer and her friends, fami ly, and loved ones (Ca lnan and 'vVill iams, 1991; Id ler, 1979). It may be in the i ronic natu r e of heal th that it is best understood when it is gone, with health defined in relat ion to illness. Th i s not ion of health is too vague, however, to satisfy the socia l scientist trying to ga i n a more precise understanding of the mean i ng of good hea lth and the p r ocesses by wh ich people pursue health and wellness.
I n the classic book Man, Medicine and Enviro11111ent (1 968), Pu li tzer Pr i ze-w i nning bi olog ist Rene Dubas makes the point that the desi r e for health is per haps the most fundamental for any organism, and th is is certainly no less the case for what Dubas descri bes i n a later book as 'the human animal' (1969) Yet, when it comes to heal th, our social natu r e renders a un ique p lace for human bei ngs. Unlike an i mal s, the human pu r suit of hea lth is fa r more than an instinctual dr ive for survival and cannot be sat isfacto r i ly understood as such. For us, health and wellness are much more than biophysical conditions and a r e never expe r ienced or under stood simply at this level. The basic idea behind the sociological understand i ng of hea lth is r eflected in the quotation from M i lls: People's locations i n the social world affect our behaviour and, ultimately, ou r health and i llness. To illustrate, aspects of our behaviour, such as liv i ng i n automotive-intensive subu r ban cities or pollut i ng the environment, shape ou r society, which, in tu r n, affects ou r health. The idea that society shapes and is shaped by human behaviour is an i mpo r tant sociol ogical insight. Under standing biography, history, and thei r intersections is the mandate of sociology. It is health sociologists who systemat ically study the soci al aspects and d i ffe r ing interests in society that affect the human pursuit of good heal th and wellness . Chapte r 2, Applying the Sociological Imaginati on to Heal th, I llness, and the Body, will present alter native sociological pa r adigms for studying health.
Accor ding to the sociologica l appr oach, health represents a fundamental part of everyday life that is shaped by society and soci al r el ations. This perspective is r eflected by a groundb r eaking i nter national policy document t i t led The Ottawa Charter for Health
Pr01notio11, rel eased by the 'vVorld Health Organization in 1986. The Ottawa Charter prov ides guidel i nes that governments th r oughout the world wer e encou r aged to adopt fo r the i r population health promotion strategies. The first Inte r nat iona l Conference on Hea lth Pr omotion meeting i n Ottawa, Canada, 'was prima r il y a response to gr ow i ng expectations for a new public health movement around the wo r ld' (1986: 1) In the Ottawa Charter, i nter national expe r ts chose to define h ea l th as
a resource fo r ever yday life, not the objective ofl iving. Health is a pos it ive concept emphasizi ng social and personal resou r ces, as well as physical capacities. T herefor e, health p r omotion is not just the responsibility of the health sector, but goes beyond healthy life-styles to well-bei ng. (Wo rld Health O r ganization, 1986: 1)
What was so novel about defini ng health i n this way, rather than in relation to ill ness, was that these experts identified a wide range of social, political, and environmental facto r s that influence health and well -bei ng beyond b iology alone. More specifically, they argued that 'the fundamental cond itions and r esources for health are: peace, shelter, education, food, income, a stable eco-system, sustainable resources, social j ustice, and equity' ('vVorld Health O r ganization, 1986: 1). This broad view of health allowed the author s of the Ottawa Charter to write, 'Professional and social groups and health per sonnel have a major respons ibil ity to mediate between differing i nterests in society fo r the pur suit of health' (1 986: 2). Although health may be viewed as a crucial resource fo r living, it is evident that we do not all experience health and wellness in the same way. Sociologists point out that our pur suit of health has impor tant social dimensions and reflects differing locations wi thin the structures of society. In keeping w ith the definition of health in the Ottawa Charter, health sociology understands health as a social construction; that is, both the health and illness of our bodies and the manner in which we understand these concepts are influenced by social facto r s.
Wh i le the term ' soc ial constr uction' has a long histor y in soc iological thought, p r obabl y the most noteworthy t r eatment comes from Peter Berger and T homas Luckman n's The Social Construction ofReality: A Treatise in the Sociology of Knowledge. Th is book, published in 1966, remains ' one of the most widely read and influential books in contemporar y sociology' (R itzer, 1992 : 387). T he pu r pose of Berger and Luckmann's book was to explor e the ways in which people in the course of their everyday lives and social interactions construct subjective mean i ngs that, i n tur n, ser ve as the bas is of the soci al real ity that is society. Real ity is seen to be creative ly shaped by people through social inter action. For the sociolog ist, aspects of our real ity such as the mean ing of good health are sa id to be soc ially constructed. Th is socio logical under standi ng of health as a social construction can be contrasted w ith the way in wh ich a doctor, for example, under stands health and i llness.
I n medical and biol ogical under standings of hea lth, human be i ngs a r e often described as little more than d i scr ete bundles of biochemica l and mechan ica l p r ocesses, and hea lth is defined clinically by physiological p r ocesses oper at i ng w ithin the l imits of certa i n predefined, scientifically measurable pa r ameters. For example, when you go to your family doctor for a physica l exam i nation, she will measure your blood pressu r e using technolog ical i nstruments such as a sphygmomanometer and stethoscope: an inflatable arm cuff to r estrict blood flow connected to a mer cury manometer to read your level of blood pressu r e and a device to listen to sounds with i n the body. If, after repeated measurements,
1 Introducing Healt h Soc io logy
you r blood pr essu r e r ead i ngs continue to fall with i n the h i gh range, you will be d i agnosed with ' hype r tension', or h igh blood pressure, a medical condition affecti ng five mill ion Canadians that can lead to stroke, hea r t attack, and k idney fa i lure ( Hea r t and Str oke Foundat ion of Canada, 2008 ) . Regardless of how you may report feeling, you are labelled ' hea lthy' i f your physi olog ical marker s are with i n the p r edefined parameters, and ' diseased' i f they are not. Indeed, hypertension is known as 'the silent killer' because a per son with high blood pressu r e experiences no symptoms.
Comment i ng on the biomedical conception of health, McKee notes that 'in contrast with the 'vVorld Health Organization's defin i t ion of health as " physical, mental, and social well-being, not merely the absence of disease o r infirmity", hea lth tends to be defined i n functiona l rather than exper iential terms, as the absence of disease ' (1988: 776). In other words, illness, scientifically labelled as disease, is understood by biomed icine in a functiona l rather than an experient i al way. As a result , d isease becomes reified. That is, disease is treated as a thing with a clearly defined r ea lity all its own: 'Th is appr oach, which posi ts a disease as a thing with an identity of its own, is known as the ontological defin i t ion of d isease. Thus, the disease and its associated symptoms become the focus of attent ion, rather than the whole patient ' (Berli ner and Sa lmon, 1979: 35) .
Understand i ng human bei ngs in te r ms of biologica l funct ion i ng has a long h istory i n Wester n thought and is descr ibed as ' b i o log ica l d e t ermi n i s m ', or the bel ief that human behav iou r can best be expl ained in terms of innate biological properties of individua ls, such as genes and biochemical processes. 'Ultimate ly, all human behaviou r -hence all human society-is governed by a chain of determ i nants that r uns from the gene to the indiv idual to the sum of behav iou r s of all indiv iduals. The determinists wou ld have it, then, that human nature is fixed by our genes' ( Rose, Lewontin, and Kamen, 1984: 6). In the West, science has offer ed us this view of ou r sel ves and a complex set of med ical practices and technologies based upon it and we have, by and large, accepted this biologicall y deter ministi c view of hea lth ( Lewont in , 1991 ) .
For the health soc iol ogist, however, heal th is not understood solely as a biophysical state exper ienced i n the same manner by all people in all times and p laces, but, r ather , as a socially constructed exper ience that varies according to cultu r al factors. Th is is what it means when health sociologists refer to health as a soci al construction. To fully understand health in a sociological per spective, you have to take into account indiv idua l differences and cultural dimensions invol ved i n health, as well as the healthiness of society. People's awareness of hea lth and their r esponses to illness va r y not only from i nd i vidual to indiv idua l because of the uniqueness of each per son's b iogr aphy, but also from cultu r e to culture. Hea lth soc iol ogy, then, is the branch of sociology that attempts to generate under standings of the social and cu ltura l contexts with i n which the meaning of good health is interpreted, i llness is r ecognized, and the pursuit of health and wellness occu r s.
Heal t h Consciousness: Producing Health versus Consuming Heal t h Care
'Hi, how are you?' This fam i lia r ph r ase is typically used to start conversations with others. Why do we gene r ally ask about the health and wellness of other people when we greet
them? The obvious answer is that th is custom is part of our cul tural tradi t ion ( like a handshake) and is learned through informal socialization in social settings such as the fam i ly and school. However, th is is not a complete expl anation for the reason why we inqu i r e about the hea lth status of others when we meet and greet them. Asking about health is a way of acknowledging ou r interest in the other person and establishing a basis for social interaction. The cul tural practice of sta r t i ng conversations wi th a question about hea lth reflects the fundamental importance that we attach to good heal th i n our society.
Lau, Ha r tman, and Ware (1986 : 26) contend that ' researcher s have frequently assumed that all people uniform ly place a very h i gh val ue on heal th' and, as a resu lt, 'the concept of hea lth as a value is one that has been surpr isi ngly underutilized i n hea lth research.' Few studies actually exam i ne the va lue that people attach to health in thei r personal lives. To correct this situati on, Lau, Hartman , and Ware developed a shor t measure of health as a va lue . The measure requires the person to rank the relative importance of health ( i.e., physica l, mental , and soci al well-being) compared to other aspects of l ife. In add i t ion, respondents are asked to indicate the extent to which they agree wi th common healthrelated expressions, such as 'If you don't have your hea lth, you don't have anything', or 'There is nothing more important than good health.' Results generally i nd i cate that hea lth is the most h ighly ranked va lue held by members of the study popu lation. Research has al so shown that people in Western culture regard a comm i tment to wellness as a moral vi rtue (Con rad, 1994). There is growing ev idence that we do indeed value health and wellness very highly.
We certainly spend a great deal of time talking about health vVe not only regularly ask about the health of others but we also constantly disclose i nformation about our own health to family members, fr iends, and co-worker s. Stop and th i nk about how many of your da i ly conversat ions at home, at school , or at work focus on hea lth-related topics. How much time do you spend each day talki ng about health? Gould (1990 : 233) contends that 'people who th i nk about hea lth a lso talk about i t.' In other words, our level of health consciousness may be reflected, in part, by the extent to which we ta lk about hea lth.
Hea l th co n sciousness can be defined as the degree to wh ich an i ndiv idual is aware of and attent ive to her own health. This awareness is a fundamental aspect of everyday social life and involves mon i toring our health status, assessing and interpreting the cond i t ion of our m i nds and bodies, and engag i ng in a wide variety of heal th actions as a routine part of our soci al practice. As we wi ll explore in Chapter 8, Unravelling the Mystery of Health: An Inter sectional Model, health consciousness, or the degr ee to which we focus on our health, is likely related to everyday hea lth behav i ours such as our eating habits and the extent to which we pay attent ion to hea lth informat ion (Kask utas and Greenfield, 199 7).
To assess your level of health consciousness, try answer i ng the questions in Box I.I.
Today we a r e bombarded by an ever-increasing amount of health i nformation from a wide diversity of sources. Most newspapers and popu lar magazines have regula r hea lth col umns , such as the popular hea lth advice column by Dr. G i fford-Jones syndicated i n over si xty Canadian newspapers. Plus, ther e a r e a tremendous number of speci ali zed publications that now focus enti r el y on health, fitness, and d i et. This point i s vivid ly illustrated by br owsi ng in your favo u r ite bookstore and not i ng the amount of she l f space devoted to tit les categorized as health, wellness, fitness, or nutrition books. Among dayt i me television's most popul ar shows are those that feature medical experts offer ing health advice,
Other documents randomly have different content
relations with financial men in Paris. The suggestion made was that Monsieur Caillaux, who was a member of the board of the Argentine Crédit Foncier, the Egyptian Crédit Foncier and other enterprises of international finance, was for personal and pecuniary reasons unable to resist the pressure brought to bear on him by his colleagues among the directors of these financial boards, and was obliged to do what they told him to do, irrespective of his own political convictions or of the higher interests of the country, which interests he as a Minister of the State should have considered first.
According to the Figaro, a Monsieur Arthur Spitzer, an Austrian by birth, a Frenchman by naturalization, and one of the most influential directors of the big French bank, the Société Générale, had gained his position there owing to the influence and recommendation of Sir Ernest Cassel.
“Since 1911,” said the Figaro, “the French Prime Ministers and Finance Ministers had successively expressed their opinions that Monsieur Spitzer took too large a share in every sense of the word of the big loans which were launched on the Paris market. In consequence Monsieur Spitzer’s re-election to the board of the Société Générale in 1913 was indirectly opposed by the Government. Monsieur Spitzer, in deference to the expression of this opinion which was conveyed to the Société Générale by a permanent official of the Ministry of Finance, resigned his position on the board of the Société Générale, but he remained on the board of the Crédit Foncier Argentin and on the board of the Crédit Foncier Egyptien, of which two boards of directors Monsieur Caillaux was a member. The intermediary between the Government and the Société Générale in the secret and delicate negotiations which resulted in the resignation of Monsieur Spitzer had been Monsieur Luquet, one of the principal permanent officials in the Ministry of Finance. Shortly after Monsieur Caillaux’s return to power an intimate friend of Monsieur Spitzer, Monsieur André Homberg, a director of the Société Générale, and another financial magnate whose name the Figarodoes not mention, called on Monsieur Caillaux at the Ministry of Finance, and shortly afterwards Monsieur Luquet was superseded and was succeeded in
his post by Monsieur Privat-Deschanel, the general secretary of the Financial office, the man in whose presence Madame Gueydan had burned her husband’s, Monsieur Caillaux, letters. In other words, Monsieur Calmette accused Monsieur Caillaux of allowing himself to be influenced by his financial friends to serve their financial needs by the removal of a useful servant of the country. On the following day, January 16, the Figaro launched another accusation against Monsieur Caillaux, that of interfering between two big shipping companies in order to please his financial friends.”
There is no need to go into the details of the quarrel between the South Atlantic Company and the Compagnie Transatlantique. Suffice it to say that the Figaro accused Monsieur Caillaux of acting in an arbitrary fashion and taking orders for his conduct from certain financial magnates, among whom was Monsieur André Homberg of the Société Générale. On January 19, Monsieur Gaston Calmette announced for the following day a series of articles describing “the nefarious part played by Monsieur Caillaux in the events which preceded the sending of a German gunboat to Agadir.” On the 20th this series of articles began. They continued without intermission till January 24. I shall refer to them more fully in another chapter of this book.
On January 26, Monsieur Gaston Calmette called Monsieur Caillaux to account in the Figaro on the question of a heavy fine of £325,000 which had been inflicted on a Paris bank (the Banque Perrier) for the non-observance of certain formalities in connexion with an emission of two million pounds sterling of Ottoman bonds. Monsieur Gaston Calmette returned the next day to the question, twitting Monsieur Caillaux somewhat cruelly with his inability to give a satisfactory reply. On Wednesday, January 28, he returned to the charge again and at some length on the front page of the Figaro, dropping it on the 29th for an article of two columns and a half on Monsieur Caillaux’s connexion with the Crédit Foncier Egyptien and the Crédit Foncier Argentin.
In this article Monsieur Calmette deliberately accused Monsieur Caillaux of allowing quantities of South American bonds and shares an official quotation on the Paris Bourse because Monsieur Spitzer, Monsieur Ullmann and others of his financial friends were interested in placing these bonds in France. Monsieur Calmette declared that during the six months of Monsieur Caillaux’s tenure of office as Finance Minister in 1911, that is to say from February to June of that year, South American bonds and shares to the amount of forty million pounds sterling received an official quotation on the Paris Bourse, and he drew up and published a Table showing the prices at which the quotations had been given, and the depreciation of these stocks and shares during the three years which followed. The depreciation is about twenty-five per cent. In other words, according to the Figaro, Monsieur Caillaux’s admission of these enormous blocks of South American bonds on the Paris Bourse resulted in a loss to French investors of ten millions sterling.
Naturally enough Monsieur Caillaux replied through the official Havas agency, and in reply to his communiquéMonsieur Calmette on January 30 returned to the charge, emphasising his original accusations.
On the first of February Monsieur Caillaux visited his constituency of Mamers. The Figaroon that day published a long and bitter article describing the misdeeds of the Minister of Finance since his entry into politics. On the 2nd it published two columns more containing a sarcastic appreciation of Monsieur Caillaux’s visit to Mamers. On February 5, Monsieur Caillaux was accused in the Figaro of postponing the French loan and so inducing French investors to place their money elsewhere, notably in Italy. On February 7 the Figaro accuses Monsieur Caillaux, of “continuing to earn the gratitude of the Triple Alliance.” After adjourning the French loan and so facilitating the success of one Prussian loan, and the preparation of a second, “Monsieur Caillaux,” he is told by the Figaro, “has enabled the Hungarian Government to contract a loan of twenty millions sterling.” “When all our enemies have filled their Treasuries,” says the Figaro of February 7, “perhaps Monsieur Caillaux will make
up his mind to reveal the great plans and schemes to which he has subordinated the eventual issue of a French loan.“ On Sunday February 8 the Figaro contented itself with publishing a photograph of Monsieur Caillaux, and making fun of it, but day by day no number of the paper appeared without an attack on him of one kind or another. On February 11, announcing the Finance Minister’s resignation from the board of the Crédit Foncier Argentin, Monsieur Calmette comments on it in these words: “Monsieur Henri Poirier, an intimate friend of Monsieur Spitzer, has taken his, Monsieur Caillaux’s, place provisionally. When Monsieur Caillaux wishes to return to the board there is no doubt that Monsieur Poirier will make way for him.” On February 19, commenting on the statement in the Senate of Monsieur Caillaux, two days before, that he had never said in 1901 that a Minister of Finance would never consent to interfere with all the taxes, the Figaro gives him the lie direct, quotes the speech he made on July 4, 1901, and declares that it is a complete condemnation of his whole fiscal policy at the present time. On the 20th Monsieur Calmette returns to the charge, compares several speeches of Monsieur Caillaux made at different dates, and comments on them in these words: “Monsieur Caillaux modifies his declarations and his financial programme according to whether he is a Minister in power or anxious to become one, according to whether he is speaking so as to remain in office or speaking against the Ministry so as to overthrow it.” On February 25 Monsieur Gaston Calmette returns to “the secret combinations of Monsieur Caillaux,” and the big fine of £325,000, “which was imposed but never collected,” and ends his article by the accusation that Monsieur Caillaux, for private reasons, authorized a loan issued by a South American bank after the authorization had been refused three times by his predecessor Monsieur Pichon. On Thursday, February 26, the Figaroreturns to the attack on the same subject. On March 2, 1914, Monsieur Calmette published a letter written on December 19, 1908, by Monsieur Caillaux, who was then Minister of Finance, to Monsieur Clemenceau, who was then Prime Minister and Minister of the Interior. In this letter Monsieur Caillaux protests against the publication in the JournalOfficielof advertisements of foreign lottery
bonds. “Six months after the date of this letter,” says Monsieur Calmette, “the Clemenceau Cabinet fell, and Monsieur Caillaux in the following autumn became President of the board of the Crédit Foncier Egyptien. He remained President of that board till January 1914, even while he was a member of the Cabinet again from March 2, 1911, till January 10, 1912. In December 1908 while Monsieur Caillaux was Minister of Finance and was not yet on the board of the Crédit Foncier Egyptien he had refused the introduction on the Paris market of 800,000 lottery bonds. In 1912 he authorized their introduction.” “Our plutocratic demagogue,” writes Monsieur Calmette, “had found in the interval between 1908 and 1912, 100,000 good reasons for suppressing his refusal of 1908 to give these bonds a market.”
This article is of course a deliberate accusation of financial and political dishonesty. On March 3, Monsieur Calmette returns to the question of the South Atlantic Shipping Company. On the 4th, Monsieur Calmette warns the public against a loan which is to be issued by this company, and suggests that Monsieur Caillaux’s reasons for encouraging it are reasons of party policy, and anything but straightforward. On March 5 the Figaro, over the signature of Monsieur Gaston Calmette, accuses Monsieur Caillaux publicly of facilitating a Stock Exchange coupby enabling his friends to gamble, with a certainty of success, in the price of French Rentes on the Paris Bourse.
This accusation needs a few words of explanation. The budget proposals contained one item of supreme interest to French investors. This was the taxation of stocks. On March 4 at five o’clock it became “known” in the lobbies of the Chamber and in the newspaper offices of Paris that Monsieur Caillaux intended to omit French Rentes from his scheme of taxation. Naturally this expected immunity of French Rentes from taxation was the reason of a rise of French Rentes. On the Thursday, March 5, Monsieur Caillaux contradicted the rumour of the afternoon before, and declared that he intended to propose the taxation of French Rentes. At twenty minutes to twelve on that morning, when the sworn brokers of the
Paris Bourse fixed the opening price, the official contradiction had not reached them. At twelve o’clock, when the opening price was published on the Bourse, Rentes were up to 88.80, the highest price which had been reached since the declaration of war in the Balkans. A large amount of stock changed hands at this high price. Seven minutes later Monsieur Caillaux’s communiquéwas generally known, and Rentes fell forty centimes in a few minutes, entailing heavy losses.
Monsieur Barthou made a cynical and characteristic comment on this Bourse operation. “The money was not lost to everybody,” he said. On March 8 Monsieur Gaston Calmette stigmatizes Monsieur Caillaux’s behaviour with reference to the immunity and taxation of French Rentes as “a double pirouette, a looping-the-loop act which allowed certain friends of the Minister of Finance, of whom he was very fond and whom he kept very well informed, to execute a most audacious Stock Exchange coup.”
Monsieur Calmette follows this up by a personal attack on Monsieur Caillaux, who, he declared, stated through the Agence Havas on December 28 that he had resigned his position on the board of the Crédit Foncier Egyptien and the Crédit Foncier Argentin, that Monsieur Caillaux had mis-stated the truth, and that he was still a member of these boards and drawing a large sum for his services. On March 10 Monsieur Calmette attacked Monsieur Caillaux in an article which occupied nearly three columns of the front page of the Figaro, on his behaviour in the Rochette case.
This article was of course written with the knowledge that the letter of Monsieur Victor Fabre, the Procureur Général, which appears earlier in this volume, would, if published, support the charges made by Monsieur Gaston Calmette against Monsieur Caillaux, and Monsieur Monis. It marks the last stage of this long series of personal attacks in the Figaro, far too many of which attacks appear to be only too well deserved.
“For Rochette to escape from legal punishment for his crime against the investing public it was necessary that his case should not
come on for trial on April 27, 1911,” wrote Monsieur Calmette in the Figaroon March 10, 1914. The meaning of this is that by French law a prosecution which has not been followed by execution within three years falls to the ground and becomes null and void. Rochette would be a free man if he remained unsentenced three years after his first prosecution in 1908. On March 2, 1911, wrote Monsieur Calmette, “Monsieur Caillaux became Minister of Finance in the Cabinet of which Monsieur Monis was Prime Minister, and Monsieur Perrier Minister of Justice. Rochette had been arrested on March 20, 1908. On May 8 he was released provisionally. He was tried on July 27, 1910, sentenced to prison, appealed, and was able to continue his inroads on the private fortunes of France in all tranquillity. Rochette in 1908 continued to speculate and continued to empty France’s woollen stocking. He got seventy-two million francs of small investors’ money before his arrest, he got sixty-eight million francs more out of it afterwards. If his case did not come on before the three years were up he would be a free man.”
Monsieur Calmette then tells the story of the pressure which was brought to bear by Monsieur Monis and Monsieur Caillaux on Monsieur Fabre and on Judge Bidault de L’Isle, which story we know in all its details now, and he comments on it in these words: “Rochette was saved. All he had to do was to wait for the previous procedure to be proclaimed null and void, and this was done on February 2, 1912. When, to his amazement, a new suit was commenced under the Cabinet of which Monsieur Poincaré was Prime Minister, Rochette took flight. He is a free man to-day, freer and better protected than all of us. He will smile as he reads this indiscreet account of his troubles which are over, and in his gratitude he will send from overseas a gracious greeting to the Minister of Finance, his saviour and his friend. Monsieur Caillaux it was who demanded, who obtained, who insisted on, the various postponements which allowed Rochette to thieve with impunity. Monsieur Caillaux it was who allowed Rochette to proceed during the long legal procedure with the systematic spoliation of the public purse for which he had been arrested, tried, and sentenced once.
The protector, the accomplice, of this shady financier is Monsieur Caillaux. Monsieur Caillaux it was who in exchange for subventions of money to the newspapers which supported him and his policy facilitated, prolonged, and increased the strength of the influence of this Stock Exchange adventurer on the public whom he was ruining.
“There you have the plutocratic demagogue! There you have the man of the Congo, the man who nearly made us quarrel with England and with Spain, the man of the Crédit Foncier Egyptien lottery bonds, the man who drew money for serving on financial boards and for services rendered, the man who indulged in secret machinations and criminal intervention, the Finance Minister of the Doumergue Cabinet! Neither the Commission of Inquiry nor Monsieur Jaurès ever really understood the Rochette affair. They guessed something about it, they felt what it meant, instinctively, and they stopped their inquiry, frightened by so much illegality, disgusted at so many crimes. Now you know the truth of it all. Here it stands revealed in all its nakedness to the public whose savings have been stolen. It can be resumed in one word—infamy! It can be resumed in one name—Caillaux!”
On March 11, Monsieur Calmette pointed out that Monsieur Caillaux had issued no official contradiction to the terrible accusations in the Figaro of the day before. On Thursday, March 12, he called public attention again to Monsieur Caillaux’s silence, and in heavy black type in the very centre of the front page of his paper appeared these three lines, which were, so soon, to be fraught with tragic consequence.
“WE
SHALL PUBLISH TO-MORROW A CURIOUS AUTOGRAPH DEDICATED BY MONSIEUR JOSEPH CAILLAUX TO HIS ELECTORS.”
On Friday, March 13, 1914—those of my readers who are superstitious will take note that it was a Friday and a thirteenth of the month—the “Ton Jo” letter appeared on the front page of the Figaro.
VII THE “TON JO” LETTER
SENAT.
With the best will in the world it was impossible for me to write to you yesterday.
I had to take my part in two terribly tiring sessions of the Chamber, one in the morning; at nine o’clock, which finished at midday, the other at two o’clock, from which I only got away at eight o’clock in the evening, dead beat. However, I secured a magnificent success.
I crushed[2] the income-tax while appearing to defend it, I received an ovation from the Centre and from the Right, and I managed not to make the Left too discontented.
I succeeded in giving the wheel a turn towards the Right which was quite indispensable. To-day I had another morning session at the Chamber which only finished at a quarter to one.
I am now at the Senate where I am
going
to have the law on the contributions directes voted, and this evening, no doubt, the session will be over. I shall be dead tired, stupid, ill almost, but I shall have done a real service to my country.
Ton
Jo.
That is the “Ton Jo” letter. That is the document which, printed in big black type in the centre of the front page of the Figaroon Friday, March 13, 1914, and re-printed in facsimile lower down on the same page, was followed on the 16th by the revolver shots which killed Monsieur Gaston Calmette. The letter was written by Monsieur Caillaux on July 5, 1901—thirteen years before it was published in the Figaro. When he wrote it Monsieur Caillaux was Minister of Finance in the Waldeck-Rousseau Cabinet, and apart from the tragic event which followed close on its publication, the letter is a curious and upsetting confession of political duplicity. The income-tax has been Monsieur Joseph Caillaux’s hobby horse for many years. It is an uncomfortable sensation to read, over his own signature, this confession, in his own handwriting, that while appearing to fight for the tax he was really doing his best to crush it out of sight. The natural deduction was of course that Monsieur Caillaux was now, in 1914, pursuing the same tactics which he pursued thirteen years ago.
La véritable déclaration de M. Caillaux relative à l’impôt sur le revenu
THE “TON JO” LETTER FROM THE FIGARO
Friday, March 13, 1914
Once again his speeches have shown him as a partisan of the income-tax, and a partisan of the taxation of French Rentes. The “Ton Jo” letter leaves us uncertain whether this partisanship is not merely a political move, and whether Monsieur Caillaux may not again be “crushing the income-tax while appearing to defend it.” His own letter is a terrible comment on his policy, and it is difficult to exaggerate the shock which the publication of this letter caused in Parliament and among the supporters of the Minister of Finance and of the present Government.
Needless to say, Monsieur Gaston Calmette made the most of it. He embodied the letter in a long article in which he repeated his former accusations against Monsieur Caillaux, accused him of conniving at the escape of Rochette from justice because Rochette’s money was useful to his personal policy, accused him of deliberate lying in the announcement he made of his resignation from the
board of the Crédit Foncier Egyptien, accused him openly of felony in connexion with the Bourse coupand the tax.
The “Ton Jo” letter was not published in its entirety. Monsieur Calmette wrote that he suppressed the end of it because that referred to a subject which had nothing to do with fiscal questions. The name of the person to whom it was written was also suppressed, but every one in Paris knew very soon that the letter had been written to Madame Gueydan-Dupré, who afterwards—five years after the letter’s date, when she was divorced—became the wife of Monsieur Caillaux. When the letter was written in these intimate terms Madame Gueydan-Dupré, whom Monsieur Caillaux addressed with the familiar “tu” which means so much in French, his note to whom he signed “Ton Jo,” was the wife of another man. When that letter was published, the woman, to whom it had been written thirteen years before, had been the wife of Monsieur Joseph Caillaux for five years and had ceased to be his wife, had been divorced from him for two years.
It is easy to imagine the feelings of the present Madame Caillaux, of the successor of Madame Gueydan in Monsieur Caillaux’s affections, when she saw this letter reproduced in facsimile on the front page of the Figaro, and realized that all France was reading between the lines. It can have mattered very little to her that Monsieur Calmette had suppressed the last few lines of this letter. The mere fact that the first part of it was published, that in his article he made it clear that he knew how it had begun and ended, and made clear to others to whom it had been written, was allsufficient for the woman who now bears Monsieur Caillaux’s name. That woman knew that there had been other letters in existence. She knew that Monsieur Caillaux had written letters to her which had been at one time in the possession of the woman to whom this “Ton Jo” letter was addressed, and these letters contained, as she well knew, the same mixture of love and politics as the document published on that Friday, March 14.
Her own married life before she became Monsieur Caillaux’s wife had not been happy. She knew and dreaded the power and the will to injure of a woman scorned. She knew of course of the dramatic scene which had occurred before she married Monsieur Caillaux, between her husband and his first wife, Madame Gueydan. She knew that the letters which she dreaded had been destroyed on that occasion, but she knew, too, that their destruction had been obtained at the price of a reconciliation between Monsieur Caillaux and his first wife, and she knew, no woman better, that Monsieur Caillaux had not kept to the spirit of the bargain, had obtained a divorce from his first wife, shortly after the destruction of these letters, and immediately after his divorce had become her own husband. She was not sure that there were no copies of the letters in existence.
One shudders to visualize that interview between husband and wife on the morning of Friday, March 13. One can realize the fears which were expressed, the mud of past years which was stirred. And that morning, we may be fairly certain, the first thought of desperation was born in Madame Caillaux’s brain. Can you not see this woman thinking, pondering, murmuring to herself, “This must be stopped”? Can you not see her snatching at her copy of the Figaro next morning, skipping with an impatient shrug of the shoulders her husband’s communiqué to the Agence Havas, and reading down the page with anxious eyes to see whether the revelation of the letters which she feared would follow? One shudders at the mental picture of the lives of Monsieur and of Madame Caillaux, of this man and this woman, during the days which followed the publication of the “Ton Jo” letter. And when she saw, on Monday, March 16, that Monsieur Calmette had not stopped his campaign against her husband although three days before, on the 13th, he had said “My task is finished” one can realize her anguish—the anguish of fear.
VIII AGADIR
IN almost every newspaper article which I have read on the Caillaux drama one sentence has invariably amused me. “The question of Agadir,” we read, in French and English papers both, “is too fresh in the reader’s mind for any exhaustive reference to it here to be necessary.” But memories are short in these fast-living days, and though the history of Agadir is recent history, no story of the Caillaux drama can be complete without recalling it at length. For one of the accusations against Monsieur Caillaux as a politician which the Figaro made constantly is that Monsieur Caillaux made mistake on mistake, and was misled by his hatred of the Ministers who had been instrumental in the original and comparative settlement of the Moroccan difficulties, to do grave wrong to France over the Agadir matter.
His hatred of his parliamentary opponents, it was said at the time, was very nearly instrumental in creating serious international complications. Further imprudence was shown by his endeavour to palliate the effect of his first ill-considered act, and he was finally forced to consent to concessions on behalf of France which France need not have made at all if Monsieur Caillaux had been more prudent from the beginning.
This, stripped of all vituperation, is the accusation which Monsieur Caillaux has to answer before the tribunal of history. Let us look into it. In order to do so we must go back to the Act of Algeciras. It will be remembered that the Act of Algeciras gave France the right of policing Morocco because of its neighbourhood to
