New Territories in Health E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 342

Veröffentlichungsjahr: 2020

Beschreibung

The third volume in the Health Information set, New Territories in Health focuses on the multifaceted spheres of influence or territories in the field of health. This book includes nine contributions based on the analysis of stakeholder logics that approach the relationships between health and territories. The authors all specialists offer original insights, enhanced by in-depth studies, on the multiple forms that this territorialization takes: political and institutional, professional and organizational, public and media.

Leseprobe

Table of Contents

Cover

Preface

Introduction

1 In a One Health Perspective

1.1. Introduction

1.2. Food links between animal and human health

1.3. The One Health concept and the institution of antimicrobial resistance as a boundary object

1.4. Conclusion

1.5. References

2 “Our Health in Danger.” The Extension of Sanitization through Media Coverage of Health Alerts. Que Choisir, 60 millions de consommateurs, 2008–2018

2.1. Introduction

2.2. Analyzing the consumer press to understand the new health territories

2.3. Sanitarization of revealed consumption: diversification and growth of “health” themes in consumer information

2.4. From risk to involvement through health warnings: analysis of framings and points of view of consumer health information

2.5. Conclusion

2.6. References

2.7. Appendices

3 Communication and Environmental Health in Critical American Approaches

3.1. Introduction

3.2. Critical orientation publications: marginal political approaches and questions in post-positivist work

3.3. A specific corpus-building process to identify publications of critical orientation

3.4. Publishers and journals of critical research articles dealing with communication on environmental health topics

3.5. Analysis of critical research articles dealing with communication on environmental health topics

3.6. References

4 Health, Environment and Nuclear Energy: Temporalities and Trajectories of Collective Mobilizations Mikaël

4.1. Introduction

4.2. From compromise confined to its conflicting publicity

4.3. Problematization and (re)appropriation of the public problem

4.4. Affirmation of problematization and displacement of collective action

4.5. Definitional issues linked to advertising and oppositional dynamics

4.6. Conclusion

4.7. References

5 Public Health Controversies: The Scattering of Arenas and Politicization. The Case of Vaccination in France during the 2010s

5.1. Introduction: vaccination and the politicization of public health

5.2. Anamnesis of vaccine controversies: a question of arenas

5.3. Scattering of controversies in arenas, an operator of politicization

5.4. Scattering-selection of controversies in a plurality of arenas: proposal for an understanding of the politicization of controversies

5.5. References

6 Internet User-Patient(s), a Collective Adventure

6.1. Introduction

6.2. From rarity to effervescence

6.3. Polyphonic formats

6.4. The bubbling of exchanges

6.5. The quest for information

6.6. Medical anxieties

6.7. From information to empowerment

6.8. The patient facing the flow: A collective

6.9. Layperson production

6.10. Conclusion

6.11. References

7 Interferences and Territorial Conflicts: The Case of the Electronic Medical Record

7.1. Introduction

7.2. Theoretical framework

7.3. Case study

7.4. Discussion

7.5. Conclusion

7.6. References

8 Professional Practices and Organizational Issues. The Case of Medical Regulating Assistants

8.1. Introduction

8.2. The medical regulation file at the heart of the service’s activities

8.3. Around the DRM (regulation file): Multiactivity at the service of efficient patient care

8.4. Conclusion

8.5. References

9 The Moral Economy of the Health “Territories.” Technocratization from the Top-Down of Biopolitics, Politicization from the Bottom-Up of Life Policies

9.1. Introduction

9.2. The system and the territory against the local

9.3. A new technocratic boundary: Escaping politics

9.4. Centralization, verticalization, and integration of sectoral government

9.5. 2009: The final fight?

9.6. An evanescent territorial health state

9.7. Technocratic “boundaries” facing the anarchy of life

9.8. References

List of Authors

Index

End User License Agreement

List of Tables

Chapter 2

Table 2.1. Categories selected for the analysis of the media coverage of health ...

Table 2.3. Top headlines on nanotechnologies – nanoparticles

Table 2.a1. Number of headlines classified by theme and year

Table 2.a2. Cross-tabulation of themes and framing of headlines (number of co-oc...

Table 2.a3. AFC on framing themes: contributions and square cosines of the rows ...

Table 2.a4. Percentage of POVs mobilized for each meta-theme on the health conso...

Chapter 3

Table 3.1. List of publishers, journals, and distribution of abstracts

Table 3.2. List of categories and distribution of abstracts

Chapter 7

Table 7.1. Data collection

List of Illustrations

Chapter 2

Figure 2.1. Nvivo® synapsy of the word “santé” on the front page of 60 millions ...

Figure 2.a1. CFA framing themes: eigenvalues and % inertia of factors

Figure 2.2., Table 2.2. Health-related consumer information: Annual increase in ...

Figure 2.3. Excerpts from the front pages of Que Choisir (Que Choisir, no. 484, ...

Figure 2.4. “Multipurpose” theme: extracts from the front pages of 60 millions d...

Figure 2.5. CFA on the co-occurrences of themes and framing. For a color version...

Figure 2.6. Toxicity, a new framework for consumer information: the case of cosm...

Figure 2.7. The benefit/risk ratio materialized by the toxicity/efficiency frame...

Figure 2.8. Changes in points of view in regard to consumer health information (...

Figure 2.9. Semi-discursive warning processes. The left figure: “deodorants, our...

Figure 2.10. Health warning on endocrine disruptors

Chapter 3

Figure 3.1. Distribution of abstracts by year and category. For a color version ...

Figure 3.2. CFA factorial plan on the text cloud

Figure 3.3. CFA factorial plan on the text cloud

Guide

Cover

Table of Contents

Begin Reading

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Health Information Set

coordinated by

Viviane Clavier and Céline Paganelli

Volume 3

New Territories in Health

Edited by

Isabelle Pailliart

First published 2020 in Great Britain and the United States by ISTE Ltd and John Wiley & Sons, Inc.

Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act 1988, this publication may only be reproduced, stored or transmitted, in any form or by any means, with the prior permission in writing of the publishers, or in the case of reprographic reproduction in accordance with the terms and licenses issued by the CLA. Enquiries concerning reproduction outside these terms should be sent to the publishers at the undermentioned address:

ISTE Ltd

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UK

www.iste.co.uk

John Wiley & Sons, Inc.

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USA

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© ISTE Ltd 2020

The rights of Isabelle Pailliart to be identified as the author of this work have been asserted by her in accordance with the Copyright, Designs and Patents Act 1988.

Library of Congress Control Number: 2019953654

British Library Cataloguing-in-Publication Data

A CIP record for this book is available from the British Library

ISBN 978-1-78630-520-6

Preface

This book is the third in a set entitled “Health Information” edited by Céline Paganelli and Viviane Clavier. This series is part of the “Health Engineering and Society” collection proposed by Bruno Salgues. Each book is the subject of a specific editorial project designed in close collaboration with the series editors.

This book focuses on a specific territorial issue in the field of health. It proposes nine contributions that approach, based on the analysis of stakeholder logic, the relationships between health and territories. The authors, all specialists, propose original insights, nourished by in-depth studies, on the multiple forms that this territorialization takes: political and institutional, professional and organizational, public and media.

I wish to thank Viviane Clavier for her trust, support and efficiency. Thanks are also due to Laure Sterchele for her editorial support.

Isabelle PAILLIART

November 2019

Introduction

The health sector is marked by strong divisions between structures that attribute to each of them “assignments to be found” in well-defined territories. The objective of the book is based on one observation: even if these assignments can be found in one or more institutional territories, a certain number of changes are to be noted. They are of three kinds: the first concerns the existence of a certain level of permeability between these territories, the second underlines the conquest by health of new social territories, and the third highlights the place of local territories within national health policies. Institutional health territories, social territories, and local territories thus determine the direction of the work. As we can see, the use of the term “territories” is broad and has a metaphorical dimension. The book deals with all these variations and considers that the territorial dimension, in its broadest sense, promotes a heuristic interpretation of the transformations underway. It is also a question of considering that the expression “new” territories underlines an interrogation on change in the health field much more than an affirmation on the “novelty” of situations. The book does not take into account all the actors involved in the field of health nor all the transformations underway; it focuses, for the most part, on the forms of advertising and media coverage, i.e., the relationship between this field and the public setting, through the media, digital devices, or information and communication activities.

Institutional territories: Compartmentalization and movement

This approach is illustrated by the chapter on antibiotic resistance. This phenomenon is at the crossroads of several territories: political, physical, and scientific. More precisely, Jocelyne Arquembourg identifies the trajectories of the problem of antibiotic resistance in bacteria. Scientists and doctors have begun to raise questions about antibiotic resistance, and in this context, the problem is confined to the medical and scientific sphere. At first, it was not considered, in France, as a risk for public authorities, unlike other countries such as Great Britain or Denmark. Gradually, and under the influence of new actors such as consumer associations, the media, politicians, and scientific actors, the issue of antibiotic resistance is emerging in the public space. But the originality of this notion is of several kinds. First, it challenges the boundaries between the territories of human and animal health since scientific research links meat consumption to the emergence of antibiotic resistance in humans. Second, the territorial scales of public action (European and national) are also mobilized in various ways; the response must be global and not fragmented into local actions. Finally, several agencies are involved in launching action plans with the objective of internationalized governance, even if these international bodies remain strongly dominated by the United States and Europe. All these elements lead Arquembourg to consider antimicrobial resistance as a “boundary object,” which is illustrated by the expression “One Health” and whose institutional implementations lead to a necessary reconfiguration of the fields of intervention of traditional actors. Approaching the issue of antibiotic resistance requires the participation of several actors and the complementarity of skills, so it is indeed a “boundary object” that is at the center of confrontations and power relations. Initially a human and animal health problem confined to the medical sphere, antimicrobial resistance has been discussed by other fields and with other types of actors, addressing new problems, making its emergence in the public sphere more complex but above all too broad.

As we can see, health is at the heart of many scientific and political strategies. It is also a field that tends to conquer new territories of social activity. In this respect, it is not only a revealing but also a driving force for social change. In short, it extends its interpretation of social relations to situations that go beyond its usual scope, a movement reflected in the expression “social sanitarization” and demonstrated by the information published by consumer associations. In the “consumer press,” the presentation of products is studied in several aspects (quality, cost, efficiency, etc.), and in particular the risks to consumer health are highlighted. It is thus the “sanitarization” of consumption process that is being studied by Benoit Lafon. Consumer information magazines contribute to the emergence of problems in the public sphere, particularly in the field of public health. Work on the construction of public problems has highlighted the importance of their role, for example, as a contribution to the construction of the asbestos problem in the public sphere; and also by revealing the underlying socioeconomic issues. The reference to health in the “conso-info” (consumer information) is made in two ways: either it concerns health issues (hospitals, mutual health insurance) or it serves as a reference to broad issues (food, cleaning products). Benoit Lafon thus underlines a double movement, that of health toward consumption and that of everyday practices as seen through the prism of health. This is what he calls the sanitarization of consumption and the consumerization of health.

Thus, we can note the interdependence and interpenetration of several fields, a situation that challenges public policies whose sectoral organization is not appropriate to these developments. The growing sanitarization is amplified by the almost systematic use, in the magazines studied, of “health warnings,” i.e., regular warnings about dangers that contribute to the translation of a situation into a health problem. Certainly, this journalistic approach corresponds to a strategy of conquering the readership through the involvement of the public. But the extension of the health territory to any activity or product, in the form of a media warning, does not seem to promote social involvement and collective awareness but rather, here as in other areas, it seems to accentuate the empowerment of individuals and the individualization of the problem.

The territory: The challenge of a public health space

The approach to environmental risks in terms of health and public health is treated here from a critical scientific perspective, identifying the political and economic stakes of power. In this field, it is dominant in France. This is not the case in the United States, as Brigitte Juanals points out in her chapter, which makes a definite contribution to the knowledge of North American work; scientific work that is part of a critical approach is in the minority compared to functionalist and post-positivist approaches. These approaches are characterized by the fact that they relate the social conditions of individuals, places, and their state of health. In France, the issue of inequality in care is social and territorial or at least the difficulties of access to care, if they manifest themselves in territorial inequalities, are social. American research adds an element that is not present in France, namely, the consideration of specific populations such as “racial and ethnic minorities.” Thus, the relationships between the location of individuals, “racial” criteria, the socioeconomic conditions of the inhabitants and their state of health are highlighted. The aim is to prove the profoundly unequal dimension of environmental health: the place devoted to power relations, modes of domination, and control and opposition movements is therefore decisive.

The critical dimension of American work is in the minority and is marked by a weakness in data production, as researchers do not sufficiently develop empirical work. Thus, the lack of accurate and quantifiable data is an obstacle to policy makers taking these issues into account. In addition, the engagement of researchers undermines the credibility of their results and approach. Juanals’ research points out that critical American research highlights ethical issues, and sociohistorical analyses to highlight the poor monitoring of demographic transformations, for example, in the context of high-risk industrial sites. It indicates the presence of specific themes: “environmental justice” in particular, or “environmental governance,” which play a decisive role in the politicization of environmental health and its inclusion in the public space. In France, the situation is different; it is the controversies on environmental health that help embed this notion in the public space. Moreover anti-nuclear movements very early on used the health argument for opposition to the nuclear industry, as shown in Mikaël Chambru’s chapter. Environmental health in anti-nuclear mobilizations is a regular reference and the researcher proposes to establish a genealogical presentation. The result shows that the public emergence of a problem does not follow a linearity that would lead to its progressive structuring; there are public times and periods of invisibility. In public, environmental health is being promoted to fight nuclear power, and this requires the support of scientists and their production of knowledge. However, like with the opposition to vaccination, the words of scientists seem to have little resonance. For different reasons: in the context of vaccination, scientists are refusing to engage in public discussion; in the context of anti-nuclear movements, their expertise leads to obscuring social movements and putting in difficulty the expertise produced by militants. The place taken by scientists leads to a loss of activist expertise and their place in the struggle for strategies; in short, it externalizes a key element of the anti-nuclear fight into the scientific field. Hence, the importance of the definitional struggle to characterize the problem arises. But there are also times when environmental health becomes secondary in the strategies of collective mobilization and in the public space. It is then necessary to identify the conditions for reactivating these arguments and to analyze, through them, the power relations between three types of arenas: institutional, media, and oppositional. The article also highlights the difficulty that activists face in agreeing on a definition of a public problem. The reference to health issues in the defense of the environment is not always shared by the various opposing sensibilities to nuclear policy. However, the author notes that the plasticity of the reference to health and environmental risks, as well as the vagueness in the strategies, offer an opportunity to find new audiences and enrich the protest movement with other themes: occupational health, the transport of radioactive materials, populations in the vicinity of nuclear tests, etc. This raises a question about the ability of protest movements to break away from their usual repertoires of action and to make new demands that could make them visible in the public space and increase public support.

Health: A new political territory

The approach developed in the book is less concerned with the progressive debating of a health issue and the actors who contribute to its problematization than with studying the “circulation” of this theme within various social fields. Thus, controversies over vaccination are indicative of the politicization of the subject and, more broadly, the politicization of health issues. In short, it is a question of approaching the new territories of health politicization in this way. The theme of immunization is particularly rich in capturing the relationships and tensions between institutional discourses to promote immunization and those that are in opposition to it. The institutional dimension is particularly important: it gives rise to public policy, funding, specific actions, public communication campaigns, and assessments. It is, moreover, old. Caroline Ollivier-Yaniv identifies different types of controversies on vaccination, but above all, she highlights the arenas in which these controversies develop. The term “arena,” a spatial metaphor like that of “public space,” is chosen because it highlights the question of inequalities of access to discussion, their closure, and the transversal modalities of passage or interarena dynamics. There are three types of arenas: discrete or invisible institutional arenas that are part of the scientific field, economic actors, and public institutions; institutionalized public arenas that correspond to the information media; and deregulated semipublic arenas that correspond to digital arenas. These three arenas raise several questions: about their access, about the actors who comprise them and their power relations, and finally about the discourses of the social actors. But the author shows that these arenas are not compartmentalized; she highlights the movement of a controversy from one arena to another and the fact that they interact with each other. As for the institutional actors, they seek to impose a rationality that is entirely scientific and political, proving to be evidence of a position of authority; in short, the rejection of the conflict leads to the reaction and politicization of the subject by other actors. Arenas are not equal among themselves, and the subject of vaccination shows, in a way, the alliance between open public arenas (media, associations). The dispersion of public arenas and their multiplication thus contribute to the politicization of the subject and to the questioning of traditional legitimacy on a scientific and political level.

The new health territories not only refer to places or spaces undergoing transformation or on territorial scales; the expression also covers other changes: the emergence of new actors and patients who redistribute the relationships between doctors and patients, and the appearance of new situations that make institutional territories evolve. Concerning the patient, his or her role has evolved considerably within the singular colloquium, in particular because of greater accessibility to health information through the Internet. Cécile Méadel thus shows the importance taken by the consultation of sites, which leads to a loss of power by the medical and scientific institution which, until now, had a clear monopoly on medical information. These sites and applications are more focused on the patient than on the enhancement of the medical institution. Admittedly, this situation is linked to profitability objectives, and exchanges between patients, and comments or advice are the purpose of these different sites. The consequence of this presence or involvement of the patient in Internet exchanges is to extend health to new situations, those of daily concerns, in short to take health and health information out of its traditional isolation. At the same time, it is the relationship with health professionals that is changing. The chapter questions the fear that physicians may encounter in the face of this quest for information. More generally, the health sector is undergoing changes in other sectors: user participation, the questioning of established and imposed knowledge, as well as the progressive recognition of expertise through experience. However, the chapter also highlights the fact that, in his or her Internet practices, the patient is not alone; the collective dimension manifests itself in several ways in discussions and exchanges with other Internet users or in expressions of support. It is also manifested in the production of secular knowledge, in forms of expression and dissemination. The production of secular knowledge ranges from the simple transmission of information to the participation in scientific knowledge (e.g., through the establishment of databases). Thus, the collective dimension linked to the experience of the disease leads on the one hand to the emergence of diseases in the public space and to promote their recognition and to change the institutional territories of medicine on the other hand.

Health: A space for confrontation between organizational territories

The French emergency medical services (SAMU) illustrate the issues that arise in the field of health (and more particularly in the organization of medical care). The territorialization of medical activities thus acts as an indicator of new problems. An emergency service is territorial in a dualistic way: it is a physical space within a hospital center, and it is located in an urban space. Chapter 8 proposes to analyze the functioning of a particular service: it is well known to the inhabitants and strongly identified, and at the same time it is marked by a certain opacity, and its functioning escapes external scrutiny and particularly that of callers. In an even more detailed way, the chapter focuses on professionals who interact strongly with callers and yet are not well known and poorly identified. Most often, it is the interactions between doctors and nurses that have been studied or the difficulties encountered by health professionals in their professional environments. Aurélia Lamy et al. are interested in professionals who are present among the public but who remain invisible. These are “medical regulatory assistants.” These actors play a mediating role between callers and doctors, who, although decisive, remain unknown and undervalued. The “info-communication” skills required are undervalued in relation to the command of technical skills, especially computer systems. In addition, these professionals must deal with a multitude of activities that require special reactivity skills. It is therefore through the role of “medical regulatory assistants” that an entire internal organization is questioned.

Questioning of the functioning of a hospital structure is highlighted during the implementation of the Electronic Medical Record (EMR), a system designed to centralize and share patient information by healthcare professionals within an institution. The hospital presents itself as an organization with many services, part of different, highly structured “worlds” that could be quickly separated into two parts: on the one hand the clinical part, and the administrative part on the other. However, the implementation of EMR blurs and even challenges the spatial, professional, and symbolic boundaries between these services. Admittedly, the implementation of information systems within organizations and companies has highlighted how complex its integration is, in particular through the collection and sharing of data. The hospital institution’s bureaucratic dimension reinforces the difficulties that concern both the issues of power and the changes in professional practices. In this sense, Roxana Ologeanu-Taddei’s chapter questions the notion of territory in its multiple meanings: it is an organizational territory (the hospital), the boundaries between services, and a reconfiguration of power spaces within a structure. The development of an EMR reveals several problems: the choice and selection of information, its access for health professionals, and the tensions between having managerial rationalization (invoicing rules) and professional rationalization (medical data). It then remains to identify which actor or mechanism can establish the link or bridge between territories that often coexist and oppose each other.

Health: Between national policies and the territorialization of public action

Finally, Frédéric Pierru’s chapter on national public policies and their relationship with local policies highlights the complexity of positioning. We should not interpret health policies dichotomously, whether they are territorialized (the action of the State in the territories) or territorial (the action of territorial authorities): the former imposing directives that the latter would be responsible for implementing, or, in an opposing interpretation, the latter being autonomous and in opposition to national structures. The sociologist clearly underlines that the territorialization of national health policies, as in other fields, is based on instruments (in particular those of new public management) and structures that frame and define health activities in the territories. And in this sector, economic rationality and the imposition of severe budgetary constraints are essential here as in other public services. More generally, the author highlights a form of depoliticization of health issues at the national level. The objective is to give way to a re-centralization of health policies accompanied and justified by their technocratization. As for the policies pursued by local and regional authorities, they are based on a twofold movement: competition between territorial levels (not only between municipalities, departments, and regions, but also between cities or between the city center and suburban cities) and that of interdependence between these levels. In short, local authorities must master the management of multilevel local interdependencies and ensure their coordination. They must also take into account a politicization of health issues for which they are relatively lacking: the demands of health personnel and in particular emergency services, territorial inequalities in access to care, dependency management, problems related to climate change such as episodes of pollution or heat waves, or the maintenance of small hospital structures. All these elements mean going beyond the verticality of State action and underlining that a certain number of new issues are being created from the territories, forcing a reconfiguration of health policies and, in general, that of the very notion of health.

All the contributions in this book highlight an intertwining of the different territories: political and institutional, organizational and professional, public and media, and, increasingly, their interdependence.

Introduction written by Isabelle PAILLIART.

1In a One Health Perspective

1.1. Introduction

Antimicrobial resistance is not an object but rather a biological phenomenon that refers to the resistance of bacteria to antibiotics. However, over time, it has become a social phenomenon and a public health problem in most European countries and in the United States – countries that have been highlighting the “global threat” since 2013 [ARQ 16]. Therefore, this public health problem can be considered to have all the characteristics of what Susan Leigh Star and Jim Greisemer [STA 89] call a “boundary object”. Through this notion, the authors wish to

describe and characterise the process through which actors from different social worlds – called upon to cooperate – manage to coordinate with each other in spite of their differing points of view: how do they create common understanding without losing the diversity of their social worlds? Those involves in areas where knowledge is not yet stabilised come up against the need to reconcile different meanings given to objects upon which they are trying to reach agreement [TRO 09, p. 5].

Boundary objects are located at the crossroads of social worlds that connect with each other and communicate, making multiple translation efforts possible. Studies on boundary objects generally focus on the activities or interactions of the actors concerned. In the case of antibiotic resistance, it is important to focus more on the boundary object itself as the origin and consequence of such activities and interactions. Antimicrobial resistance is a global threat that makes it imperative for scientific and institutional actors to coordinate with each other appropriate responses. However, this object is not entirely pre-existing, and as we move forward, we will see that its definitions and interpretation frameworks evolve, expanding its own boundaries and thereby increasing the number of social worlds to which it belongs. While the authors who work on this notion frequently use the term “social worlds” to refer to social, professional and disciplinary universes that come into contact through a boundary object, we would prefer to talk here about territories. Antibiotic resistance is a matter for different territories, whether institutional (areas of intervention and places of power), scientific (disciplinary areas), geographical (countries) or economic (places of agricultural production, mass retailing, etc.). Our aim is thus to locate a boundary object at the heart of the different territories it concerns or crosses, and above all, to observe the mutual movements by which this object constitutes a form of formal notice to act for increasingly diverse actors – located in increasingly vast territories – who, in return, will shape this boundary object itself, its definition, and its interpretation frameworks.

1.1.1. Institutional division, splitting up the problem and sectional containment

Bacterial resistance to antibiotics is a process that has been known for a long time, but which, at first, did not appear to be a major threat. Confidence in the ability of researchers, and pharmaceutical companies, to produce new antibiotics has long led to the belief that the discovery of new drugs would beat the ability of bacteria to adapt, without realizing that this race could generate new forms of adaptation in the bacteria [AND 16]. On the other hand, antimicrobial resistance remained a difficult phenomenon to observe [JEN 19] until effective monitoring systems were put in place, which, in France, was done in the 1990s [FOR 15]. Although the medical and veterinary professions were getting more concerned about antibiotic resistance, this anxiety led initially to action programs that took place in pre-existing institutional frameworks. The media coverage of this issue in newspapers such as Le Monde reflects this situation. News related to antibiotic resistance usually appears in the science column and never usually under the society column or on the front page. This says a lot about the primary definition of the problem, long considered a scientific issue related to human health and the sole responsibility of scientific researchers and physicians. This first framework of interpretation was reinforced when in the 1980s and 1990s, cases of mortality due to penicillin-resistant pneumococci in cities, and above all methicillin-resistant Staphylococcus aureus (MRSA) in hospitals, were reported. Consequently, in France, the first whistleblowers to be concerned about this problem were resuscitators [CRE 16]. The combination of syntagma-resistant bacteria and nosocomial diseases has helped to strengthen this first definition, even though in other European countries, such as the United Kingdom, Denmark and Sweden, the framework for interpreting the problem included other dimensions related to antibiotic consumption in livestock farms and food. In fact, for a long time, bacterial resistance to antibiotics appeared, first to scientists and then to stakeholders, as an addition of problems from different territories or environments. First, there are scientific reasons for this. Until the 1960s, scientists conceived that resistance was transmitted horizontally by contact. A first level of doubt was instilled by the discovery of plasmids – mobile genetic elements located outside the nucleus of the bacterial cell – by R.W. Hedges and A.E. Jacob, leading to the discovery that these plasmids could exchange resistance genes. As Tristan Berger [BER 16, p. 9] observes,

The transmission of antimicrobial resistance [H] between bacteria can therefore be vertical and/or horizontal, the latter aggravating their multiplication. However, at the time, this development seemed to meet boundaries of territory, environments – hospital, rural, urban – and species: there was no evidence that there could be any links between antimicrobial resistance [H] and [A]. Therefore, while it is certain that the use of antibiotics in humans can accelerate the development of antibiotic resistance [H], the problem analyzed here – antibiotic resistance [A] – seemed a priori safe for human health.

Thus, in France, responses to the increasingly blatant and threatening emergence of resistant bacteria were initially incorporated into a partition between human and animal health, and were not taking into account the role of the environment in the proliferation of the bacteria. With regard to these institutional and scientific territories, antimicrobial resistance has first been the subject of sectional containment, which has slowed its emergence as a social and public problem. However, this threat has, through its persistence and scale, played a revealing role, casting a stark light on the limits of these territories and their inability to solve individually a problem that overwhelmed them to the point of making their collaboration necessary.

The first signs of trouble regarding antibiotic consumption in livestock farms appeared in the pages of Le Monde at the end of the 1960s, when articles began to question consumption of antibiotics in intensive livestock farming. The often-quoted risk concerned the supposed presence of antibiotic residues in food. At first, this anxiety proved vague and mixed up with other concerns. For the actors who gave it a certain degree of publicity, especially the scientific journalists at Le Monde, it was part of a broader debate opposing two conceptions of livestock, and then, a debate that combined all the treatments used in the context of modern agricultural practices, such as hormones, tranquilizers and anabolic steroids. The question of the use of antibiotics as growth promoters is sometimes raised in articles but seems to be part of debates that do not go beyond the scientific framework [ARQ 16]. Thus, it can be considered that in France, until the early 2000s, antimicrobial resistance was not considered a risk to both human and animal health. The issue did not receive any real recognition from public authorities, and in the case of animal health, did not stand out among a list of other significant problems affecting agricultural production methods.

Notably, the situation is quite different in the United Kingdom and Denmark, where the link between the consumption of antibiotics on farms and the spread of bacteria resistant to equivalent molecules in humans has been widely publicized since the 1990s, leading Denmark to ban the agricultural use of vancomycin. Sweden, from the late 1980s, has already taken radical measures to ban the use of antibiotics as growth promoters, and to implement the use of veterinary prescriptions for both preventive and curative uses. On the other hand, in France, the major communication campaign to reduce antibiotic consumption in 2002, “Antibiotics are not automatic”, was followed in 2007 by another which only targeted human health. Antimicrobial resistance is treated in two different and parallel ways in two distinct territories that mutually reject its responsibility: human and animal health. The treatment also demonstrates great difficulty in totalizing an object of common interest that arouses a broad public mobilization.

1.1.2. Sectional ownership strategies and power struggles

It is important to review the first health crises that triggered a re-articulation of human and animal health territories in the face of antimicrobial resistance. This re-articulation has taken different forms in different European countries.

In 1960 in Great Britain, 60 people were contaminated by the consumption of raw milk from cows infected with resistant bacteria (Salmonella typhimurium). Very quickly, public opinion reactions pointed to the use of antibiotics as growth promoters in livestock farming. It was not until 1969 that the British government commissioned Meredith Michael Swann to produce a report on this issue. The report recognized the link between growth-enhancing antibiotics, the development of resistant bacteria, and the risk of contamination to humans through food. It advocated the prudent use of antibiotics and recommended that their delivery to farmers be subject to veterinary prescription. However, as Maryn Mckenna [MCK 17] observed, “So many prescriptions were being written that more antibiotics were used on British farms in the wake of the Swann Report than before.” Indeed, in two years, consumption rose from 41 to 80 tons. So much so that in 1980, The British Medical Journal accused the local and specialized press of encouraging farmers to obtain antibiotics from unofficial markets. A public arena then emerged around debates whose frameworks were very well described in the article by Carol Morris et al. [MOR 16]. The main stakeholders involved in the problem, whether associations, livestock breeders’ unions, veterinarians or institutional representatives, adopted one or the other of the three positions that structured the debate: denouncing the failure of a production system, maintaining and observing the status quo, or calling for a voluntary approach and responsible use of antibiotics. The debate then pitted two types of arguments against each other: on the one hand, a radical criticism of a system based not only on farmers’ practices but also on pressure from traders and consumers to consume ever-cheaper meat, and on the other hand, the other two categories of actors who were making human health responsible for antimicrobial resistance. This, however, resulted in three types of proposals: the first requesting government intervention to control antibiotic use in livestock farming, the second suggesting that the measures already in place were sufficient, and the third limiting a request for voluntary action backed by efforts to improve hygiene and biosecurity.

These debates, which appeared in the general daily press and in the specialized press, shed light on the figures of antibiotic consumption on livestock in Great Britain. The same study on human health consumption would have certainly shown a high collective sensitivity to the risks of antibiotic resistance and a more widely shared desire to reduce consumption. But the fact that these debates were reported in the newspapers highlights the mobilization of associations and non-governmental actors.