Whose Lyme is it anyway? Subject positions and the construction of responsibility for managing the health risks from Lyme disease

Abstract

There has been a significant increase during the last decade in the UK of the incidence of the Lyme disease. It is transmitted through tick bites, and can have serious health consequences if not treated early. This study examined how the responsibility for managing and communicating the health risks from Lyme disease to forest workers and recreational visitors was constructed and acted upon by 21 interviewees in key managerial positions within one of the largest UK forestry organisations. The in-depth, semi-structured interviews were analysed using discourse analysis within a Foucauldian framework. The results demonstrated that the construction of responsibility towards the workforce and visitors was embedded into broader representations of the forest as a working, recreational and natural environment, as well as into the binary conceptualisation of forest hazards as natural and human-made. These constructions prescribed respective subject positions which differentially informed assumptions of responsibility, and consequent actions, towards the workforce and the public.

Introduction

The countryside is commonly represented as a benign risk-free environment and a place for relaxation, in contrast to the demands and stresses of city life. However, rural landscapes are also places of potential hazard and risk, whether physical (e.g., tripping, falling and drowning), climatic (e.g., hypothermia, sun stroke, sun burn) or biological (e.g., stings, bites, allergic reactions). Moreover, they are also sites of production and thus additional hazards are associated with the countryside being a working environment. There are few other workplaces where the public would be permitted almost unfettered access to potentially risky and dangerous work processes and settings (e.g., farms, forests). Of course, the public is protected from many countryside operations (e.g., harvesting sites, chemical treatments), but the working environment still poses risks (e.g., fallen trees, forest vehicles, the dangers of getting lost in unmarked places). The exposure to a range of natural and human-sourced hazards for different groups of countryside users who assess and act upon the health risks in different ways, makes this an ideal setting to explore the claims made around responsibility for managing risks, and the way these responsibilities are addressed by those liable for managing rural environments.

Zoonotic diseases present a particular hazard to health in the countryside. The World Health Organisation defines zoonoses as “diseases and infections that are transmitted naturally between vertebrate animals and man” (World Health Organisation, 1959:6). One such zoonosis is Lyme disease (also known as Lyme borreliosis). This is caused by bacteria (Borrelia burgdorferi s.l.) transmitted through tick bites (usually the Ixodes ricinus species in the UK). Early signs may include a bull's-eye rash and flu-like symptoms, and at this stage the disease is readily treated with antibiotics. Without treatment, there can be late stage complications involving many tissues, especially the nervous, musculoskeletal and cardiovascular systems (O'Connell, 2005). Lyme disease was first recognised in the USA in the late 1970s (Steere et al. 1977), but there is evidence of early occurrence in a number of European countries (Piesman and Gern, 2004). As far as the UK is concerned, laboratory confirmed cases of Lyme disease began to be reported in 1986 and an enhanced surveillance scheme was initiated in 1996 (Health Protection Agency, 2011a, Health Protection Agency, 2011b). From then on, there appears to be a year on year increase in the incidence of the disease in England and Wales. Between 1997 and 2008 reported cases rose by 384% (813 cases in England and Wales in 2008) of which approximately one sixth were reported to have been acquired overseas. By 2009, this had risen to 973 cases in England and Wales (DEFRA, 2009), and by 2010, to 1009 cases (Health Protection Agency, 2011a, Health Protection Agency, 2011b). The Department of Environment, Food, and Rural Affairs (DEFRA) reported a 27% increase across the UK from 2008 to 2009. It is unclear to what extent the increase is in part attributable to improved diagnosis, as both the diagnosis and treatment of Lyme disease is a contentious and political issue (Tonks, 2007). Lyme disease can be found throughout the British Isles and although there are reputedly ‘hot spots’, the results from a study by Dobson et al. (2011: 73) suggest that there is “…no biological reason to suppose, nor epidemiological data to suggest, that the New Forest, for example, is any more hazardous than large patches of similar woodland elsewhere in the UK”. What makes a ‘hotspot’ is not the number of ticks, but the number of people who visit the place and whether they address the risk.

Lyme disease (LD) risk is a well-defined and accepted hazard for forestry and countryside organisations operating in the UK. It is not a notifiable disease but is acknowledged by staff and organisations who respond to it through health and safety procedures that are enshrined in both legislation and good management practices (e.g., the distribution of information to staff, incident notification procedures). For visitors, there are no government or health agency derived policies or procedures for organisations to follow for the management of LD risk, and advice is often arbitrary. Indeed, there may be a reluctance to raise awareness of hazards and of associated precautionary actions as this may heighten concern (Timotijevic and Barnett, 2006), and places can become stigmatised through their association with risk (Kasperson et al., 2001). A consequence of this is that not only are different groups (i.e., workers and recreationalists) implicated in risk communications, but the purpose, needs, and obligations for such communications to each will be very different. Forest, land, and park managers are key agents for supplying precautionary information to both their workforce and the public. While they are not the only authorities to provide information on LD (other sources in the UK include the Health Protection Agency (HPA), National Health Service (NHS) Direct), forest managers are particularly significant because, by virtue of their occupational position, they have a responsibility for informing both workers and the public about potential risk, as well as managing the health risk itself.

These issues were investigated in a three-year project ‘Assessing and communicating animal disease risks for countryside users’, which was part of the ESRC Rural Economy and Land Use Programme. The research focussed on the perception of the health risks from LD for countryside visitors and foresters, and the appropriate management and communication strategies for managing that risk (Quine et al., 2011).

The notion of responsibility plays a pivotal role in defining, organising and regulating social relations, both at collective and individual levels, although a person's social relations will also impact upon the notion of responsibility. Responsibility enables societies to distribute rewards and sanctions and to control human behaviour on the basis of a set of established social norms, roles and arrangements (Schlenker et al., 1994). The triangle model of responsibility (Schlenker et al., 1994) proposes that judgements of responsibility are bound to three elements and their links among them: an event, the prescriptions and a person's identity. To the extent that a person's identity is linked to a set of prescriptions and a certain event, and the event is connected with these prescriptions, the actor is more likely to be held responsible for this event.

Responsibility is a broad and dynamic term which bears multiple meanings in linguistic interactions, these meanings frequently being deduced from the context. For this reason, the word is often used interchangeably with other similar terms such as accountability, culpability, blame or liability. Thus, the various interpretations of responsibility may structure accounts of human behaviour in different ways.

A first connotation of responsibility derives from the identification of the term with the concept of causality; an entity is held responsible as long as it has caused a certain effect. Causal responsibility (Hart, 1968) does not, however, entail straightforwardly blameworthiness, unless human agents have contributed to the realisation of the effect. Thus, a virus can be causally responsible for the onset of a disease but a proportion of the blame can be attributed to the patient for not taking precautions.

Moral responsibility can be ascribed only to human agents when certain assumptions about conduct are met. First, the behaviour should be the result of free will and autonomous action, meaning that at least one option is available to the actor (Vallentyne, 2008). Second, the actor must directly or indirectly have produced the effect, implying that moral responsibility presupposes a certain level of causal responsibility. Third, the actor must have been able to foresee the consequences of his/her behaviour. Last, moral responsibility is closely bound with the notion of intentionality (Heider, 1958, Shaver and Schutte, 2001, Schlenker et al., 1994). Moral responsibility can also be employed to ascribe a higher value to the actor or the action specified (Birnbacher, 2001). This reveals that the notion has been transformed into a social value, able to induce desirable outcomes when it is substantiated and social sanctions when it is violated (Beck-Gernsheim, 2000).

Finally, responsibility may be conceptualised in legal terms and is closely interwoven with the notions of duty, liability or answerability (Bennett and Crowe, 2008). In other words, role responsibility is tied to a social position (Hart, 1968) and derives from the rules and the requirements that a certain position imposes on the occupants independent of the individual. Moral codes of conduct can also prescribe the responsibilities stemming from the occupation of social positions (Schlenker et al., 1994).

Given these multiple facets of responsibility, it could be argued that the enactment of responsibility will be a function of its discursive construction. Thus, responsibility can be conceptualised as a negotiable construct against which legitimate positionings are attempted on the basis of the various ‘theories of responsibility’ (Cobb, 1994) that invoke differentially discourses of human agency, free will, human determinism and social roles (Thompson, 2009). Adopting this latter stance in our theoretical management of responsibility, in this paper we explore how responsibility for preventing and managing the risk of ticks and LD is constructed in the discourses of forest managers, and what particular conceptualisations of responsibility are invoked within and across discourses. Finally, we examine the implications of these discourses for action.