Honolulu: University of Hawai‘i Press, 2013. xix, 292 pp. (Figures, maps, table.) US$54.00, cloth. ISBN 978-0-8248-3685-6.
“Tobacco is the drug about which Islanders should really be concerned—not marijuana, alcohol or methamphetamines, that is the legacy of Drinking Smoke” (222). With this statement, renowned medical anthropologist Mac Marshall concludes his magnificent new book Drinking Smoke: The Tobacco Syndemic in Oceania. As with Marshall’s other books on alcohol and drug studies, this volume is an impressive contribution to a topic not yet extensively explored by anthropologists.
Marshall’s solemn and powerful warning is a fitting place to begin, as it speaks to the aims of the book: not only to demonstrate the enormous impact tobacco has on Pacific Islanders’ social and economic worlds and health, but to also argue for an approach to tobacco that views tobacco as the connector between all the major causes of mortality in the region. Marshall writes that tobacco lies at the core of a complex set of disorders and diseases, not just cancer, but tuberculosis, obesity, diabetes, chronic obstructive pulmonary disease, and cardiovascular disease as well. He employs the term the “tobacco syndemic” to explain that these “smoking diseases” are interrelated. It is a term conceptualized by medical anthropologist Merill Singer to account for the way in which diseases cluster as they are exacerbated by social context. Drinking Smoke recounts, in fascinating detail, how this has come to be.
The book is divided into two parts. The first part, comprised of five chapters, draws on historical research and ethnography to document the spread of tobacco throughout Oceania by seventeenth- and eighteenth-century colonial explorers and traders. A self-proclaimed amateur historian, Marshall shows how this exotic (not to mention addictive) new substance became a much sought-after object in the region. One of the reasons tobacco was quickly incorporated into Pacific culture was because people classified it as a comestible, as something to be eaten or drunk. Marshall explains that before tobacco became part of mainstream culture in Europe no word existed to describe its consumption. It was compared with drinking and so people spoke of “drinking smoke.” As food gifts are seen as a token of sociality used to create and sustain relationships, giving and receiving gifts of tobacco fit into already established cultural norms in Oceania. Marshall notes a mother who gave her baby a puff of tobacco whilst breastfeeding. Until recently children in Oceania consumed tobacco as it was given to them in the same manner as other food items.
As tobacco became incorporated into Oceanic societies it developed as an important exchange commodity between islanders and foreigners. Marshall shows how prices became standardized (one chicken could be traded for one stick of tobacco) and tobacco became the first globally traded luxury item. Interestingly, Marshall notes how anthropologists have also used tobacco in exchange. Malinowski spent 20 percent of his fieldwork budget on tobacco for trading purposes, and a poll of anthropologists shows that many have given, traded or shared tobacco with the people with whom they work.
Marshall also surveys transformations in the ways Pacific Islanders consumed tobacco. Tobacco was first smoked in its loose-leaf form in clay, coral and stone pipes, or in loosely wrapped little cigars (sometimes wrapped in banana leaf or in pages of the Sydney Morning Herald). He notes how when ear ornaments went out of style, some Islanders carried their tobacco and pipes in their stretched perforated ear lobes. Pacific Islanders began replacing their loose tobacco for industrially manufactured cigarettes in the early twentieth century; an act that Marshall writes changed tobacco consumption forever as the nicotine content in industrially manufactured cigarettes is stronger and more dangerous. Both World Wars were instrumental in the spread of cigarettes as soldiers were given cigarettes in their rations and shared them freely. Marshall shows how this uptake of cigarette smoking has resulted in enormous health and economic costs, and notes the efforts by national governments, NGOs and churches to control it. Success has been moderate, but a “non-smoking” Fijian village stands out as an effective example of public health intervention at the community level.
Part 2 examines the impact of tobacco on people’s health. It draws on a vast amount of health-related sources from medicine, environmental health, public health, maternal and child health, medical anthropology and regional health statistics. Most of the material in part 2 is presented in three case studies: Maori and Pacific Islanders in New Zealand, US associated Micronesians, and native Hawaiians in Hawaii. Marshall shows how the relative mortality risk for each of these groups is much higher than that of other ethnic groups in these countries. He argues that the high prevalence of tobacco-related diseases among these populations is not because of any ethnic or genetic reason, but rather because of the impact on peoples’ health of imperialism, intrusion, loss, dispossession, colonization, trauma, chronic stress, racism, poverty, and unequal access to medical care. Marshall writes that such histories have created a climate of poverty, and statistics reveal that lower-income populations have higher rates of smoking and other diseases. Marshall uses these case studies to demonstrate how human social environment influences tobacco-caused diseases. The tobacco syndemic is one of the legacies of invasion, colonization, and globalization. Marshall writes that to combat this legacy, Pacific Islanders must stop viewing tobacco in a positive light. Instead, Pacific Islanders must “de-normalize” tobacco and start thinking about tobacco as an addictive poison.
That tobacco smoke is the single greatest cause of preventable death worldwide makes anthropological lack of attention to it astounding. With Drinking Smoke, Mac Marshall fills this gap in our knowledge. It is a meticulously supported and well-argued text that is an important contribution not only to academia focused on Oceania but to a broader readership interested in the effects of tobacco on global health and the rise of the dominant tobacco industry as well. Full of anecdotes, historical episodes, statistics, and medical claims that demonstrate the power of this significant commodity, Drinking Smoke makes for compelling and informative reading and I highly recommend it.
Daniela Kraemer
University of Toronto, Toronto, Canada
pp. 751-753