Competing reference frames and influence process : Living or assessing health risks

1. Competing reference frames and influence process : Living or assessing health risks Geneviève Paicheler CNRS/CERMES Paris- France

2. The policy of risk • Increasingly, political decisions have to deal with risk management • But risk is very fuzzy and difficult to grasp, which makes political decisions particularly difficult • As a social construction, risk is the result of controversies based on different ways of conceiving the danger • Therefore, different social groups have opposed risk perceptions • To impose one’s own perception — or framing— allows to influence political decisions

3. The crisis of expertiseThe disenchantment of science • Experts are no longer relied on when risk management is at stake : scientists arouse more and more distrust and scepticism. • More science can mean more uncertainty • The validity of the scientific tools and methods of risk assessment is questioned • Science is loosing its authority and is no more conceived as the unique way to grasp the risks it often contributes to create

4. The rise of a « non-professional expertise » • What is the best way of knowing the risks : assessing or living them ? • Lay people — through organized movements — claim an inside knowledge of risk through their intimate experience • This knowledge is emotionally tainted (outrage, blaming, denunciation).

5. The assumption • The failure of scientific expertise, due to the uncertainty andindecisiveness of health risks creates a vacuum of authority that favours lay expertise — life, field, experience expertise — based on new visions of risk linked of moral, symbolic, emotional dimensions, to a citizens’ involvement and to an intense mediatization.

6. The example • Prophylaxis of AIDS transmission after sexual exposure • « Accidents » of prevention ? • Fast decisions in the French context : availability without limit ? • The cost out of concern. • The impossible evaluation of the relevance of the political decision.

7. A twofold framing • Controversies : battle of words, fights of figures. • The epidemiologists’ frame : risk scale, benefit/risk, cost/benefit. • The organizations’ frame : everybody is entitled to receive the treatment : no « good » or « bad » risk exposure. • The « property of the problem » is based on an intimate knowledge, of the illness, alien to the healthy people pretending to interfere.

8. Credibility struggles and risk exposure • Focused on the validity of two kinds of epidemiological data :the probability of transmission for one sexual contact, and the follow-up of the people receiving the .prophylactic treatment • The arguments are either internal — treatment and interpretation of data — or external to epidemiology, by supplying information for the field changing the interpretation of data. • Other arguments take into account the dramatic individual dimension of HIV transmission.

9. The ethical and emotional dimensions of controversies • Reference to values : equality principle and rejection of stigmatization. • Rejection of political cynicism : the refusal of the cost-efficiency balance. • Dramatization and visibility : the instrumentalization of the media.

10. Conclusion • The rise of a lay expertise is based on the use of subversionaiming to a consensus on the extreme positions of the more involved actors, suffering in their own bodies. • Experts are expelled out of the political stage where efficiency and rationality are disqualified to the benefit of dramatization and emotions. • The question of risk becomes focused on the question of individual exposure, on the singularity of the situations but at the same time realized a rise in generality based on moral values of discrimination rejection and of the right to life protection.