The problem and the productivity of ignorance: Public health campaigns on antibiotic stewardship

Abstract

This article offers a critical account of efforts to engage people with the issue of antimicrobial resistance (AMR). It analyses how public health workers encourage what they understand as responsible antibiotic use or antibiotic stewardship, and how their efforts are shaped by different theories of ‘behaviour’ or social action. Discourse analysis of all major UK campaigns and their evaluations over the last two decades reveals how different versions of the citizen jostle for attention in a public health that draws on sociology, psychology, and increasingly behavioural economics. Rejecting an explanation which focuses solely on the appeal of emotion in new forms of governance, I deploy theories of expert and lay ignorance to show how public health is pushed towards new approaches as it struggles with an apparently recalcitrant public in the case of AMR. Here ignorance is both problematic and productive, prompting a shift to campaigns based on unreflective action, that are accompanied by decisions to work with potential misunderstandings about antibiotics and their effects. I suggest the term ‘shrug’ as a provocative counterpart to the ‘nudge’ of behavioural economics, drawing attention to the ways in which behavioural interventions may be linked to strategic retreats from engagement, when policy makers feel unable to affect or predict the understanding and views of non-experts. The article thus contributes to sociological and political critique of narrow forms of behavioural thinking and their effects on relations between governments and their citizens.