Journal articles on the topic 'United States. National Council on Drug Abuse Control'

Background: The cost of chronic pain in the United States is extremely high. Opioids are one of the most common medications prescribed for the treatment of chronic pain, and their misuse and addiction have been of concern. It has been found that opioids are frequently abused and negatively impact the American workforce. Objectives: The objective of this study was to obtain data on US employers’ concerns and priorities, perceptions of prescription drug abuse, perceived impact of prescription drug use on the workplace, identification of and response to drug abuse, perceived ability to handle prescription drug abuse in the workplace, and workplace initiatives, employee assistance programs, employee drug testing, workplace prescription drug training, insurance coverage of alternative treatment, and overall preparedness to deal with the issue. Study Design: This research used an employer proprietary questionnaire created by members of the National Safety Council in cooperation with market research experts at B2B International. Setting: Employers surveyed via an online survey represent diverse industries and geographical areas. Methods: The research was conducted using a proprietary questionnaire. Participants were recruited from a sample of verified panelists through Research Now, and fieldwork was conducted online by B2B International. This report is on 501 interviews that each represent a US employer with 50 or more employees. The employers sampled are extremely diverse in not only size and industry, but also geography and centralization. Results: Our results showed that 67% of employers reported concerns related to prescription drug misuse, which was comparable to workplace violence and more concerning than the use of illegal drugs. Sixty-one percent reported concerns related to prescription opioids, which was a higher concern than using anti-anxiety medications, stimulants, and even heroin. Limitations: Survey study with descriptive analysis with limited sample. Conclusions: Prescription drug misuse and abuse concern American employers. Their side effects are clear, but employers are less likely to acknowledge their detrimental business effect. Employers report being unprepared for dealing with issues related to this; however, the firms with programs in place feel more prepared to deal with misuse and abuse. Key words: Prescription drugs, US workforce, chronic pain

The general public in the United States has been inundated during the 1980s and early 1990s with information about narcotics abuse, trafficking, and control. From journalists, politicians, law enforcement officials, and the medical community, the American populace ascertained that illicit drug use and trading have recently become among the nation's most intractable problems. Repeatedly, those sources reported that the consumption of cocaine, especially “crack”, had reached epidemic proportions, that drug-related violence overran the country's major cities, that youths should (according to First Lady Nancy Reagan) “just say no” to the purveyors of addictive substances, and that Presidents Ronald Reagan and George Bush had declared war on drugs. Americans learned too that only partial gains had been made against narcotics abuse and trafficking. Such a realization proved difficult for them to fathom following the 1988 presidential election campaign with its antidrug rhetoric, after the enactment by Congress of the Omnibus Drug Act of 1988 (which created a cabinet level “drug czar”—the director of the office of National Drug Control Policy in the Executive Office of the President), and given the stormy two-year tenure of William Bennett in that post. Of greater concern by 1991, evaluations of the nation's antinarcotics endeavors by the press, government authorities, and other informed observers indicated that the fundamental strategy of drug control was in dispute. Notwithstanding compelling arguments which insisted that the narcotics problem would continue until the domestic demand for drugs ended, federal government efforts have generally sought to eliminate foreign narcotics production and the smuggling of those substances into the United States.

Substance use and mental health disorders can result in disability, death, and economic cost. In the United States, rates of death from suicide, drug overdose, and chronic liver disease (a marker for alcohol abuse) have been rising for the past 15 years. Good public health surveillance for these disorders, their consequences, and their risk factors is crucially important for their prevention and control, but surveillance has not been conducted consistently in the states. In 2015, the Council of State and Territorial Epidemiologists convened a workgroup to develop a set of uniformly defined surveillance indicators that could be used by state and local health departments to monitor these disorders and to compare their occurrence in various jurisdictions. This report briefly describes the indicators and outlines the process used to develop them.

Data from the National Institute on Drug Abuse (NIDA) and the Centers for Disease Control and Prevention (CDC) reveal high numbers of adolescent substance use in the United States. Substance use among adolescents can lead to increased risk of transmission of sexually transmitted infections, vehicular fatalities, juvenile delinquency, and other problems associated with physical and mental health. Adolescents are particularly susceptible to involvement in substance use due to the underdeveloped state of the adolescent brain, which can lead to reduced decision-making ability and increased long-term effects of drugs and alcohol. Understanding the causes of adolescent substance use is vital for successful prevention and intervention programs.

Background: The epidemic of medical use and abuse of opioid analgesics is linked to the economic burden of opioid-related abuse and fatalities in the United States. Multiple studies have estimated the extent to which prescription opioid analgesics contribute to the national drug abuse problem; studies also assessing the trends in medical use and abuse of opioid analgesics have confirmed the relationship between increasing medical use of opioids and increasing fatalities. The available data is limited until 2002.. Study Design: Retrospective analysis of data from 2004 to 2011 from 2 databases: Automation of Reports and Consolidated Orders System (ARCOS) for opioid use data and Drug Abuse Warning Network (DAWN) for drug misuse data. Objective: To determine the proportion of drug abuse related to opioid analgesics and the various trends in the medical use and abuse of 8 opioid analgesics commonly used to treat pain: buprenorphine, codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, and oxycodone. Methods: The data obtained from DAWN is a nationally representative sample of hospital emergency department admissions resulting from drug abuse. Main outcome measure was the identification of trends in the medical use and misuse of opioid analgesics from 2004 to 2011. Results: From 2004 to 2011, there was an increase in the medical use of all opioids except for a 20% decrease in codeine. The abuse of all opioids including codeine increased during this period. Increases in medical use ranged from 2,318% for buprenorphine to 35% for fentanyl, including 140% for hydromorphone, 117% for oxycodone, 73% for hydrocodone, 64% for morphine, and 37% for methadone. The misuse increased 384% for buprenorphine with available data from 2006 to 2011, whereas from 2004 to 2011, it increased 438% for hydromorphone, 263% for oxycodone, 146% for morphine, 107% for hydrocodone, 104% for fentanyl, 82% for methadone, and 39% for codeine. Comparison of opioid use showed an overall increase of 1,448% from 1996 to 2011, with increases if 690% from 1996 to 2004 and 100% from 2004 to 2011. In contrast, misuse increased more dramatically: 4,680% from 1996 to 2011, with increases of 1,372% from 1996 through 2004 and 245% from 2004 to 2011. The number of patients seeking rehabilitation for substance abuse also increased 187% for opioids, whereas it increased 87% for heroin, 40% for marijuana, and decreased 7% for cocaine. Limitations: Limitations of this assessment include the lack of data from 2003, lack of data available on meperidine, and that the aggregate data systems used in the study did not identify specific formulations or commercial products. Conclusion: The present trend of continued increase in the medical use of opioid analgesics appears to contribute to increases in misuse, resulting in multiple health consequences. Key words: Medical use of opioids, inappropriate use of opioids, abuse of opioids, opioid-related fatalities, Automation of Reports and Consolidated Orders System (ARCOS), Drug Abuse Warning Network (DAWN), International Narcotics Control Board (INCB)

The Centers for Disease Control and Prevention reported 8,916 cases of tuberculosis in 2019. Reducing the number of cases of active tuberculosis requires identification of patients with latent tuberculous infections (LTBI). Optimal screening for LTBI requires information about the demographics and characteristics of people who are more likely to have had tuberculous infection. Information from the 2011–2012 National Health and Nutrition Examination Survey (NHANES) was used to determine the number and characteristics of adults from a representative sample of the United States who had LTBI. Latent tuberculous infection was identified either by a positive skin test or by a positive QuantiFERON blood test. Information about the number of patients with active tuberculosis in Texas was determined from reports from the Texas State Department of Health Services. The NHANES database for the years 2011-2012 included 5,684 adults. Participants with a positive QuantiFERON blood test were more likely in the age group 45-64, male, foreign born, and have less than a high school education. Participants with a positive skin test had similar characteristics. Participants who had both a positive skin test and positive QuantiFERON test were more likely to be in the age group 45-64, males, foreign born, and Hispanic. In addition, they had diabetes, self-reported fair/poor health, and an educational level less than high school. In the State of Texas tuberculosis occurred more frequently in individuals older than 75 who were male and were not US born Texas residents. Important clinical diagnoses included diabetes, alcohol abuse, correctional facility residence, non-injection drug use, positive HIV status, and homelessness. Information from the NHANES study and from the State Department of Health Services in Texas provides information needed to develop screening programs for latent tuberculosis and active tuberculosis.

Today, more than 400 drugs in veterinary medicine are used in three main purposes, in the treatment of microbial infections, infection prevention, and growth promoters in order to achieve a faster animal growth. Residues of medicines in meat and meat products can have a number of negative effects on consumer health, ranging from hypersensitivity to cancerous, mutagenic or teratogenic effects, normal intestinal flora disorders, and antibiotic-resistant bacterial strains. In the European Union (EU), the largest meat producers are Spain, Italy, Germany, Poland, France and the United Kingdom, which also have the largest drug sales. The largest quantities of drugs sold were found for tetracyclines, penicillins and sulphonamides whose combined sales at EU level in 2015 were 69.6 % and in Croatia 76.7 %. EU members under Council Directive 96/23/EC carry out control of residues of veterinary drugs according to national residue monitoring plans (NRMP) in animals used for food production. Screening and confirmatory methods are used to control of drug residues. Most commonly, liquid chromatography in combination with tandem mass spectrometry is used. Today, priority is the development of effective multimethods that allow simultaneous analysis of residues of different antibiotic families. Every year, the European Food Safety Authority (EFSA) summarizes the results of the NRMP of the EU Member States in a joint report. The total number of non-compliant antibiotic results in meat samples in 2015 and 2016 was 250 and 195, respectively. The highest number of non-compliant results was found for tetracyclines. A coordinated and comprehensive control of veterinary medicines is established in the EU necessary for a high level of consumer health protection. The system of regulations just as well as analytical methods are constantly being upgraded and developed.

In April 2000, the American Thoracic Society published guidelines for targeted tuberculin testing and the treatment of latent tuberculosis infection (LTBI) (1). These guidelines are a joint statement of the American Thoracic Society and the Centers for Disease Control and Prevention, and were endorsed by both the Infectious Diseases Society of America and the American Academy of Pediatrics. Similar recommendations were published by the Infectious Diseases Society of America in its guidelines for the treatment of tuberculosis (TB) (2). These updated guidelines were developed in recognition of the importance of treating LTBI as one component of eliminating TB in the United States - a goal reiterated in 1999 by the Advisory Council for the Elimination of Tuberculosis (3) - but also realizing the differing risks and benefits of treatment for patients based on their individual risks of developing active disease or drug toxicity (4). The 2000 edition of theCanadian Tuberculosis Standardsprovided similar recommendations for the treatment of LTBI (formerly known as chemoprophylaxis) and reminded us of the two major Canadian TB elimination initiatives: the National Tuberculosis Elimination Strategy (Medical Services Branch, 1992), with the aim of eliminating TB in First Nations people by 2010, and the National Consensus Conference on Tuberculosis (Health Canada, 1997), with an interim goal of a 5% reduction in the number of TB cases each year in Canada (5). Given the recent publication of the American guidelines and the updatedCanadian Tuberculosis Standards(Fifth Edition), it was considered timely to remind readers of the evidence supporting the use of antituberculous chemotherapy in the treatment of latent infection.

ABSTRACT The electronic prescribing of controlled substances (EPCS) is now becoming implemented in most health care practices and pharmacies in the United States. This review aims to detail the steps needed for EPCS adoption and synthesize the most current literature on the benefits and challenges associated with its adoption. Our systematic review of seven published studies from 1990 to 2020 notes the benefits of EPCS in the reduction of errors, fraud, overprescribing, cost and efficiency improvements. There is limited published evidence of challenges, such as the cost of implementation and prescriber burden. With EPCS becoming a nationwide process, further research needs to be conducted to maximize the effectiveness of EPCS and explore additional benefits and challenges. We used a modified version of the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) system for systematic reviews highlighted in the “Cochrane Handbook for Systematic Reviews of Interventions” to assess the quality of the primary studies reviewed.1 Each author was tasked with determining the quality of each primary study reviewed and assigning a quality score of either high, moderate or low quality. Evidence stemming from randomized controlled trials starts as high quality while evidence from observational studies starts as low quality. Quality can be lowered by five factors: risk of bias, imprecision, inconsistency, indirectness, and publication bias and can be raised by a large magnitude of effect and a clear dose-response gradient. We extracted data from the text, tables and graphs of the original publications. Appendix A illustrates the quality of the studies. Databases reviewed included PubMed, Google Scholar, Cochrane and SCOPUS. The search was started in 1990, with the first wave of the opioid epidemic and the first published studies of e-prescribing, and continued to the year of 2020. The key phrases “electronic prescribing of controlled substances,” “e-prescribing of controlled substances,” “fraudulent prescribing of controlled substances,” “EPCS with PDMP,” and “drug interactions with e-prescribing of controlled drugs” were used as an inclusion criterion to search online scholarly databases for articles. Only primary and secondary data from reports, reviews and research studies written in English were included. The Centers for Disease Control (CDC), National Institute on Drug Abuse (NIDA), Drug Enforcement Administration (DEA), Substance Abuse and Mental Health Services Administration (SAMHSA), American Academy of Family Medicine (AAFP), and nationally represented health information networks were used to obtain updated statistics regarding EPCS.

Abstract Introduction Mothers dealing with depressive problems often report using more harsh parenting practices. This occurs, in part, due to a scarcity of effective coping mechanisms and increased irritability. In addition, depressed mothers are less likely to set consistent rules and expectations within the home, which may result in children who stay up late. Children who get inadequate levels of sleep also are more likely to have behavior problems, irritability, and defiance toward their parents, particularly in adolescence. However, no studies have examined the potential of adolescent sleep as a contributor to the association between maternal depression and the use of harsh parenting. The current study examined whether mothers’ perceptions of inadequate adolescent sleep duration mediated the relationship between maternal depression and harsh parenting, with child gender as a moderator. Methods The sample (N=318) consisted of mothers reporting on adolescents aged 16-18 (M=16.89, SD = .429; 53.4% female) from the 10th wave of the Schools and Families Educating Children Study (SAFE). The SAFE study was a randomized control trial conducted from 1997-2008 designed to investigate children and families living in inner-city Chicago, Il. Measures included the Child Behavior Checklist (CBCL), Center for Epidemiologic Studies Depression Scale (CESD), and the Parenting Practices Questionnaire (PPQ). Results Too little adolescent sleep mediated (β = .15) the relation between maternal depression and her reported use of harsh parenting. Mediation was further moderated by child gender, such that the mediation occurred for sons (β = .12) but not daughters. Conclusion These results suggest that too little adolescent sleep is the process through which mothers experiencing depressive problems engage in more harsh parenting. In addition, important child gender differences were apparent, such that sons’ lack of sleep may be more related to maternal depression and the use of harsh discipline. Support United States Department of Health and Human Services. National Institutes of Health. National Institute on Drug Abuse (5 R01 DA020829)

This study aims to investigate the influence of the formulation factors on the drug release kinetics, thereby selecting the compositions of extended-release nifedipine tablet based on the similarity coefficient f2 obtained when compared with Adalat LA tablet. The formulation factors such as: molecular weight of the polyethylene oxide (PEO) and osmotic agent amount in drug layer and push layer, semi permeable membrane thickness (estimated by coating weight gain), orifice size, type of plasticizers and ratios of coating polymer to plasticizer in semipermeable membrane were evaluated. It was found that developed tablets were able to deliver nifedipine in an approximate zero-order manner up to 20 hours and drug release profile of developed tablets was similar to that from Adalat LA tablets. The developed tablet contained: PEO N10, PEO 303 in drug layer and push layer, respectively; percentages of osmotic agent in drug layer and push layer were 10% and 30%, respectively; weight gain of semipermeable coating was 12%; and orifice size was 0.8 mm. Keywords Nifedipine, GPKD, push-pull osmotic pump, PEO, Tlag. References [1] Vietnamese National Drug Formulary Council, Nifedipine, Vietnamese National Drug Formulary, 2nd edition, Medical Publising House, Hanoi, 2018, pp. 1056-1058 (in Vietnamese).[2] A. Nokhodchi, M.N. Momin, J. Shokri, et al., Factors affecting the release of nifedipine from a swellable elementary osmotic pump, Drug Delivery, 15 (1) (2008) 43-48. https://doi.org/10.1080/10717540701829028[3] R.K. Verma, D.M. Krishna, S. Garg, Formulation aspects in the development of osmotically controlled oral drug delivery systems, Journal of controlled release 79 (1-3) (2002) 7-27. https://doi.org/10.1016/s0168-3659(01)00550-8.[4] The United States Pharmacopeial Convention, Nifedipine Extended-Release Tablets, The United States Pharmacopeia, 41st edition, United Book Press, Baltimore, 2018, pp. 2938 - 2944.[5] V. Malaterre, J. Ogorka, N. Loggia, et al., Approach to design push–pull osmotic pumps, International Journal of Pharmaceutics 376 (1–2) (2009) 56-62. http://dx.doi.org/10.1016/j.ijpharm.2009.04.015.[6] S. Missaghi, P. Patel P, Farrell T. P., et al., Investigation of critical core formulation and process parameters for osmotic pump oral drug delivery, AAPS PharmSciTech 15 (1) (2014) 149-160. http://doi.org/10.1208/s12249-013-0040-4.[7] V. Malaterre, H. Metz, J. Ogorka , et al., Benchtop-magnetic resonance imaging (BT-MRI) characterization of push-pull osmotic controlled release systems, J Control Release 133 (1) (2009) 31-36. http://doi.org/10.1016/j.jconrel.2008.09.007.[8] Z. Zhang, W. Li, S. Nie, et al., Overcome side identification in PPOP by making orifices on both layers, International journal of pharmaceutics 371 (1-2) (2009) 1-7. http://dx.doi.org/10.1016/j.ijpharm.2008.12.006[9] C. Wu, Z. Zhao, Y. Zhao, et al., Preparation of a push–pull osmotic pump of felodipine solubilized by mesoporous silica nanoparticles with a core–shell structure, International Journal of Pharmaceutics,475 (1-2) (2014) 298 - 305 . http://dx.doi.org/10.1016/j.ijpharm.2014.08.033.[10] V. Patel, A. Chudasama, M. Nivsarkar, et al., Push-pull osmotic pump for zero order delivery of lithium carbonate: Development and in vitro characterization, Pharmaceutical development and technology, 17 (3) (2012) 375-382. http://doi.org/10.3109/10837450.2010.542577.[11] C.N. Patra, S. Swain, J. Sruti, et al., Osmotic drug delivery systems: Basics and design approaches, Recent Patents on Drug Delivery & Formulation 7(2) (2013) 1 - 12. http://doi.org/10.2174/1872211311307020007.

In this paper we explore the rise of anti-gambling apps in the context of the massive expansion of gambling in new spheres of life (online and offline) and an acceleration in strategies of anticipatory and individualised management of harm caused by gambling. These apps, and the techniques and forms of labour they demand, are examples of and a mechanism through which a mode of governance premised on ‘self-care’ and ‘self-control’ is articulated and put into practice. To support this argument, we explore two government initiatives in the Australian context. Quit Pokies, a mobile app project between the Moreland City Council, North East Primary Care Partnership and the Victorian Local Governance Association, is an example of an emerging service paradigm of ‘self-care’ that uses online and mobile platforms with geo-location to deliver real time health and support interventions. A similar mobile app, Gambling Terminator, was launched by the NSW government in late 2012. Both apps work on the premise that interrupting a gaming session through a trigger, described by Quit Pokies’ creator as a “tap on the shoulder” provides gamblers the opportunity to take a reflexive stance and cut short their gambling practice in the course of play. We critically examine these apps as self-disciplining techniques of contemporary neo-liberalism directed towards anticipating and reducing the personal harm and social risk associated with gambling. We analyse the material and discursive elements, and new forms of user labour, through which this consumable media is framed and assembled. We argue that understanding the role of these apps, and mobile media more generally, in generating new techniques and technologies of the self, is important for identifying emerging modes of governance and their implications at a time when gambling is going through an immense period of cultural normalisation in online and offline environments. The Australian context is particularly germane for the way gambling permeates everyday spaces of sociality and leisure, and the potential of gambling interventions to interrupt and re-configure these spaces and institute a new kind of subject-state relation. Gambling in Australia Though a global phenomenon, the growth and expansion of gambling manifests distinctly in Australia because of its long cultural and historical attachment to games of chance. Australians are among the biggest betters and losers in the world (Ziolkowski), mainly on Electronic Gaming Machines (EGM) or pokies. As of 2013, according to The World Count of Gaming Machine (Ziolkowski), there were 198,150 EGMs in the country, of which 197,274 were slot machines, with the rest being electronic table games of roulette, blackjack and poker. There are 118 persons per machine in Australia. New South Wales is the jurisdiction with most EGMs (95,799), followed by Queensland (46,680) and Victoria (28,758) (Ziolkowski). Gambling is significant in Australian cultural history and average Australian households spend at least some money on different forms of gambling, from pokies to scratch cards, every year (Worthington et al.). In 1985, long-time gambling researcher Geoffrey Caldwell stated thatAustralians seem to take a pride in the belief that we are a nation of gamblers. Thus we do not appear to be ashamed of our gambling instincts, habits and practices. Gambling is regarded by most Australians as a normal, everyday practice in contrast to the view that gambling is a sinful activity which weakens the moral fibre of the individual and the community. (Caldwell 18) The omnipresence of gambling opportunities in most Australian states has been further facilitated by the availability of online and mobile gambling and gambling-like spaces. Social casino apps, for instance, are widely popular in Australia. The slots social casino app Slotomania was the most downloaded product in the iTunes store in 2012 (Metherell). In response to the high rate of different forms of gambling in Australia, a range of disparate interest groups have identified the expansion of gambling as a concerning trend. Health researchers have pointed out that online gamblers have a higher risk of experiencing problems with gambling (at 30%) compared to 15% in offline bettors (Hastings). The incidence of gambling problems is also disproportionately high in specific vulnerable demographics, including university students (Cervini), young adults prone to substance abuse problems (Hayatbakhsh et al.), migrants (Tanasornnarong et al.; Scull & Woolcock; Ohtsuka & Ohtsuka), pensioners (Hing & Breen), female players (Lee), Aboriginal communities (Young et al.; McMillen & Donnelly) and individuals experiencing homelessness (Holsworth et al.). While there is general recognition of the personal and public health impacts of gambling in Australia, there is a contradiction in the approach to gambling at a governance level. On one hand, its expansion is promoted and even encouraged by the federal and state governments, as gambling is an enormous source of revenue, as evidenced, for example, by the construction of the new Crown casino in Barangaroo in Sydney (Markham & Young). Campaigns trying to limit the use of poker machines, which are associated with concerns over problem gambling and addiction, are deemed by the gambling lobby as un-Australian. Paradoxically, efforts to restrict gambling or control gambling winnings have also been described as un-Australian, such as in the Australian Taxation Office’s campaign against MONA’s founder, David Walsh, whose immense art collection was acquired with the funds from a gambling scheme (Global Mail). On the other hand, people experiencing problems with gambling are often categorised as addicts and the ultimate blame (and responsibility) is attributed to the individual. In Australia, attitudes towards people who are arguably addicted to gambling are different than those towards individuals afflicted by alcohol or drug abuse (Jean). While “Australians tend to be sympathetic towards people with alcohol and other drug addictions who seek help,” unless it is seen as one of the more socially acceptable forms of occasional, controlled gambling (such as sports betting, gambling on the Melbourne Cup or celebrating ANZAC Day with Two-Up), gambling is framed as an individual “problem” and “moral failing” (Jean). The expansion of gambling is the backdrop to another development in health care and public health discourse, which have for some time now been devoted to the ideal of what Lupton has called the “digitally engaged patient” (Lupton). Technologies are central to the delivery of this model of health service provision that puts the patient at the centre of, and responsible for, their own health and medical care. Lupton has pointed out how this discourse, while appearing new, is in fact the latest version of the 1970s emphasis on the ‘patient as consumer’, an idea given an extra injection by the massive development and availability of digital and interactive web-based and mobile platforms, many of these directed towards the provision of health and health-related information and services. What this means for patients is that, rather than relying solely on professional medical expertise and care, the patient is encouraged to take on some of this medical/health work to conduct practices of ‘self-care’ (Lupton). The Discourse of ‘Self-Management’ and ‘Self-Care’ The model of ‘self-care’ and ‘self-management’ by ‘empowering’ digital technology has now become a dominant discourse within health and medicine, and is increasingly deployed across a range of related sectors such as welfare services. In recent research conducted on homelessness and mobile media, for example, government department staff involved in the reform of welfare services referred to ‘self-management’ as the new service paradigm that underpins their digital reform strategy. Echoing ideas and language similar to the “digitally engaged patient”, customers of Centrelink, Medicare and other ‘human services’ are being encouraged (through planned strategic initiatives aimed at shifting targeted customer groups online) to transact with government services digitally and manage their own personal profiles and health information. One departmental staff member described this in terms of an “opportunity cost”, the savings in time otherwise spent standing in long queues in service centres (Humphry). Rather than view these examples as isolated incidents taking place within or across sectors or disciplines, these are better understood as features of an emerging ‘discursive formation’ , a term Foucault used to describe the way in which particular institutions and/or the state establish a regime of truth, or an accepted social reality and which gives definition to a new historical episteme and subject: in this case that of the self-disciplined and “digitally engaged medical/health patient”. As Foucault explained, once this subject has become fully integrated into and across the social field, it is no longer easy to excavate, since it lies below the surface of articulation and is held together through everyday actions, habits and institutional routines and techniques that appear to be universal, necessary and/normal. The way in which this citizen subject becomes a universal model and norm, however, is not a straightforward or linear story and since we are in the midst of its rise, is not a story with a foretold conclusion. Nevertheless, across a range of different fields of governance: medicine; health and welfare, we can see signs of this emerging figure of the self-caring “digitally engaged patient” constituted from a range of different techniques and practices of self-governance. In Australia, this figure is at the centre of a concerted strategy of service digitisation involving a number of cross sector initiatives such as Australia’s National EHealth Strategy (2008), the National Digital Economy Strategy (2011) and the Australian Public Service Mobile Roadmap (2013). This figure of the self-caring “digitally engaged” patient, aligns well and is entirely compatible with neo-liberal formulations of the individual and the reduced role of the state as a provider of welfare and care. Berry refers to Foucault’s definition of neoliberalism as outlined in his lectures to the College de France as a “particular form of post-welfare state politics in which the state essentially outsources the responsibility of the ‘well-being' of the population” (65). In the case of gambling, the neoliberal defined state enables the wedding of two seemingly contradictory stances: promoting gambling as a major source of revenue and capitalisation on the one hand, and identifying and treating gambling addiction as an individual pursuit and potential risk on the other. Risk avoidance strategies are focused on particular groups of people who are targeted for self-treatment to avoid the harm of gambling addiction, which is similarly framed as individual rather than socially and systematically produced. What unites and makes possible this alignment of neoliberalism and the new “digitally engaged subject/patient” is first and foremost, the construction of a subject in a chronic state of ill health. This figure is positioned as terminal from the start. They are ‘sick’, a ‘patient’, an ‘addict’: in need of immediate and continuous treatment. Secondly, this neoliberal patient/addict is enabled (we could even go so far as to say ‘empowered’) by digital technology, especially smartphones and the apps available through these devices in the form of a myriad of applications for intervening and treating ones afflictions. These apps range fromself-tracking programs such as mood regulators through to social media interventions. Anti-Pokie Apps and the Neoliberal Gambler We now turn to two examples which illustrate this alignment between neoliberalism and the new “digitally engaged subject/patient” in relation to gambling. Anti-gambling apps function to both replace or ‘take the place’ of institutions and individuals actively involved in the treatment of problem gambling and re-engineer this service through the logics of ‘self-care’ and ‘self-management’. Here, we depart somewhat from Foucault’s model of disciplinary power summed up in the institution (with the prison exemplifying this disciplinary logic) and move towards Deleuze’s understanding of power as exerted by the State not through enclosures but through diffuse and rhizomatic information flows and technologies (Deleuze). At the same time, we retain Foucault’s attention to the role and agency of the user in this power-dynamic, identifiable in the technics of self-regulation and in his ideas on governmentality. We now turn to analyse these apps more closely, and explore the way in which these articulate and perform these disciplinary logics. The app Quit Pokies was a joint venture of the North East Primary Care Partnership, the Victorian Local Governance Association and the Moreland City Council, launched in early 2014. The idea of the rational, self-reflexive and agentic user is evident in the description of the app by app developer Susan Rennie who described it this way: What they need is for someone to tap them on the shoulder and tell them to get out of there… I thought the phone could be that tap on the shoulder. The “tap on the shoulder” feature uses geolocation and works by emitting a sound alert when the user enters a gaming venue. It also provides information about each user’s losses at that venue. This “tap on the shoulder” is both an alert and a reprimand from past gambling sessions. Through the Responsible Gambling Fund, the NSW government also launched an anti-pokie app in 2013, Gambling Terminator, including a similar feature. The app runs on Apple and Android smartphone platforms, and when a person is inside a gambling venue in New South Wales it: sends reminder messages that interrupt gaming-machine play and gives you a chance to re-think your choices. It also provides instant access to live phone and online counselling services which operate 24 hours a day, seven days a week. (Google Play Store) Yet an approach that tries to prevent harm by anticipating the harm that will come from gambling at the point of entering a venue, also eliminates the chance of potential negotiations and encounters a user might have during a visit to the pub and how this experience will unfold. It reduces the “tap on the shoulder”, which may involve a far wider set of interactions and affects, to a software operation and it frames the pub or the club (which under some conditions functions as hubs for socialization and community building) as dangerous places that should be avoided. This has the potential to lead to further stigmatisation of gamblers, their isolation and their exclusion from everyday spaces. Moreland Mayor, Councillor Tapinos captures the implicit framing of self-care as a private act in his explanation of the app as a method for problem gamblers to avoid being stigmatised by, for example, publicly attending group meetings. Yet, curiously, the app has the potential to create a new kind of public stigmatisation through potentially drawing other peoples’ attention to users’ gambling play (as the alarm is triggered) generating embarrassment and humiliation at being “caught out” in an act framed as aberrant and literally, “alarming”. Both Quit Pokies and Gambling Terminator require their users to perform ‘acts’ of physical and affective labour aimed at behaviour change and developing the skills of self-control. After downloading Quit Pokies on the iPhone and launching the app, the user is presented an initial request: “Before you set up this app. please write a list of the pokies venues that you regularly use because the app will ask you to identify these venues so it can send you alerts if you spend time in these locations. It will also use your set up location to identify other venues you might use so we recommend that you set up the App in the location where you spend most time. Congratulation on choosing Quit Pokies.”Self-performed processes include installation, setting up, updating the app software, programming in gambling venues to be detected by the smartphone’s inbuilt GPS, monitoring and responding to the program’s alerts and engaging in alternate “legitimate” forms of leisure such as going to the movies or the library, having coffee with a friend or browsing Facebook. These self-performed labours can be understood as ‘technologies of the self’, a term used by Foucault to describe the way in which social members are obliged to regulate and police their ‘selves’ through a range of different techniques. While Foucault traces the origins of ‘technologies of the self’ to the Greco-Roman texts with their emphasis on “care of oneself” as one of the duties of citizenry, he notes the shift to “self-knowledge” under Christianity around the 8th century, where it became bound up in ideals of self-renunciation and truth. Quit Pokies and Gambling Terminator may signal a recuperation of the ideal of self-care, over confession and disclosure. These apps institute a set of bodily activities and obligations directed to the user’s health and wellbeing, aided through activities of self-examination such as charting your recovery through a Recovery Diary and implementing a number of suggested “Strategies for Change” such as “writing a list” and “learning about ways to manage your money better”. Writing is central to the acts of self-examination. As Jeremy Prangnell, gambling counsellor from Mission Australia for Wollongong and Shellharbour regions explained the app is “like an electronic diary, which is a really common tool for people who are trying to change their behaviour” (Thompson). The labours required by users are also implicated in the functionality and performance of the platform itself suggesting the way in which ‘technologies of the self’ simultaneously function as a form of platform work: user labour that supports and sustains the operation of digital systems and is central to the performance and continuation of digital capitalism in general (Humphry, Demanding Media). In addition to the acts of labour performed on the self and platform, bodies are themselves potentially mobilised (and put into new circuits of consumption and production), as a result of triggers to nudge users away from gambling venues, towards a range of other cultural practices in alternative social spaces considered to be more legitimate.Conclusion Whether or not these technological interventions are effective or successful is yet to be tested. Indeed, the lack of recent activity in the community forums and preponderance of issues reported on installation and use suggests otherwise, pointing to a need for more empirical research into these developments. Regardless, what we’ve tried to identify is the way in which apps such as these embody a new kind of subject-state relation that emphasises self-control of gambling harm and hastens the divestment of institutional and social responsibility at a time when gambling is going through an immense period of expansion in many respects backed by and sanctioned by the state. Patterns of smartphone take up in the mainstream population and the rise of the so called ‘mobile only population’ (ACMA) provide support for this new subject and service paradigm and are often cited as the rationale for digital service reform (APSMR). Media convergence feeds into these dynamics: service delivery becomes the new frontier for the merging of previously separate media distribution systems (Dwyer). Letters, customer service centres, face-to-face meetings and web sites, are combined and in some instances replaced, with online and mobile media platforms, accessible from multiple and mobile devices. These changes are not, however, simply the migration of services to a digital medium with little effective change to the service itself. Health and medical services are re-invented through their technological re-assemblage, bringing into play new meanings, practices and negotiations among the state, industry and neoliberal subjects (in the case of problem gambling apps, a new subjectivity, the ‘neoliberal addict’). These new assemblages are as much about bringing forth a new kind of subject and mode of governance, as they are a solution to problem gambling. This figure of the self-treating “gambler addict” can be seen to be a template for, and prototype of, a more generalised and universalised self-governing citizen: one that no longer needs or makes demands on the state but who can help themselves and manage their own harm. Paradoxically, there is the potential for new risks and harms to the very same users that accompanies this shift: their outright exclusion as a result of deprivation from basic and assumed digital access and literacy, the further stigmatisation of gamblers, the elimination of opportunities for proximal support and their exclusion from everyday spaces. References Albarrán-Torres, César. “Gambling-Machines and the Automation of Desire.” Platform: Journal of Media and Communication 5.1 (2013). Australian Communications and Media Authority. “Australians Cut the Cord.” Research Snapshots. Sydney: ACMA (2013) Berry, David. Critical Theory and the Digital. Broadway, New York: Bloomsbury Academic, 2014 Berry, David. Stunlaw: A Critical Review of Politics, Arts and Technology. 2012. ‹http://stunlaw.blogspot.com.au/2012/03/code-foucault-and-neoliberal.html›. Caldwell, G. “Some Historical and Sociological Characteristics of Australian Gambling.” Gambling in Australia. Eds. G. Caldwell, B. Haig, M. Dickerson, and L. Sylan. Sydney: Croom Helm Australia, 1985. 18-27. Cervini, E. “High Stakes for Gambling Students.” The Age 8 Nov. 2013. ‹http://www.theage.com.au/national/education/high-stakes-for-gambling-students-20131108-2x5cl.html›. Deleuze, Gilles. "Postscript on the Societies of Control." October (1992): 3-7. Foucault, Michel. “Technologies of the Self.” Eds. Luther H. Martin, Huck Gutman and Patrick H. Hutton. Boston: University of Massachusetts Press, 1988 Hastings, E. “Online Gamblers More at Risk of Addiction.” Herald Sun 13 Oct. 2013. ‹http://www.heraldsun.com.au/news/online-gamblers-more-at-risk-of-addiction/story-fni0fiyv-1226739184629#!›.Hayatbakhsh, Mohammad R., et al. "Young Adults' Gambling and Its Association with Mental Health and Substance Use Problems." Australian and New Zealand Journal of Public Health 36.2 (2012): 160-166. Hing, Nerilee, and Helen Breen. "A Profile of Gaming Machine Players in Clubs in Sydney, Australia." Journal of Gambling Studies 18.2 (2002): 185-205. Holdsworth, Louise, Margaret Tiyce, and Nerilee Hing. "Exploring the Relationship between Problem Gambling and Homelessness: Becoming and Being Homeless." Gambling Research 23.2 (2012): 39. Humphry, Justine. “Demanding Media: Platform Work and the Shaping of Work and Play.” Scan: Journal of Media Arts Culture, 10.2 (2013): 1-13. Humphry, Justine. “Homeless and Connected: Mobile Phones and the Internet in the Lives of Homeless Australians.” Australian Communications Consumer Action Network. Sep. 2014. ‹https://www.accan.org.au/grants/completed-grants/619-homeless-and-connected›.Lee, Timothy Jeonglyeol. "Distinctive Features of the Australian Gambling Industry and Problems Faced by Australian Women Gamblers." Tourism Analysis 14.6 (2009): 867-876. Lupton, D. “The Digitally Engaged Patient: Self-Monitoring and Self-Care in the Digital Health Era.” Social Theory & Health 11.3 (2013): 256-70. Markham, Francis, and Martin Young. “Packer’s Barangaroo Casino and the Inevitability of Pokies.” The Conversation 9 July 2013. ‹http://theconversation.com/packers-barangaroo-casino-and-the-inevitability-of-pokies-15892›. Markham, Francis, and Martin Young. “Who Wins from ‘Big Gambling’ in Australia?” The Conversation 6 Mar. 2014. ‹http://theconversation.com/who-wins-from-big-gambling-in-australia-22930›.McMillen, Jan, and Katie Donnelly. "Gambling in Australian Indigenous Communities: The State of Play." The Australian Journal of Social Issues 43.3 (2008): 397. Ohtsuka, Keis, and Thai Ohtsuka. “Vietnamese Australian Gamblers’ Views on Luck and Winning: Universal versus Culture-Specific Schemas.” Asian Journal of Gambling Issues and Public Health 1.1 (2010): 34-46. Scull, Sue, Geoffrey Woolcock. “Problem Gambling in Non-English Speaking Background Communities in Queensland, Australia: A Qualitative Exploration.” International Gambling Studies 5.1 (2005): 29-44. Tanasornnarong, Nattaporn, Alun Jackson, and Shane Thomas. “Gambling among Young Thai People in Melbourne, Australia: An Exploratory Study.” International Gambling Studies 4.2 (2004): 189-203. Thompson, Angela, “Live Gambling Odds Tipped for the Chop.” Illawarra Mercury 22 May 2013: 6. Metherell, Mark. “Virtual Pokie App a Hit - But ‘Not Gambling.’” Sydney Morning Herald 13 Jan. 2013. ‹http://www.smh.com.au/digital-life/smartphone-apps/virtual-pokie-app-a-hit--but-not-gambling-20130112-2cmev.html#ixzz2QVlsCJs1›. Worthington, Andrew, et al. "Gambling Participation in Australia: Findings from the National Household Expenditure Survey." Review of Economics of the Household 5.2 (2007): 209-221. Young, Martin, et al. "The Changing Landscape of Indigenous Gambling in Northern Australia: Current Knowledge and Future Directions." International Gambling Studies 7.3 (2007): 327-343. Ziolkowski, S. “The World Count of Gaming Machines 2013.” Gaming Technologies Association, 2014. ‹http://www.gamingta.com/pdf/World_Count_2014.pdf›.

ObjectiveTo utilize New Jersey’s syndromic surveillance data in the study and comparison of trends in injection opioid use and infection with selected bloodborne pathogens (BBPs) over the years 2013-2017.IntroductionWhen the opioid epidemic began in the early 1990s, pills such as oxycodone were the primary means of abuse. Beginning in 2010, injection use of, first, heroin and then synthetic opioids dramatically increased, which led the number of overdose deaths involving opioids to increase fivefold between 1999 and 2016.1 It would be expected that BBP rates would rise with this increase in injection use, and, nationally, there has been a rise in acute hepatitis C (HCV) rates, although the other two main BBPs, acute hepatitis B (HBV) and acute human immunodeficiency virus (HIV) have been flat and declining, respectively.2,3In this study, we compared New Jersey’s reported incidence of these three BBPs (acute HBV, acute HCV, and HIV) over five years (2013-2017) with syndromic surveillance data for opioid use over the same time period in order to test the hypothesis that emergency department (ED) visits for opioid use could be used as a predictor of BBP infection.MethodsTo indirectly track the number of injection opioid users, we wrote a custom classifier for EpiCenter, New Jersey's statewide syndromic surveillance system, to search ED chief complaints for the number of visits related to injection opioid usage. Our custom classifier creation started with the CDC’s National Syndromic Surveillance Program (NSSP) ESSENCE Chief Complaint Category classifier for opioid overdose.4 As we were looking to count not just overdoses but all visits likely to be associated with injection drug use, we chose not to omit the keyword “withdrawal,” differing from CDC’s classifier in which it is a negative indicator.Positive indicator keywords included “opioid,” “heroin,” “narcot,” “opiate,” “fentanyl,” “naloxo,” “narcan,” "ivdu," and the ICD-9 and ICD-10 codes e850.[0-2], 304, 305.5, f11, t40.[0-6], and 965. These keywords were used to target the chief complaints of people using injection opioids. Negative indicators included “patch,” “allerg,” and “med” to eliminate medical opioid use. Negative indicators also included “vicodin,” “tramadol,” “percocet,” “oral,” and t40.5 to filter out opioids most commonly used in pill form, as well as other drugs.Cases of acute HCV and acute HBV were totaled using CDRSS, New Jersey's Communicable Disease Reporting and Surveillance System. In order to maintain consistency, we used the respective 2012 case definition for each disease. Numbers of new HIV infections were accessed from NJ’s reportable disease list.5 All of the data sets followed the epidemiologic years 2013–2017 (based upon MMWR weeks).ResultsHIV diagnosis rates slightly decreased over time. HBV rates trend upwards, similar to the rates of injection drug use (IDU) for the first three years but start to drop after 2015. Aside from an unexplained dip in 2016, the HCV rates generally track the EpiCenter data for IDU (Figure 1). On a regional scale, NJ’s Northwest region had the highest rates per capita of the five NJ regions and the most similar trending between the HCV and EpiCenter data sets (Figure 2). This result follows the nationwide trend of the opioid epidemic occurring more widely in rural areas, as this region is the most rural region in New Jersey.6In figures 1 & 2, IDU (EpiCenter) and HIV are plotted on the primary (left) axis and HCV and HBV are plotted on the secondary (right) axis.ConclusionsBoth IDU related visits and cases of acute HCV show an ongoing upward trend. This result agrees with the initial hypothesis. However, the association between acute HBV cases and IDU wasn’t as strong. This finding can be attributed to the fact that while HBV is a BBP, it is most commonly transmitted vertically from an infected mother to her child at birth, whereas HCV is primarily transmitted through the sharing of needles or syringes.7,8 There is no apparent relationship between HIV rates and injection drug rates, likely because HIV has a 0.3% infection risk rate from a single infected needlestick versus the 1.8% risk of acquiring HCV and 22-31% risk of acquiring HBV.9References1. Centers for Disease Control and Prevention (CDC), Understanding the Epidemic; August 30, 2017. https://www.cdc.gov/drugoverdose/epidemic/index.html. Accessed 13 July 2018.2. CDC, Viral Hepatitis; May 19, 2016. https://www.cdc.gov/hepatitis/hbv/statisticshbv.htm. Accessed 24 July 2018.3. CDC, HIV in the United States: At A Glance; June 26, 2018. https://www.cdc.gov/hiv/statistics/overview/ataglance.html. Accessed 24 July 2018.4. CDC, NSSP Update; May, 2017. https://www.cdc.gov/nssp/documents/nssp-update-2017-05.pdf. Accessed 23 July 2018.5. NJDOH, HIV, STD, and TB Services; December, 2016. https://www.cdc.gov/hiv/statistics/overview/ataglance.html Accessed 27 July 20186. Schranz, A.J., Barrett, J., Hurt, C.B. et al. Challenges Facing a Rural Opioid Epidemic: Treatment and Prevention of HIV and Hepatitis C. Curr HIV/AIDS Rep. 2018;15(3):245-254.7. Rolls, David A. et al. Hepatitis C Transmission and Treatment in Contact Networks of People Who Inject Drugs. PLoS ONE. 2013;8(11).8. Perrillo, R.P. Hepatitis B: transmission and natural history. Gut. 1993;34(2):S48-S49.9. Berry, Arnold J. Needle stick and other safety issues. Anesthesiology Clinics of North America. 2004; 22(3):493-508.

Introduction The highly contagious COVID-19 virus has presented particularly difficult public policy challenges. The relatively late emergence of an effective treatments and vaccines, the structural stresses on health care systems, the lockdowns and the economic dislocations, the evident structural inequalities in effected societies, as well as the difficulty of prevention have tested social and political cohesion. Moreover, the intrusive nature of many prophylactic measures have led to individual liberty and human rights concerns. As noted by the Victorian (Australia) Ombudsman Report on the COVID-19 lockdown in Melbourne, we may be tempted, during a crisis, to view human rights as expendable in the pursuit of saving human lives. This thinking can lead to dangerous territory. It is not unlawful to curtail fundamental rights and freedoms when there are compelling reasons for doing so; human rights are inherently and inseparably a consideration of human lives. (5) These difficulties have raised issues about the importance of social or community capital in fighting the pandemic. This article discusses the impacts of social and community capital and other factors on the governmental efforts to combat the spread of infectious disease through the maintenance of social distancing and household ‘bubbles’. It argues that the beneficial effects of social and community capital towards fighting the pandemic, such as mutual respect and empathy, which underpins such public health measures as social distancing, the use of personal protective equipment, and lockdowns in the USA, have been undermined as preventive measures because they have been transmogrified to become a salient aspect of the “culture wars” (Peters). In contrast, states that have relatively lower social capital such a China have been able to more effectively arrest transmission of the disease because the government was been able to generate and personify a nationalist response to the virus and thus generate a more robust social consensus regarding the efforts to combat the disease. Social Capital and Culture Wars The response to COVID-19 required individuals, families, communities, and other types of groups to refrain from extensive interaction – to stay in their bubble. In these situations, especially given the asymptomatic nature of many COVID-19 infections and the serious imposition lockdowns and social distancing and isolation, the temptation for individuals to breach public health rules in high. From the perspective of policymakers, the response to fighting COVID-19 is a collective action problem. In studying collective action problems, scholars have paid much attention on the role of social and community capital (Ostrom and Ahn 17-35). Ostrom and Ahn comment that social capital “provides a synthesizing approach to how cultural, social, and institutional aspects of communities of various sizes jointly affect their capacity of dealing with collective-action problems” (24). Social capital is regarded as an evolving social type of cultural trait (Fukuyama; Guiso et al.). Adger argues that social capital “captures the nature of social relations” and “provides an explanation for how individuals use their relationships to other actors in societies for their own and for the collective good” (387). The most frequently used definition of social capital is the one proffered by Putnam who regards it as “features of social organization, such as networks, norms and social trust that facilitate coordination and cooperation for mutual benefit” (Putnam, “Bowling Alone” 65). All these studies suggest that social and community capital has at least two elements: “objective associations” and subjective ties among individuals. Objective associations, or social networks, refer to both formal and informal associations that are formed and engaged in on a voluntary basis by individuals and social groups. Subjective ties or norms, on the other hand, primarily stand for trust and reciprocity (Paxton). High levels of social capital have generally been associated with democratic politics and civil societies whose institutional performance benefits from the coordinated actions and civic culture that has been facilitated by high levels of social capital (Putnam, Democracy 167-9). Alternatively, a “good and fair” state and impartial institutions are important factors in generating and preserving high levels of social capital (Offe 42-87). Yet social capital is not limited to democratic civil societies and research is mixed on whether rising social capital manifests itself in a more vigorous civil society that in turn leads to democratising impulses. Castillo argues that various trust levels for institutions that reinforce submission, hierarchy, and cultural conservatism can be high in authoritarian governments, indicating that high levels of social capital do not necessarily lead to democratic civic societies (Castillo et al.). Roßteutscher concludes after a survey of social capita indicators in authoritarian states that social capital has little effect of democratisation and may in fact reinforce authoritarian rule: in nondemocratic contexts, however, it appears to throw a spanner in the works of democratization. Trust increases the stability of nondemocratic leaderships by generating popular support, by suppressing regime threatening forms of protest activity, and by nourishing undemocratic ideals concerning governance (752). In China, there has been ongoing debate concerning the presence of civil society and the level of social capital found across Chinese society. If one defines civil society as an intermediate associational realm between the state and the family, populated by autonomous organisations which are separate from the state that are formed voluntarily by members of society to protect or extend their interests or values, it is arguable that the PRC had a significant civil society or social capital in the first few decades after its establishment (White). However, most scholars agree that nascent civil society as well as a more salient social and community capital has emerged in China’s reform era. This was evident after the 2008 Sichuan earthquake, where the government welcomed community organising and community-driven donation campaigns for a limited period of time, giving the NGO sector and bottom-up social activism a boost, as evidenced in various policy areas such as disaster relief and rural community development (F. Wu 126; Xu 9). Nevertheless, the CCP and the Chinese state have been effective in maintaining significant control over civil society and autonomous groups without attempting to completely eliminate their autonomy or existence. The dramatic economic and social changes that have occurred since the 1978 Opening have unsurprisingly engendered numerous conflicts across the society. In response, the CCP and State have adjusted political economic policies to meet the changing demands of workers, migrants, the unemployed, minorities, farmers, local artisans, entrepreneurs, and the growing middle class. Often the demands arising from these groups have resulted in policy changes, including compensation. In other circumstances, where these groups remain dissatisfied, the government will tolerate them (ignore them but allow them to continue in the advocacy), or, when the need arises, supress the disaffected groups (F. Wu 2). At the same time, social organisations and other groups in civil society have often “refrained from open and broad contestation against the regime”, thereby gaining the space and autonomy to achieve the objectives (F. Wu 2). Studies of Chinese social or community capital suggest that a form of modern social capital has gradually emerged as Chinese society has become increasingly modernised and liberalised (despite being non-democratic), and that this social capital has begun to play an important role in shaping social and economic lives at the local level. However, this more modern form of social capital, arising from developmental and social changes, competes with traditional social values and social capital, which stresses parochial and particularistic feelings among known individuals while modern social capital emphasises general trust and reciprocal feelings among both known and unknown individuals. The objective element of these traditional values are those government-sanctioned, formal mass organisations such as Communist Youth and the All-China Federation of Women's Associations, where members are obliged to obey the organisation leadership. The predominant subjective values are parochial and particularistic feelings among individuals who know one another, such as guanxi and zongzu (Chen and Lu, 426). The concept of social capital emphasises that the underlying cooperative values found in individuals and groups within a culture are an important factor in solving collective problems. In contrast, the notion of “culture war” focusses on those values and differences that divide social and cultural groups. Barry defines culture wars as increases in volatility, expansion of polarisation, and conflict between those who are passionate about religiously motivated politics, traditional morality, and anti-intellectualism, and…those who embrace progressive politics, cultural openness, and scientific and modernist orientations. (90) The contemporary culture wars across the world manifest opposition by various groups in society who hold divergent worldviews and ideological positions. Proponents of culture war understand various issues as part of a broader set of religious, political, and moral/normative positions invoked in opposition to “elite”, “liberal”, or “left” ideologies. Within this Manichean universe opposition to such issues as climate change, Black Lives Matter, same sex rights, prison reform, gun control, and immigration becomes framed in binary terms, and infused with a moral sensibility (Chapman 8-10). In many disputes, the culture war often devolves into an epistemological dispute about the efficacy of scientific knowledge and authority, or a dispute between “practical” and theoretical knowledge. In this environment, even facts can become partisan narratives. For these “cultural” disputes are often how electoral prospects (generally right-wing) are advanced; “not through policies or promises of a better life, but by fostering a sense of threat, a fantasy that something profoundly pure … is constantly at risk of extinction” (Malik). This “zero-sum” social and policy environment that makes it difficult to compromise and has serious consequences for social stability or government policy, especially in a liberal democratic society. Of course, from the perspective of cultural materialism such a reductionist approach to culture and political and social values is not unexpected. “Culture” is one of the many arenas in which dominant social groups seek to express and reproduce their interests and preferences. “Culture” from this sense is “material” and is ultimately connected to the distribution of power, wealth, and resources in society. As such, the various policy areas that are understood as part of the “culture wars” are another domain where various dominant and subordinate groups and interests engaged in conflict express their values and goals. Yet it is unexpected that despite the pervasiveness of information available to individuals the pool of information consumed by individuals who view the “culture wars” as a touchstone for political behaviour and a narrative to categorise events and facts is relatively closed. This lack of balance has been magnified by social media algorithms, conspiracy-laced talk radio, and a media ecosystem that frames and discusses issues in a manner that elides into an easily understood “culture war” narrative. From this perspective, the groups (generally right-wing or traditionalist) exist within an information bubble that reinforces political, social, and cultural predilections. American and Chinese Reponses to COVID-19 The COVID-19 pandemic first broke out in Wuhan in December 2019. Initially unprepared and unwilling to accept the seriousness of the infection, the Chinese government regrouped from early mistakes and essentially controlled transmission in about three months. This positive outcome has been messaged as an exposition of the superiority of the Chinese governmental system and society both domestically and internationally; a positive, even heroic performance that evidences the populist credentials of the Chinese political leadership and demonstrates national excellence. The recently published White Paper entitled “Fighting COVID-19: China in Action” also summarises China’s “strategic achievement” in the simple language of numbers: in a month, the rising spread was contained; in two months, the daily case increase fell to single digits; and in three months, a “decisive victory” was secured in Wuhan City and Hubei Province (Xinhua). This clear articulation of the positive results has rallied political support. Indeed, a recent survey shows that 89 percent of citizens are satisfied with the government’s information dissemination during the pandemic (C Wu). As part of the effort, the government extensively promoted the provision of “political goods”, such as law and order, national unity and pride, and shared values. For example, severe publishments were introduced for violence against medical professionals and police, producing and selling counterfeit medications, raising commodity prices, spreading ‘rumours’, and being uncooperative with quarantine measures (Xu). Additionally, as an extension the popular anti-corruption campaign, many local political leaders were disciplined or received criminal charges for inappropriate behaviour, abuse of power, and corruption during the pandemic (People.cn, 2 Feb. 2020). Chinese state media also described fighting the virus as a global “competition”. In this competition a nation’s “material power” as well as “mental strength”, that calls for the highest level of nation unity and patriotism, is put to the test. This discourse recalled the global competition in light of the national mythology related to the formation of Chinese nation, the historical “hardship”, and the “heroic Chinese people” (People.cn, 7 Apr. 2020). Moreover, as the threat of infection receded, it was emphasised that China “won this competition” and the Chinese people have demonstrated the “great spirit of China” to the world: a result built upon the “heroism of the whole Party, Army, and Chinese people from all ethnic groups” (People.cn, 7 Apr. 2020). In contrast to the Chinese approach of emphasising national public goods as a justification for fighting the virus, the U.S. Trump Administration used nationalism, deflection, and “culture war” discourse to undermine health responses — an unprecedented response in American public health policy. The seriousness of the disease as well as the statistical evidence of its course through the American population was disputed. The President and various supporters raged against the COVID-19 “hoax”, social distancing, and lockdowns, disparaged public health institutions and advice, and encouraged protesters to “liberate” locked-down states (Russonello). “Our federal overlords say ‘no singing’ and ‘no shouting’ on Thanksgiving”, Representative Paul Gosar, a Republican of Arizona, wrote as he retweeted a Centers for Disease Control list of Thanksgiving safety tips (Weiner). People were encouraged, by way of the White House and Republican leadership, to ignore health regulations and not to comply with social distancing measures and the wearing of masks (Tracy). This encouragement led to threats against proponents of face masks such as Dr Anthony Fauci, one of the nation’s foremost experts on infectious diseases, who required bodyguards because of the many threats on his life. Fauci’s critics — including President Trump — countered Fauci’s promotion of mask wearing by stating accusingly that he once said mask-wearing was not necessary for ordinary people (Kelly). Conspiracy theories as to the safety of vaccinations also grew across the course of the year. As the 2020 election approached, the Administration ramped up efforts to downplay the serious of the virus by identifying it with “the media” and illegitimate “partisan” efforts to undermine the Trump presidency. It also ramped up its criticism of China as the source of the infection. This political self-centeredness undermined state and federal efforts to slow transmission (Shear et al.). At the same time, Trump chided health officials for moving too slowly on vaccine approvals, repeated charges that high infection rates were due to increased testing, and argued that COVID-19 deaths were exaggerated by medical providers for political and financial reasons. These claims were amplified by various conservative media personalities such as Rush Limbaugh, and Sean Hannity and Laura Ingraham of Fox News. The result of this “COVID-19 Denialism” and the alternative narrative of COVID-19 policy told through the lens of culture war has resulted in the United States having the highest number of COVID-19 cases, and the highest number of COVID-19 deaths. At the same time, the underlying social consensus and social capital that have historically assisted in generating positive public health outcomes has been significantly eroded. According to the Pew Research Center, the share of U.S. adults who say public health officials such as those at the Centers for Disease Control and Prevention are doing an excellent or good job responding to the outbreak decreased from 79% in March to 63% in August, with an especially sharp decrease among Republicans (Pew Research Center 2020). Social Capital and COVID-19 From the perspective of social or community capital, it could be expected that the American response to the Pandemic would be more effective than the Chinese response. Historically, the United States has had high levels of social capital, a highly developed public health system, and strong governmental capacity. In contrast, China has a relatively high level of governmental and public health capacity, but the level of social capital has been lower and there is a significant presence of traditional values which emphasise parochial and particularistic values. Moreover, the antecedent institutions of social capital, such as weak and inefficient formal institutions (Batjargal et al.), environmental turbulence and resource scarcity along with the transactional nature of guanxi (gift-giving and information exchange and relationship dependence) militate against finding a more effective social and community response to the public health emergency. Yet China’s response has been significantly more successful than the Unites States’. Paradoxically, the American response under the Trump Administration and the Chinese response both relied on an externalisation of the both the threat and the justifications for their particular response. In the American case, President Trump, while downplaying the seriousness of the virus, consistently called it the “China virus” in an effort to deflect responsibly as well as a means to avert attention away from the public health impacts. As recently as 3 January 2021, Trump tweeted that the number of “China Virus” cases and deaths in the U.S. were “far exaggerated”, while critically citing the Centers for Disease Control and Prevention's methodology: “When in doubt, call it COVID-19. Fake News!” (Bacon). The Chinese Government, meanwhile, has pursued a more aggressive foreign policy across the South China Sea, on the frontier in the Indian sub-continent, and against states such as Australia who have criticised the initial Chinese response to COVID-19. To this international criticism, the government reiterated its sovereign rights and emphasised its “victimhood” in the face of “anti-China” foreign forces. Chinese state media also highlighted China as “victim” of the coronavirus, but also as a target of Western “political manoeuvres” when investigating the beginning stages of the pandemic. The major difference, however, is that public health policy in the United States was superimposed on other more fundamental political and cultural cleavages, and part of this externalisation process included the assignation of “otherness” and demonisation of internal political opponents or characterising political opponents as bent on destroying the United States. This assignation of “otherness” to various internal groups is a crucial element in the culture wars. While this may have been inevitable given the increasingly frayed nature of American society post-2008, such a characterisation has been activity pushed by local, state, and national leadership in the Republican Party and the Trump Administration (Vogel et al.). In such circumstances, minimising health risks and highlighting civil rights concerns due to public health measures, along with assigning blame to the democratic opposition and foreign states such as China, can have a major impact of public health responses. The result has been that social trust beyond the bubble of one’s immediate circle or those who share similar beliefs is seriously compromised — and the collective action problem presented by COVID-19 remains unsolved. Daniel Aldrich’s study of disasters in Japan, India, and US demonstrates that pre-existing high levels of social capital would lead to stronger resilience and better recovery (Aldrich). Social capital helps coordinate resources and facilitate the reconstruction collectively and therefore would lead to better recovery (Alesch et al.). Yet there has not been much research on how the pool of social capital first came about and how a disaster may affect the creation and store of social capital. Rebecca Solnit has examined five major disasters and describes that after these events, survivors would reach out and work together to confront the challenges they face, therefore increasing the social capital in the community (Solnit). However, there are studies that have concluded that major disasters can damage the social fabric in local communities (Peacock et al.). The COVID-19 epidemic does not have the intensity and suddenness of other disasters but has had significant knock-on effects in increasing or decreasing social capital, depending on the institutional and social responses to the pandemic. In China, it appears that the positive social capital effects have been partially subsumed into a more generalised patriotic or nationalist affirmation of the government’s policy response. Unlike civil society responses to earlier crises, such as the 2008 Sichuan earthquake, there is less evidence of widespread community organisation and response to combat the epidemic at its initial stages. This suggests better institutional responses to the crisis by the government, but also a high degree of porosity between civil society and a national “imagined community” represented by the national state. The result has been an increased legitimacy for the Chinese government. Alternatively, in the United States the transformation of COVID-19 public health policy into a culture war issue has seriously impeded efforts to combat the epidemic in the short term by undermining the social consensus and social capital necessary to fight such a pandemic. Trust in American institutions is historically low, and President Trump’s untrue contention that President Biden’s election was due to “fraud” has further undermined the legitimacy of the American government, as evidenced by the attacks directed at Congress in the U.S. capital on 6 January 2021. As such, the lingering effects the pandemic will have on social, economic, and political institutions will likely reinforce the deep cultural and political cleavages and weaken interpersonal networks in American society. Conclusion The COVID-19 pandemic has devastated global public health and impacted deeply on the world economy. Unsurprisingly, given the serious economic, social, and political consequences, different government responses have been highly politicised. Various quarantine and infection case tracking methods have caused concern over state power intruding into private spheres. The usage of face masks, social distancing rules, and intra-state travel restrictions have aroused passionate debate over public health restrictions, individual liberty, and human rights. Yet underlying public health responses grounded in higher levels of social capital enhance the effectiveness of public health measures. In China, a country that has generally been associated with lower social capital, it is likely that the relatively strong policy response to COVID-19 will both enhance feelings of nationalism and Chinese exceptionalism and help create and increase the store of social capital. In the United States, the attribution of COVID-19 public health policy as part of the culture wars will continue to impede efforts to control the pandemic while further damaging the store of American community social capital that has assisted public health efforts over the past decades. References Adger, W. Neil. “Social Capital, Collective Action, and Adaptation to Climate Change.” Economic Geography 79.4 (2003): 387-404. Bacon, John. “Coronavirus Updates: Donald Trump Says US 'China Virus' Data Exaggerated; Dr. Anthony Fauci Protests, Draws President's Wrath.” USA Today 3 Jan. 2021. 4 Jan. 2021 <https://www.usatoday.com/story/news/health/2021/01/03/COVID-19-update-larry-king-ill-4-million-december-vaccinations-us/4114363001/>. Berry, Kate A. “Beyond the American Culture Wars.” Regions & Cohesion / Regiones y Cohesión / Régions et Cohésion 7.2 (Summer 2017): 90-95. Castillo, Juan C., Daniel Miranda, and Pablo Torres. “Authoritarianism, Social Dominance and Trust in Public Institutions.” Annual Scientific Meeting of the International Society of Political Psychology, Istanbul, 9-12 July 2011. 2 Jan. 2021 <https://pdfs.semanticscholar.org/>. Chapman, Roger. “Introduction, Culture Wars: Rhetoric and Reality.” Culture Wars: An Encyclopedia of Issues, Viewpoints, and Voices. Eds. Roger Chapman and M.E. Sharpe. 2010. 8-10. Chen, Jie, and Chunlong Lu. “Social Capital in Urban China: Attitudinal and Behavioral Effects on Grassroots Self-Government.” Social Science Quarterly 88.2 (June 2007): 422-442. China's State Council Information Office. “Fighting COVID-19: China in Action.” Xinhuanet 7 June 2020. 2 Sep. 2020 <http://www.xinhuanet.com/english/2020-06/07/c_139120424.htm?bsh_bid=551709954>. Fukuyama, Francis. Trust: The Social Virtues and the Creation of Prosperity. Hamish Hamilton, 1995. Kelly, Mike. “Welcome to the COVID-19 Culture Wars. Why Are We Fighting about Masks?’ Yahoo News 4 Dec. 2020 <https://www.msn.com/en-us/news/us/welcome-to-the-COVID-19-culture-wars-why-are-we-fighting-about-masks-mike-kelly/ar-BB1bCOHN>. Luigi Guiso, Paola Sapienza, and Luigi Zingales, “Social Capital as Good Culture.” National Bureau of Economic Research Working Paper No. 13712. 2007. 18 ct. 2017 <http://www.nber.org/papers/w13712.pdf>. Malik, Nesrine. “The Right's Culture War Is No Longer a Sideshow to Our Politics – It Is Our Politics.” The Guardian 31 Aug. 2020. 6 Jan. 2021 <https://www.theguardian.com/commentisfree/2020/aug/31/the-rights-culture-war-politics-rightwing-fantasy-elections>. Offe, Carl. “How Can We Trust Our Fellow Citizens?” Democracy and Trust. Ed. M.E. Warren. Cambridge University Press, 1999. 42-87. Ostrom, Elinor, and T.K. Ahn. “The Meaning of Social Capital and Its Link to Collective Action.” Handbook of Social Capital: The Troika of Sociology, Political Science and Economics. Eds. Gert Tinggaard Svendsen and Gunnar Lind Haase Svendsen. Edward Elgar, 2009. 17–35. Paxton, Pamela. “Is Social Capital Declining in the United States? A Multiple Indicator Assessment.” American Journal of Sociology 105.1 (1999): 88-127. People.cn. “Hubeisheng Huanggangshi chufen dangyuan ganbu 337 ren.” [“337 Party Cadres Were Disciplined in Huanggang, Hubei Province.”] 2 Feb. 2020. 10 Sep. 2020 <http://fanfu.people.com.cn/n1/2020/0130/c64371-31565382.html>. ———. “Zai yiqing fangkong douzheng zhong zhangxian weida zhongguo jingshen.” [“Demonstrating the Great Spirit of China in Fighting the Pandemic.”] 7 Apr. 2020. 9 Sep. 2020 <http://opinion.people.com.cn/n1/2020/0407/c1003-31663076.html>. Peters, Jeremy W. “How Abortion, Guns and Church Closings Made Coronavirus a Culture War.” New York Times 20 Apr. 2020. 6 Jan. 2021 <http://www.nytimes.com/2020/04/20/us/politics/coronavirus-protests-democrats-republicans.html>. Pew Research Center. “Americans Give the U.S. Low Marks for Its Handling of COVID-19, and So Do People in Other Countries.” 21 Sep. 2020. 15 Jan. 2021 <https://www.pewresearch.org/fact-tank/2020/09/21/americans-give-the-u-s-low-marks-for-its-handling-of-covid-19-and-so-do-people-in-other-countries/>. Putnam, Robert D. “Bowling Alone: America’s Declining Social Capital.” Journal of Democracy 6.1 (1995): 65-78. ———. Making Democracy Work: Civic Traditions in Modern Italy. Princeton University Press, 1993. Roßteutscher, Sigrid. “Social Capital Worldwide: Potential for Democratization or Stabilizer of Authoritarian Rule?” American Behavioural Scientist 53.5 (2010): 737–757. Russonello, G. “What’s Driving the Right-Wing Protesters Fighting the Quarantine?” New York Times 17 Apr. 2020. 2 Jan. 2021 <http://www.nytimes.com/2020/04/17/us/politics/poll-watch-quarantine-protesters.html>. Shear, Michael D., Maggie Haberman, Noah Weiland, Sharon LaFraniere, and Mark Mazzetti. “Trump’s Focus as the Pandemic Raged: What Would It Mean for Him?” New York Times 31 Dec. 2020. 2 Jan. 2021 <https://www.nytimes.com/2020/12/31/us/politics/trump-coronavirus.html>. Tracy, Marc. “Anti-Lockdown Protesters Get in Reporters’ (Masked) Faces.” New York Times 13 May 2020. 5 Jan. 2021 <https://www.nytimes.com/2020/05/13/business/media/lockdown-protests-reporters.html>. Victoria Ombudsman. “Investigation into the Detention and Treatment of Public Housing Residents Arising from a COVID-19 ‘Hard Lockdown’ in July 2020.” Dec. 2020. 8 Jan. 2021 <https://assets.ombudsman.vic.gov.au/>. Vogel, Kenneth P., Jim Rutenberg, and Lisa Lerer. “The Quiet Hand of Conservative Groups in the Anti-Lockdown Protests.” New York Times 21 Apr. 2020. 2 Jan. 2021 <http://www.nytimes.com/2020/04/21/us/politics/coronavirus-protests-trump.html>. Weiner, Jennifer. “Fake ‘War on Christmas’ and the Real Battle against COVID-19.” New York Times 7 Dec. 2020. 6 Jan. 2021 <https://www.nytimes.com/2020/12/07/opinion/christmas-religion-COVID-19.html>. White, Gordon. “Civil Society, Democratization and Development: Clearing the Analytical Ground.” Civil Society in Democratization. Eds. Peter Burnell and Peter Calvert. Taylor & Francis, 2004. 375-390. Wu, Cary. “How Chinese Citizens View Their Government’s Coronavirus Response.” The Conversation 5 June 2020. 2 Sep. 2020 <https://theconversation.com/how-chinese-citizens-view-their-governments-coronavirus-response-139176>. Wu, Fengshi. “An Emerging Group Name ‘Gongyi’: Ideational Collectivity in China's Civil Society.” China Review 17.2 (2017): 123-150. ———. “Evolving State-Society Relations in China: Introduction.” China Review 17.2 (2017): 1-6. Xu, Bin. “Consensus Crisis and Civil Society: The Sichuan Earthquake Response and State-Society Relations.” The China Journal 71 (2014): 91-108. 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Since September 11, Muslims in Australia have experienced a heightened level of religiously and racially motivated vilification (Human Rights and Equal Opportunity Commission). These fears were poignantly expressed in a letter to the Editor of The West Australian newspaper from a Muslim woman shortly after the London terror attacks: All I want to say is that for those out there who might have kamikaze ideas of doing such an act here in Australia, please think of others (us) in your own community. The ones who will get hurt are your own, especially we the women who are an obvious target in the public and have to succumb to verbal abuse most of the time. Dealing with abuse and hatred from some due to 9/11 and Bali is not something I want to go through again. (21) The atmosfear of terror finds many expressions among the Muslim communities in Australia: the fear of backlash from some sectors of the wider community; the fear of subversion of Islamic identity in meeting the requirements of a politically defined “moderate” Islam; the fear of being identified as a potential terrorist or “person of interest” and the fear of potentially losing the rights bestowed on all other citizens. This fear or fears are grounded in the political and the media response to terrorism that perpetuates a popular belief that Muslims, as a culturally and religiously incompatible “other”, pose a threat to the Australian collective identity and, ostensibly, to Australia’s security. At the time of publication, for example, there was mob violence involving 5,000 young people converging on Sydney’s Cronulla beach draped in Australian flags singing Waltzing Matilda and Advance Australia Fair as well as chanting “kill the Lebs”, “no more Lebs” (Lebanese). The mob was itself brought together by a series of SMS messages, appealing to participants to “help support Leb and Wog bashing day” and to “show solidarity” against a government-identified “threat to Aussie identity” (The West Australian). Since September 11 and the ensuing war on terror, a new discourse of terrorism has emerged as a way of expressing how the world has changed and defining a state of constant alert (Altheide). “The war on terror” refers as much to a perpetual state of alertness as it does to a range of strategic operations, border control policies, internal security measures and public awareness campaigns such as “be alert, not alarmed”. According to a poll published in The Sydney Morning Herald in April 2004, 68 per cent of Australians believed that Australia was at threat of an imminent terrorist attack (Michaelsen). In a major survey in Australia immediately after the September 11 attacks Dunn & Mahtani found that more than any other cultural or ethnic group, Muslims and people from the Middle East were thought to be unable to fit into Australia. Two thirds of those surveyed believed that humanity could be sorted into natural categories of race, with the majority feeling that Australia was weakened by people of different ethnic origins. Fifty-four per cent of those surveyed, mainly women, said they would be concerned if a relative of theirs married a Muslim. The majority of the Muslim population, not surprisingly, has gone into a “siege mentality” (Hanna). The atmosfear of terror in the Western world is a product of the media and political construction of the West as perpetually at threat of a terrorist attack from a foreign, alien, politically defined “other”, where “insecurity…is the new normal” (Massumi 31). Framed in a rhetoric that portrays it as a battle for the Western values of democracy and freedom, the “war on terror” becomes not just an event in space and time but a metonym for a new world order, drawing on distinctions between “us” and “them” and “the West” and “others” (Osuri and Banerjee) and motivating collective identity based on a construction of “us” as victims and “them” as the objects of fear, concern and suspicion. The political response to the war on terror has inculcated an atmosfear of terror where Australian Muslims are identified as the objects of this fear. The fear of terrorism is being modulated through government and the popular media to perpetuate a state of anxiety that finds expression in the heightened levels of concern and suspicion over a perceived threat. In the case of the war on terror, this threat is typically denoted as radical Islam and, by inference, Australian Muslims. In his exposition of political fear, Corey Robin notes that a central element of political fear is that it is often not read as such – rendering it alien to analysis, critical debate and understanding. Nowhere is this more salient than in the rhetoric on the war on terror characterised by the familiar invocation of terms like democracy and freedom to make distinctions between “the West and the rest” and to legitimise references to civilised and uncivilised worlds. In his speech delivered at the United Nations Security Council Ministerial Session on Terrorism on 20 January 2003, Colin Powell invoked the rhetoric of a clash of civilisations and urged, “we must rid the civilised world of this cancer … We must rise to the challenge with actions that will ride the globe of terrorism and create a world in which all God’s children can live without fear”. It is this construction of the war on terror as a global battle between “the West and the rest” that enables and facilitates the affective response to political fear – a reaffirmation of identity and membership of a collective. As Robin states: Understanding the objects of our fear as less than political allows us to treat them as intractable foes. Nothing can be done to accommodate them: they can only be killed or contained. Understanding the objects of our fear as not political also renews us as a collective. Afraid, we are like the audience in a crowded theatre confronting a man falsely shouting fire: united, not because we share similar beliefs of aspiration but because we are equally threatened. (6) This response has found expression in the perception of Muslims as an alien, culturally incompatible and utterly threatening other, creating a state of social tension where the public’s anxiety has been and continues to be directed at Australian Muslims who visibly represent the objects of the fear of terror. The Australian Government’s response to the war on terror exemplifies what Brian Massumi terms “affective modulation” whereby the human response to the fear of terror, that of a reinforcement and renewal of collective identity, has been modulated and transformed from an affective response to an affective state of anxiety – what the authors term the atmosfear of terror. Affect for Massumi can be inscribed in the flesh as “traces of experience” – an accumulation of affects. It is in this way that Massumi views affect as “autonomous” (Megan Watkins also makes this argument, and has further translated Massumi's notions into the idea of pedagogic affect/effect). In the Australian context, after more than four years of collected traces of experiences of images of threat, responses to terrorism have become almost reflexive – even automated. Affective modulation in the Australian context relies on the regenerative capacity of fear, in Massumi’s terms its “ontogenetic powers” (45) to create an ever-present threat and maintain fear as a way of life. The introduction of a range of counter-terrorism strategies, internal-security measures, legislative amendments and policies, often without public consultation and timed to coincide with “new” terror alerts is testimony to the affective machinations of the Australian government in its response to the war on terror. Virilio and Lotringer called “pure war” the psychological state that happens when people know that they live in a world where the potential for sudden and absolute destruction exists. It is not the capacity for destruction so much as the continual threat of sudden destruction that creates this psychology. Keith Spence has stated that in times of crisis the reasoned negotiation of risk is marginalised. The counter-terrorism legislation introduced in response to the war on terror is, arguably, the most drastic anti-libertarian measures Australia has witnessed and constitutes a disproportionate response to Australia’s overall risk profile (Michaelsen). Some of these measures would once have seemed an unthinkable assault on civil liberties and unreasonably authoritarian. Yet in the war on terror, notes Jessica Stern, framed as a global war of good versus evil, policies and strategies that once seemed impossible suddenly become constructed as rationale, if not prudent. Since September 11, the Australian government has progressively introduced a range of counter-terrorism measures including over 30 legislative amendments and, more recently, increased powers for the police to detain persons of interest suspected of sedition. In the wake of the London bombings, the Prime Minister called a summit with Muslim representatives from around the nation. In the two hours that they met, the summit developed a Statement of Principles committing members of Muslim communities to combat radicalisation and pursue “moderate” Islam. As an affective machination, the summit presents as a useful political tool for modulating the existing anxieties in the Australian populace. The very need for a summit of this nature and for the development of a Statement of Principles (later endorsed by the Council of Australian Governments or COAG) sends a lucid message to the Australian public. Not only are Australian Muslims responsible for terrorism but they also have the capacity to prevent or minimise the threat of an attack in Australia. Already the focus of at least a decade of negative stereotyping in the popular Australia media (Brasted), Australian Muslims all too quickly and easily became agents in the Government’s affective tactics. The policy response to the war on terror has given little consideration to the social implications of sustaining a fear of terrorism, placing much emphasis on security- focused counter-terrorism measures rather than education and dialogue. What governments and communities need to address is the affective aspects of the atmosfear of terror. Policy makers can begin by becoming self-reflexive and developing an understanding of the real impact of fear and the affective modulation of this fear. Communities can start by developing an understanding of how policy induced fear is affecting them. To begin this process of reflection, governments and communities need to recognise fear of terrorism as a political tool. Psychological explanations for fear or trauma are important, especially if we are to plan policy responses to them. However, if we are to fight against policy-induced fear, we need to better understand and recognise affective modulation as a process that is not reducible to individual psychology. Viewed from the perspective of affect, the atmosfear of terror reveals an attempt to modulate public anxiety and sustain a sense of Australia as perpetually at threat from a culturally incompatible and irreconcilable “other”. References Altheide, David. L. “Consuming Terrorism.” Symbolic Interaction 27.3 (2004): 289–308. Brasted, Howard, V. “Contested Representations in Historical Perspective: Images of Islam and the Australian Press 1950-2000”. In A. Saeed & S. Akbarzadeh, Muslim Communities in Australia. Sydney: U of NSW P, 2001. Dunn, K.M., and M. Mahtani. “Media Representations of Ethnic Minorities.” Progress in Planning 55.3 (2001): 63–72. Dunn, K.M. “The Cultural Geographies of Citizenship in Australia.” Geography Bulletin 33.1 (2001): 4–8. “Genesis of Cronulla’s Ugly Sunday Began Years Ago.” The West Australian 2005: 11. Green, Lelia. “Did the World Really Change on 9/11?” Australian Journal of Communication 29.2 (2002): 1–14. Hanna, D. 2003. “Siege Mentality: Current Australian Response.” Salam July-Aug. (2003): 12–4. Human Rights and Equal Opportunity Commission. Ismaa – Listen: National Consultations on Eliminating Prejudice against Arab and Muslim Australians. Sydney: Human Rights and Equal Opportunity Commission, 2004. Kerbaj, Richard. “Clerics Still Preaching Hatred of West.” The Australian 3 Nov. 2005. Kinnvall, Catarina. “Globalization and Religious Nationalism: Self, Identity, and the Search for Ontological Security.” Political Psychology 25.5 (2004): 741. “Letters to the Editor.” The West Australian 25 July 2005: 21. Massumi, Brian. “Fear (The Spectrum Said).” Positions 13.1 (2005): 31–48. Massumi, Brian. “The Autonomy of Affect.” In P. Patton, ed., Deleuze: A Critical Reader. Cambridge, Mass.: Blackwell, 1996. “Meeting with Islamic Community Leaders, Statement of Principles.” 23 Aug. 2005. http://www.pm.gov.au/news/media_releases/media_Release1524.html> Michaelsen, Christopher. “Antiterrorism Legislation in Australia: A Proportionate Response to the Terrorist Threat?” Studies in Conflict and Terrorism 28.4 (2005): 321–40. Osuri, Goldie, and Subhabrata Bobby Banerjee. “White Diasporas: Media Representations of September 11 and the Unbearable Whiteness of Being in Australia.” Social Semiotics 14.2 (2004): 151–71. Powell, Colin. “Ridding the World of Global Terrorism: No Countries or Citizens are Safe.” Vital Speeches of the Day 69.8 (2003): 230–3. Robin, Corey. Fear: The History of a Political Idea. New York: Oxford UP, 2004. Spence, Keith. “World Risk Society and War against Terror.” Political Studies 53.2 (2005): 284–304. Stern, Jessica. “Fearing Evil.” Social Research 71.4 (2004): 1111–7. “Terrorism Chronology.” Parliament of Australia Parliamentary Library. http://www.aph.gov.au/library/intguide/law/terrorism.htm> Tomkins, Silvan. Affect, Imagery and Consciousness. New York: Springer Publishing, 1962. Virilio, Paul, and Sylvere Lotringer. Pure War. New York: Semio-text(e), 1997. Watkins, Megan. “Pedagogic Affect/Effect: Teaching Writing in the Primary Years of School.” Presented at Redesigning Pedagogy: Research, Policy, Practice Conference. Singapore: National Institute of Education, 31 May 2005. Citation reference for this article MLA Style Aly, Anne, and Mark Balnaves. "The Atmosfear of Terror: Affective Modulation and the War on Terror." M/C Journal 8.6 (2005). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0512/04-alybalnaves.php>. APA Style Aly, A., and M. Balnaves. (Dec. 2005) "The Atmosfear of Terror: Affective Modulation and the War on Terror," M/C Journal, 8(6). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0512/04-alybalnaves.php>.

The advent of the #MeToo movement and the scale of participation in 85 countries (Gill and Orgad; see Google Trends) has greatly expanded debate about the revival of feminism (Winch Littler and Keeler) and the contribution of digital media to a “reconfiguration” of feminism (Jouet). Insofar as these campaigns are concerned with sexual harassment and related forms of sexual abuse, the longer history of sexual harassment in which this practice was named by women’s movement activists in the 1970s has gone largely unremarked except in the broad sense of the recharging or “techno-echo[es]” (Jouet) of earlier “waves” of feminism. However, #MeToo and its companion movement #TimesUp, and its fighting fund timesupnow.org, stemmed directly from the allegations in 2017 against the media mogul Harvey Weinstein by Hollywood professionals and celebrities. The naming of prominent, powerful men as harassers and the celebrity sphere of activism have become features of #MeToo that warrant comparison with the naming of sexual harassment in the earlier era of feminism.While the practices it named were not new, the term “sexual harassment” was new, and it became a defining issue in second wave feminism that was conceptualised within the continuum of sexual violence. I outline this history, and how it transformed the private, individual experiences of many women into a shared public consciousness about sexual coercion in the workplace, and some of the debate that this generated within the women’s movement at the time. It offers scope to compare the threshold politics of naming names in the 21st century, and its celebrity vanguard which has led to some ambivalence about the lasting impact. For Kathy Davis (in Zarkov and Davis), for instance, it is atypical of the collective goals of second wave feminism.In comparing the two eras, Anita Hill’s claims against Clarence Thomas in the early 1990s is a bridging incident. It dates from closer to the time in which sexual harassment was named, and Hill’s testimony is now recognised as a prototype of the kinds of claims made against powerful men in the #MeToo era. Lauren Berlant’s account of “Diva Citizenship”, formulated in response to Hill’s testimony to the US Senate, now seems prescient of the unfolding spectacle of feminist subjectivities in the digital public sphere and speaks directly to the relation between individual and collective action in making lasting change. The possibility of change, however, descends from the intervention of the women’s movement in naming sexual harassment.The Name Is AllI found my boss in a room ... . He was alone ... . He greeted me ... touched my hair and ... said ... “Come, Ruth, sit down here.” He motioned to his knee. I felt my face flush. I backed away towards the door ... . Then he rose ... and ... put his hand into his pocket, took out a roll of bills, counted off three dollars, and brought it over to me at the door. “Tell your father,” he said, “to find you a new shop for tomorrow morning.” (Cohen 129)Sexual coercion in the workplace, such as referred to in this workplace novel published in 1918, was spoken about among women in subcultures and gossip long before it was named as sexual harassment. But it had no place in public discourse. Women’s knowledge of sexual harassment coalesced in an act of naming that is reputed to have occurred in a consciousness raising group in New York at the height of the second wave women’s movement. Lin Farley lays claim to it in her book, Sexual Shakedown, first published in 1978, in describing the coinage of the term from a workshop on women and work in 1974 at Cornell University. The group of participants was made up, she says, of near equal numbers of black and white women with “economic backgrounds ranging from very affluent to poor” (11). She describes how, “when we had finished, there was an unmistakable pattern to our employment ... . Each one of us had already quit or been fired from a job at least once because we had been made too uncomfortable by the behaviour of men” (11–12). She claims to have later devised the term “sexual harassment” in collaboration with others from this group (12).The naming of sexual harassment has been described as a kind of “discovery” (Leeds TUCRIC 1) and possibly “the only concept of sexual violence to be labelled by women themselves” (Hearn et al. 20). Not everyone agrees that Farley’s group first coined the term (see Herbert 1989) and there is some evidence that it was in use from the early 1970s. Catherine Mackinnon accredits its first use to the Working Women United Institute in New York in connection with the case of Carmita Wood in 1975 (25). Yet Farley’s account gained authority and is cited in several other contemporary radical feminist works (for instance, see Storrie and Dykstra 26; Wise and Stanley 48), and Sexual Shakedown can now be listed among the iconic feminist manifestoes of the second wave era.The key insight of Farley’s book was that sexual coercion in the workplace was more than aberrant behaviour by individual men but was systemic and organised. She suggests how the phrase sexual harassment “is the first verbal description of women’s feelings about this behaviour and it unstintingly conveys a negative perception of male aggression in the workplace” (32). Others followed in seeing it as organised expression of male power that functions “to keep women out of non-traditional occupations and to reinforce their secondary status in the workplace” (Pringle 93), a wisdom that is now widely accepted but seemed radical at the time.A theoretical literature on sexual harassment grew rapidly from the 1970s in which the definition of sexual harassment was a key element. In Sexual Shakedown, Farley defines it with specific connection to the workplace and a woman’s “function as worker” (33). Some definitions attempted to cover a range of practices that “might threaten a woman’s job security or create a stressful or intimidating working environment” ranging from touching to rape (Sedley and Benn 6). In the wider radical feminist discussion, sexual harassment was located within the “continuum of sexual violence”, a paradigm that highlighted the links between “every day abuses” and “less common experiences labelled as crimes” (Kelly 59). Accordingly, it was seen as a diminished category of rape, termed “little rape” (Bularzik 26), or a means whereby women are “reminded” of the “ever present threat of rape” (Rubinstein 165).The upsurge of research and writing served to document the prevalence and history of sexual harassment. Radical feminist accounts situated the origins in the long-standing patriarchal assumption that economic responsibility for women is ultimately held by men, and how “women forced to earn their own living in the past were believed to be defenceless and possibly immoral” (Rubinstein 166). Various accounts highlighted the intersecting effects of racism and sexism in the experience of black women, and women of colour, in a way that would be now termed intersectional. Jo Dixon discussed black women’s “least advantaged position in the economy coupled with the legacy of slavery” (164), while, in Australia, Linda Rubinstein describes the “sexual exploitation of aboriginal women employed as domestic servants on outback stations” which was “as common as the better documented abuse of slaves in the American South” (166).In The Sexual Harassment of Working Women, Catherine Mackinnon provided a pioneering legal argument that sexual harassment was a form of sex discrimination. She defined two types: the quid pro quo, when “sexual compliance is exchanged, or proposed to be exchanged, for an employment opportunity” (32); and sexual harassment as a “persistent condition of work” that “simply makes the work environment unbearable” (40). Thus the feminist histories of sexual harassment became detailed and strategic. The naming of sexual harassment was a moment of relinquishing women’s experience to the gaze of feminism and the bureaucratic gaze of the state, and, in the legal interventions that followed, it ceased to be exclusively a feminist issue.In Australia, a period of bureaucratisation and state intervention commenced in the late 1970s that corresponded with similar legislative responses abroad. The federal Sex Discrimination Act was amended in 1984 to include a definition of sexual harassment, and State and Territory jurisdictions also framed legislation pertaining to sexual harassment (see Law Council of Australia). The regimes of redress were linked with Equal Opportunity and Affirmative Action frameworks and were of a civil order. Under the law, there was potential for employers to be found vicariously liable for sexual harassment.In the women’s movement, legislative strategies were deemed reformist. Radical and socialist feminists perceived the de-gendering effects of these policies in the workplace that risked collusion with the state. Some argued that naming and defining sexual harassment denies that women constantly deal with a range of harassment anywhere, not only in the workplace (Wise and Stanley 10); while others argued that reformist approaches effectively legitimate other forms of sex discrimination not covered by legislation (Game and Pringle 290). However, in feminism and in the policy realm, the debate concerned sexual harassment in the general workplace. In contrast to #MeToo, it was not led by celebrity voices, nor galvanised by incidents in the sphere of entertainment, nor, by and large, among figures of public office, except for a couple of notable exceptions, including Anita Hill.The “Spectacle of Subjectivity” in the “Scene of Public Life”Through the early 1990s as an MA candidate at the University of Queensland, I studied media coverage of sexual harassment cases, clipping newspapers and noting electronic media reports on a daily basis. These mainly concerned incidents in government sector workplaces or small commercial enterprises. While the public prominence of the parties involved was not generally a factor in reportage, occasionally, prominent individuals were affected, such as the harassment of the athlete Michelle Baumgartner at the Commonwealth Games in 1990 which received extensive coverage but the offenders were never publicly named or disciplined. Two other incidents stand out: the Ormond College case at the University of Melbourne, about which much has been written; and Anita Hill’s claims against Clarence Thomas during his nomination to the US Supreme Court in 1991.The spectacle of Hill’s testimony to the US Senate is now an archetype of claims against powerful men, although, at the time, her credibility was attacked and her dignified presentation was criticised as “too composed. Too cool. Too censorious” (Legge 31). Hill was also seen to counterpose the struggles of race and gender, and Thomas himself famously described it as “a hi-tech lynching of an uppity black” (qtd in Stephens 1). By “hi-tech”, Thomas alluded to the occasion of the first-ever live national broadcast of the United States Senate hearings in which Hill’s claims were aired directly to the national public, and re-broadcast internationally in news coverage. Thus, it was not only the claims but the scale and medium of delivery to a global audience that set it apart from other sexual harassment stories.Recent events have since prompted revisiting of the inequity of Hill’s treatment at the Senate hearings. But well before this, in an epic and polemical study of American public culture, Berlant reflected at length on the heroism of Hill’s “witnessing” as paradigmatic of citizenship in post-Reaganite America’s “shrinking” public sphere. It forms part of her much wider thesis regarding the “intimate public sphere” and the form of citizenship “produced by personal acts and values” (5) in the absence of a context that “makes ordinary citizens feel they have a common public culture, or influence on a state” (3), and in which the fundamental inequality of minority cultures is assumed. For Berlant, Hill’s testimony becomes the model of “Diva Citizenship”; the “strange intimacy” in which the Citizen Diva, “the subordinated person”, believes in the capacity of the privileged ones “to learn and to change” and “trust[s] ... their innocence of ... their obliviousness” of the system that has supported her subjugation (222–223). While Berlant’s thesis pertains to profound social inequalities, there is no mistaking the comparison to the digital feminist in the #MeToo era in the call to identify with her suffering and courage.Of Hill’s testimony, Berlant describes how: “a member of a stigmatised population testifies reluctantly to a hostile public the muted and anxious history of her imperiled citizenship” (222). It is an “act of heroic pedagogy” (223) which occurs when “a person stages a dramatic coup in a public sphere in which she does not have privilege” (223). In such settings, “acts of language can feel like explosives” and put “the dominant story into suspended animation” (223). The Diva Citizen cannot “change the world” but “challenges her audience” to identify with her “suffering” and the “courage she has had to produce” in “calling on people to change the practices of citizenship into which they currently consent” (223). But Berlant cautions that the strongest of Divas cannot alone achieve change because “remaking the scene of public life into a spectacle of subjectivity” can lead to “a confusion of ... memorable rhetorical performance with sustained social change itself” (223). Instead, she argues that the Diva’s act is a call; the political obligation for the action of change lies with the collective, the greater body politic.The EchoIf Acts of Diva Citizenship abound in the #MeToo movement, relations between the individual and the collective are in question in a number of ways. This suggests a basis of comparison between past and present feminisms which have come full circle in the renewed recognition of sexual harassment in the continuum of sexual violence. Compared with the past, the voices of #MeToo are arguably empowered by a genuine, if gradual, change in the symbolic status of women, and a corresponding destabilization of the images of male power since the second wave era of feminism. The one who names an abuser on Twitter symbolises a power of individual courage, backed by a responding collective voice of supporters. Yet there are concerns about who can “speak out” without access to social media or with the constraint that “the sanctions would be too great” (Zarkov and Davis). Conversely, the “spreadability” — as Jenkins, Ford and Green term the travelling properties of digital media — and the apparent relative ease of online activism might belie the challenge and courage of those who make the claims and those who respond.The collective voice is also allied with other grassroots movements like SlutWalk (Jouet), the women’s marches in the US against the Trump presidency, and the several national campaigns — in India and Egypt, for instance (Zarkov and Davis) — that contest sexual violence and gender inequality. The “sheer numbers” of participation in #MeToo testify to “the collectivity of it all” and the diversity of the movement (Gill and Orgad). If the #MeToo hashtag gained traction with the “experiences of white heterosexual women in the US”, it “quickly expanded” due to “broad and inclusive appeal” with stories of queer women and men and people of colour well beyond the Global North. Even so, Tarana Burke, who founded the #MeToo hashtag in 2006 in her campaign of social justice for working class women and girls of colour, and endorsed its adoption by Hollywood, highlights the many “untold stories”.More strikingly, #MeToo participants name the names of the alleged harassers. The naming of names, famous names, is threshold-crossing and as much the public-startling power of the disclosures as the allegations and stimulates newsworthiness in conventional media. The resonance is amplified in the context of the American crisis over the Trump presidency in the sense that the powerful men called out become echoes or avatars of Trump’s monstrous manhood and the urgency of denouncing it. In the case of Harvey Weinstein, the name is all. A figure of immense power who symbolised an industry, naming Weinstein blew away the defensive old Hollywood myths of “casting couches” and promised, perhaps idealistically, the possibility for changing a culture and an industrial system.The Hollywood setting for activism is the most striking comparison with second wave feminism. A sense of contradiction emerges in this new “visibility” of sexual harassment in a culture that remains predominantly “voyeuristic” and “sexist” (Karkov and Davis), and not least in the realm of Hollywood where the sexualisation of women workers has long been a notorious open secret. A barrage of Hollywood feminism has accompanied #MeToo and #TimesUp in the campaign for diversity at the Oscars, and the stream of film remakes of formerly all-male narrative films that star all-female casts (Ghostbusters; Oceans 11; Dirty, Rotten Scoundrels). Cynically, this trend to make popular cinema a public sphere for gender equality in the film industry seems more glorifying than subversive of Hollywood masculinities. Uneasily, it does not overcome those lingering questions about why these conditions were uncontested openly for so long, and why it took so long for someone to go public, as Rose McGowan did, with claims about Harvey Weinstein.However, a reading of She Said, by Jodie Kantor and Megan Tuohey, the journalists who broke the Weinstein story in the New York Times — following their three year efforts to produce a legally water-tight report — makes clear that it was not for want of stories, but firm evidence and, more importantly, on-the-record testimony. If not for their (and others’) fastidious journalism and trust-building and the Citizen Divas prepared to disclose their experiences publicly, Weinstein might not be convicted today. Yet without the naming of the problem of sexual harassment in the women’s movement all those years ago, none of this may have come to pass. Lin Farley can now be found on YouTube retelling the story (see “New Mexico in Focus”).It places the debate about digital activism and Hollywood feminism in some perspective and, like the work of journalists, it is testament to the symbiosis of individual and collective effort in the action of change. The tweeting activism of #MeToo supplements the plenum of knowledge and action about sexual harassment across time: the workplace novels, the consciousness raising, the legislation and the poster campaigns. In different ways, in both eras, this literature demonstrates that names matter in calling for change on sexual harassment. But, if #MeToo is to become the last long take on sexual harassment, then, as Berlant advocates, the responsibility lies with the body politic who must act collectively for change in ways that will last well beyond the courage of the Citizen Divas who so bravely call it on.ReferencesBerlant, Lauren. The Queen of America Goes to Washington City: Essays on Sex and Citizenship. 1997. Durham: Duke UP, 2002.Bularzik, Mary. “Sexual Harassment at the Workplace: Historical Notes.” Radical America 12.4 (1978): 25-43.Cohen, Rose. Out of the Shadow. NY: Doran, 1918.Dixon, Jo. “Feminist Reforms of Sexual Coercion Laws.” Sexual Coercion: A Sourcebook on Its Nature, Causes and Prevention. Eds. Elizabeth Grauerholz and Mary A. Karlewski. Massachusetts: Lexington, 1991. 161-171.Farley, Lin. Sexual Shakedown: The Sexual Harassment of Women in the Working World. London: Melbourne House, 1978.Game, Ann, and Rosemary Pringle. “Beyond Gender at Work: Secretaries.” Australian Women: New Feminist Perspectives. Melbourne: Oxford UP, 1986. 273–91.Gill, Rosalind, and Shani Orgad. “The Shifting Terrain of Sex and Power: From the ‘Sexualisation of Culture’ to #MeToo.” Sexualities 21.8 (2018): 1313–1324. <https://doi-org.elibrary.jcu.edu.au/10.1177/1363460718794647>.Google Trends. “Me Too Rising: A Visualisation of the Movement from Google Trends.” 2017–2020. <https://metoorising.withgoogle.com>.Hearn, Jeff, Deborah Shepherd, Peter Sherrif, and Gibson Burrell. The Sexuality of Organization. London: Sage, 1989.Herbert, Carrie. Talking of Silence: The Sexual Harassment of Schoolgirls. London: Falmer, 1989.Jenkins, Henry, Sam Ford, and Joshua Green. Spreadable Media: Creating Value and Meaning in a Networked Culture. New York: New York UP, 2013.Jouet, Josiane. “Digital Feminism: Questioning the Renewal of Activism.” Journal of Research in Gender Studies 8.1 (2018). 1 Jan. 2018. <http://dx.doi.org.elibrary.jcu.edu.au/10.22381/JRGS8120187>.Kantor, Jodi, and Megan Twohey. She Said: Breaking the Sexual Harassment Story That Helped Ignite a Movement. London: Bloomsbury, 2019.Kelly, Liz. “The Continuum of Sexual Violence.” Women, Violence, and Social Control. Eds. Jalna Hanmer and Mary Maynard. London: MacMillan, 1989. 46–60.Legge, Kate. “The Harassment of America.” Weekend Australian 19–20 Oct. 1991: 31.Mackinnon, Catherine. The Sexual Harassment of Working Women. New Haven: Yale UP, 1979.New Mexico in Focus, a Production of NMPBS. 26 Jan. 2018. <https://www.youtube.com/watch?v=LlO5PiwZk8U>.Pringle, Rosemary. Secretaries Talk. Sydney: Allen and Unwin, 1988.Rubinstein, Linda. “Dominance Eroticized: Sexual Harassment of Working Women.” Worth Her Salt. Eds. Margaret Bevege, Margaret James, and Carmel Shute. Sydney: Hale and Iremonger, 1982. 163–74.Sedley, Ann, and Melissa Benn. Sexual Harassment at Work. London: NCCL Rights for Women Unit, 1986.Stephens, Peter. “America’s Sick and Awful Farce.” Sydney Morning Herald 14 Oct. 1991: 1.Storrie, Kathleen, and Pearl Dykstra. “Bibliography on Sexual Harassment.” Resources for Feminist Research/Documentation 10.4 (1981–1982): 25–32.Wise, Sue, and Liz Stanley. Georgie Porgie: Sexual Harassment in Every Day Life. London: Pandora, 1987.Winch, Alison, Jo Littler, and Jessalyn Keller. “Why ‘Intergenerational Feminist Media Studies’?” Feminist Media Studies 16.4 (2016): 557–572. <https://doi.org/10.1080/14680777.2016.1193285>.Zarkov, Dubravka, and Kathy Davis. “Ambiguities and Dilemmas around #MeToo: #ForHowLong and #WhereTo?” European Journal of Women's Studies 25.1 (2018): 3–9. <https://doi.org/10.1177/1350506817749436>.

IntroductionIn Britain, hunger is often hidden in the privacy of the home. Yet otherwise private hunger is currently being rendered public and visible in the growing queues at charity-run food banks, where emergency food parcels are distributed directly to those who cannot afford to feed themselves or their families adequately (Downing et al.; Caplan). Food banks, in providing emergency relief to those in need, are responses to crisis moments, actualised through an embodied feeling of hunger that cannot be alleviated. The growing queues at food banks not only render hidden hunger visible, but also serve as reminders of the corporeal vulnerability of the human body to political and socio-economic shifts.A consideration of corporeality allows us to view the world through the lived experiences of the body. Human beings are “creatures of the flesh” who understand and reason, act and interact with their environments through the body (Johnson 81). The growing academic interest in corporeality signifies what Judith Butler calls a “new bodily ontology” (2). However, as Butler highlights, the body is also vulnerable to injury and suffering. An application of this ontology to hunger draws attention to eating as essential to life, so the denial of food poses an existential threat to health and ultimately to survival. The body’s response to threat is the physiological experience of hunger as a craving or longing that is the “most bodily experience of need […] a visceral desire locatable in a void” in which an empty stomach “initiates” a series of sounds and pangs that “call for action” in the form of eating (Anderson 27). Food bank queues serve as visible public reminders of this precariousness and of how social conditions can limit the ability of individuals to feed themselves, and so respond to an existential threat.Corporeal vulnerability made visible elicits responses that support societal interventions to feed the hungry, or that stigmatise hungry people by withdrawing or disparaging what limited support is available. Responses to vulnerability therefore evoke nurture and care or violence and abuse, and so in this sense are ambiguous (Butler; Cavarero). The responses are also normative, shaped by social and cultural understandings of what hunger is, what its causes are, and whether it is seen as originating in personal or societal failings. The stigmatising of individuals by blaming them for their hunger is closely allied to the feelings of shame that lie at the “irreducible absolutist core” of the idea of poverty (Sen 159). Shame is where the “internally felt inadequacies” of the impoverished individual and the “externally inflicted judgments” of society about the hungry body come together in a “co-construction of shame” (Walker et al. 5) that is a key part of the lived experience of hunger. The experience of shame, while common, is far from inevitable and is open to resistance (see Pickett; Foucault); shame can be subverted, turned from the hungry body and onto the society that allows hunger to happen. Who and what are deemed responsible are shaped by shifting ideas and contested understandings of hunger at a particular moment in time (Vernon).This exploration of corporeal vulnerability through food banks as a historically located response to hunger offers an alternative to studies which privilege representations, objectifying the body and “treating it as a discursive, textual, iconographic and metaphorical reality” while neglecting understandings derived from lived experiences and the responses that visible vulnerabilities elicit (Hamilakis 99). The argument made in this paper calls for a critical reconsideration of classic political economy approaches that view hunger in terms of a class struggle against the material conditions that give rise to it, and responses that ultimately led to the construction of the welfare state (Vernon). These political economy approaches, in focusing on the structures that lead to hunger and that respond to it, are more closed than Butler’s notion of ambiguous and constantly changing social responses to corporeal vulnerability. This paper also challenges the dominant tradition of nutrition science, which medicalises hunger. While nutrition science usefully draws attention to the physiological experiences and existential threat posed by acute hunger, the scientific focus on the “anatomical functioning” of the body and the optimising of survival problematically separates eating from the social contexts in which hunger is experienced (Lupton 11, 12; Abbots and Lavis). The focus in this article on the corporeal vulnerability of hunger interweaves contested representations of, and ideas about, hunger with the physiological experience of it, the material conditions that shape it, and the lived experiences of deprivation. Food banks offer a lens onto these experiences and their complexities.Food Banks: Deprivation Made VisibleSince the 1980s, food banks have become the fastest growing charitable organisations in the wealthiest countries of North America, Europe, and Australasia (Riches), but in Britain they are a recent phenomenon. The first opened in 2000, and by 2014, the largest operator, the Trussell Trust, had over 420 franchised food banks, and more recently was opening more than one per week (Lambie-Mumford et al.; Lambie-Mumford and Dowler). British food banks hand out emergency food relief directly to those who cannot afford to feed themselves or their families adequately, and have become new sites where deprivation is materialised through a congregation of hungry people and the distribution of food parcels. The food relief parcels are intended as short-term immediate responses to crisis moments felt within the body when the individual cannot alleviate hunger through their own resources; they are for “emergency use only” to ameliorate individual crisis and acute vulnerability, and are not intended as long-term solutions to sustained, chronic poverty (Perry et al.). The need for food banks has emerged with the continued shrinkage of the welfare state, which for the past half century sought to mediate the impact of changing individual and social circumstances on those deemed to be most vulnerable to the vicissitudes of life. The proliferation of food banks since the 2009 financial crisis and the increased public discourse about them has normalised their presence and naturalised their role in alleviating acute food poverty (Perry et al.).Media images of food bank queues and stacks of tins waiting to be handed out (Glaze; Gore) evoke collective memories from the early twentieth century of hunger marches in protest at government inaction over poverty, long queues at soup kitchens, and the faces of gaunt, unemployed war veterans (Vernon). After the Second World War, the spectre of communism and the expansionist agenda of the Soviet Union meant such images of hunger could become tools in a propaganda war constructed around the failure of the British state to care for its citizens (Field; Clarke et al; Vernon). The 1945 Labour government, elected on a social democratic agenda of reform in an era of food rationing, responded with a “war on want” based on the normative premise that no one should be without food, medical care, shelter, warmth or work. Labour’s response was the construction of the modern welfare state.The welfare state signified a major shift in ideational understandings of hunger. In the seventeenth and eighteenth centuries, ideas about hunger had been rooted in a moralistic account of divine punishment for individual failure (Vernon). Bodily experiences of hunger were seen as instruments for disciplining the indigent into a work ethic appropriate for a modern industrialised economy. The infamous workhouses, finally abolished in 1948, were key sites of deprivation where restrictions on how much food was distributed served to punish or discipline the hungry body into compliance with the dominant work ethic (Vernon; Foucault). However, these ideas shifted in the second half of the nineteenth century as the hungry citizen in Britain (if not in its colonies) was increasingly viewed as a victim of wider forces beyond the control of the individual, and the notion of disciplining the hungry body in workhouses was seen as reprehensible. A humanitarian treatment of hunger replaced a disciplinarian one as a more appropriate response to acute need (Shaw; Vernon). Charitable and reformist organisations proliferated with an agenda to feed, clothe, house, and campaign on behalf of those most deprived, and civil society largely assumed responsibility for those unable to feed themselves. By the early 1900s, ideas about hunger had begun to shift again, and after the Second World War ideational changes were formalised in the welfare state, premised on a view of hunger as due to structural rather than individual failure, hence the need for state intervention encapsulated in the “cradle to grave” mantra of the welfare state, i.e. of consistent care at the point of need for all citizens for their lifetime (see Clarke and Newman; Field; Powell). In this context, the suggestion that Britons could go to bed hungry because they could not afford to feed themselves would be seen as the failure of the “war on want” and of an advanced modern democracy to fulfil its responsibilities for the welfare of its citizens.Since the 1980s, there has been a retreat from these ideas. Successive governments have sought to rein in, reinvent or shrink what they have perceived as a “bloated” welfare state. In their view this has incentivised “dependency” by providing benefits so generous that the supposedly work-shy or “skivers” have no need to seek employment and can fund a diet of takeaways and luxury televisions (Howarth). These stigmatising ideas have, since the 2009 financial crisis and the 2010 election, become more entrenched as the Conservative-led government has sought to renew a neo-liberal agenda to shrink the welfare state, and legitimise a new mantra of austerity. This mantra is premised on the idea that the state can no longer afford the bloated welfare budget, that responsible government needs to “wean” people off benefits, and that sanctions imposed for not seeking work or for incorrectly filling in benefit claim forms serve to “encourage” people into work. Critics counter-argue that the punitive nature of sanctions has exacerbated deprivation and contributed to the growing use of food banks, a view the government disputes (Howarth; Caplan).Food Banks as Sites of Vulnerable CorporealityIn these shifting contexts, food banks have proliferated not only as sites of deprivation but also as sites of vulnerable corporeality, where people unable to draw on individual resources to respond to hunger congregate in search of social and material support. As growing numbers of people in Britain find themselves in this situation, the vulnerable corporeality of the hungry body becomes more pervasive and more visible. Hunger as a lived experience is laid bare in ever-longer food bank queues and also through the physiological, emotional and social consequences graphically described in personal blogs and in the testimonies of food bank users.Blogger Jack Monroe, for example, has recounted giving what little food she had to her child and going to bed hungry with a pot of ginger tea to “ease the stomach pains”; saying to her curious child “I’m not hungry,” while “the rumblings of my stomach call me a liar” (Monroe, Hunger Hurts). She has also written that her recourse to food banks started with the “terrifying and humiliating” admission that “you cannot afford to feed your child” and has expressed her reluctance to solicit the help of the food bank because “it feels like begging” (Monroe, Austerity Works?). Such blog accounts are corroborated in reports by food bank operators and a parliamentary enquiry which told stories of mothers not eating for days after being sanctioned under the benefit system; of children going to school hungry; of people leaving hospital after a major operation unable to feed themselves since their benefits have been cut; of the elderly having to make “hard choices” between “heat or eat” each winter; and of mixed feelings of relief and shame at receiving food bank parcels (All-Party Parliamentary Inquiry; Beattie; Cooper and Dumpleton; Caplan; Perry et al.). That is, two different visibilities have emerged: the shame of standing or being seen to stand in the food bank queue, and blogs that describe these feelings and the lived experience of hunger – both are vulnerable and visible, but in different ways and in different spaces: the physical or material, and the virtual.The response of doctors to the growing evidence of crisis was to warn that there were “all the signs of a public health emergency that could go unrecognised until it is too late to take preventative action,” that progress made against food poverty since the 1960s was being eroded (Ashton et al. 1631), and that the “robust last line of defence against hunger” provided by the welfare state was failing (Loopstra et al. n.p). Medical professionals thus sought to conscript the rhetorical resources of their professional credibility to highlight that this is a politically created public health crisis.This is not to suggest that acute hunger was absent for 50 years of the welfare state, but that with the closure of the last workhouses, the end of hunger marches, and the shutting of the soup kitchens by the 1950s, it became less visible. Over the past decade, hunger has become more visible in images of growing queues at food banks and stacked tins ready to be handed out by volunteers (Glaze; Gore) on production of a voucher provided on referral by professionals. Doctors, social workers or teachers are therefore tasked with discerning cases of need, deciding whose need is “genuine” and so worthy of food relief (see Downing et al.). The voucher system is regulated by professionals so that food banks are open only to those with a public identity constructed around bodily crisis. The sense of something as intimate as hunger being defined by others contrasts to making visible one’s own hunger through blogging. It suggests again how bodies become caught up in wider political struggles where not only is shame a co-construction of internal inadequacies and external judgements, but so too is hunger, albeit in different yet interweaving ways. New boundaries are being established between those who are deprived and those who are not, and also between those whose bodies are in short-term acute crisis, and those whose bodies are in long-term and chronic crisis, which is not deemed to be an emergency. It is in this context that food banks have also become sites of demarcation, shame, and contestation.Public debates about growing food bank queues highlight the ambiguous nature of societal responses to the vulnerability of hunger made visible. Government ministers have intensified internal shame in attributing growing food bank queues to individual inadequacies, failure to manage household budgets (Gove), and profligate spending on luxury (Johnston; Shipton). Civil society organisations have contested this account of hunger, turning shame away from the individual and onto the government. Austerity reforms have, they argue, “torn apart” the “basic safety net” of social responses to corporeal vulnerability put in place after the Second World War and intended to ensure that no-one was left hungry or destitute (Bingham), their vulnerability unattended to. Furthermore, the benefit sanctions impose punitive measures that leave families with “nothing” to live on for weeks. Hungry citizens, confronted with their own corporeal vulnerability and little choice but to seek relief from food banks, echo the Dickensian era of the workhouse (Cooper and Dumpleton) and indict the UK government response to poverty. Church leaders have called on the government to exercise “moral duty” and recognise the “acute moral imperative to act” to alleviate the suffering of the hungry body (Beattie; see also Bingham), and respond ethically to corporeal vulnerability with social policies that address unmet need for food. However, future cuts to welfare benefits mean the need for relief is likely to intensify.ConclusionThe aim of this paper was to explore the vulnerable corporeality of hunger through the lens of food banks, the twenty-first-century manifestations of charitable responses to acute need. Food banks have emerged in a gap between the renewal of a neo-liberal agenda of prudent government spending and the retreat of the welfare state, between struggles over resurgent ideas about individual responsibility and deep disquiet about wider social responsibilities. Food banks as sites of deprivation, in drawing attention to a newly vulnerable corporeality, potentially pose a threat to the moral credibility of the neo-liberal state. The threat is highlighted when the taboo of a hungry body, previously hidden because of shame, is being challenged by two new visibilities, that of food bank queues and the commentaries on blogs about the shame of having to queue for food.ReferencesAbbots, Emma-Jayne, and Anna Lavis. Eds. Why We Eat, How We Eat: Contemporary Encounters between Foods and Bodies. Farnham: Ashgate, 2013.All-Party Parliamentary Inquiry. “Feeding Britain.” 2014. 6 Jan. 2016 <https://foodpovertyinquiry.files.wordpress.com/2014/12/food>.Anderson, Patrick. “So Much Wasted:” Hunger, Performance, and the Morbidity of Resistance. 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