塵蟎治理：小兒過敏風險、健康消費與密集親職

Abstract

小兒過敏的風險治理，是當代台灣重要的健康議題。醫學典範下的過敏疾病具有遺傳、免疫系統狀態、空氣汙染、過敏原…等多重歸因。本研究視治理為動態的過程，面對多重風險因子的過敏學理，欲透過多方行動者的實作來理解治理的圖像。本論文旨在瞭解台灣的醫學專家、國家和商業組織在過敏治理上的特質及影響；並探討治理中的主角─家長如何編排親職工作以防治小兒過敏風險因子，社會位置差異如何影響父母親具備的相關知識與行動。本研究採取多重研究方法，資料來自田野觀察、歷史檔案資料以及29個家庭的深度訪談。以下為主要五項研究發現：（1）多方行動者透過知識建構、健康傳播及健康親職共同參與小兒過敏的風險治理，非人的行動者─塵蟎─在治理歷程中成為重要節點之一。（2）眾多過敏風險因子並沒有相應的處理手段，兩者間存在落差。治理逐漸限縮於特定的小環境風險─家庭環境、母體環境─形成家庭化、媽媽化的風險治理特色。即便某些做法在學理上仍有爭議，各種實際的防治策略與衍生的知識和商品共同強化了家庭化、媽媽化的過敏風險治理特徵。（3）限縮的環境風險治理特徵加強了父母親對於孩子健康的道德責任。在過敏風險因子的處理上，親職工作呈現出消費密集、知識密集並且勞心勞力的特色，我稱為「財識心力密集」的健康親職。過敏風險治理的知識不僅作為當代家長的育兒指南，也成為年長父母重新詮釋過去親職實作的工具，經常伴隨著自我譴責的追悔態度。（4）商業組織在2000年前後加入過敏風險治理的行列，過去販售日用品和家電商品的廠商成為過敏治理中的重要新引擎，超越既有的醫療產業範圍。防蟎抗過敏商品的行銷是台灣家長過敏知識的重要來源，廠商健康傳播的內容更聚焦塵蟎與消費的解決手段。（5）台灣在2013年發生的防蟎洗衣精含農藥成分之爭議為例，此爭議鬆動了塵蟎風險因子的治理現況，家長、廠商、各政府部門、化學專家、塵蟎專家和醫師對於防蟎風險認知的差異始浮上檯面，一方面彰顯出台灣政府在化學物質管制上的高度分工特性，並凸顯出許多為了處理兒童過敏風險的健康商品，可能非意圖地在過敏治理的家庭環境、生態環境及政策環境上產生新的風險問題。綜結本文，在當代的小兒過敏治理中，國家的角色較為薄弱，廠商做為健康傳播新引擎，與既有專家知識結合，將過敏風險的處理朝向個人化或家庭化的環境控制縮限，並反映在台灣家庭財識心力密集的親職實作上。然而超越個人及家庭層次的生態環境風險─環境汙染、空氣汙染等過敏風險因子，需要更多制度性的政策、政府更有力地介入，才能更清楚看見過敏風險治理的整體樣貌。

Childhood allergic diseases are currently a crucial health concern in Taiwan. This study examined the risk governance of childhood allergies. This study involved determining how, during different historical periods, experts, the government, and industries in Taiwan have recognized these risk factors; examining the management practices that they have recommended; and investigating the effects of these management practices on parents. In addition, this study examined the knowledge and practices of parents, and describing their gender, generation and structural difference. The data used in this study include information obtained from archives, interviews, and participant observation. The five major findings of this study are described as follows: 1） During the process of governance, knowledge producers, health promoters, and parents participate in preventing and reducing the risks of childhood allergies. Moreover, a non–human actor, the dust mite, plays a critical role in connection with other participants. 2） However, not every risk factor has a corresponding strategy for reducing or preventing risks. Therefore, a gap exists between risk assessment and management, and the environmental risks associated with childhood allergies are restricted to specific “environments” on the micro level, especially the maternal environment and household environment. The environmental controlling strategies involve knowledge, strategies, and commodities. 3） The limited environmental risks reinforce the moral responsibility of parents regarding the health of their children. This study follows the concept “intensive parenthood” to describe the role of parenting in preventing and reducing the risks of allergies. Parenting is financially expensive, knowledge–rich, labor–intensive, and emotionally absorbing. Younger parents collect information from both the expert–guided biomedicine paradigm and situated knowledge provided by lay’s experience. 4） Risk governance became increasingly market driven in approximately 2000. Corporations that are related to preventing and reducing the risks of allergies have shifted from traditional medical industries to industries that manufacture household electronic appliances and cleaning products. Corporations focus on dust mites and identify product consumption as the primary solution. 5） In 2013, there has been a controversy regarding anti–dust–mite products in Taiwan. The deficit in Taiwanese regulations was discovered because of public concerns. In conclusion, regarding the multiple risks associated with allergies, the current solutions are often reduced to a specific range of “environmental” controls, which are combined with individualized behavior management. The commercial corporations play an essential role in it. However, the anti–dust–mite product unintentionally causes new risks on the ecological environment, parenting, and regulatory policies.