Psychological understandings and individualistic theories of human behaviour
and behaviour change have dominated both academic research and interventions
at the ‘coalface’ of public health. Meanwhile, efforts to understand persistent
inequalities in health point to structural factors, but fail to show
exactly how these translate into the daily lives (and hence health) of different
sectors of the population. In this paper, we suggest that social theories of
practice provide an alternative paradigm to both approaches, informing significantly
new ways of conceptualising and responding to some of the most
pressing contemporary challenges in public health. We introduce and discuss
the relevance of such an approach with reference to tobacco smoking, focusing
on the life course of smoking as a practice, rather than on the characteristics
of individual smokers or on broad social determinants of health. This
move forces us to consider the material and symbolic elements of which
smoking is comprised, and to follow the ways in which these elements have
changed over time. Some of these developments have to do with the relation
between smoking and other practices such as drinking alcohol, relaxing and
socialising. We suggest that intervening in the future of smoking depends, in
part, on understanding the nature of these alliances, and how sets of practices
co-evolve. We conclude by reflecting on the implications of taking social
practices as the central focus of public health policy, commenting on the benefits
of such a paradigmatic turn, and on the challenges that this presents for
established methods, policies and programmes.