The Politics of Self-Craft

Abstract

As the global challenges posed by chronic, noncommunicable diseases (NCDs) run into longer life expectancies and restrictive fiscal environments, public health programs must respond to these issues. In doing so, health practitioners have framed NCDs as apolitical and largely the product of an individual's risk behavior. Consequently, governance strategies embraced by public health to address NCDs emphasize the role of the private sector, including opportunities for patient self-management of illness. The Expert Patients Programme (EPP), an initiative of the U.K. Department of Health, applies to a range of chronic conditions. Via a case analysis of the EPP, this article argues that public health governance of NCDs is increasingly a project of individuals' self-governance, and that although the techniques of the EPP are constructed as politically neutral, they rather demonstrate a pervasive neoliberal political rationality: in devolving public health responsibilities to the private sector and in constructing the healthy, active participant whose primary aim is to return to an economically productive life.

On Folk Devils, Moral Panics and New Wave Public Health

“…This shift from a collective moral commitment, evidenced in public works programmes, via a combination of legal and behavioural change to a concern with the moral failings of those who are seen as putting their health at risk has occurred at the same time as a shift in the role of the state in healthcare, within a broader shift in the nature of government. These are shifts that have been well-documented within the neoliberal governmentality literature, 4,5 with recent extensions exploring the role of pastoral power in promoting adherent patient subjectivities. 6 According to Foucault 7 the logic of neoliberal governmentality is to “to extend the rationality of the market, the schemes of analysis it proposes, and the decision-making criteria it suggests to areas that are not exclusively or not primarily economic” (p. 79).…”

“…There is intense critique within the medical sociology and ‘Fat Studies’ literature with regards to the assumed objectivity and neutrality of epidemiological science and its apocalyptic predictions around the so called ‘obesity epidemic.’ 5,20-23 This literature also highlights the creation of new moral panics around ‘classed’ demographics of fatness based on geographical location and social background, around “communities of color” 22 and especially the moralisation around childhood obesity – which it is argued, serves as a vehicle for the victim – blaming of working-class mothers. 24 Indeed, it is becoming increasingly clear that the dominant obesity discourse with its emphasis on individual moral responsibility and personal lifestyle modification, ignores biological, social and structural contexts.…”

Perspectives and Challenges for Implementing the Expert Patient Program: A Scoping Review

“…Led by patients with CNCDs, a program to promote self-management is not based on traditional patient education models, but on carrying out educational activities on the management of health conditions by the expert patients themselves, based on sharing experiences and tips necessary to be able to empower other individuals to self-manage their chronic diseases [13][14]21 .…”

Philosophical foundations of research, and the case of the epistemic well, in a least developed nation.

“…Neoliberalism touches all aspects of life and research is no exception. Under neoliberalism, the dominant philosophy in general has been characterized as detached(Kelly, Keck and Lynteris, 2019), decontextualized (Kirmayer, 2012), depoliticized(O and A, 2010), dehistoricized (Dunn, 2000), dissocialized/desocialized (Matusitz and Breen, 2007), deproblematized(Juul Nielsen and Grøn, 2012), reductionist/individualist(Lencucha and Thow, 2019), instrumentalization (Engel and Susilo, 2014), separation (Fisher and Lees, 2016), marketisation(Sell and Williams, 2020), positivist (Smith, 2019) and objectivist (Glasgow, 2012). These dozen features identi ed in the study can be said to make an imaginary well, which the authors try to conceptualise as epistemic well of research (see gure two).…”

“…The lack of historically informed analysis is absent and this lacuna manifests itself when doing health research. (Glasgow, 2012). These dozen features identi ed in the study can be said to make an imaginary well, which the authors try to conceptualise as epistemic well of research (see gure two).…”