Neoliberalism and Health Part Three: The Morality of Health.

Happy Saturday! It’s Part 3 of my series on neoliberalism and health. If this is your first time reading you may want to go back to Part 1: The Obesity Epidemic where I engaged critically with the construction of the “obesity epidemic” and suggest that it is an inaccurate and alarmist construct. In Part 2: The Fat Body in the Neoliberal Context I looked at how we have come to understand, culturally, the role and significance of the fat body in the neoliberal paradigm. In this third section I look at how health has become a moral imperative and its implications for how we understood the roles of food and exercise in our lives.

Although I source along the way, for those of you who are interested in reading and exploring more I will be posting a complete reference list with the last post in the series.

The Morality of Health

Neoliberalism and the Body as Site of Citizenship

Unlike in decades past, where citizenship was conceived of as necessitating both participation in the public sphere and the dual contributions to society of the production and consumption of goods, the shift of production to off-shore sites has lead to a reconceptualization of the neoliberal citizen as “the citizen consumer whose contribution to society is mainly to purchase the products of global capitalism” (Guthman & DuPuis, 2006, p. 443). Guthman and DuPuis (2006) further argue that consumption has superseded colonization as a Western project, thus, “we buy and eat to be good subjects” (p. 443).

However, the ill health associated with excess consumption conflicts “too uncomfortably with the image of the ‘good citizen’ as someone who actively participates in social and economic life, makes rational choices and is independent, self-reliant and responsible (Galvin, 2002, p. 108). Thus, the body in the neoliberal context is subject to a constant tension between the duties to “achieve both eating and thinness” (Guthman & DuPuis, 2006, p. 443).  Those who are able to walk the tightrope between consumption and self-discipline vis-à-vis thinness are able to perform a neoliberal success through the body (Guthman, 2009). The inherent contradiction of the neoliberal citizen is that she must simultaneously embrace and eschew the Puritan ethic of self-sacrifice. That is, she must self-sacrifice through the deprivation and discipline considered necessary to achieve thinness, while engaging in the hedonistic consumption of readily available, highly palatable foods. Thus, “spending money on becoming thin is the perfect solution for both neoliberal subjectivity and neoliberal capitalism more broadly” (Guthman, 2009, p. 193).

Both Schee (2008) and Guthman and DuPuis (2006) borrow Foucault’s concept of governmentality to describe the ways that dominant forces shape a self-governing ethic that creates a “hypervigilance about control and deservingness” which then “creates divisions between active citizens, those who can manage their own risks, and ‘targeted populations’, those who require intervention in management of risks” (Guthman & DuPuis, 2006, p. 443). Colls and Evans (2009) argue that even those who are at a ‘normal’ weight are considered at “risk of becoming ‘overweight’ which in turn is a risk for becoming ‘obese’” (p.1013), thus all bodies are subject to that hypervigilance and surveillance. Those currently construed as active citizens are viewed as self-disciplined and rational, while those who fail to achieve the twin duties of eating and thinness are viewed as irrational and lacking discipline (Guthman & DuPuis, 2006). It is in this way that class (and its corollaries race and gender) is performed through the body (Guthman & DuPuis, 2006).

Healthism

The conflation of health with thinness, according to Wright, O’Flynn, and Macdonald (2006) creates powerful internalized edicts for how people should understand themselves and live their lives. The concept of healthism was developed by Crawford to describe the morally charged discourse in which individuals are held responsible for their own health (Wright, et al., 2006), requiring a balance between the hedonistic consumption patterns of the neoliberal era and a preoccupation with health practices (Ayo, 2012). Far from maximizing health, however, the “healthism discourse” may have deleterious effects for many, from the lopsided social capital afforded those who are and are not able to meet societal body ideals, to the problematic behaviours people (especially young women) resort to when attempting to meet the imperative for slimness (Wright, et al., 2006, p. 708). This discourse encourages the constant surveillance and management of the body as a morally positive act for both the individual and society and places the burden for health at the feet of the individual rather than society (Wright, et al., 2006; Ayo, 2012). Thus, individual choices regarding exercise and food habits take on a complex moral burden.

Exercise

The choice to exercise is not morally neutral in contemporary North American culture. Since bodies reflect cultural meanings in their shape, movement, and adornment, “the body shows the work done on it both intentionally and unintentionally” (Wright, et al., 2006, p.709). In an increasingly secular society, the concept of individual morality has become fragmented, which may explain in part why “the pursuit of fitness and wellness has become a path of individual and moral action” (Conrad, 1994, p. 388). The pursuit of fitness has become a morally positive act individuals can take for not just themselves but for the good of society as well. The conflation of health with slimness and the moral imperative toward health has lead, Conrad (1994) argues, to a “morality play which takes the form of getting into shape” in which the “forces of good (slimness) and evil (fatness) are pitted against each other” (p. 388).

This morality play can also be seen in the health promotion campaigns around leisure activities (Fullagar, 2002). So-called “active leisure” (for example, jogging, sports and other forms of exercise enacted during leisure time) can be “understood as political in the sense that they are neo-liberal practices implicated in the everyday exercise of power over the self” (Fullagar, 2002, p. 69). In the same way that exercise itself cannot be considered a morally neutral activity in the neoliberal era, so health promotion must be understand in the context of governance and biopower/biopolitics (Fullagar, 2002). Biopower can be understood as “forms of power exercised over persons specifically in so far as they are thought of as living beings: a politics concerned with subjects as members of a population, in which issues of individual sexual and reproductive conduct intersect with issues of national policy and power” (Gordon, 1991, p. 4-5). According to Fullagar (2002), despite little change in recreational physical activity rates, health promotion policies pushing exercise are still considered “the best buy in public health” due to their low cost and reinforcement of the individual responsibility for health (p. 71). She also argues that the discourses used in health promotion frame self-governance as a route to freedom. These discourses, however, reinforce social stratifications, since certain populations have lower rates of physical activity and are thus considered in need of governmental intervention (Fullagar, 2002).

In this same way, the experience and understanding of exercise and fitness are not universal across gender lines. In Wright, et al. (2006)’s study of college-aged men and women’s food and exercise habits, fitness was often described as an enabling and embodied experience for the males, one which increased their capacity to respond to the demands and pleasures of life, whereas the female participants framed their experiences of fitness and exercise as being a tool (along with limited food intake) to achieve slimness.

 The Politics of Food

The neoliberal mandate to consume as the major form of citizenship can be understood, Guthman (2009) argues, as a reaction against the “consume less” mandate of the 1970s crisis period. Much like consumption is understood as a moral imperative in the neoliberal paradigm, the choice of which foods to eat is equally imbued with moral weight. Wright, et al. (2006), in their survey of college-aged students found that food choices were made within a moral context, with foods deemed “healthy” eaten for their proposed nutritional benefits, while “bad” foods were eaten for pleasure (and often accompanied by guilt). The mandate to consume ever more goods and services is extended to both those whose basic needs have been met and those whose basic needs are unmet (Guthman, 2009).

            Fast Food. Otero, Pechlaner and Gürcan (2014) describe the “neoliberal diet” as “largely composed of ‘energy-dense’ foods with high contents of fat and empty calories with low nutritional value” (p. 1), otherwise known as junk food. While those in the upper classes in North America have increasing availability to high-quality food thanks, in large part, to globalization, those living in poverty are largely limited to this neoliberal diet. Due to the natural limits placed upon human consumption, one way to increase profits in the face of inelastic demand was to “turn to processing as the means to maintain profit making” (Otero, et al., 2014, p. 3).

The fast food industry, in many ways, serves as the ideal case study for the neoliberal project. The increased availability of food, due in large part to government supports in the form of subsidies, as well as the deregulation of health and safety mechanisms allows fast food to fill the need created by the attack on living wages (Guthman, 2007; Otero, et al., 2014; Guthman & DuPuis, 2006). Thus,

Fast and convenient food has been a triply good fix for American capitalism. It entails the super-exploitation of the labor force in its production, it provides cheap food to support the low wages of the food and other industries by feeding their low-wage workers, and it absorbs the surpluses of the agricultural economy, soaking up . . . the excesses of overproduction to keep the farm sector marginally viable (Guthman, 2011, p. 177).

While junk food is certainly cheaper than its unprocessed counterparts, therefore constituting a better caloric return for those with limited funds (Otero, et al., 2014), the problem of junk food goes beyond class lines. Otero, et al. (2014) cite Block, et al. (2004) who found that access to quality and healthy food is racialized, with 80% Black neighbourhoods boasting an average of 2.4 fast food restaurants per square mile as compared with 20% Black neighbourhoods which have 1.5 per square mile. More important than median household income was percentage of Black residents in a given neighbourhood in predicting the number of fast food restaurants (Otero, et al., 2014). That is, in relation to food access as it relates to fast food restaurants, race is a more important factor even than class.

Another issue in the propagation of fast food in certain communities has been the use of “a ‘scientific’ approach to optimize foods geared to reach a combination of the ‘bliss point’ and ‘mouth feel’ that creates addiction” (Otero, et al., 2014, p. 13). These foods are not made with nutrition in mind, but with both immediate and long-term profits as the driving force, they are engineered to be as addictive as possible, and are increasingly being marketed towards Black and Hispanic communities (Otero, et al., 2014).

         Nutritionism. Despite essentially unchanging recommendations over what constitutes a healthful diet (a largely plant-based diet with few processed foods), the public is more confused than ever about what to eat (Scrinis, 2008). Scrinis attributes this confusion, in part, to what he has termed “nutritionism”, which he coined to describe the focus of dieticians, nutrition scientists and public health authorities on individual nutrients rather than foods as a whole. He argues “this focus on nutrients has come to dominate, to undermine, and to replace other ways of engaging with food and of contextualizing the relationship between food and the body” (Scrinis, 2008, p. 39). He also cites noted nutrition and sociology professor Marion Nestle’s critique of the way that the food industry has lobbied the United States government’s to create dietary guidelines that suggest lower consumption of certain nutrients such as fat and sugar rather than lower consumption of the actual foods that contain high levels of fat and sugar (Scrinis, 2008). He criticizes her approach, however, for failing to consider the way that the popularity of nutritionism itself has allowed these types of guidelines to be considered acceptable (Scrinis, 2008).

The dominance of the nutritionism paradigm works in concert with the acontextual use of the BMI to displace other ways of understanding and experiencing the food-body relationship (Scrinis, 2008). Scrinis (2008) uses the example of the promotion of margarine in place of butter to describe the way in which healthism supersedes other ways of using and experiencing food (for example, pleasure). Nutritionism has also been heavily used in the marketing of various foods over the past three decades, often using the qualities of a single nutrient to imbue a sense of health into the product as a whole (Scrinis, 2008). The increased use of so-called “functional foods” (those marketed with explicit health claims) has created, in the neoliberal tradition of creating “purchasable solutions to the problems it generates” (Guthman & DuPuis, 2006, p. 441), a new set of needs (Scrinis, 2008). These needs include “nutritional information, dietary assessment, and advice, and…nutritionally engineered and functionally marketed foods” (Scrinis, 2008, p. 46).

Stay tuned for the final entry in my Neoliberalism and Health series: Health as a Social Justice Issue.