Hello! We’re here at the fourth and final instalment of my neoliberalism and health series. Part 1 critically engaged with the rhetoric of the “obesity academic” and unpacked some of the problems behind it. Part 2 examined the ways that the neoliberal paradigm has shaped our understanding of bodies–fat bodies in particular. And Part 3 looked at how health has become a set of actions we are morally compelled to take in order to fulfill our roles as “good citizens”. In this final section I look at health as a social justice issue and wrap things up. I will also provide a (rather lengthy) list of references at the bottom for anyone interested. Thanks for reading!
Health as a Social Justice Issue
Offer, Pechey, and Ulijaszek (2010) link the move away from social democratic welfare regimes toward neoliberal, market-oriented policies with the emergence of obesity and its related health conditions. Not only is there a link between market-liberal countries and obesity, in the United States there is positive correlation between food insecurity and obesity (Offer, et al., 2010). They suggest multiple mechanisms by which the obesity rate might be inversely related to socio-economic status: the shift from manufacturing to service jobs as well as the increased reliance on cars have decreased many people’s opportunities for physical activity, while food prices have fallen, especially highly-palatable, energy-dense fast foods, making calories much more easily accessed. Offer, et al. (2010) found that “the more intensive the competitive and market orientation of welfare regimes, the higher the level of body weight, at both aggregate and personal levels” (p. 298). Which is to say, the more neoliberal the country, the higher the rate of obesity at the population level and the more obese the individuals.
This link between neoliberalism and obesity may be due to “work-related insecurity, including low income, poor job mobility and the absence of union protection” which “elevates the likelihood of stress and ill health” (Offer, et al., 2010). Guthman (2011) traces the “systematic production of inequality” through “farm and food policy…trade, labor, immigration, health care, economic development, taxation and financial policy—in other words, just about all policies that have kept American capitalism (barely) afloat” (p. 196). This systemic production of inequality insures that “access to specific foods tends to be closely related to people’s class, race and gender background” (Otero, et al., 2014, p. 11).
The term “food oppression” was coined to describe a “form of structural subordination” since “government support of the fast food industry severely limits dietary choices for low-income, urban African Americans and Latinos” (Freeman, 2007, p. 2245). Both Guthman (2011) and Otero, et al. (2014) call for state intervention to counter the inequalities created by neoliberal policies that have placed the responsibility for health on the individual while creating institutional structures that actively promote inequality and insecurity. These calls for state intervention can be understood within the broader conversation around the social determinants of health.
Although there is an increasing recognition from population health researchers of the impact of the social determinants of health on both individual and population health, the critical linking of the social determinants of health to macro-level political, social, and economic power structures is rare (Raphael, 2006). Although there are multiple conceptions of what constitute the social determinants of health, Raphael (2006) cites a synthesis of several works, which identify 11 key social determinants of health. These include: early life, Aboriginal status, employment and working conditions, education, housing, income and income distribution, social safety net, access to health care, food security, unemployment and employment security, and social exclusion (Raphael, 2006).
The above 11 key social determinants of health help to illustrate how inadequate the neoliberal conception of health as an individual responsibility and project is. While ability to access healthful food and to get adequate exercise are impacted by each of the 11 social determinants of health, the reverse cannot be said to be true. Rather than understanding health as an individual moral imperative, the role of the social determinants of health—and government’s responsibility to provide them—can be understood within the human rights framework (Raphael, 2006). The moral imperative to provide for citizen’s health is rooted in the idea of social justice which “raises issues of equitable distribution of collective goods, institutional resources (such as social wealth), and life opportunities” and “calls for the empowerment of citizens and the establishment of transparent democratic structures to promote social goals” (Raphael, 2006, p. 667).
Health must be understood as being shaped by and existing in the political context of its culture. In the neoliberal paradigm citizenship is understood within a moral imperative to consume ever more goods and services. So too has health been constructed as a site of consumption. But the twin pressures to consume and achieve thinness are at odds with each other. This problem was solved, as many in the neoliberal era are, by the creation of purchasable solutions to the problems inherent to neoliberalism. These solutions involve the creation of diet foods and supplements that bypass metabolic regulation as well as the moralizing discourse around physical activity. The increased obsession around health has opened up markets from functional foods to yoga pants as daywear, though many of these markets are mainly available to middle-class individuals who have the ability to consume for their health.
Obesity rates and access to healthy foods are striated along class and race lines. These striations suggest an institutionalized “food oppression” (Freeman, 2007, p. 2245) made possible by policy that favours those who wield immense political and economic power, and suggest a failure of North American governments to attend to the social determinants of health. In this way, the construction of health in the neoliberal paradigm as an individualized process of consumption and behaviour can be understood as a social justice issue to be countered by strong policy responses to the institutional structures that promote inequality.
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