Neoliberalism and Health Part 4: Health as a Social Justice Issue

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).

Conclusion

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.

References

Agger, B. (2010). Bodies of knowledge: Considerations of science, exercise, food and body politics. disClosure: A Journal of Social Theory,  19: 1-6.

Ayo, N. (2012). Understanding health promotion in a neoliberal climate and the making of health conscious citizens. Critical Public Health, 22(1): 99-105.

Canadian Diabetes Association. (2014). Body Mass Index (BMI) Calculator. Retrieved April 18, 2014 from http://www.diabetes.ca/diabetes-and-you/healthy-living-resources/weight-management/body-mass-index-bmi-calculator

Colls, R, & Evans, B. (2009). Introduction: Questioning obesity politics. Antipode, 41(5): 1011-1020. DOI: 10.1111/j.1467-8330.2009.00705.x

Coulter, K. (2009). Women, poverty policy, and the production of neoliberal politics in Ontario, Canada. Journal of Women, Politics & Policy 30(1): 23-45. DOI: 10.1080/15544770802367788

Eknoyan, G. (2007). Adolphe Quetelet (1796-1874)—the average man and indices of obesity. Nephrology Dialysis Transplantation: 1-5. doi:10.1093/ndt/gfm517

Freeman, A. (2007). Fast food: Oppression through poor nutrition. California Law Review, 95(6): 2221-2259.

Fullager, S. (2002). Governing the health body: Discourses of leisure and lifestyle within Australian health policy. Health (London), 6(1): 69-84.

Galvin, R. (2002). Disturbing notions of chronic illness and individual responsibility: Towarda genealogy of morals. Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, 6(2), 107-137.

Gordon, C. (1991). Governmental rationality: An introduction. In B. Burchell, C. Gordon, and P. Miller (Eds) The Foucault Effect: Studies in Governmentality. Chicago: University of Chicago Press.

Guthman, J. (2009). Neoliberalism and the constitution of contemporary bodies. The Fat Studies Reader. New York: NYU Press.

Guthman, J. (2011). Weighing in: obesity, food justice, and the limits of capitalism. Berkeley: California University Press.

Guthman, J. & DuPuis, M. (2006). Embodying neoliberalism: economy, culture, and the politics of fat. Environment and Planning D: Society and Space, 24: 427-448.

Lake, A. & Townshend, T. (2006). Obesogenic environments: exploring the built food environment. The Journal of the Royal Society for the Promotion of Health, 126(6): 262-267.

Macdonald, D. (2011). Like a fish in water: Physical education practice in the era of neoliberal globalization. Quest, 63(3): 36-45. DOI: 10.1080/00336297.2011.10483661

Monagahn, L. F., Colls, R., & Evans, B. (2013). Obesity discourse and fat politics: research, critique and interventions. Critical Public Health, 23(3): 249-262.

National Heart, Lung, and Blood Institute. (2014). Calculate Your Body Mass Index. Retrieved April 18, 2014 from https://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm

Offer, A., Pechey, R., Ulijaszek, S. (2010). Obesity under affluence varies by welfare regimes: The effect of fast food, insecurity, and inequality. Economics and Human Biology, 8: 297-308.

Oliver, J. E. (2006). The politics of pathology: How obesity became a disease. Perspectives in Biology and Medicine, 49(4): 611-627. DOI: 10.1353/pbm.2006.0062

Otero, G. Pechlaner, G. & Gürcan, E. C. (2014). The neoliberal diet: Fattening profits and people. In S. Haymes, M. Vidal de Haymes, and R. Miller (Eds) Routledge Handbook of Poverty and the United States (Forthcoming). Routledge.

Pekar, T. (2011). Body mass index. IMS Magazine (Summer): 21-22.

Raphael, D. (2006). Social determinants of health: Present status, unanswered questions, and future directions. International Journal of Health Services, 36)4): 651-677.

Rich, E. & Evans, J. (2005). ‘Fat ethics’—The obesity discourse and body politics. Social Theory and Health, 3: 341-358. DOI: 10.1057/palgrave.sth.8700057

Scrinis, G. (2008). On the ideology of nutritionism. Gastonima: The Journal of Food and Culture, 8(1): 39-48.

Swinburn, B., Egger, G., & Raza, F. (1999). Dissecting obesogenic environments: the development and application of a framework for identify and prioritizing environmental interventions for obesity. Preventative Medicine, 29: 563-570.

The Endocrine Society. (2009, June 22). Widely Used Body Fat Measurements Overestimate Fatness In African-Americans, Study Finds. ScienceDaily. Retrieved April 13, 2014 from www.sciencedaily.com/releases/2009/06/090611142407.htm

Wright, J., O’Flynn, & Macdonald, D. (2006). Being fit and looking healthy: Young women’s and men’s constructions of health and fitness. Sex Roles, 54: 707-716.

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4 thoughts on “Neoliberalism and Health Part 4: Health as a Social Justice Issue

      1. Thanks for the quick reply and resources! I asked partly because I didn’t know if you had published this in another form elsewhere or anything — I’ll work with those citation categories if you haven’t. And I can certainly share with you whatever I manage to put together — it might not be for a few weeks though. My “about me” web presence is linked if you click my name in these comments I think, and you can let me know through there or some other way if you’d like me to be able to email you — otherwise I can share with you when/if I post something publicly or publish.

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