In recent years, the concept “neoliberalism” has emerged to represent everything that is bad, or at least nothing good. Some have questioned whether the concept is so overused to the point of being meaningless. In public health, there has been an explosion of neoliberal analyses. In an editorial for Critical Public Health, Kirsten Bell and Judith Green lament the ”reductive ways neoliberalism often tends to be used.” One such reduction is the characterization of the beneficent welfare state as under-attack from maleficent neoliberalism. This characterization is not only simplistic, but it misunderstands the effects of neoliberalism on the provision of welfare. I suggest that the proliferation of “lifestyle” practices and policies can better help us understand the relationship between neoliberalism and the welfare state, particularly in relation to “obesity” governance.
The neoliberal state has not simply replaced the post-war welfare state, where the latter represents the ‘good old days’ of communal concern, while the former is a bleak dystopia of competition. Such narratives are commonplace, yet they ignore the disciplinary features of post-war state institutions that secured and protected some sections of the population while marginalizing and excluding others. This characterization also ignores the continued provision of social services by neoliberal governments.
While neoliberal ideas have transformed the provision of health care to operate according market logics, David Garland notes, ”there is no state in the industrialized world that lacks a developed welfare state apparatus or which does not devote a significant fraction of its budget to social expenditures.” In Australia, for example, ”health expenditure grew from $50.3 billion in 1989–90 to $154.6 billion in 2013–14 in real terms (adjusted for inflation).”
Neoliberal ideas are applied and enacted differently in different countries and localities. Nevertheless, ‘welfare’ is still part of neoliberal governmentality, but like freedom it is recoded and edited. This has involved the narrowing of who the welfare is for and the means by which it is determined. The neoliberal emphasis on individual freedom and responsible choice intensify and narrow the community that is cared for and secured. A central device that enabled this narrowing effect of neoliberal welfare is lifestyle.
Lifestyle: A Biopolitical not a Healthism Intervention
Released by the National Cancer Institute, CC BY-SA 3.0 de, via Wikimedia Commons
Emerging in the mid-20th century, the notion of lifestyle came to occupy the attention of epidemiologists and health policy-makers concerned with the association between certain behaviors and incidence of certain diseases. To varying degrees, governments in the industrialized world sought to intervene in health-related behaviors such as smoking, drinking, diet and exercise in order to prevent diseases and conditions, such as diabetes, cardiovascular disease, and cancers. More recently, “obesity” has become the primary target of national and international lifestyle health-strategies.
The 1980s and 90s lifestyle interventions gave rise to healthism critiques from Robert Crawford, Petr Skrabenak and others. Healthism critiques argued that lifestyle health programs are unjustified government interventions into the lives of individuals. While I have sympathies with these critiques, they have an air of Cold War paranoia about them where any government intervention is seen as a step towards serfdom. The healthism critique also assumes stable ideas of freedom, the State, individuals and legitimacy.
Instead, I find Michel Foucault’s notion of biopolitics provides a more useful analytic lens. The biopolitical critique of lifestyle argues that lifestyle is problematic not because it illegitimately intervenes in freedom but because it recodes freedom and social relations in a way that isolates individuals and makes them responsible for outcomes that are not necessarily within their control. Biopolitics produces a population that is to be cared for. Yet there are those who do not fall within this population. They are implicitly or explicitly set apart and excluded from the population of care. The biopolitics of lifestyle masks a shift from a socialized welfare that purports to secure the many, to an individualized welfare that secures those who are able to care for themselves.
In order to address and modify the health-related behaviors of individuals, governments mobilized a vast array of techniques and strategies. Epidemiologists, personal trainers, mHealth (mobile health) devices, nutritionists, celebrity chefs, school pedagogy, reality television, family physicians, scales, and BMI calculators are just some of the threads that comprises the lifestyle network of governance.
Lifestyle works as a network that enables the isolation of the bodies and choices of individuals and governs them in relation to the population. If the individual is able to adopt and develop a ‘healthy lifestyle’ they remain inconspicuously nestled within the secured population. However, when the bodies and choices of individuals deviate from norms associated with the health of the population, they become exposed to disciplinary practices of exclusion and marginalization. For example, in Britain, there have been calls for welfare benefits to be withheld from people regarded as “obese” and do not attempt to lose weight.
Incentives also operate in the lifestyle network. Strategies such as social marketing campaigns, tax-breaks, and workplace health programs seek to entice the individual towards a ‘healthy lifestyle’. However, these also serve as avenues to judge the failure of others. Social marketing campaigns instruct the population not only about their own health and behaviors, but how to judge the health-related behaviors of others and who is deserving of support. The individual becomes responsible for their own welfare and cannot expect social welfare provision to protect them from their own choices or the inability to choose due social and structural factors that are beyond their control.
Lifestyle makes visible those who are responsible and those who purportedly harm society, while hiding broader structural influences such as growing income inequality. Within the logics of lifestyle, people’s health status is due to responsible choice. Therefore, health inequalities are understood as irresponsible choosing. As such, those with diseases or engaged in behaviors associated with certain diseases not only harm themselves but are regarded as financially burdening the wider population. This logic is then used to justify implicit or explicit exclusion from care and stigmatization.
Atomization of Social Relations
The dominance of responsibility in the lifestyle rhetoric of choice blurs the boundaries between the public and the private realm. These blurred boundaries are governed through various techniques of social marketing and smartphone apps to orchestrate the everyday life of the individual. Lois McNay suggests that such techniques ”atomizes our understanding of social relations, eroding collective values and intersubjective bonds of duty and care at all levels of society.” Choice and responsibility are mobilized in the lifestyle network to recode social welfare as an individual’s capacity to provide their own welfare through private health insurance, gym membership and other self-care programs.
As such, the biopolitics of lifestyle depoliticizes political and social relations by turning them into privatized relations of consumer choice that individuals are responsible for making. Rather than deep collective values and public goods, the network of lifestyle fragments social relations and thins out the idea of public health, education and security. In this context, it is only a collection of self-governing individuals that remain.
The individual that appears to be self-governing and responsible, that is the healthy subject, is enfolded into the secured population, while the irresponsible chooser with an unruly body or lacking the means to appear responsible is left exposed and vulnerable. That is, the lifestyle network serves to bracket off hard and historically constituted issues of social determinants of health and subsequently depoliticizes public health by reducing health and welfare to individual choices and consumer behaviors. Lifestyle and the thin sociality of neoliberal governmentality allow for blame and exclusion, but little room for collective care or solidarity. In the governance of public health, collective welfare and social security are recoded as an individual’s abilities to secure themselves and not be a burden on others.
Increasingly what is needed is not a self-styled security but solidarity with the excluded. As Foucault states in an interview – ”The Risks of Security” – ”we should expect our system of social security to free us from dangers and from situations that tend to debase or to subjugate us.” The network of lifestyle alters the social landscape such that we do not all share the same fate. Creative forms of resistance and solidarity are needed to thicken social relations and foster practices of collective care.
