Healthy Cities, Governable Subjects

Ever wonder what it would be like to live in a city where everyone was healthy, wealthy and wise? A city where there were no Big Macs, where everyone rode their bicycles to work and people just seemed to be in better spirits? If you are looking for such a utopia, Manchester England may be your Xanadu.

The newswires were abuzz yesterday with reports that Britain’s National Health Service has cooperated with local authorities in Manchester to provide incentives to citizens to eat more fruit, spend more time at the gym, engage in more preventative health measures and just lead a more productive and healthy lifestyle. Manchester is hoping to fight the fat with a reward system that will operate, for all intents and purposes, like a retail loyalty card program. But rather than earning credit for opening their wallets only, citizens will earn points for spending their hard earned dollars on fresh fruits and veggies and their leisure time doing pilates.

According to a report in the Associated Press, Manchester residents will be able to “swipe their rewards cards and earn points every time they buy fruits and vegetables, use a community swimming pool, attend a medical screening or work out with a personal trainer. Points can be redeemed for athletic equipment, donations to school athletic departments and personal training sessions with local athletes.”

It’s a public health craze that appears to be gaining traction in the UK. Tower Hamlets, the third most deprived London borough, will be undergoing an extreme makeover of its own — according to a report by the BBC, almost £10 million of government and local money has been earmarked for a “Healthy Cities” initiative that will turn the community into a place where people will find it easier to exercise and choose healthy food: walking and cycling routes will be extended, food co-ops will be established and fast food outlets will be enlisted in a campaign to offer more healthy meals on their menus.

With below average life expectancy, low exercise rates and unhealthy eating habits, the people of Tower Hamlets are thought to be at the centre of what the local primary care trust calls an “obesity epidemic.”

Beyond Manchester and Tower Hamlets, towns in other countries have tried similar programs. Varallo, a small town in northern Italy, offered cash rewards for residents who lost weight and kept it off for 12 months. Some U.S. companies wanting to keep health care costs down have also established reward programs for their staff through what HR types would call value-added employee assistance programs. For example, the Michigan-based Freedom One Financial Group sent 21 employees who met weight-loss goals on a four-day Caribbean cruise in 2005.

What does all of this tell us about the politics of public health today?

In The Politics of Health in the Eighteenth Century, Michel Foucault accounts for the emergence of a medical services market, the professionalization of medical practitioners, the development of benevolent associations and learned societies concerned with the observation of social conditions and innovation in medical techniques, among other things. While the state plays a variety of roles in relation to these developments, he argues, the ways in which health and sickness became matters of problematization ‘beyond the state’ contribute to an awareness of them as elements of population management.

Central to the politics of health in this period is the emergence of concern for the well-being of the population as an essential objective of political power – this is a view of power that concerns itself not with the capacity to dominate and repress but to produce things, to manage conduct and coordinate new ways of thinking and behaving. This shift towards policing the social body that Foucault argues was peculiar to the 18th century was related to the broader consequences of the industrial period’s demographic transition, in which an urgent need arose to rapidly integrate increasing numbers of people into the apparatus of production and to control them closely. It was these forces, he argues, that made the notion of “population” appear not just as a theoretical concept, but “as an object of surveillance, of analysis, of intervention, of initiatives aimed at modification.”

The cases of Manchester and Tower Hamlets, Varalla, and many others illustrate not only Foucault’s argument that the exercise of power is concerned increasingly with managing and channeling human conduct (rather than dominating or repressing it) but it also show that while non-governmental bodies play a key role in contemporary health politics, the state also plays a fundamental role in terms of ensuring that “the state of health of a population as a general objective.” Whether this is a good thing, a bad thing or something more dangerous remains to be determined.

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Filed under Health Issues, Health Promotion, Lifestyle Risks, Public Health, Surveillance

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