The Private Life of Public Health: Managing Chronic Disease in an Era of Neoliberal Governmentality

Abstract

Noncommunicable diseases (NCDs) such as heart disease and cancer account for over half of the global mortality burden, and are the leading cause of death in every region of the world except Sub-Saharan Africa. Despite this, they remain off the analytical radarscope in political science. This silence has been coupled with the tendency of public health researchers to frame NCDs as apolitical--largely a product of an individual's risk behaviors. Such an accounting depoliticizes NCDs, as well as public health approaches to their analysis and prevention. This project's central aim is to introduce a political analysis of chronic disease, demonstrating that public health approaches to NCDs exhibit political rationality.

To that end, I explore several questions. How are NCDs accounted in behavioral terms, and how are their risks constructed as apolitical in the public health discourse? Additionally, if public health is presented as a domain of neutral science, how is it that its practices increasingly display market values, including a limited role for the state, a preoccupation with cost efficiency and choice, and the cultivation of the entrepreneurial self who sees her health as a site of investment?

To answer these, I employ a discursive approach, specifically Foucault's framework of government rationality, or "governmentality." It is through the deployment of neoliberal governmentality in three spheres - knowledge, power, and subjectivity - that public health reveals itself not a neutral science, but rather one brimming with the values and logic of the private sector. I develop this argument through a critique of the discipline and practices of public health in three cases: the United States, United Kingdom, and Sweden. Despite exhibiting historically different approaches to health and social welfare, all three show a marked manifestation of neoliberal rationality in public health approaches to chronic disease. The consistency of these findings, in addition to the more general features of the public health discourse, thus allow a conclusion that public health approaches to NCDs are not value-neutral, and are indeed a political phenomenon.