Thursday, January 14, 2010

The Comment From Hell: On Health and Ideologies of Health

I just posted a comment on Sociological Images, in relation to a post of theirs on images of obesity and the environment, and how the two are linked in the concept of personal responsibility. What interested me was their discussion of health ideologies.

So this was the comment-from-hell that I left in response to the post. (Sorry it's so long, Sociological Images. But if you will keep posting interesting things that make me reflect sociologically...)

...the most interesting thing about this shift in ideologies of health (and one reason it’s linked with environmentalism) is the concept of personal responsibility. Health used to be understood as something that ‘happened to’ people. That, too, was a mis-reading of the situation, since disease usually spread because of poor living conditions related to poverty, and this wasn’t acknowledged in social policy until about the early twentieth century. Nonetheless, for centuries a person’s health status was not understood as something that they could do much about.

But today, in our consumer society, health is seen as an issue of personal responsibility. Need to lose weight? You should be paying for the best gyms and the most expensive fresh, preferably organic meat and produce. You shouldn’t be poor and stretched for time, without the means to make decent meals and without access to exercise facilities, and with all manner of difficulties relating to living conditions or educational background. Need to recover from an injury? Pay for the best healthcare practitioners, so that you can be back to work and contributing to the economy as quickly as is humanly possible (preferably quicker). If you can only afford to wait for the NHS, be careful – if long-term impairment results, and it affects your employment potential, you’ll be punished for it later. Do not ever make the wrong health-related choices. You will be forever reminded of this – while other situations, like doctors’ mistakes, will go easily forgotten.

Among the most affected by this new ideology of health-as-personal-responsibility are disabled people, who are seen by practitioners and the public alike as being personally responsible for disability. We are not, of course, because disability is a socially created form of oppression. But you’d never know that to listen to a doctor or physiotherapist talk to a disabled person (or to read the Daily Mail reflecting on Incapacity Benefit). We must do our exercises and buy the best rehabilitation equipment and work impossibly hard towards ‘recovery’ and definitely, definitely not end up dependent on the state for our unreasonably high living expenses.

Like Melissa says above about the environment, then: the concept of personal responsibility in health is being used to distract us from the social, political and economic causes of poor health. We need to refocus social policy on reducing health inequalities, as well as onto education, social welfare and (not least) health services. A healthy society would be a society where everyone could afford, and was empowered, to make healthy life choices. It’s a shame that the ‘obesity project’ gives us the opposite message.

In memememe news, I have been tired, pained and sublux-y for the last few months, hence the NaBloPoMo FAIL and the dearth of content here. I shall endeavour to fix that. I managed to get my dissertation in (still waiting for the result) and am working on journal articles. After which there will be PhD applications. Treadmill, anyone? Fortunately, otherwise life is good.