A governmental analysis of the Stop the Spread campaign
In a novel departure in Irish public health promotion, 250,000 free measuring tapes were distributed via pharmacies throughout Ireland to encourage people to measure their waists in 2011. This was part of the Stop the Spread (STS) campaign which sought to change people's perception of a healthy and normal waist size. Its central message was that a waist circumference above 32 and 37 inches for women and men, respectively is overweight and an indicator of particular health risks. This chapter suggests that STS campaign illustrates a change in biopedagogical instructions and techniques in health promotion. It focuses on some recent Foucauldian scholarship in order to extend the relevance of such concepts to twenty-first-century movements in biopolitics and neoliberalism, and in order to set out an analytical framework by which STS can be analysed.
This chapter establishes some of the conceptual cornerstones associated with governmentality thinking and considers their implications for an analysis of health and health policy in Ireland. It begins by laying out Michel Foucault and others' understandings of governmentality, and follows this by exploring how governmentality literature has been deployed within studies of health and health policy analysis. The chapter provides a context to some of the specificities and contingencies of Irish health policy debates. It also presents some key concepts discussed in this book. The book focuses on the way in which different health issues, through sources including policy documents, television health promotion campaigns and documents from professional bodies, have sought to 'bring into being' particular health problems and construct particular health behaviours as problematic. It deals with the issues of obesity and childhood, albeit in very different ways.
This chapter explores the Assessment of Need (AoN) process as a governmental technology which literally brings into being a new classification of people with disabilities and their assessed needs as governable entities. Governmentality literature has provided a fruitful hunting ground in terms of finding conceptual tools to analyse the ways in which states problematise and govern 'the wealth, health and happiness of populations'. Ireland has witnessed significant developments in the domain of disability policy and legislation. In a declared commitment to furthering the participation of people with disabilities in society, the government published a National Disability Strategy in 2004, the cornerstone of which was the passing of the Disability Act 2005. The chapter explores the spaces in-between the rationalities of particular policy programmes on the one hand, and the end point of many Foucauldian studies, namely the creation of self-governing subjects, on the other.
Governmentality, health policy and the place of critical politics
Eluska Fernández and Claire Edwards
This conclusion presents some closing thoughts on the concepts discussed in the preceding chapters of this book. The book explores the potential of governmentality-inspired ideas to develop a more nuanced and indeed critical understanding of the construction of health-based policy in Ireland. One of the key points underpinning accusations of governmentality's limited critical potential relates to the suggestion that studies often fail to capture the messy actualities of social and political relations. The book provides a clear example of how different and often competing voices, each drawing on different types of knowledge, build into governmental visions and approaches to organ donation. It illustrates how the management of obesity is increasingly being placed in the hands of individuals, by vesting them with a technology designed to monitor their waist circumference.
Exploring the introduction of the smoking ban in Ireland
This chapter focuses on one of the most well-known episodes in the history of tobacco control in Ireland: the introduction of an overall workplace smoking ban in 2004. It draws some key ideas and concepts put forward by governmentality studies. The introduction of the smoking ban in Ireland is considered by politicians, public health and anti-smoking advocates and Irish citizens as one of the biggest success stories in the history of public health policy and tobacco control. The chapter discusses some of the social and political implications of conducting a governmental analysis by drawing attention to the fact that the regulation of smoking became interlinked with social and moral processes. It exposes how some of these processes played a symbolic role in promoting boundaries between different social groups.
This chapter analyses recent Irish interventions into the 'obesity' discourse from the critical stance. It focuses on evidence from the first longitudinal study of children in Ireland, Growing Up in Ireland (GUI), and how its findings have entered the media and policy arenas. The analysis is based on secondary documentation, including published reviews of childhood obesity prevalence and GUI reports. Families and children were to be responsibilised to protect against the risks of overweight and obesity through educational and lifestyle interventions. The chapter considers some examples of how child fatness nevertheless continues to be framed as a pervasive and urgent issue in Irish society. The framing of childhood obesity illustrates how 'governmentality works by positioning or representing a problem in particular ways'. Body Mass Index (BMI) is even less satisfactory as a measure of childhood 'obesity'.
The case of Universal Health Insurance – by competition
This chapter discusses how the trajectory of health policy in Ireland enabled the imagining of Universal Health Insurance by Competition (UHI-C). UHI-C represents both an emerging discourse for governing healthcare and a governmental technology-in-development. It also represents a particular moment in Irish health policymaking. The chapter argues that UHI-C was a rationality and technology of advanced liberal governing, masquerading in claims to social solidarity. Without UHI-C implemented in practice, the chapter uses existing policy documents to critique the proposal as an example of the rationality and technology of advanced liberal government developed by Nikolas Rose and Peter Miller. The chapter examines the UHI-C documents in terms of four elements of governing in an advanced liberal state. The four elements include seeking to govern at a distance; placing responsibility on individuals through choice; the management of risk; and the fragmentation of the social sphere into multiple communities.
The dead body, the individual and the limits of medicine
This chapter explores how the efforts to increase the availability of human organs by moving to an institutional arrangement based on presumed consent necessarily extend beyond shaping people's cultural attitude towards organ donation. Transforming the prevailing cultural attitude and habitual behaviour in respect of organ donation also requires subtle but significant shifts in how people imagine the dead body, the individual and her or his responsibilities to others, and the limits of medicine. The chapter considers the debates in light of the ideas of Michel Foucault about the construction and government of the modern individual. Central to Foucault's conceptualisation of governmentality is that the modern sovereign state and the modern autonomous individual, homo economicus, co-determined each other's emergence. Peter Wehling is ambivalent about the emergence of active biological citizenship, which he regards as a new and significant element in contemporary governmental regimes of medicine.
This chapter examines the writings of Jean Jacques Rousseau. It focuses on how his critical social theory and his normative political theory meet as a conception of childhood that would come into sharper focus during the nineteenth century. The chapter also examines reformatory education and public hygiene, focusing on how the public health strategies were developed and deployed in Ireland. Both in terms of design and strategic objective, the penal reformatory school exemplified biosocial power in that it was deployed as a social technology to refashion life that had been deformed by social circumstances. The chapter looks at how the 'biosocial' apparatus has recently been reconfigured through a policy framework called Healthy Ireland, the purpose of which is to 'reduce health inequalities' by 'empowering people and communities'. It also looks at how the prescriptive thrust of Emile was made practical through a pedagogical form of philanthropy.
This chapter seeks to analyse the reform process initiated in 2005, examining the policy tools used to improve care provision and their impact on older people. It examines the impact of recent budgetary constraints on the long-term care sector, as a result of the recession in Ireland's free market economy. The chapter also examines how older people are conceptualised and analyses the relationships between the state and other stakeholders in the design and implementation of long-term care reform policies between 2005 and 2015. It is guided by a governmentality perspective, critically analysing the changing power relations within the long-term care sector in Ireland. Drawing on the particular conceptualisation of power, Michel Foucault developed the concept of governmentality, or 'the art of government'. Foucault's work on governmentality has been used by many other scholars as a framework for analysing power relations in society.