The Irish government has developed policies that set out its vision, priorities and direction for improving and sustaining the health of its people. This chapter critically appraises how these strategies have been configured to structure responsibility for health. It exposes a number of key characteristics of neoliberal governmentality, including the shift towards a market-based model of health, and the distribution of power across a range of agents and agencies of health. The need to reduce healthcare expenditure appeared in the first national, strategic public health policy, Shaping a Healthier Future. The chapter illustrates three evolving rationalities in strategic public health policies in Ireland. They are a market-based model of healthcare, devolution of responsibility, and capabilities and techniques to manage the self and ensure individual behaviour aligns with political objectives.
Recent years have witnessed a burgeoning international literature which seeks to analyse the construction of health and health policy through an analytical lens drawn from post-Foucauldian ideas of governmentality. This book is the first to apply the theoretical lens of post-Foucauldian governmentality to an analysis of health problems, practices, and policy in Ireland. Drawing on empirical examples related to childhood, obesity, mental health, smoking, ageing and others, it explores how specific health issues have been constructed as problematic and in need of intervention in the Irish State. The book focuses specifically on how Jean Jacques Rousseau's critical social theory and normative political theory meet as a conception of childhood. 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'. Child fatness continues to be framed as a pervasive and urgent issue in Irish society. In a novel departure in Irish public health promotion, the Stop the Spread (STS) campaign, free measuring tapes were distributed throughout Ireland to encourage people to measure their waists. A number of key characteristics of neoliberal governmentality, including the shift towards a market-based model of health; the distribution of power across a range of agents and agencies; and the increasing individualisation of health are discussed. One of the defining features of the Irish health system is the Universal Health Insurance and the Disability Act 2005.
Analysing mental health discourses and practices in Ireland
In this chapter, the author utilizes ideas drawn from governmentality to explore the emergence, and sometimes uneasy co-existence, of the biomedical discourses in the mental health policy arena. As Michel Foucault and other authors have noted, discourses constructing mental health have been strongly tied to biomedical understandings of mental illness and the medical speciality of psychiatry. The operational elements of A Vision for Change: Report of the Expert Group on Mental Health Policy (AVFC) betray the claims to whole-population relevance of mental health and reinforce a narrow conception of mental health as a euphemism for mental illness. The theoretical framework of governmentality can be helpful in exploring tensions between the mentalities and practices of governing, and discourses as they have developed around mental health policy and practice in Ireland.