In the previous post in this series I discussed the development of the “medical gaze” over time and how this can be seen as technology for constructing the truth of the body. In particular, I looked at how technologies such as x-rays and MRI is, as well as more simple technologies such as books shaped how we understand bodies and health.
In this fourth post I will discuss how we can approach public health strategies as “technologies of government” which, like the devices discussed in my previous post, helped to construct the truth of the situation as well as providing a means to intervene in it and exert control and power.
David Armstrong (1995) has famously analysed the emergence of what he refers to as “surveillance medicine” this involves the extension of the “medical gaze” from the human body and its biology into social spaces. What he is trying to capture with this analysis is how the medical profession sees the everyday actions of individuals and their cultural and social lives as being legitimately within the remit of medical intervention.
This is partly because of a change in the kinds of diseases which are most prominent in Western societies. This is related to a process which is referred to as the “epidemiological transition” which occurs when the majority of the most serious “communicable diseases”, such as tuberculosis, (which tend to be acute conditions) are largely eradicated. As these kinds of diseases decline in significance (on the population level) they are replaced by “noncommunicable diseases”, such as obesity, stress and diabetes, (which tend to be chronic conditions).
This second category of health problems are generally considered to be largely “lifestyle diseases”, that is, caused by the actions or social contexts of people’s lives such as the amount of exercise they take, what kinds of foods they eat, the character of their employment or whether or not they smoke or drink alcohol. For this reason, medicine can no longer simply concentrate on biological processes but must take note of the social and psychological as well.
Armstrong characterises this as “surveillance medicine” because in order to understand how these conditions develop on the level of “social” it is necessary to conduct forms of surveillance over the whole population. This surveillance takes the form of gathering data from GP or hospital visits or conducting in surveys of patients and the population in general.
But surveillance is also part of the way in which this disease is our tackled. Evidence suggests that the most effective method of managing these “lifestyle diseases” is prevention through changing behaviour of individuals by increasing awareness of their health and behaviours in relation to other members of the population and to engage in “self surveillance” through monitoring their own practices.
The sociologists Alan Petersen and Deborah Lupton (2000) suggested that this approach to medicine helped to instigate a new paradigms of public health refered to as “the new public health”. Government departments tasked with improving the health of the population no longer focus on issues such as sanitation, vaccination or encouraging people to improve the cleanliness of their homes. Instead, the focus shifted to analysing populations in relation to groups or individuals who have particular “risk profiles” expressing their likelihood of developing particular conditions and encouraging people to change their “lifestyles”. The tools of public health have developed in response to incorporate “health promotion” and social marketing. Tactics previously associated with the commercial world have thus become part of medical practice such as advertising (see video below) or self tracking wearables.
So, the spaces between people, social relations, identities, culture and other areas of life which have previously been a concern largely of sociologists and psychologists come within the “medical gaze”. In the process we are increasingly encouraged to think of more areas of our lives as medical because the “technologies all government” used by public health to make us healthier reframe everyday life as health promoting or health damaging.
There are many ways to think about the food we eat, our physical movement and activity, our jobs and social activities (for their enjoyment or their social benefits, for instance). But public health often encourages us to think of these things in relation to their impact on our health. Also, in order to achieve population level changes (such as reductions in levels of obesity) health promotion campaigns need to be implemented on the whole population. Combined with the emphasis on prevention and identification of potential future illness (through risk analysis) we are all considered to be “pre- symptomatically ill” rather than there being a simple binary between health and illness. This perhaps means that concern for possible health problems comes to dominate all of our lives and may well itself contribute towards stress and anxiety.
In the next post in this series I will discuss how techniques and technologies of psychological assessment and treatment have changed the ways in which we understand the mind and brain. This will involve discussion of psychological, psychiatric and neuroscientific therapies, experiments and scans which have modelled our consciousness and ultimately what it means to be a human being in profoundly different ways.
Armstrong, D. (1995) ‘The rise of surveillance medicine’ Sociology of Health & Illness, 17(3): 393-404.
Petersen, AR. and Lupton, D. (2000) The new public health : health and self in the age of risk. London: Sage Publications.