Table Of ContentNEOLIBERAL GOVERNANCE AND HEALTH
NEOLIBERAL
GOVERNANCE
AND
HEALTH
Duties, Risks, and Vulnerabilities
Edited by Jessica Polzer and Elaine Power
© McGill-Queen’s University Press 2016
ISBN 978-0-7735-4782-7 (cloth)
ISBN 978-0-7735-4783-4 (paper)
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LIBRARY AND ARCHIVES CANADA CATALOGUING IN PUBLICATION
Neoliberal governance and health : duties, risks, and vulnerabilities / edited by Jessica Polzer and Elaine Power.
Includes bibliographical references and index.
Issued in print and electronic formats.
ISBN 978-0-7735-4782-7 (cloth). – ISBN 978-0-7735-4783-4 (paper). – ISBN 978-0-7735-9954-3 (ePDF). – ISBN 978-0-
7735-9955-0 (ePUB)
1. Medical care – Canada – Case studies. 2. Medical policy – Canada – Case studies. 3. Public health – Canada – Case
studies. 4. Neoliberalism – Canada – Case studies. I. Polzer, Jessica, 1969–, author, editor II. Power, Elaine M., 1961–,
author, editor
RA395.C3N45 2016 362.10971 C2016-901775-3
C2016-901776-1
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CONTENTS
Acknowledgments
Introduction: The Governance of Health in Neoliberal Societies
Jessica Polzer and Elaine Power
1 Fat Children, Failed (Future) Consumer-Citizens, and Mothers’ Duties in Neoliberal
Consumer Society
Elaine Power
2 Environment-as-Risk and Green Consumerism in Neoliberal Public Health Practices
Rebecca Hasdell
3 Tween Girls, Human Papillomavirus (HPV), and the Deployment of Female Sexuality in
English Canadian Magazines
Laura Cayen, Jessica Polzer, and Susan Knabe
4 Risk, Retirement, and the “Duty to Age Well”: Shaping Productive Aging Citizens in
Canadian Newsprint Media
Debbie Laliberte-Rudman
5 The Political Is Personal: Breast Cancer Risk, Genetic(optim)ization, and the Proactive
Subject as Neoliberal Biological Citizen
Jessica Polzer
6 Global Biopolitics and Pandemic Influenza Preparedness: Securitization and the Regulation
of Viral Uncertainty and Mutual Vulnerability
Sarah Sanford
7 Risk and Resistance: Citizenship and Self-Determination through Health Governance in
Nunavut, Canada
Sara Tedford
8 “So It’s Always a Dance”: The Politics of Gifts and Governance at a Drop-In Centre for
Vulnerable Women in Southern Ontario
Treena Orchard
9 “You Are Free to Set Your Own Hours”: Governing Worker Productivity and Health
through Flexibility and Resilience
Ellen MacEachen, Jessica Polzer, and Judy Clarke
10 Active Citizenship and the Management of Stigma in Contingent Work
Marcia Facey
11 Self-Management and the Government of Disability: Reinforcing Normalcy through the
Construction of Able-Disabled Subjectivities
Erika Katzman
Contributors
Index
ACKNOWLEDGMENTS
We acknowledge the faculty and staff of the former Department of Behavioural Science and
Social Science and Health Graduate Program, University of Toronto, who worked against the
institutional grain to create a space within which graduate training in critical social science
perspectives on health could flourish, with special thanks extended to Robin Badgley, David
Coburn, Joan Eakin, Blake Poland, Ann Robertson, and Harvey Skinner. In particular we
would like to acknowledge Ann Robertson whose supervision helped us craft our own distinct
critical sensibilities and bring them together fruitfully in this volume. We express our thanks to
Jonathan Crago at McGill-Queen’s University Press for his guidance throughout the process of
bringing this manuscript to publishable form and the anonymous reviewers for their thoughtful
feedback on previous versions of the manuscript. Thank you as well to Joanne Muzak for her
fine editorial care and attention and to Ryan Van Huijstee for his assistance with the cover
design.
NEOLIBERAL GOVERNANCE AND HEALTH
INTRODUCTION
The Governance of Health in Neoliberal
Societies
Jessica Polzer and Elaine Power
Discourses on health come into and go out of fashion, but not arbitrarily. Rather, they emerge and gain
widespread acceptance primarily because they are more or less congruent with the prevailing social,
political and economic context within which they are produced, maintained and reproduced. In addition,
because they are always attached to other interests and agendas – professional, economic, political,
cultural, ideological – the ways in which we conceptualize and speak and write about health are never
just about health; they also function as repositories and mirrors of our ideas and beliefs about human
nature and the nature of reality, as well as about the kind of society we can imagine creating and how
best to achieve it.
Robertson, “Shifting Discourses in Health Promotion”
Since the stormy development of Medicare in Canada, the relationship between health,
governance, and citizenship has been thrown into sharp relief. The provision of publicly
funded, universal health insurance, conceived by Tommy Douglas as an inalienable right of
citizenship (Redden 2002), has become a cornerstone of Canadian identity and a tireless target
of political deliberation. Beginning in the mid-1970s, the right to health care, with its emphasis
on the collective pooling of risks and government responsibility for health, has been
increasingly displaced by a discourse of individual responsibility for health and the prevention
of disease through the identification and management of risk. This shift has in part stemmed
from efforts to broaden policy frameworks concerning the determinants of health beyond
curative biomedicine, which focus on the treatment of disease, to consider the various
personal, environmental, and social determinants of health, which focus on the prevention of
disease (see, for example, the Lalonde Report [Lalonde 1974], the Epp Report [HWC 1986],
and the Ottawa Charter for Heath Promotion [WHO 1986]). However, the tendency in public
and professional discourse to privilege individual behaviours and biological processes as
explanations of health over social determinants and social well-being is symptomatic of a
political shift that began in earnest in the 1980s. With this shift from welfare state to neoliberal
approaches, the legitimacy of free market rationalities has become entrenched in social policy,
emphasizing the principles of individualism, privatization, and de-centralization over those of
universal social rights and collective welfare (Broad and Antony 1999; McGregor 2001). In
health care, this has transformed the way in which patients in publicly funded health care
systems are increasingly understood and represented as consumers of health services rather
than recipients of care and social entitlements. More generally, neoliberal approaches to social
policy favour a model of citizenship in which individuals are expected to demonstrate their
duties to maintain their health through their own “free choices” and “informed decisions.”
In this collection, we present a range of case studies that explore how neoliberal styles of
governance idealize particular notions of health and citizenship and the implications for human
