New Perspectives on Health and Social Care

146 Pages·2023·1.992 MB·English

by  Jason Powell

International Perspectives on Social Policy,
Administration, and Practice
Jason Powell
New Perspectives
on Health and
Social Care
International Perspectives on Social Policy,
Administration, and Practice
Series Editors
Sheying Chen, Pace University
New York, NY, USA
Jason L. Powell, Department of Social and Political Science
University of Chester
Chester, UK
The Springer series International Perspectives on Social Policy, Administration and
Practice puts the spotlight on international and comparative studies of social policy,
administration, and practice with an up-to-date assessment of their character and
development. In particular, the series seeks to examine the underlying assumptions
of the practice of helping professions, nonprofit organization and management, and
public policy and how processes of both nation-state and globalization are affecting
them. The series also includes specific country case studies, with valuable
comparative analysis across Asian, African, Latin American, and Western welfare
states. The series International Perspectives on Social Policy, Administration and
Practice commissions approximately six books per year, focusing on international
perspectives on social policy, administration, and practice, especially an East-West
connection. It assembles an impressive set of researchers from diverse countries
illuminating a rich, deep, and broad understanding of the implications of comparative
accounts on international social policy, administration, and practice.
Jason Powell
New Perspectives on Health
and Social Care
Jason Powell
Office of the Provost
Crescent College Birmingham
Birmingham, United Kingdom
ISSN 2625-6975 ISSN 2625-6983 (electronic)
International Perspectives on Social Policy, Administration, and Practice
ISBN 978-3-031-25431-4 ISBN 978-3-031-25432-1 (eBook)
https://doi.org/10.1007/978-3-031-25432-1
© Springer Nature Switzerland AG 2023
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Preface
This original book is one of the first to explore contemporary health and social care
developments in the occidental world through a conceptual lens that is utilised by
Michel Foucault and innovative conceptual tools and differential epistemological
theories. In the current socio-economic climate in the UK, for example, health and
social care are at a crossroads with implications for how service users’ needs are
being met or not, how assessment encroaches on power and surveillance and the
extent to which service users ‘voice’ is being translated into the health and social
care policy and practices that help them facilitate their independence and, crucially,
quality of life. This relentlessly critical book is one of the first to develop new per-
spectives deriving from Foucault in the application of health and social care policy,
theory and practice. The book draws heavily on Foucauldian insights from social
gerontology as it is older people predominantly, whilst not exclusively, who access
health and social care services; adding a vital and new theoretical perspective to
understanding health and social care.
v
Contents
1 Introduction: Perspectives on Health and Social Care . . . . . . . . . . . 1
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Health and Social Care as ‘Science’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Health and Social Care as Social Theory . . . . . . . . . . . . . . . . . . . . . . . . 7
Mapping Out the Terrain: Modern and Postmodern Theories
of Health and Social Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Social Theory and the Rise of Functionalist Accounts of Health
and Social Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Political Economy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Feminism: Health and Social Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Postmodern Health and Social Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
2 New Perspectives: Foucault and Applicability to Health
and Social Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Power and the Modern Subject . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Genealogy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
The Body . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
The Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
The Individual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Implications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
3 A Foucauldian Analysis of Health and Social Care . . . . . . . . . . . . . . 39
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
The Biomedical Model and Aging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Foucault and Aging: An Important Conceptual Toolkit . . . . . . . . . . . . . 42
A History of the Present: The Management of Aging
by Social Work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
A Genealogy of the Post-Second World War Consensus of Care
and Aging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
vii
viii Contents
Psycho-Casework with Older People . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Health, Care, Market Forces and Aging . . . . . . . . . . . . . . . . . . . . . . . . . 47
Aging and Care Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
The Embedded Market of Care and Aging . . . . . . . . . . . . . . . . . . . . . . . 48
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
4 Surveillance and Health and Social Care . . . . . . . . . . . . . . . . . . . . . . 51
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
The Rise of Personalisation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Foucault and Surveillance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
The Technologies of Health and Social Care . . . . . . . . . . . . . . . . . . . . . 55
The Panoptic Culture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
5 Governmentality and Health and Social Care . . . . . . . . . . . . . . . . . . 61
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Governmentality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Social Policy: Constructing the Context . . . . . . . . . . . . . . . . . . . . . . . . . 63
Integrating Services: Social Policy and Career People . . . . . . . . . . . . . . 65
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
6 Performativity and Health and Social Care . . . . . . . . . . . . . . . . . . . . 69
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Performance and Performativity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Rethinking Power and Resistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Performativity and Professionalisation . . . . . . . . . . . . . . . . . . . . . . . . . . 74
‘A Professional Performance’: Social Work, Knowledge
and Subjection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
7 Power and Health and Social Care . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
A Foucauldian Analytical Framework: Medicalisation and
Managerialism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
Concluding Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
8 Narrative, Health, Care and Family . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
‘Grand-Parenting’ Policy and Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
9 Health and Care in the ‘Risk Society’ . . . . . . . . . . . . . . . . . . . . . . . . . 103
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
From Trust to Risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
The Historical Rise and Consolidation of ‘Risk’ . . . . . . . . . . . . . . . . . . 106
The ‘Risk Society’ Thesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
Contents ix
Health and Social Care in Risk Society: A Case Study Based
on Health and Social Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
Genealogy of Risk and Health and Social Care Identities . . . . . . . . . . . 113
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
10 Towards Global Health? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Global Health in Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
The Challenges and Consequences of Global Health . . . . . . . . . . . . . . . 125
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Chapter 1
Introduction: Perspectives on Health
and Social Care
Introduction
There has long been a propensity in matters of health and social care to engage in
the ontological and epistemic reductionism of health to its biological and psycho-
logical dimensions. Indeed, in Western culture, health and care practices came to be
understood in terms of biological science to be only material, and the scientific
approach to medicine became overwhelmingly objective, reductionistic and ratio-
nal. These scientific dimensions primarily are a set of normative ‘stages’ of body
and mind process that position the experiences and representations of service users
in Western culture (Gilleard & Higgs, 2000). As the preceding chapter indicated, for
the biomedical model, growing old would primarily be a process of inevitable phys-
ical and mental ‘decline’ and of preparation for the ultimate ending: death itself.
The paradox, of course, is that the biomedical homogenising of the experience of
health which the reliance on the biological and psychological dimensions of health
entails is in fact one of the key elements of the (public) dominant ‘common-sense’
discourses on health and care. A deeper under-standing of health requires, however,
that we move beyond common-sense approaches and broaden our view to under-
stand how processes, from the biomedical level of the individual cell to overall
society, influence us and in turn are influenced by us as individuals progressing
through the life-course.
We also highlighted how health and care was a social category in terms of social
constructionism with reference to its definition as both a categorisation and popula-
tional construct. The biomedical and social conceptualisations of health and social
care demand theoretical interrogation of what Phillipson (1998) calls the ‘social
construction of health’. The social construction of health is an important process in
debunking discourses of ‘truth’ and can be used as an alternative to narrow medical
narratives (Powell, 2002); it includes how ‘norms’ or pervasive attitudes materi-
alise – from basic biomedical functions to sophisticated and complex social/cultural
© Springer Nature Switzerland AG 2023 1
J. Powell, New Perspectives on Health and Social Care, International
Perspectives on Social Policy, Administration, and Practice,
https://doi.org/10.1007/978-3-031-25432-1_1