Appeals to autonomy and obedience: continuity and change in governing technologies in Danish and Swedish health promotion

Health Promotion Practices and Michel Foucault: A Scoping Review

OBJECTIVE

To analyze Health Promotion (HP) practices in different settings worldwide, presented in studies that employed the Foucauldian framework.

DATA SOURCE

Scoping review performed on LILACS, MEDLINE, IBECS, BDENF, SciELO, CINAHL, Embase, Web of Science, and Scopus databases.

STUDY INCLUSION AND EXCLUSION CRITERIA

We included original articles, review articles, reflection articles, and case studies published in English, Portuguese, and Spanish, which addressed HP practices, analyzed using the Foucauldian framework.

DATA SYNTHESIS

In the numerical synthesis, the characteristics of the included studies were described: number of studies, types of method, year of publication, characteristics of the study population, origin countries, and the HP practices addressed in the articles. The thematic synthesis was organized according to the nature of the HP practices presented and the Foucauldian analysis matrix used.

RESULTS

The review covered 34 studies, published between 2006 and 2019, whose analysis resulted in 2 thematic synthesis: 1) HP as a biopolitical strategy in the neoliberal context; 2) HP as an expression of resistance and counter-conduct, presenting tensions, struggles, and power games.

CONCLUSION

The field of HP mostly consists of governmentality practices that reinforce the neoliberal health perspective. Some practices show resistance and counter-conduct in the face of governmentality practices, which explains the power relationships in the field of HP.

Lifestylisation of the social: The government of diabetes care in Denmark

Since the 1970s, the public authorities of many OECD countries have emphasised the need for preventing lifestyle diseases and promoting the vigour of their populations. Based on the Foucauldian analytics of dispositive, we critically address some of the normative implications of the preventive interventions in the area of type 2 diabetes care. Through an analysis of public health documents from 1981 to 2016, it is shown that the government of lifestyle was extended and institutionalised by a reform of the Danish public sector in 2007. Following the reform, rationalities of public health policies sought to prevent unhealthy lifestyles not only through individual behaviour but also through the social surroundings of citizens. In contrast to the claim that we are seeing a retraction of state responsibility and interventions in the area of public health, it is suggested that we are witnessing an expansion in state ambitions expressed through a lifestyle dispositive. These ambitions are less about transferring the responsibility to the individual and more about governing and mobilising the social relations and environments of type 2 diabetes patients and citizens in general to make the everyday choice of a healthy lifestyle easier.

A stitch in time saves nine: Perceptions about colorectal cancer screening after a non-cancer colonoscopy result. Qualitative study

OBJECTIVES

To explore perceptions of colorectal cancer (CRC) screening among participants who have experienced a 'false alarm' for CRC, and to explore perceptions about the relevance of screening for themselves or others.

METHODS

Semi-structured interviews with screening participants who had participated in the Danish CRC screening program and experienced a 'false alarm' for colorectal cancer. A thematic analysis was performed, based on an interpretive tradition of ethnography.

RESULTS

Perceptions about CRC screening after a non-cancer colonoscopy result were characterized by trust in the colonoscopy result showing no CRC, and satisfaction with the screening offer despite the risk for 'false alarm'. The patient-involving behavior of the healthcare professionals during the examination was for most participants a cornerstone for trusting the validity of the colonoscopy result showing no CRC. Strong notions about perceived obligation to participate in screening were common.

CONCLUSIONS

Prominent themes were trust in the result, satisfaction with the procedure, and moral obligations to participate both for themselves and for others.

PRACTICE IMPLICATIONS

Information to future invitees after a 'false alarm' experience could build on peoples' trust in the validity of a previous non-cancer result and should underscore the importance of subsequent screening even after a 'false alarm' for cancer.

The Chronic Responsibility: A Critical Discourse Analysis of Danish Chronic Care Policies

This article reports on the results of a Fairclough-inspired critical discourse analysis aiming to clarify how chronically ill patients are presented in contemporary Danish chronic care policies. Drawing on Fairclough's three-dimensional framework for analyzing discourse, and using Dean's concepts of governmentality as an interpretative lens, we analyzed and explained six policies published by the Danish Health and Medicines Authority between 2005 and 2013. The analysis revealed that discourses within the policy vision of chronic care consider chronically ill patients' active role, lifestyle, and health behavior to be the main factors influencing susceptibility to chronic diseases. We argue that this discursive construction naturalizes a division between people who can actively manage responsible self-care and those who cannot. Such discourses may serve the interests of those patients who are already activated, while others remain subjugated to certain roles. For example, they may be labeled as "vulnerable."

'Rhyme or reason?' Saying no to mass vaccination: subjective re-interpretation in the context of the A(H1N1) influenza pandemic in Sweden 2009-2010

During the swine flu pandemic of 2009-2010, all Swedish citizens were recommended to be vaccinated with the influenza vaccine Pandemrix. However, a very serious and unexpected side effect emerged during the summer of 2010: more than 200 children and young adults were diagnosed with narcolepsy after vaccination. Besides the tragic outcome for these children and their families, this adverse side effect suggests future difficulties in obtaining trust in vaccination in cases of emerging pandemics, and thus there is a growing need to find ways to understand the complexities of vaccination decision processes. This article explores written responses to a questionnaire from a Swedish folk life archive as an unconventional source for analysing vaccine decisions. The aim is to investigate how laypersons responded to and re-interpreted the message about the recommended vaccination in their answers. The answers show the confusion and complex circumstances and influences in everyday life that people reflect on when making such important decisions. The issue of confusion is traced back to the initial communications about the vaccination intervention in which both autonomy and solidarity were expected from the population. Common narratives and stories about the media or 'big pharma capitalism' are entangled with private memories, accidental coincidences and serendipitous associations. It is obvious that vaccination interventions that require compliance from large groups of people need to take into account the kind of personal experience narratives that are produced by the complex interplay of the factors described by the informants.

Governing obesity policies from England, France, Germany and Scotland

Defining a phenomenon as a political problem could be considered a crucial part of any political process. Body weight, when categorised as obesity, has been defined as a political problem since the beginning of the 21st century and has entered the political agenda in many countries. In this article, I present a study of four plans from four Western European countries: England, France, Germany and Scotland, identifying how obesity is defined as a political issue. The questions addressed are: How is the development in the obesity prevalence explained and who is considered responsible for the development? What are the suggested remedies and who is considered responsible for acting? All plans state that obesity is a political issue because it causes health problems; in fact, weight is almost equated to health. The English and Scottish plans present a bio-political argument, characterising obesity as a serious threat to the countries' economies. So does the German plan, but not with the same emphasis. The plans portray people with obesity as being economically harmful to their fellow citizens. The French plan expresses another concern by focussing on the discrimination and stigmatization of obese people. All plans define the physical and food environment as a crucial factor in the obesity development, but only the Scottish Government is prepared to use statutory means towards industry and other actors to achieve change. The policies convey an unresolved dilemma: To govern or not to govern? The Governments want individuals to choose for themselves, yet they try to govern the populations to choose as the Governments find appropriate. The plans have a legitimising function, showing that the Governments take the issue seriously. Accordingly, in this case, the actual problematisations seem to be less crucial.