Healthism

"Healthism", sometimes called "public-healthism", is a neologism to describe a variety of ideological constructs concerning health and medicine. The term ‘healthism’ was most likely first used by the political economist Robert Crawford, whose article ‘Healthism and the medicalization of everyday life’ [Robert Crawford, "Healthism and the medicalization of everyday life". (Health:, Vol. 10, No. 4, 401-420 (2006))] was published in 1980. In this article Crawford describes how the new political ideology, which emerged in the US during the 1970s, shifted health responsibility from the state to that of the individual. The term is also know for its use in the 1994 book "The Death of Humane Medicine and the Rise of Coercive Healthism" by Petr Skrabanek. Skrabanek's use of "healthism," and most subsequent uses, are pejorative in intent.

krabanek: the threat of health fascism

According to Skrabanek, "healthism" begins when the government begins to use propaganda and coercion to establish norms of health and begins to attempt to impose norms of a "healthy lifestyle." All human activities are weighed in the balance of their real or imagined effects on health: all human activities are divided into "healthy" and "unhealthy", prescribed and proscribed, approved and disapproved, responsible and irresponsible, based on this measure. [Petr Skrabanek, "The Death of Humane Medicine and the Rise of Coercive Healthism" (Social Affairs, 1994), ISBN 978-0-907631-59-0. Available for [http://www.medicine.tcd.ie/public_health_primary_care/skrabanek/Death-of-Humane-Medicine.pdf download] from the Skrabanek Foundation. (PDF)] In Skrabanek's view, "healthism" goes hand in hand with what he calls "lifestylism", another neologism, which Skrabanek uses to describe the view that most diseases are the result of unhealthy habits or behaviour. Skrabanek notes that while "lifestylism" is ostensibly founded on a basis of mathematics and statistics, it nevertheless has a strong moralistic flavour. Skrabanek cites a British epidemiologist, Geoffrey Rose, as expressing the belief that most people live "unhealthily" and constitute a "sick population". But since (according to Skrabanek) this message would lead to a fatalistic rejection of the lifestyle doctrine, it must be recast to be socially and politically acceptable, quoting Rose for the view that the "sick" society must be re-educated in its "perception of what is normal and acceptable." ["The Death of Humane Medicine", pp. 15-16]

Ultimately, Skrabanek claims that "healthism" either leads to, or is a symptom of, incipient totalitarianism. Skrabanek claims that healthism justifies racism, segregation, and eugenic control; for the healthist, what is "healthy" is moral, patriotic, and pure; while what is "unhealthy" is foreign, polluted, and impure. The doctrine of "lifestylism" suggests that state actions to prescribe what is healthy or forbid what is unhealthy are limitless in scope, and offer no grounds for privacy.

Nikolas Rose: a Foucauldian view

Following Skrabanek, Nikolas Rose has described "healthism" as a doctrine that links the "public objectives for the good health and good order of the social body with the desire of individuals for health and well-being". But while Skrabanek's version is used as a basis to criticize state interventions to coerce people into healthy lifestyles, according to Rose, the capitalist society finds coercion unnecessary. Since people want to be "healthy", the apparatus of advertising and other means of capitalist persuasion leads to people internalizing the message of healthism without state intervention. Rose's healthism represents "responsibilization": here, the burden of remaining healthy is no longer on the shoulders of the government, but must be endured by individuals, who then are held to be blameworthy if they get sick. Rose's view represents an extension of Michel Foucault's theory of "governmentality". [Nikolas Rose, "Powers of Freedom: Reframing Political Thought". (Cambridge: Cambridge University Press, 1999) ISBN 978-0-521-65075-5 ]

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