Critical Public Health – Basic Concepts

1. Critical Public Health – Basic Concepts John O’Neil Community Health Sciences

2. Discourse of Public Health • Discourse – a conversation about a subject by a group of people who share a common language, values, and principles. • Technologies of discourse include textbooks, scientific journals, conferences, seminars, hallway conversations, e-mail, listserves, etc, etc. • Discourse reflects taken-for-granted assumptions about the subject, values and beliefs of the professional class who participate in the conversation, etc.

3. continued • Discourse produces counter-discourse from excluded groups (ie., consumers, ethnic groups, disciplines, etc) • Discourse can be studied (examined) scientifically and critically – analogous to a culture – ethnographic methods. • Critical examination of our discourse exposes assumptions values, beliefs that constrain our science and practice – and impact on the health of populations.

4. Critiques of Public Health • Right Wing – too much govt control – limitation of freedom - NO • Left Wing – too much focus on individual behaviour to exclusion of structural/environmental constraints – OK - Farmer • Discourse Analysis – How do we limit our potential to improve health of populations through our cultural construction of the subject – Lupton

5. Biopower • Individual bodies defined in medicalization discourse and medical encounter • Body politic through public health regulatory apparatus and discourse on health promotion • Subjective discipline – identity, self- discipline, and health behaviour.

6. Governmentality • Modern state must govern without exercise of power through violence. • Regulation of the population through self-discipline. Punishment as a last resort. • Achieved through social institutions like schools, mass media, workplaces, and government – public health promotes governance of the self (self-government) and regulates population level behaviour.

7. The Good and the Bad • Moral exclusion – “cleanliness is next to godliness” – personal hygiene (e.g., wash hands, use condoms) to prevent disease transmission. • Moral failure – “thinness is next to godliness” - exercise and diet as an individual’s social responsibility. • Moral deviance – “abnormal” sexual identity and expression as cause of disease.

8. Disciplinary Functions of Surveillance – First Nations Example • Surveillance technologies important and expanding component of public health systems • Surveillance expanding from counting cases of disease occurrence to constructing complex databases that include behavioural and social information from surveys • Production of knowledge from these activities constructs a “normative” portrait of different groups in society.

9. Structural Violence vs Cultural Difference • Race as a substitute for class • Gender and poverty • Culture as determinant vs culture as solution