Power, technology, resistance. The material micropolitics of health encounters.

1. Power, technology, resistance. The material micropolitics of health encounters. Nick J Fox Universities of Sheffield and Huddersfield @socnewmat

2. Introduction • A new materialist ontology. • The micropolitics of health encounters. • Digital health technologies. • Digital capitalism and health. • Power, resistance and technology. • ‘Citizen health’? @socnewmat

3. Biomedicine, neoliberalism and beyond • Perspectives on health encounters. • Biomedicine as dominant Western theory of health and illness. • Medical dominance and disempowering of patients. • Disciplining of sick bodies. • Health care as a business. • Neoliberalisation of health care. • I will focus instead on the micropolitics of health care. @socnewmat

4. A new materialist ontology @socnewmat

5. A materialist research journey I have explored materiality in a varioety of health encounters: • The material micropolitics of surgical authority. • Pharmaceuticals, Internet and consumers. • Obesity and the neoliberal food economy. • Power and digital health technologies. @socnewmat

6. Micropolitics of surgical spaces • The everyday material/semiotic production of surgery: • Surgical spaces (operating rooms and wards). • Technologies (instruments, equipment, drugs). • Clothing and conventions. • How these materialities sustain the power and authority of biomedicine. Fox, N.J. (2011) Boundary objects, social meanings and the success of new technologies. Sociology, 45(1): 70–85 @socnewmat

7. Pharmaceuticals and Internet • Market forces in 21st century healthcare. • Studies of drugs for weight-loss, erectile dysfunction. • Impact of Internet on consumption of pharmaceuticals. • Pharmaceuticalisation of everyday life. • Domestication of health care. Fox, N.J. and Ward, K.J. (2008) Pharma in the bedroom … and the kitchen. The pharmaceuticalisation of daily life’. Sociology of Health and Illness Monograph, 306): 856-868. @socnewmat

8. Obesity and food sovereignty • Material relations of ‘becoming-fat’ and ‘becoming-slimmer’ bodies. • The obesity assemblage of human and non-human relations. • Willpower opposed to powerful relations in food industry. • An uneven struggle! • Change how food is produced, marketed and retailed. Fox, N.J., Bissell, P., Peacock, M. et al. (2018) The micropolitics of obesity: materialism, neoliberal markets and food sovereignty. Sociology, 52(1): 111-127 @socnewmat

9. The micropolitics of health encounters • Consider health encounters as assemblages. • What capacities do these assemblages produce? • What are the micropolitics of an encounter in terms of power, resistance? • How might these micropolitics be changed? @socnewmat

10. Digital health technologies • Technologies/apps used by individuals beyond healthcare settings. • Self-tracking or monitoring of body functions or performance. • May have capacities for therapeutic intervention. • May use communication or networked functionality. • May serve biomedical or corporate interests. Fox, N.J. (2017) Personal health technologies, micropolitics and resistance: a new materialist analysis. Health. 21(2): 136-153. @socnewmat

11. Do we know what a health technology actually does? • Don’t look at a health technology as an entity. • Explore how DHTs and bodies assemble. • What capacities do these assemblages produce in bodies? • Can we re-engineer DHTs to other purposes. @socnewmat

12. Biotech app to assess MS • Monitoring app to assess multiple sclerosis progression. • What does it do? – multiple posture and gait monitors on patients’ bodies gather data over months, and crunch these to provide information to clinicians on disease progression. • The MS-monitoring assemblage: body – monitors – app - clinician – pharma companies • Micropolitics: Gives clinicians ‘objective’ data, rather then depending upon patients’ memories. @socnewmat

13. Splendid project splendid-program.eu/ • EU–funded project to reduce obesity among adolescents and young adults. • What does it do? – body sensors monitor physical activity, meal portion size, chewing. Linked by smart-phone to clinicians who provide advice on nutrition. • The Splendid-assemblage: body – food – terrain – sensors – phone - doctors – advice – population • Micropolitics: biomedicaliseseating; disempowers people from managing their food consumption and health needs. @socnewmat

14. Vida: virtual coaching www.vida.com • App links fitness monitoring data to online health and fitness coaches. • What does it do? Enables virtual coaching to support individuals’ fitness programme. • The Vida-assemblage: body – app – device – coach – health programme – company – shareholders – profit • Micropolitics – monetises health-monitoring apps, privatises health and fitness, replaces clinical advisors with commercial health coaches. @socnewmat

15. The micropolitics of DHTs • Some apps enhance a biomedical model of health and illness. • Other apps facilitate market and neoliberal social relations (Barassi, 2015). • ‘Digital capitalist’ knowledge economy: • Development of commercial digital platforms. • Monetises data. • Replaces traditional providers with online. • Are DHTs shifting control of healthcare from biomedicine to neo-liberalism? @socnewmat

16. Digital capitalism and health • Efficiencies. • Health knowledge as commercial resource. • Monetising services. • Marketisation of health. • Consumerisation. • Opportunities for privatising/out-sourcing. @socnewmat

17. Vida as exemplar of DC • Reduces costs of providing coaching. • Connects coaches and consumers/clients. • Establishes a global market that feels local. • Creates virtual versions of existing businesses and business models. • Reduces margins and increases volume of sales. @socnewmat

18. Power, resistance and technology • Digital technologies may be designed to address: • Biomedicine and biomedical priorities. • Corporate interests and neoliberalism. • Citizen interests. • Potential to use digital health technologies to establish ‘citizen health’.

19. Citizen Health • Use the same material analysis to re-design DHTs with different micropolitical outcomes: • Connect people to challenge both biomedicine and neoliberalism. • Reject individualised approach to health. • Reject monetisation of health and fitness. • Challenge health policy. • Organise resistance and protest. @socnewmat

20. A citizen health example • Using readily-available apps: • Build a network of air quality monitors to assess risks in a locality. • Use social media to notify communities, activists and local media of risks. • Co-ordinate action and build coalitions. • Campaign to change local policy. @socnewmat

21. Conclusions • A materialist analysis reveals the forces between health professionals, users, industry and technologies. • Digital health technologies may enhance biomedical and neoliberal interests. • Digital capitalism is transforming health care. • Use the same analysis to resist both biomedicine and neoliberalism, and build citizen health. @socnewmat

22. Power, technology, resistance. The material micropolitics of health encounters. @socnewmat