(HEA4) Health and Its Publics

This session will explore the varied ways in which ‘publics’ (whether general or specific) engage with or are depicted in health education, public health, health promotion, health policy, the sociology of health, and/or health-related media coverage. Tags: Equality and Inequality, Health and Care, Policy

Organizer: Emma Whelan, Dalhousie University; Chair: Fiona Martin, Dalhousie

Presentations

Emma Whelan, Dalhousie University

Health promotion and its publics: Justifying handwashing education, 1920-1950

This paper speaks to the broader question of how ideologies of class, ‘race,’ and gender shape representations of ‘the public’ in health promotion, through an analysis of British and Canadian cleanliness and handwashing promotion, circa 1920 to 1950. Building on Steven Epstein’s concept of niche standardization and on Michel Foucault’s discussion of health as “the duty of each and the objective of all,” I argue that there are three main contexts in which ‘the public’ or certain segments of it are depicted: as advocates/supporters of cleanliness promotion; as hygienically ignorant or disadvantaged; and/or as responsible for causing or solving cleanliness-related problems. Illustrative examples are drawn from the papers of the voluntary health association, the Health and Cleanliness Council (England and Wales, 1926-1946), along with soap industry and state publications in Britain and its former colonies. The paper contributes to an understanding of how representations of ‘the public,’ while appearing to include everyone, may be deployed strategically and selectively to justify biopolitical interventions that responsibilize some citizens more than others for public health problems and their solutions.

Patricia Cormack, St. Francis Xavier University; James Cosgrave, Trent University

Canada's official recreational drug users: Fifty years of making publics

Jurisdictions around the world are moving to decriminalize or legalize recreational cannabis consumption, with other illicit drugs like psilocybin and LSD also on the radar. Regardless of the legal and regulatory models adopted, the figure of the recreational drug user will emerge as socio-legal subject variously defined by the state and its agents of public administration. In this paper, we employ a genealogical method that considers the state and official discursive formulations of drug use and users (Foucault 1977; Durkheim 1995; Cosgrave and Cormack 2023). A genealogical approach uncovers the social, historical, and political forces that coalesce to enable the conditions of possibility, and discursive transformations constitutive of, legalized drug and their users. Through what we will characterize as a “rationalization of morality” notions like vice and the prohibitionist state begin to be replaced by scientific and health discourses, but a moral discourse nevertheless persists, constructed around good and bad drug practices, habits, and attitudes. Being “informed” about the consequences of drug use becomes an obligation of the citizen who puts faith in scientific and expert pronouncements. Canada first criminalized recreational drugs in 1908 with the Opium Act, aimed primarily at Asian workers in western Canada (Boyd, 1984; Carstairs, 1998; Comack, 1991). Federal ministries of health and law enforcement worked together to define and criminalize drug production and consumption from these early days, legitimizing and entrenching their legal-bureaucratic power by entwining public health and public protection in their discursive rhetorics (Giffen, et al, 1991; Hewitt, 2016). Periodic moral panics, supported by media, shored up fear of drug vendors and users through the 20th century, often cut through with racist overtones (Carstairs, 1999). Social transformations of the 1960s—high immigration, cultural and commercial nationalism, conflicts related to Quebecois nationalism, youth movements and student protests (Boudreau, 2012), contributed to the decline of Protestant value hegemony and a shift of English-Canadian society out of the Victorian era (Morton 2003). We take 1969 as a Canadian discursive turning point, because it marks a conscious “modernization”, indicated by omnibus Bill C-150, which liberalized contraception and abortion, “homosexuality”, divorce, and gambling. Also in 1969, Canada’s first royal commission to investigate recreational drug use, the Le Dain Commission, was struck. Beginning with the Le Dain Commission, we find that a general discursive figure of the utilitarian pleasure-seeker, the risk-assessing consumer, the media dupe, along with figures like endangered “youth”, emerge in state discourse, domesticating the citizen toward state mediation of drug use. We argue that the cannabis consumer under the 2018 legalization regime is historically prefigured in the Le Dain Commission Report and becomes discursively set over the 50 years of such official accounts. Examining official government representations of drugs and drug users covering a fifty-year period, we ask how these representations, along with broader cultural trends, shape the state-citizen relationship. Documents examined include: The Commission of Inquiry into the Non-Medical Use of Drugs (Le Dain Commission Report), 1973; Report of the Senate Special Committee on Illegal Drugs (Nolin Commission Report), 2002; the Cannabis Task Force Report, 2016; and the Cannabis Act, 2018. These documents are grounded in differing mandates and authority: two are royal commissions, one is a task force, and one is federal legislation. The first discursive layer of these documents involves their own authority to speak about the drug user. As will be discussed, the committee members root their own authority in that of science and scientific information, although some of them hold political authority without being scientists themselves. A second discursive layer involves their assertions about human nature in general as grounds for their construction of the drug user. Again, in some cases the authority of named philosophers is invoked, in other cases more general demographic assertions are made about types of people – e.g., “youth”. Finally, we examine their assertions about the nature of the state and its mediation of drug use. Legal cannabis (and other drug) markets in Canada cannot be understood without consideration of the state’s role in discursively constructing drugs as substance, and the user as a subject. As the drug user is to be socialized by discourses about health, safety, and risk, the emergence of legal markets reveals the state’s ongoing construction of threats, forms of deviance, and an illegal “outside”. These threats include those who encourage or support drug consumption or experimentation by youth, uninformed consumption, illicit producers and vendors. A world of experiential, local and user knowledge is now marginalized and discredited as public health publics arise and legitimate state-expert-bureaucratic administration of pleasure and recreation.  

Krystle Shore, University of Waterloo

Rationalizing the coercive police monitoring of people with cognitive differences who wander through conceptions of 'vulnerability' and 'risk': Findings from a case study of Project Lifesaver

People with cognitive differences (e.g., people diagnosed with autism or dementia) often engage in wandering behaviour. While wandering can be a meaningful and enjoyable activity for these individuals, it can become dangerous and is a commonly expressed concern for their caregivers. As such, many caregivers rely on consumer electronic monitoring (EM) devices to keep their loved ones safe. Police organizations across Canada and the U.S. are also involved in managing the safety of people who wander through ‘Project Lifesaver’ surveillance programs; caregivers living in jurisdictions where police have implemented Project Lifesaver can have the people with cognitive differences they care for outfitted by police with radio frequency transmitter bracelets. Then, in the event of a wandering incident, police can use radio frequency tracking antenna to home in on the bracelet’s signal and locate the device wearer. While the intentions behind these EM practices may seem benevolent, literature on caregiver EM of people with cognitive differences shows that such practices carry a propensity to erode the personal autonomy, sense of self, and quality of life for those being monitored. Further, research shows that police efforts to protect vulnerable populations often rely on carceral logics and tactics and can therefore lead to serious individual and systemic harms for the communities targeted by the intervention. This paper draws from a large, qualitative case study of Project Lifesaver and considers how the program is designed and rationalized as a form of protection for people with cognitive differences and how it operates as such in an Ontario context, including the implications of the program for the communities it is designed to protect. This research involves content and thematic analyses of a variety of data sources including observations of an international Project Lifesaver conference and training program, the contents of Project Lifesaver promotional material and internal police documents (obtained through Freedom of Information requests), and interviews with various stakeholders involved in Ontario Project Lifesaver programs. The study adopts an abductive analytic approach, using an iterative process of data collection and analysis to situate empirical findings in relation to existing theoretical insights. Of note, two theoretical frameworks proved especially relevant to the analysis: Jennifer Musto’s (2016) concept of ‘carceral protectionism,’ which describes how state interventions can deliver protection for vulnerable populations through carceral systems and tactics, and classical Foucauldian perspectives on the relationship between population control and the promotion of population health. Findings discussed here call into question the protective benefits of Project Lifesaver for people with cognitive differences by showing that Project Lifesaver tracking technology is not often deployed by Ontario police to locate individuals enrolled in the program. Moreover, findings reveal Project Lifesaver to be a coercive and dehumanizing form of police surveillance that is rationalized as ‘care’ for vulnerable populations. In practice, the program denies the autonomy of those being monitored and renders them as objects to be tracked rather than humans to be engaged with and empowered. At the same time, these problematic program elements are obscured by Project Lifesaver discourse that frames people with cognitive differences as a particularly vulnerable population: classifications of vulnerability are applied in such a way that these individuals are simultaneously characterized as at-risk of imminent danger and inherently risky and dangerous. This discourse, in turn, reinforces the need for coercive police surveillance to manage this population’s behaviour. Study findings situate Project Lifesaver as a form carceral protectionism — the program functions as a form of social control that merges carceral logics, technologies, and techniques with the protection of vulnerable groups. As a result, the program extends the reach of the police apparatus into population health and welfare, as well as into the private domain of caregiving. Importantly, though, it is the ‘caring’ elements of PL that buttress this expansion of the state’s carceral machinery; the invasive, coercive, and dehumanizing aspects of the program are veiled by constructions of vulnerability and risk which effectively position this police surveillance as a necessary and benevolent safety mechanism for people with cognitive differences. Thus, Project Lifesaver operates as a subtle form of population control—one that appeals to caregivers’ rational interests in managing the safety of their dependents.