The medicalisation of society has brought about many, sometimes contradicting, conversations on what is a medical problem, what makes an individual medically different from others, and the relevance of social and political contexts (Conrad and Bergey, 2015).
To participate in these conversations, health must be defined. Traditionally, health is seen as the absence of illness, disease, and disability (Tulchinsky and Varavikova, 2000). More recently, the WHO (2022) has added a state of complete physical, mental, and social well-being. These standards have been guidelines for the organisation of public health.
In this article, obesity will be looked at as a medical deviant from the healthy standard. The WHO (2023) clinically defines obesity as an excessive fat accumulation that puts one’s health at risk, or a body mass index over 30.
Lastly, societal reactions to individuals that have seemingly abnormal bodies will be examined and health equity will be a context guide.
Messaging around medical deviants has created pictures of blame, that lie with the individual, which can leave psychological damage.
The right to label an issue as a medical problem historically belonged to members of the medical world. The evolution of medical science and public health strategies has created a whole new scope of health labels, and the efforts to guarantee rights of healthcare for all have mainly been left in the hands of public health (Tulchinsky and Varavikova, 2000).
Public health has been described by Winslow in 1920 as a framework of preventing disease, prolonging life, and community collaboration to ensure health is promoted (Grant, 2012). There is a combined focus on the efforts of social structures as well as citizens’ own skills to maximise the prevention of ill health, through health services like the NHS, environmental protection, and promotion of lifestyle practices (NHS, 2023).
According to Petersen and Lupton (1996), the New Public Health - an expansion of the public health approach - centralises individuals’ obligations and rights to use what public health can offer and teach them. In neoliberal societies, governments limit their involvement, and citizens’ prosperity, active participation, production, and consumption are main goals (Vallier, 2021). To ensure participation and production, individuals are obligated to remain healthy and prevent disruption of their well-being, to represent good citizens for their state (Petersen and Lupton, 1996). Foucault (1982) on the other hand, viewed the possibility to govern over one’s own body as a fundamental right. He cautioned against governmentality techniques to govern over people’s health and described the technologies of self as skills and attitudes to maintain good health and to facilitate personal choice of treatments.
Despite the significant responsibility on the individual contained within the NPH ideas, many initiatives, locally and globally, play an important role in educating the population, maintaining and operating health services, improving people’s quality of life through e.g. housing, employment and education, and providing environmental protection (Gray et al., 2006).
The NPH focusses more on inequity in health than traditional public health and reflects that through programmes, services and initiatives for protection, prevention, and improvement, but criticisms of the new policies have grown too.
In the UK, public health experts deemed the smoking ban, the sugar levy, and the Marmot Review into health equalities as the top three biggest UK public health accomplishments of the 21st century so far (RSPH, 2022). Globally, vaccination programmes, control of infectious diseases, motor-vehicle safety, safer workplaces, regulation of food, and family planning are examples of initiatives designed to reduce risk and improve public health (Gray et al., 2006).
Where the Marmot Report investigated health inequalities in the UK and made recommendations (RSPH, 2022), this inequity is still prevalent today and a major concern worldwide. A wide range of factors like governance, social and public policies, culture, socioeconomic position, gender, ethnicity, and behaviour have an impact on health and well-being inequity (Solar and Irwin, 2010). Its impact can go as far as for example the implanting of contraceptives by poor women to control fertility (Conrad and Bergey, 2015).
Neoliberal governing has had some negative influence on public health as well. When the condition of the market is paramount, cuts in funding for public services and local authorities, an increase of income inequality, and a bigger divide in quality and quantity between public and private care will follow (Middleton, 2011). Giroux (2010) talks about ‘Zombie Politics’ where, specifically in healthcare, major corporations are allowed to take up huge chunks of the economy, leaving little to spend on social services.
The NPH’s ever-evolving approach and motivation to improve health and quality of life for all are to be praised, but criticisms are important to address too and provide knowledge for governments and e.g. the WHO so they can keep updating their approach and interventions. That knowledge is important for populations too to educate themselves, as they are the ones that can influence and put pressure on governments with their votes and demands.
When the question of what a medical problem is, is answered through the lens of the NPH, the discourse of prevention takes centre stage. Prevention to keep individuals on an equal level of health. This raises the question of what makes an individual medically different from others.
Petersen and Lupton (1996) argue that in a capitalist society, citizens are supposed to work, and consume commodities, and link it to the aesthetics of their citizenship. The consummation of unhealthy commodities like alcohol, cigarettes, and unhealthy foods, results in distorted aesthetics and condition of the body. This personifies the existence of normal and abnormal bodies, and according to Goffman (1990), stigmatises the people that don’t adhere to these societal expectations. These people will be viewed as different and can perceive their own bodies as failures. Mass media plays a major part in conveying this message via news, tv programmes, advertisement, social media, etc (Coates et al., 2009).
However, the link between the consummation of alcohol, cigarettes, drugs and unhealthy foods, and ill health is valid (Bell et al., 2011). According to the WHO (2023), 4 million people die each year from diseases linked to obesity, and this is a growing number. With such a high death toll, public health interventions like education on overeating are needed (Bell et al., 2011).
While obesity is a real health issue, people with obesity are facing more and more discrimination because of society’s learned views (Bombak et al., 2016). As Goffman’s (1990) theory about stigma also indicates, Barlösius and Phillips (2015) argue that people with obesity feel and internalise stigma even without the presence of clear discrimination. A study by Bombak et al. (2016) showed that pregnant women with obesity felt discriminated against in accessing and receiving reproductive care, and perceived obesity related discrimination has been shown to lead to symptoms of depression (Robinson et al., 2016).
The messaging around obesity has failed to address social and political contexts to paint a holistic picture. The factors that influence health inequality also impact levels of obesity (Solar and Irwin, 2010), but the discourse of prevention has put much of the blame on the individual.
The NPH places a high level of responsibility on the individual to manage their own health. As the brainchild of mainly neoliberal thinkers, it has brought along cuts in funding, privatisation, more responsibility for local authorities, and tackling health inequity is an ongoing issue. Nevertheless, it has accomplished many positive initiatives that have made populations all over the world safer and healthier.
The shift of responsibility towards the individual has put prevention at the forefront and messaging has created a divide between normal and abnormal bodies. Specifically in the case of people with obesity, this has led to unconscious bias and overt and perceived discrimination.
Implementing their ever-evolving approach, the NPH can create opportunities for education around these issues for organisations, governments, and populations.
References
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