The Biopolitics of Lifestyle

Foucault, Ethics and Healthy Choices

Christopher Mayes

• Publisher: Routledge
• Year: 2015
• Print ISBN: 9781138933866
• eBook ISBN: 9781317382362
• Edition: 1
• Topic: Politics & International Relations
• Subtopic: City Planning & Urban Development
• Index: Politics & International Relations

A growing sense of urgency over obesity at the national and international level has led to a proliferation of medical and non-medical interventions into the daily lives of individuals and populations. This work focuses on the biopolitical use of lifestyle to govern individual choice and secure population health from the threat of obesity. The characterization of obesity as a threat to society caused by the cumulative effect of individual lifestyles has led to the politicization of daily choices, habits and practices as potential threats. This book critically examines these unquestioned assumptions about obesity and lifestyle, and their relation to wider debates surrounding neoliberal governmentality, biopolitical regulation of populations, discipline of bodies, and the possibility of community resistance.

The rationale for this book follows Michel Foucault's approach of problematization, addressing the way lifestyle is problematized as a biopolitical domain in neoliberal societies. Mayes argues that in response to the threat of obesity, lifestyle has emerged as a network of disparate knowledges, relations and practices through which individuals are governed toward the security of the population's health. Although a central focus is government health campaigns, this volume demonstrates that the network of lifestyle emanates from a variety of overlapping domains and disciplines, including public health, clinical medicine, media, entertainment, school programs, advertising, sociology and ethics.

This book offers a timely critique of the continued interventions into the lives of individuals and communities by government agencies, private industries, medical and non-medical experts in the name of health and population security and will be of interests to students and scholars of critical international relations theory, health and bioethics and governmentality studies.

1
Obesity, bioethics and the lifestyle dispositif

Personal responsibility is the foundation of an ethical society.

David Cameron, UK Prime Minister (2010).

In its everyday usage, the concept of lifestyle appears to refer to a set of stable and concrete phenomena. Politicians valorize their nation’s lifestyle as uniquely good and worthy of protection, fashion designers claim their clothes and accessories provide a lifestyle, medical professionals fear the effect of the modern lifestyle on global health, and environmentalists chide the Western lifestyle as a primary cause of climate change. In these instances the intended audience is assumed to know what is being referred to, however, closer inspection reveals lifestyle as an imprecise and vague idea.

Lifestyle may have an ambiguous meaning, but like life, health or sex, it has a powerful rhetorical influence. Lifestyle is increasingly used to frame political action, shape social relations, and redefine interactions between individuals and populations. The diverse uses of lifestyle establish a network through which the everyday habits and activities of individuals are made visible and governable. Food choice, exercise habits, fashion or leisure activities may be innocuous personal preferences, but viewed through the lens of lifestyle they represent an identity, a politics, or a threat to population health. In making these choices visible, techniques of governance can be mobilized to secure the population by encouraging individuals to adopt responsible lifestyle choices. The successful creation of a healthy lifestyle enfolds the individual into the population to be protected and cared for. However, failure to adopt choices associated with a healthy lifestyle can result in the stigmatization and scrutiny of the individual’s life through disciplinary mechanisms.

The biopolitics of lifestyle masks a shift from a socialized welfare that purports to secure the many, to an individualized welfare that secures those who are able to care for themselves. Lifestyle makes visible those who are responsible and those who purportedly harm society. To be seen as harming or financially burdening other can lead to implicit or explicit exclusion from care. Stigma and harm associated with lifestyle is an underexplored theme. Much of the discussion of the purported harmful effects of lifestyle is taken for granted. It is assumed as an obvious fact that smokers, the obese and the lazy are a drain on society. This allows the effects of stigma to be ignored or minimized.

This chapter uses a recent debate in the bioethics literature over obesity and the individual to illustrate the way the logics of lifestyle allows certain interventions to prevent harms seem obvious and acceptable. The obviousness of these interventions hides and minimizes the stigmatization of people who are overweight or obese. Prominent bioethicists Peter Singer and Dan Callahan have argued for coercive interventions into the lives of individuals on grounds that unhealthy choices of individuals harm the rest of the population. This bioethical debate serves to highlight the usefulness of the work of Michel Foucault in tracing the entangled lines and threads that flow through strategies of lifestyle governance.

Following an analysis and discussion of Singer and Callahan’s arguments, I develop Foucault’s notions of dispositif and biopolitics. Dispositif is an apposite analytic framework for this project as it incorporates the three main lines of Foucault’s work – knowledge, power, and subjectivity – to make specific subjects, truths, and practices visible, possible, and governable. However, it is under-theorized in existing literature and mistakenly assumed to be equivalent to apparatus or indistinct from genealogy. Although related to both apparatus and genealogy, my analysis sheds light on the concept of dispositif in Foucault’s later work. I use this broadened perspective to address the way lifestyle is a biopolitical mechanism that identifies and governs those whose lives are to be cared for and those excluded from care and exposed to violence. This chapter sets up the theoretical groundwork to respond to the questions of how lifestyle emerged to govern, guide and foster the life of the individual for the security of the population.

Bioethics and the harm of obesity

Debate over the impact of the obesity epidemic and what should be done about it has been ongoing among public health, health policy and social scientists since at least the 1990s. Bioethicists, however, have been relatively silent on this issue. Traditionally focused on ethical issues pertaining to the individual and the clinic, bioethicists have addressed obesity primarily in the context of concerns relating to resource allocation or clinical procedures such as bariatric surgery. Prominent bioethicists Peter Singer and Dan Callahan have recently entered the obesity debate to argue that obesity is not simply a clinical or personal issue but an ethical issue with social and political consequences (Singer 2012, Callahan 2013). As such, they contend that interventions into the lives of individuals and populations are needed to curb the rise of obesity.

The arguments put forward by Singer and Callahan are not particularly striking or original. What is interesting however is the use of normative ethics to justify coercive interventions as well as the reliance on the logics of lifestyle for these arguments and interventions to seem like common sense. The strength of their respective arguments rests on empirical claims that obesity is caused by individual liberty, which in turn harms society. Although tightly argued, Singer and Callahan’s proposals do not accord with empirical research. By drawing attention to this research I argue that Singer and Callahan contribute to the stigmatization of people defined as overweight or obese, which can itself be considered a form of harm.

The contributions of Singer and Callahan to the obesity debate provide a helpful avenue into the way obesity is framed such that individuals’ incidental behaviours become visible while more problematic structural forces remain hidden. Singer and Callahan’s respective arguments that individuals should be made responsible for the obesity epidemic contain two problems widespread in obesity discourse. First, an uncritical assumption that individuals are autonomous agents responsible for health related effects associated with food choices and physical inactivity. In their view, individuals are obese because they choose certain foods or refrain from physical activity. However, they acknowledge that this alone does not justify intervening in the lives of individuals. Both Singer and Callahan believe that autonomous individuals are free to make foolish choices so long as those choices do not harm or impose costs on others. It is at this point that the second problematic aspect arises. To legitimately interfere in the liberty of individuals they invoke the harm principle. That is, they seek to demonstrate that obese individuals are harming others. In attempting to activate the harm principle, both Singer and Callahan rely on superficial readings of public health research to amplify the harm caused by obese individuals and ignore pertinent epidemiological research on the social determinants of obesity. The mobilization of the harm principle and corresponding focus on individual behaviours is made possible through the belief that the individual is the primary unit through which to understand social interactions.

Like many within contemporary bioethics, Singer and Callahan operate with a theoretical toolbox largely defined by the liberal tradition of moral and political philosophy. In particular, they characterize persons as rational, self-conscious and autonomous agents free to determine their own ends. This idea is upheld as axiomatic and deserving of social and juridical guarantee. The dominance of this idea among bioethicists partly explains their relative silence on public health issues like obesity. If it is true that obesity is the result of choosing to eat more and exercise less, then it would appear that autonomous persons in liberal societies should be left alone to pursue the activities and ends of their own determining. This at least seems to be the conclusion to draw from J.S. Mill, who writes ‘the only purpose for which power can be rightfully exercised over any member of a civilized community, against his [sic] will, is to prevent harm to others. His own good, either physical or moral, is not a sufficient warrant’ (1996: 78). However, as is demonstrated below, the relationship between individuals and society is not so clear-cut.

Singer on the cost of heavy passengers

In an article for Project Syndicate¹ entitled ‘Weigh More, Pay More’, Singer echoes the harm principle when he writes:

Is a person’s weight his or her own business? Should we simply become more accepting of diverse body shapes? I don’t think so. Obesity is an ethical issue, because an increase in weight by some imposes costs on others.

(Singer 2012)

Singer uses the example of air travel to demonstrate the way obese individuals impose a cost on others. Drawing on figures offered by the chief economist at Qantas, Singer claims that a weight increase of two kilos per passenger since 2000 has resulted in the airline spending an extra $472 in fuel per Sydney to London flight or $1 million annually. Singer suggests that this cost should not be borne by the airline or the passengers as a collective, but by those individuals exceeding a 75-kilo threshold. Singer claims that this measure is ‘not to punish a sin’ but ‘a way of recouping…the true cost of flying you to your destination, rather than imposing it on your fellow passengers’ (2012).

Singer points out that air travel is not a human right and that appropriate costs for air travel is limited to the realm of private enterprise. If Qantas wishes to pass operating costs on to customers it could. To this point Singer is sounding more like a spokesperson for the airline industry rather than a bioethicist. However, Singer’s real concern is not Qantas’s bottom line. Although the airplane example and title of his article suggests that Singer wants obese people to pay the financial costs purportedly associated with their weight, his real interest is in non-financial harms.

The more obviously ethical feature of Singer’s argument is when he links increased fuel use to global warming. According to Singer, heavy passengers require more fuel, which produces ‘higher greenhouse-gas emissions’ and ‘exacerbate[s] global warming’ (2012). He applies the same logic to public transport and health care. According to Singer, larger and heavier people use more health care resources due to their greater mass and the variety of medical problems purported to be associated with being overweight and obese.

Singer maintains that these examples demonstrate that ‘the size of our fellow-citizens affects us all’ and that ‘[i]f we value both sustainable human well-being and our planet’s natural environment, my weight – and yours – is everyone’s business’ (2012). Singer concludes by returning to the harm principle, arguing that the harms and costs caused by obese individuals ‘justify public policies that discourage weight gain’ (2012). Thus it is not simply a matter of requiring obese individuals to offset the economic costs, but due to non-economic costs such as harm to the environment or use of health resources, it is necessary to discourage and prevent individuals from making choices purported to cause obesity. It is on this point that Callahan offers a number of suggestions, including stigmatization.

Callahan and the use of stigma to benefit society

In an article published in the Hastings Center Report, Daniel Callahan asks ‘how far can government and business go in trying to change behavior that harms health?’ (2013). Callahan is specifically interested in behaviours associated with obesity. Like Singer, Callahan considers obesity to pose significant harms to human wellbeing and society. According to Callahan, the combination of prevalence (67 per cent of Americans are overweight or obese) and costs (financial, social and medical) of obesity constitutes a harm that justifies the introduction of ‘coercive public health measures’ (2013: 36).

The nature of the problem, as defined by Callahan, means that individuals need to be induced ‘to change the way they eat, work, and exercise’ (2013: 39). Despite acknowledging social influences, Callahan argues that the primary ‘causes of obesity’ are the sedentary habits, poor diet and ‘all the luxuries we possess – automatic garage door openers, can openers, food blenders and mixers, escalators, elevators, golf carts, automobiles, and so on’ (2013: 35). Therefore it is at this level that behaviour change strategies need to operate and ‘awaken’ overweight and obese people ‘to the reality of their condition’ (2013: 40).

What is needed, according to Callahan, is a three-pronged approach that includes ‘coercive public health measures, mainly by government but also by the business community; childhood prevention programs; and social pressure on the overweight’ (2013: 36). Although Callahan notes a role for government and business in shaping the environment, he maintains that ultimately individuals need to work ‘to stay thin in the first place and to lose weight early on if excess weight begins to emerge’ (2013: 40). By coercing and pressuring individuals, Callahan believes it will be possible to change behaviours and reduce obesity rates. Callahan acknowledges that these strategies will interfere with individual liberty, however, like Singer, Callahan believes that the magnitude of the harms posed to future human wellbeing and society justify this approach.

Both Singer and Callahan assert that obesity harms society due to associated economic costs. A strategy to rebut their respective arguments could be to refute this economic assertion. The Wall Street Journal published an estimate that the diet and obesity management industry will be worth $139.5 billion dollars by 2017 (Anonymous 2013). This figure does not include the value of so-called obesogenic industries such as fast food and soda. It could therefore be argued that the health costs of obese people and associated activities are neutralized by the gains of industries associated with causing or curing obesity. Rather than targeting individuals, Singer and Callahan should focus their energies on getting governments to adjust tax rates and distribution accordingly to ensure public transport and health systems can grow to support these profitable industries. Rather than taking this route I will assume that the collective weight gain in Western populations poses some economic costs to society. However, I maintain that the positions of Singer and Callahan are untenable and ignore pertinent research. To rebut their positions I focus on two related questions: Do individual choices cause obesity? And, are the str...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Acknowledgements
• Introduction: the lifestyle problematic
• 1 Obesity, bioethics and the lifestyle dispositif
• 2 Lifestyle as politics: choice and responsibility
• 3 Lifestyle as health: articulating an ‘urgent need’
• 4 Lifestyle as identity: consumption and the ethics of the self
• 5 A cacophony of guidance: hearing, seeing and judging choices
• 6 Styles of resistance: the body, counter-conduct and critique
• 7 Relations of care: restless and endless transformation
• Conclusion: style, solidarity and security
• Index