Neoliberal Health Organizing

Communication, Meaning, and Politics

Mohan J Dutta

• Editorial: Routledge
• Año: 2016
• ISBN:
  9781315423517
• Edición: 1
• Categoría: Languages & Linguistics
• Categoría: Communication Studies

Mohan J Dutta closely interrogates the communicative forms and practices that have been central to the establishment of neoliberal governance. In particular, he examines cultural discourses of health in relationship to the market and the health implications of these cultural discourses. Using examples from around the world, he explores the roles of public-private partnerships, NGOs, militaries, and new technologies in reinforcing the link between market and health. Identifying the taken-for-granted assumptions that constitute the foundations of global neoliberal organizing, he offers an alternative strategy for a grassroots-driven participatory form of global organizing of health. This inventive theoretical volume speaks to those in critical communication, in health research, in social policy, and in contemporary political economy studies.

1 Neoliberalism and Health

DOI: 10.4324/9781315423531-1

Contemporary organizing of health across the globe has been constituted under the framework of globalization, marked by the rapid shrinking of time and space and by the accelerated movement of labor, capital, and resources across global boundaries (Navarro, 2007). Globalization as we know it today has been driven by the political and economic rationality of neoliberal organizing that celebrates individual responsibility, self-care, empowerment, and self-help, accompanied by the minimized role of the state in the delivery of welfare; deregulation of labor, environment, and finance; and stimulation of global commerce and investments through minimization of regulations, tariffs, and subsidies (Brown & Baker, 2012; Dutta, 2008, 2011; Harvey, 2005; Navarro, 2007; Shugart, 2010). Neoliberalism refers to a complex web of political and economic thought that considers at its heart the principle of the free market as a driving mechanism for political, economic, and social organizing (Harvey, 2003, 2005), and, therefore, constructs governance in the image of the free market based on an “individualist micro-economic model” (Bourdieu, 1998, p. 9). Under the narrative of the free market, human potential is maximized when the limits imposed by the state are minimized, thus enabling a catalytic climate for growth, productivity, and efficiency.

Although primarily formulated as a form of economic organizing captured in the understanding of a free market as an enabler of freedom, neoliberalism amalgamates political, social, and cultural narratives of organizing within its framework of the free market achieved through the participation of the individual in exchange processes (Brown & Baker, 2012; Moreton, 2009) and through the catalyzing role of the state as an enabler of free enterprise (Harvey, 2003, 2005; Navarro, 2007). The free enterprise of neoliberalism is manifested in the freedom of transnational corporations (TNCs) to trade freely across global borders, serving primarily as a pattern of global organizing that enables the continual accumulation of capital in the hands of the power elite. In this sense then, neoliberalism is a particular form of global organizing backed by powerful global actors with economic resources to shape politics, economics, and social organizing in ways that enable this cycle of continual extraction of resources, accumulation of capital, and consolidation of power, carried out under the twin narratives of growth and liberty. Communication, working through dynamic processes of assigning meanings, constitutes the framework of legitimacy for global organizing structures, working through public relations, persuasion, and journalism. It is, therefore, vital to interrogate the meanings that circulate in neoliberal formulations of local, national, and global policies. Journalism, public relations, and public communication campaigns are integral to the global diffusion of neoliberal values within mainstream structures. What then are the specific meanings that are given precedence within these mainstream communicative structures?

This book specifically focuses on connecting these meanings that achieve hegemonic status within the mainstream structures of global organizing to questions of health. The hegemony of neoliberalism, I argue, is achieved through communicative inversions, the deployment of communication to circulate interpretations that are reversals of the material manifestations. These communicative inversions are fundamental to key disciplinary threads of communication scholarship, constituting communication as advertising, public relations, persuasion, strategic communication, integrated marketing communication, communication management, and communication campaigns directed at changing knowledge, attitude, and behavior through influence. One of the dominant threads of communicative inversion under neoliberalism centers on the organizing role of the state in facilitating the hegemony of the free market. Whereas the neoliberal organizing of the globe is predicated on the communicative circulation of the narrative of minimal state intervention, the materiality of neoliberal organizing is predicated on the powerful imperial role of the United States in protecting internal markets and simultaneously manipulating international financial institutions (IFIs), namely, the World Bank (WB), the International Monetary Fund (IMF), and the World Trade Organization (WTO), to open up markets for U.S. TNCs. Similarly, nation-states across the globe have played instrumental roles in shaping the conceptualization and implementation of the neoliberal model. These communicative inversions are integral to the production of the health inequalities that we witness across the globe. Throughout the book, we will interrogate the discursive articulations, processes, and strategies that are deployed toward reproducing global health inequalities and weakening public health infrastructures.

Yet another element in establishing the power of the global elite in the context of health is communicative inequality. Communicative inequality refers to the unequal access to sites of discourse, discursive processes, and discursive articulations (Dutta, 2004a). Communicative inequality works hand in hand with material inequality such that the lack of access to material resources mirrors the lack of access to symbolic resources (Dutta, 2008). The voices of subaltern communities are erased from discursive spaces by turning them into subjects of interventions, stripping communities of their agency and of their ability to make meaningful decisions. Techno-deterministic solutions foregrounding innovations and new technologies are directed at subaltern communities, generating new markets for privatized innovations and simultaneously excluding subaltern communities from participatory opportunities. Expert-driven solutions such as building culturally sensitive health promotion campaigns and building cyber-infrastructures and information superhighways offer one-way channels for message dissemination without really creating spaces for listening to subaltern communities or addressing the underlying material inequalities (Viswanath & Kreuter, 2007; Viswanath, 2011). The framing of communicative inequality in the dominant literature constituted within neoliberal logics promotes techno-deterministic solutions without really addressing the underlying material inequalities and without creating spaces for listening to subaltern voices. Communicative inequality thus is constituted amid neoliberal governance as the absence of spaces for voicing community needs, ideas, and imaginations within global discursive spaces. As an exemplar of communicative inversion, these erasures of participatory opportunities for the subaltern sectors are often carried out through technologies of participation that apply tools of participation, collaborative decision making, community engagement, and deliberative democracy precisely to accomplish the preconfigured agendas of the powerful global actors (see the critique offered by Dutta & Basnyat, 2008).

Against this backdrop of communicative inequalities, the health impacts of neoliberalism are witnessed in the weakening of public health programs and resources, the displacement of the poor from their spaces of livelihood, the weakening of local agriculture in the face of large-scale corporate agriculture, the piracy of indigenous knowledge and the corresponding commoditization of health solutions in a global market, the rising inequalities within states, the minimization of economic opportunities for the poor amid structural adjustment programs, growing unemployment, the weakening of unions and organized sites of resistance amid state-sponsored violence, the increasing exposure to workspace risks as the poor subject their labor to exploitation in unregulated spaces, the increasing exposure to pollutants and health risks at global sites of production, and the minimization of opportunities for productive participation at the margins of global economies (Dutta, 2013a, 2013b; Millen & Holtz, 2000; Millen, Irwin & Kim, 2000). Human health is one of the fundamental areas that has been adversely affected by the neoliberal organizing of global politics, economics, and society. What then are the dominant interpretive frames of neoliberalism, and how are these frames connected to health?

Evident in the neoliberal organizing of the globe in the two decades following the introduction of the neoliberal reforms in the 1990s is the dramatic rise in global inequalities. Inequalities are evident both within and across nation-states, with nation-states in Africa experiencing large-scale extraction of resources. The large-scale inequalities evidenced globally are pronounced, with increasing disparities in the distribution of resources between the haves and have-nots (Gershman & Irwin, 2000; Monteiro, Conde & Popkin, 2004; Piketty, 2014). Based on analysis of U.S. income data from 1910 to 2010, Piketty (2014) demonstrates that in the United States, the top decile share in the national income increased from 30 percent to 35 percent in 1970, and to 45 percent to 50 percent in 2010. Moreover, critical to the analysis offered by Piketty is the accumulation of private wealth, measured in the form of real estate, financial assets, professional capital, and net of debt, demonstrating that in Britain, France, and Germany, the rise in private wealth went from one to three times the national income in 1950 to four to six times in 2010. He notes that at the juncture of the financial crisis in the United States in 2008, the upper decile’s share exceeded 50 percent of the U.S. national income. Piketty thus offers a twofold explanatory framework: (a) the large gaps in income inequality are tied to the power held by the managerial classes to set their own remuneration, which, in many cases, cannot be correlated with their productivity; and (b) the disproportionate levels of return on capital compared with the growth rate of the economy suggest that inherited wealth has grown at a greater level than economic output has. What then are the systems of global organizing prevailing from 1990 onward underlying the persistently increasing patterns of income and wealth inequalities?

Ample evidence connects income and wealth inequality with inequalities in health outcomes. Moreover, evidence from public health documents the relationship of societal-level inequalities with broader aggregate health outcomes for the entire society. Persistent inequities in health outcomes are observed both within as well as across countries (World Health Organization [WHO], 2008). For instance, infant mortality varies dramatically within countries with the level of mother’s education. In Mozambique, babies born to a mother with no education have infant mortality rates greater than 120 per 1,000 live births compared with babies born to a mother with secondary or higher education (60–70 per 1,000 live births). These inequalities are observed in comparison of countries, as well, with infant mortality of just over 20 per 1,000 live births in Columbia compared with the infant mortality of just over 120 per 1,000 in Mozambique. According to the WHO (2008) report, in the United Kingdom the mortality rates among the poorest segment are higher than those in the middle segment, which in turn are higher than those in the least-deprived segment. Marmot (2004) refers to this relationship between social disadvantage and health outcomes as the social gradient in health. Aligned with critical health analyses that point toward broader structures of organizing that constitute inequities in health outcomes, the chapters in this book seek to interpret the structures of organizing that normalize, produce, and circulate inequities in health outcomes. How do these underlying forms of global organizing of resources constitute inequalities in health outcomes? What stories, meanings, and interpretations get circulated within these structures?

In this introductory chapter, I first examine the ways in which global health has been formulated under the organizing principles of neoliberalism and then work through the potential challenges that result from the framing of health as a subject of neoliberal intervention (Dutta, 2008; Youde, 2012). What are the assumptions in the neoliberal organizing of health, and how are these assumptions framed in the health communication solutions? What are the meanings of health that emerge in neoliberal policies and programs, and how are these meanings organized globally? Most importantly, what are the health impacts tied to these policy articulations and the meanings they circulate?

As we read this introductory chapter as a framework for understanding the key principles of neoliberalism, we will first review the literature in critical health communication, identifying the key debates in communication of and communication about health. Our critical reading will examine questions of power and the ways in which these questions of power play out in formulation of policies. Through an emphasis on the meanings that circulate around health, we will attend to the broader structures of organizing within which health is situated. Structures refer to the frameworks of organizing material resources that both enable as well as constrain access to these resources. Structures of health constitute resources such as hospitals, education, food, employment, work, and so on, that reflect the ambit of global health inequalities. How then are these inequalities reproduced through the meanings circulated in neoliberal conceptualizations of global health? After taking a close look at the intellectual trajectory of neoliberalism and the key tenets of neoliberalism, we will then examine the role of neoliberal interventions within the broader framework of health. It is my goal to demonstrate throughout this chapter the continuities and divergences between the imperial tropes of development communication in global health and the contemporary epoch of neoliberal health organizing.

Critical Health Communication: Meaning, Culture, and Power

This book is guided by a critical framework of health communication, engaging with questions of meaning, power, and practice of health as understood and disseminated within the structures of globalization (Dutta, 2008; Zoller & Dutta, 2008). Conceptualizing power as structurally situated in relationships, institutions, and networks, critical health communication examines the meanings of health that are circulated globally, and the communicative processes that carry over these meanings in policies, programs, and reports. Attention focuses on discourse and the ways in which language works in health settings to serve the interests of the status quo while simultaneously marginalizing certain sectors of society (Lupton, 1994). Specific interpretations of health are put forth as organizing frames of global governance, framing politics, economics, and society along the lines of these meanings. Examining closely these meanings in relationship to the structural formations that constitute them offers entry points to understanding the processes and networks of control that are intrinsic to the accumulation of wealth and the dispossession of the margins. Aligning this understanding with the context of health focuses attention on the specific forms of communication that are deployed in the privatization of health, normalization of global inequalities, and dissemination of capital accumulating practices that are intrinsically threatening to the health of communities.

In laying the foundations of critical health communication theorizing almost two decades ago amid widespread neoliberal reforms that were taking root globally, Lupton (1994, p. 55) offers the following guiding questions: “In whose interests is the discourse operating? What (and whose) values, beliefs, and concepts are espoused, and what others are neglected? What pre-established knowledge or belief systems are drawn upon to create meaning? What types of social differences are established or perpetuated?” Cultural values, forms of representation, and narratives emerge as the contextually situated sites for the enactment of power, as well as for the consolidation of resources in the hands of the global elite. Practices of health come to be formulated within the narrow terrains of capitalism accumulation and health is turned into a commodity to be exchanged through participation in the market. The depiction of the health consumer as the owner of health accomplishes the privatization of health through a language of participation. Participation in the market is seen as the mechanism for ensuring health. As a consequence, health solutions that are put forth are organized in the logic of accumulation, not as a fundamental human necessity and right. Critical interrogation of the meanings of health attends to the structures of governance through which health is constituted, delivered, and talked about in policies and programs. How health is talked about and the meanings assigned to health are essential to the hegemonic assertion of neoliberal health policies. As Hall (2003, p. 10) notes, “a new neoliberal common sense” has captured the imagination of civil society, having achieved hegemonic status in the everyday organizing and workings of society.

The crit...