The public health movement is an accepted influence across society today. Its power goes beyond the medical institution and aims to sustain a dominance over individuals in society. Foucault’s theory of the “medical gaze” and Illich’s concepts of iatrogenesis and holistic approach to medical dominance highlight how the Medicalisation of society remains a reality today.
The early public health movement focused on the environmental and social causes of illness, encouraging local government regulation of clean water, sanitisation and standards of housing conditions (Orme et al, 2007). Today attention has shifted towards the individual and preventing disease before it becomes problematic (Lupton, 1995; Peckham in Orme et al, 2007). According to Armstrong (1993: 407, cited in Lupton, 1995: 51-52), public health has generated ‘a vast network of observation and caution’ across society. This refers to the Medicalisation of society and Foucault’s “medical gaze” (Foucault, 2003).
Foucault argues that modern systems of power are more penetrating and sinister compared to previous forms (Taylor in Owen, 2014). Building upon his theories of the “panoptic gaze” in relation to crime and punishment, the medical gaze suggests that an authority – the public health movement – attempt to maintain control over everyone in society through constant surveillance (Foucault, 2003; Taylor in Owen, 2014). At the centre of Foucault’s gaze is a dichotomy of normality/deviance as medical knowledge is constructed by studying the “healthy individual” and portraying it as a status of normality, and those who deviate are viewed as an “other” or deviant (Foucault, 2003).
This is clearly seen in contemporary public health as it aims to educate individuals by providing information about body maintenance and lifestyle changes to remain “healthy” and thus normal (Lupton, 1995). It is done to facilitate individuals to voluntarily make decisions that will positively impact their body, and when it is appropriate to access certain health services if they require help (Lupton, 1995). Additionally, public health discourse depicts an “unhealthy” deviant individual as someone who lacks self-control and self-discipline, allowing themselves to be affected by disease through a failure to regulate their lifestyle and instead engage in self-destructive behaviours (Lupton, 1995). This supports Foucault’s medical gaze as individuals, aware they are under surveillance, begin to regulate their own behaviour and may even regulate others by highlighting when someone else is being deviant and advice on how to revert to normality (Taylor in Owen, 2014). The approach taken by the public health movement towards obesity is an ideal example of the medical gaze in contemporary society.
In 2015, 58% of women and 68% of men were identified as overweight or obese in the UK (NHS, 2017). Furthermore, between 2015/16, over 1 in 5 children in their first year of primary school were measured as obese or overweight, and 1 in 3 among children in their final year of primary school (NHS, 2017). Obesity has been regarded as an “epidemic” in the 21st century (Orme et al, 2007; Baggot, 2011) and has become a key health issue for the public health movement. Increased regulations in schools have not only been developed in reaction to child obesity: they also serve as a preventive strategy against obesity in adulthood. Emphasis on childhood became prominent in 2005 following a media campaign by celebrity chef Jamie Oliver (Baggott, 2011). Oliver highlighted the “unhealthy” meals being served in schools and set out to improve the diets of schoolchildren (Baggott, 2011). This became a catalyst for the School Meals Review Panel in 2005 which introduced a £280 million three year funding package towards school meals and new mandatory food and nutrient standards were introduced (Baggot, 2011).
A criticism of Foucault is that only the medical industry that holds power in society, yet the public health movement includes the government, advocacy groups and the media to promote its knowledge – and all play as important a role in health and Medicalisation. Illich (1976) acknowledges aspects of Foucault’s theory, suggesting that Medicalisation has turned society into ‘a world turned into a hospital ward’ (Illich, 1976: 271) and to be successful is to have self-awareness, self-discipline and the ability to regulate diet and lifestyle (Illich, 1976), yet he is able to see its impact from political, social and cultural perspectives.
His concept of iatrogenesis (Illich, 1976) accounts for the potential negative health impacts of promoting a “normal” body type, and also recognises that individuals who are “healthy” have access to “maintaining health” (Illich, 1976). Health inequalities are an aspect of obesity that is often unacknowledged, yet Baker (2017) in relation to childhood obesity identifies that 7% more children in their first year of primary school in areas regarded as most deprived were obese compared to children in the “least deprived” areas. These trends continue into the final year of primary school with 26% of children in most deprived areas being obese compared to only 11.5% in the least deprived areas (Baker, 2017).
Overall, Illich’s ideas of medical imperialism remain relevant in explaining the dominance of public health in society today. His concepts, along with Foucault, suggest how medicine is no longer institutionalised and instead is a commonplace, and accepted, influence within society. Despite its efforts to regulate and the benefits of this in reducing obesity, it fails to recognise the role of inequality and it is potentially favourable for public health to pay attention on reducing inequalities and access to “being healthy” over a emphasis on the normal body.
By Rachel Lawson
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