Making the Blue Zones Neoliberalism and Nudges in Public Health Promotion
Making the Blue Zones: Neoliberalism and nudges in public health promotion
Abstract
This paper evaluates the ideological and political origins of a place-based and commercial health promotion effort, the Blue Zones Project (BZP), launched in Iowa in 2011. Through critical discourse analysis, I argue that the BZP does reflect a neoliberalization of public health, but as an "actually existing neoliberalism" it emerges from a specific policy context, including dramatic health sector policy changes due to the national Affordable Care Act, also known as Obamacare; a media discourse of health crisis for an aging Midwestern population; and an effort to refashion Iowa cities as sites of healthy and active living, to retain and attract a creative class of young entrepreneurs. The BZP employs many well-known mechanisms of neoliberal governance: the public-private partnership; competition among communities for "public" funds; promotion of an apolitical discourse on individual responsibility and ownership of health; decentralizing governance to the "community" level; and marketing, branding, and corporate sponsorship of public projects. The BZP exemplifies the process of "neoliberal governmentality," by which individuals learn to govern themselves and their "life projects" in line with a market-based rationality. However, with its emphasis on "nudging" individuals towards healthy behaviors through small changes in the local environment, the BZP reflects the rise of "libertarian paternalism," a variant of neoliberalism, as a dominant ideology underlying contemporary health promotion efforts.
Introduction
A growing critical literature in geography addresses how neoliberalism impacts the discourse and practice of public health (Evans et al., 2012, Guthman, 2011, Guthman and DuPuis, 2006, Rawlins, 2008). Meanwhile, and mostly on a separate trajectory, there is revitalized scholarly interest in how place influences health. Linked to increasing attention on "social determinants of health" (Masuda et al., 2012), systematic research on "place effects" or "neighborhood effects" has begun to shed light on socio-environmental causes of obesity and other chronic health problems (Cummins et al., 2007). This growing recognition of the influence of place on health is beginning to have an influence on public health promotion efforts (Larsen and Manderson, 2009, Lovell et al., 2013) and urban design, for example to improve "walkability" in cities (Andrews et al., 2012, Evans et al., 2012).
Building on these developments in both academic literature and public health policy, this paper offers a critical evaluation of the "Blue Zones Project," a health promotion program that began in the US state of Iowa in 2011, based on advice for healthy living conceived by journalist and "happiness expert" Dan Buettner in his book The Blue Zones (Buettner, 2012). In short, the Blue Zones Project (hereafter, BZP) is a place-based, community-centered, and commercial health promotion enterprise, which became the centerpiece of a state-sponsored campaign to make Iowa the healthiest state in the nation by 2016.
The questions driving this paper are: What are the ideological and political origins of the BZP? Does it represent increasing neoliberalization of health, specifically in health promotion? And if so, what are the consequences? To answer these questions, I use a methodology based on critical discourse analysis of BZP project materials, media coverage, and social media messaging. I argue that the BZP represents, at one level, a policy neoliberalism that involves commercial actors and market logics in the governance of public health. Moreover, the BZP advances a kind of deep neoliberalism—neoliberal governmentality—that affects how people perceive, problematize, and manage their own health, a project to produce self-regulating subjects that is enhanced by interactive social media technologies. However, specific political circumstances explain why the BZP emerges now and in Iowa, of all places. The BZP addresses a variety of local-, regional-, and national-scale concerns, such as dramatic health sector policy changes due to the national Affordable Care Act (ACA), also known as Obamacare; a media discourse of health crisis for an aging Midwestern population; and an effort to refashion Iowa cities as healthy and active, to attract and retain a creative class of young entrepreneurs in a competitive global economy. With its emphasis on how small environmental modifications can make places healthier, the BZP exemplifies a variant of neoliberalism, libertarian paternalism, which enjoys broad support as a foundation for health-promoting public policies.
The primary goal of this paper is to inform and refine discussions of neoliberalization of health. It is rather too easy to treat neoliberalism as a totalizing discourse, governing all social relations and cultural production, but the BZP did not just emerge spontaneously from a neoliberal milieu. Rather, as an "actually existing neoliberalism" (Brenner and Theodore, 2002), the BZP emerges from the opportunities and constraints of a particular political context. Thus, this paper makes a significant contribution as a case study that explains how neoliberal governance of public health is actually conceived, planned, and implemented. I also seek to refine our understanding of consequences of neoliberalization. Since neoliberalization seems to lead to medicalization, individualization of risk, and de-socialization, many scholars are highly critical of it (Guthman, 2011, Rawlins, 2008, Rose, 2007). I propose that the BZP does not fit this template so neatly. The BZP actually foregrounds holistic ideas of well-being, the influence of place on human health, and community-based strategies for health promotion. Such principles and strategies share common ideological ground with libertarian paternalism, which emphasizes how numerous yet slight changes to social and built environments can "nudge" people toward healthy, responsible, and productive behaviors (Jones et al., 2011, Jones et al., 2013). Yet the BZP offers a thoroughly desocialized discourse about designing healthy communities, with little room for discussion of poverty, unemployment, or other social determinants of health (Crawshaw, 2012).
A secondary goal of this paper is to inform a broader literature in health policy, especially health promotion, which includes the work of geographers but transcends any one discipline. The BZP is a good example of increasingly common "area-based initiatives" or "place-based policies" aimed at creating "healthy cities" in hopes of attracting financial and human capital (Andrews et al., 2012, Evans et al., 2012). If the experience of the BZP is any guide, public-private partnerships to design healthy communities are likely to become more commonplace. While scholars of public health should be wary of the role that "lifestyle" and "wellness" industry professionals play in framing the terms of discussion for creating healthy places, initiatives like the BZP could nonetheless be a realistic option for enhancing community health and well-being.
Section snippets
Neoliberal governmentality and making healthy places
This paper seeks to refine and extend understandings of the neoliberalization of health. Scholarship in this area is crucial for understanding that the BZP, despite its slick imagery, feel-good rhetoric, and innocuous health advice, is a deeply political project. At one level, neoliberalization entails the increasing involvement of private actors in the governance of public health, a "policy neoliberalism" that finds parallels in the privatization of sectors such as policing, prisons, and
Critical discourse analysis and the political economy of health
To evaluate the ideological and political origins of the BZP, and how the BZP seeks to implement forms of neoliberal governance in public health, I apply a methodology based on critical discourse analysis (CDA), which has become widely used in studies of health politics and governance (Ayo, 2012, Braun, 2007, Brown and Bell, 2008, Crawshaw, 2007, King, 2002, Rawlins, 2008). Building on Guthman's (2011) study of the politics of obesity, which in turn draws on a "critical political ecology"
The origins of The Blue Zones
Buettner's book The Blue Zones (originally published in 2008, with a second edition in 2012) is the conceptual foundation of the BZP. The book itself is often part of BZP activities, as individuals and communities act to apply "tenets" or "principles" of the book to their everyday lives and local environment. The colorful places Buettner describes in the book are meant as exemplars: the BZP seeks to transform ordinary American towns into extraordinary places where people live long, healthy
Public health politics: the Healthiest State Initiative
Soon after taking office in 2011, Iowa governor Terry Branstad, a Republican, proposed an ambitious program to make Iowa the healthiest state in the US, called the Healthiest State Initiative (HSI). While the HSI cuts across many sectors of public health, the Blue Zones Project is its centerpiece. In this section, I explain how and why specific individual and institutional actors have transformed the Blue Zones model into a health promotion policy. The political motives behind the HSI are not
Technologies of neoliberal governance in the Blue Zones Project
To promote community and individual health, the BZP employs well-known mechanisms of neoliberal governance: a public-private partnership structure; competition among communities for "public" funds; promotion of an apolitical discourse on individual responsibility and ownership of health; devolving governance to the "community" level; and marketing, branding, and corporate sponsorship of public projects. It also goes beyond a kind of policy neoliberalism—where private firms increasingly fill
Discussion
The BZP would seem to be the epitome of neoliberal governmentality in public health promotion: a commercial venture, with a public-private partnership structure, that works to make people take responsibility for, and govern, their own selves. Yet, its analysis of the ingredients for healthy living is also holistic and place-based, acknowledging the impact that culture, social norms, and environment have on individual health. The Blue Zones discourse, then, only partly "individualizes" risk and,
Conclusions
While it exemplifies major ideological and political currents, the Blue Zones Project originated from a specific, but not uncommon, concatenation of events. A discourse of health crisis in Iowa, dramatic national health policy changes, and a change in party control of state government led to the Healthiest State Initiative and its public-private partnership structure. The BZP is undoubtedly a neoliberal policy approach insofar as it outsources certain aspects of health promotion to a commercial
Acknowledgments
The author would like to thank Katie Pratt, Ron Barrett, Daniel Trudeau, Morgan Adamson, and Neela Nandyal for their feedback on draft versions of this article; Ellen Kehr, Amy Tomcyzk, and Nick Buettner for providing background information about the Blue Zones Project; and Doroteja Postonjski and Kendra Komoto for their editorial assistance.
References (72)
-
Depression and mental health in neoliberal times: a critical analysis of policy and discourse
Soc. Sci. Med.
(2009)
- et al.
You, too, can be an international medical traveler: reading medical travel guidebooks
Health & Place
(2012)
- et al.
Out of our inner city backyards: re-scaling urban environmental health inequity assessment
Soc. Sci. Med.
(2012)
- et al.
Online social networking sites—a novel setting for health promotion?
Health Place
(2014)
- et al.
"A good spot": health promotion discourse, healthy cities and heterogeneity in contemporary Denmark
Health Place
(2009)
-
Standardizing sustainable development? The Forest Stewardship Council's plantation policy review process as neoliberal environmental governance
Geoforum
(2010)
- et al.
Understanding and representing 'place' in health research: a relational approach
Soc. Sci. Med.
(2007)
-
Governing at a distance: social marketing and the (bio) politics of responsibility
Soc. Sci. Med.
(2012)
-
Governing the healthy male citizen: men, masculinity and popular health in Men's Health magazine
Soc. Sci. Med.
(2007)
- et al.
Imperial or postcolonial governance? Dissecting the genealogy of a global public health strategy
Soc. Sci. Med.
(2008)
Moving beyond walkability: on the potential of health geography
Soc. Sci. Med.
(2012)
Understanding health promotion in a neoliberal climate and the making of health conscious citizens
Crit. Public Health
(2012)
Healthways shares jump following analyst upgrade
(2013, June 3)
Blue Zones Home Checklist
(2013)
Blue Zones Project Certification Overview
(2012)
Condition of the State Address
(2013 January 15)
Biopolitics and the molecularization of life
Cult. Geogr.
(2007)
Cities and the geographies of "Actually existing neoliberalism"
Antipode
(2002)
The Nudge Debate
(2013 August 9)
Weed: Been There. Done That
(2014 January 3)
Differences by degree: fatness, contagion and pre-emption
Health
(2014)
Placing geographies of public health
Area
(2002)
Businesses Start Blue Zones Certification
(2012 Sep 27)
The secrets of living longer
Natl. Geogr.
(2005 November)
The Blue Zones: 9 Lessons for Living Longer from the People Who've Lived the Longest
(2012)
City Residents Take Part in a Pilot Project to Live Longer, Better Lives
(2009 October 13)
The spread of obesity in a large social network over 32 years
N. Engl. J. Med.
(2007)
Building green: the emerging geography of LEED-certified buildings and professionals
Prof. Geogr.
(2009)
Creating Citizen-consumers: Changing Publics and Changing Public Services
(2007)
Toward the Healthy City: People, Places, and the Politics of Urban Planning
(2009)
Health as a meaningful social practice
Health
(2006)
The Will to Empower: Democratic Citizens and Other Subjects
(1999)
Governmentality: Power and Rule in Modern Society
(2009)
Nudging us into the Blue Zones
(2013, Sep. 10)
Editorial: Get Healthy–For All Kinds of Good Reasons
(2011, August 15)
Obesity/fatness and the city: critical urban geographies
Geogr. Compass
(2012)
Cited by (50)
Recommended articles (6)
Copyright © 2015 Elsevier Ltd. All rights reserved.
Source: https://www.sciencedirect.com/science/article/pii/S0277953615000271
Belum ada Komentar untuk "Making the Blue Zones Neoliberalism and Nudges in Public Health Promotion"
Posting Komentar