Neoliberal capitalism and the limits of individual choice
We tend to about labour as something we engage in physically or mentally and which, both historically and in our contemporary context, is constituted by the capitalist imperative to extract labour for profit. This remains the case even though it is increasingly the growth of finance, supported by the State, that, through a kind of liquid capitalism, has produced a system based on speculation, manipulation, and exploitation. Moreover, it is often forgotten that labour, as a form of praxis and engagement, is also present in other domains of social life – most visibly in the home (site of social reproduction), and, increasingly, as I argue in this article, in the domain of health.
With State supported, taxpayer funded forms of health care becoming less and less accessible, individual citizens are ‘responsibilized’ to take on any and all obligations for maintaining ‘good health’ in line with becoming ‘self-responsible health consumer.’ Technological artifacts like health tracking apps, scientific innovations such as health correlated DNA mapping, and governmental and media discourses that perpetuate the connection between health and individual choice has become our economic system’s handmaidens which requires our cognitive, physical, affective, and bodily labour as supports and which profits from the data and information produced therein. Marrying a left critique of neoliberalism with Michel Foucault’s theory of biopolitics and biopower provides a necessary lens through which to assess the current environment. Biopower and biopolitics refers to the myriad techniques and technologies by which we are managed and governed (biopolitics), and reflects a shift to a monitoring of biological processes including: “propagation, births and mortality, the level of health, life expectancy and longevity, with all the conditions that can cause these to vary. Their supervision was effected through an entire series of interventions and regulatory controls: a biopolitics of the population.”
Constituting the first layer of this analysis are health tracking apps, the most desirable of which, according to Forbes, includes Beachbody On Demand, a fitness and diet app; MyFitnessPal; a meal and nutrition tracking diet app; and Sleep++, a sleep monitoring app that monitors and diagnoses sleep problems. Also worth including are wearable devices like the Fitbit and heart rate monitors. Each of these apps work synergistically to manage, track, measure, and quantify bodily processes in what has become to be known as the ‘quantified self, ‘ a movement that has its roots in Silicon Valley and is aimed at pursuing “self knowledge through numbers”, but which has taken on a negative valence by academics and critics for whom the quantified self is the embodiment of the “neoliberal citizen: the self-optimizing individual who voluntarily monitors, measures, regulates and collects biometric data on their own health, wellbeing and fitness; taking control of their own bodies on a minute and detailed level.”
Chris Till makes the compelling argument that fitness monitoring apps facilitate the monetization of immaterial labour through a process of gamification that extracts value without payment. Moreover, each of these apps, through gamification and the sharing of data, aims to provide a kinds of pseudo sociality, which we all crave, by encouraging users to share their data with ‘friends,’ and groups. Cumulatively, this voluntary labour produces lucrative data for corporations and, depending on how it is collected, for Facebook who uses it to improve ad targeting. These technologies also transmogrifies socio-political and cultural expectations about health wherein individual lifestyle choices replace collective responsibility, public provisioning, and social welfare, counterintuitively perhaps, which has been found to increase poverty and lead to more glaring socioeconomic and health disparities.
Next are a suite of technologies that whose stated purpose is to provide the consumer with detailed knowledge of their DNA which is then linked to health advice. It includes such diverse companies as 23andME, HomeDNA, Helix, and TELOYEARS. Each of the these entities, for a blood sample and fee, claim to provide the consumer with, one, the statistics necessary to gage overall health and wellness; two, ancestry and basic genetic information – which is ostensibly used to extrapolate and come to conclusions and recommendations about ideal diet and fitness plans; three, likely food allergies; four, ‘genetic weight,’ five, metabolic health, and six, aging. These services are similar to those listed above in that they work within the same ecosystem wherein individuals are cultivated into self-monitoring subjects whose choice, agency, and labour bear ultimate responsibility for good health. However, they are distinct in that they transform the self-quantifying subject into one whose data is cellular. The objective of these companies, in addition to serving a larger goal of neoliberalizing health care, is to accumulate biocapital wherein, according to Natasha Dow Schüll, “government-sponsored researchers or multinational corporations…harness and exploit…personal data streams” which they buy, self, transfer and mine for “insight in comparison with those of others.” Yet, there is something even more pernicious about this kind of data extraction since it reaches into and commodifies the very essence of who we are and who we ought to be by genetifying our existence.
These services also draw on, exploit and kick into high gear the notion that it is the individual’s responsibility, given this knowledge, to mitigate all health risks. As such, it becomes even more incumbent on the subject to align their interests, behaviours, and labour in ways that are consistent with neoliberal health objectives. This approach callously disregards inequalities of income, access, and education; the role played by the environment in determining health outcomes (e.g. pollution, waste, infrastructure) – which often cleave along racial lines, and the very real way in which the ability to engage in labour oriented around health and wellness requires that ones’ labour in the public sphere (i.e. productive work) is stable, sustaining, and life-affirming.
Notably, most of these services allow for and recommend that consumers to engage in form of communicative interaction through social networking such that the data that is produced, according to Tamar Sharon, becomes “not just a tool for gaining insights about oneself but becomes a medium for connecting with others.” In doing so, as stated by Deborah Lupton, they aim to fulfil the very human need to be part of a social community, albeit superficially, and does so by encouraging users to produce personal health narratives through blog posts, entries, and videos about ones’ findings, conditions and progress – all forms of affective, unpaid labour.
It should also be noted, however, that there is a considerable amount of medical scepticism with respect to the veracity, accuracy, and usefulness of this genetically derived advice which has resulted in calls for regulation - even a moratorium – as well as the communication of real concerns about the potential for discrimination if results are made accessible to employers and/or insurance companies.
Finally, we have we have a thriving ecosystem of governmental and media discourses that perpetuate the connection between health and individual choice through the technification of health provision, coupled with the further responsibilization of individuals for their health through policy and action, and paired with a hyperbolically positive embrace of private companies to act as primary health care providers. They work to support eHealth or mHealth initiatives through, according to the WHO (World Health Organization),“medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants (PDAs), and other wireless devices.” The patient, in this context, becomes the labouring subject who is responsible for their wellbeing, with some technological support, which is subsequently packaged by governments and companies as facilitating patient engagement and/or patient empowerment, which sounds ideal, but which ignores how health depends fundamentally on factors related with employment, citizenship, racialization, poverty, capitalism and colonialism,
These discourses of empowerment have become a central part of health care reform and are increasingly referred to, positively, as the cultivation of “the digitally engaged patient” whose autonomy can be better realized and enacted in a context of increased choice and information which will result in better resource allocation, enhanced services, and patient control. I would argue, however, that what they really represent are fiscal concerns dressed up as patient empowerment. Moreover, they allows the State to obscure the process of privatizing health care by presenting a model of medicine that is extracted from the social and placed firmly in the sphere of the economic but which justifies itself through a rhetoric of control that “renders everything that happens behind it invisible and unproblematic.” It also, as Brian J. Brown and Sally Baker argue, clientises the poor, depoliticizes radical empowerment and autonomy, and subverts forms of collective action.
Media, both legacy and new, perpetuate this rhetoric of wellness and health as something that can be realized through personal labour, choice and action. Major newspapers and magazines from The New York Times to GQ and Cosmopolitan traffic in this kind of rhetoric through articles like ‘How to Halve the Death Rate from Colon Cancer,’ ‘How to Improve your Mental Health in Just Ten Minutes,’ and ‘What’s Your Risk for Breast Cancer or Ovarian Cancer.’ In each of these pieces products and activities are suggested and preventative strategies are proposed which expands the disengagement of citizens from the public provisioning of health care which seen not as a right of citizenship and a necessary prerequisite for social justice, but as a product of personal decision-making and investment.
Celebrity run lifestyle and health companies like Goop (woman and man), Equinox, and mindbodygreen also play on this notion of empowerment but do so in manner that inflates and transmogrifies the neoliberal agenda by capitalizing on the practice of healthism defined as a cultural movement that moralizes healthy behavior and encourages actions, practices, and modes of labour that perpetuates the connection between personal responsibility and wellbeing. It also proactively advocates for a particular kind of ideal bodily comportment and lifestyle that becomes the gage of ones’ self-worth and social status. Unfortunately, these kinds of socio-material discourses have devolved into an unhelpful and dangerous form of healthism that is particularly burdensome to women and which leads to non-normative and racialized bodies being seen as failing to adhere to productive forms of self-management. These bodies are thus not only pathologized, but perceived of and labelled as burdensome, unproductive, and even immoral.
A final pointsworth considering: It is interesting that companies like Facebook, 23andMe, Microsoft, Twitter, and Amazon, with the support of the State and insurance companies, have initiated their own workplace wellness programs that, through access to gyms, healthy food, monitoring programs, classes, and counselling (solely for the highest paid workers of course), have basically instituted a form of modern managerial control under the guise of empowerment. These programs tie workers to their employers on an emotional level through services of various kinds, most of which require self-tracking, and provides an avenue for even more intrusion into the private sphere wherein leisure time is transformed into productive time. As such, these initiatives represent another opportunity to shape workers into the ideal industrious neoliberal subject. Rather than resulting in concrete benefits to health, which they fail to do, these techniques work to reduce employees to data even further, facilitate a new form of surveillance (often referred to as dataveillance), and, tailor work practices in a manner that aims to extracs the most productivity possible based on information produced, packaged, delivered, and, sometimes even paid for, by the employees themselves.
Taken together, it becomes patently clear that our current health care ecosystem is increasingly operating, disfunctionally, under the erroneous belief that the health and fitness technologies that surveil and track us, the DNA techniques that data-ify our biology, and the health-related discursive practices that provide ideological justification for individualized health care, simply results in the delegation of responsibility for health and wellbeing away from governments and places it onto individuals. The pernicious way in which this occurs is through a process of responsibilization aimed at producing ideal neoliberal subjects willing to labour in pursuit of corporate profits and attenuated public (i.e. State) obligations. Resisting these practices and technologies is no small feat given that they are form the basis of economic structures, processes of knowledge production, public policy, and popular discourses we are all implicated in. A first step, following the advice of Phoebe Moore, is to resist, through “a refusal to track the body, a refusal to subordinate the qualitative to the quantitative, a refusal of surveillance, a refusal to share data with corporations and the state” and (and this is my addition) by becoming active participants, in community, in advocating for a public system and an ecological conception of health and wellbeing supported by technologies that are pro-social and shaped by democratic principles that align, in both design and use, with truly empowering objectives.