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Health promotion and non-compliance - an analysis of resistance to regulatory technologies
Emma Hughes
School of Public Health, La Trobe University, Bundoora VIC
Abstract
We are now critically aware of the long lasting and devastating effects of colonialism, where values and knowledges are imposed from an assumed position of superior authority. In this way the authority and knowledges of the colonised are undermined, and in turn the dependence of the colonised on the colonisers is encouraged. This process fundamentally denies the rights of the colonised.
A similar denial of rights may be found within health promotion. Here the colonising of a population is underpinned by a `healthism' equivalent to the racism found in the colonisation of one nation by another. Like racism, `healthism' is an ideology, one that condemns the inability to manage one's behaviour in a `healthy' manner as irrational and irresponsible. As an ideology `healthism' is part of a power/knowledge dynamic that supports health promotion, and makes legitimate the subjection of populations. Whilst this paper focuses on health promotion, parallels with the subjection found in colonialism cannot help but be recognised. As the adverse effects of colonialism are well established this similarity informs a critique of the potential negative effects of health promotion.
This paper begins with a fairly well established form of analysis, looking at health promotion as a `technology of subjection' through the application of Michel Foucault's (1977) notion of the Panopticon. Evidence to support this theorising is drawn from a research project that took place in four indigenous communities in northern Saskatchewan, Canada 2. The quantitative data resulting from a questionnaire that was used has yet to be analysed, however in-depth interviews were also undertaken, and this is the material drawn on. The project primarily set out to investigate cultural factors relevant to improving `compliance' with injury prevention programs. The project exemplifies the way in which 'non-compliant' behaviours continue to be perceived as undermining the best intentions of health promotion programs - a perception that has prompted much research focusing on `non-compliance' as a source of program failure.
A Foucauldian analysis allows the theorising of `non-compliance' as resistance. Documenting some of the complexities of the relationship between regulation and resistance in the Saskatchewan project forms the middle section of this paper. In particular this section focuses on the resistance/regulation relationship reflected in the power/knowledge dynamics of this context. A contention of this paper is that the health promotion view of non-compliant behaviours as irrational and irresponsible in itself poses a problem. To counteract noncompliance, it is likely that health promotion will employ more pervasive or subtle means of subjection, in turn raising the possibility of non-compliance taking increasingly active forms of resistance. Examining the dynamics of regulation and resistance shifts the focus of the paper towards Foucault's work on technologies of the self. Incorporating these notions into the panoptic model allows a novel and constructive examination of `non-compliance'.
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