Mobile health (mHealth) technologies for self-monitoring health-relevant parameters such as heart frequency, sleeping patterns or exercise regimes aim at fostering healthy behavior change and increasing the individual users to promote and maintain their health. We argue that this aspect of mHealth supports healthism, the increasing shift from institutional responsibility for public health toward individual engagement in maintaining health as well as mitigating health risks. Moreover, this healthist paradigm leads to a shift from understanding health as the absence of illness (...) to regarding health as the performance of certain rituals in order to project healthiness. By drawing from the analogy between healthiness and traditional virtues, we evaluate the promises made by proponents of mHealth technologies for self-monitoring. We argue that the implementation and use of mHealth risk entrenching existing inequalities and, more particularly, tend to exclude populations situated at the losing end of those inequalities from participating in the quasi-virtue of healthiness. Consequently, the implementation and use of mHealth technologies not only present challenges for social justice but also undermine their primary societal goal—to promote public health. Finally, we offer several suggestions on how to realize the potential benefit of mHealth. (shrink)

The American Journal of Bioethics, Volume 11, Issue 7, Page 57-59, July 2011.

This article explores how ‘fat shaming’ as a practice that encourages open disdain for those living in larger bodies operates as a moralising tool to regulate and manage those who are viewed as ‘bad citizens’. It begins by outlining the problematic use of fat shaming language that is often used as a tool to promote ‘healthy’ lifestyle choices by those who view it as not only an acceptable way of communicating the health risks associated with obesity, but also a productive (...) way of motivating people with overweight and obesity to lose weight. I then go on to discuss how shame as it relates to body image and excess weight is culturally produced through both objective conceptualisations of deviance and subjective judgements about the moral character of those who are living with excess weight. Adopting a feminist theoretical perspective, this article further considers the reciprocal nature of fat shaming by calling attention to how shame as a felt emotion is dependent on understandings of oneself in relation to others, as well as the relationships that one forms with others. In this way, I argue that shame in general, and fat shaming in particular, is performative to the extent that it exists as a relational construct that is iteratively produced through the language and actions that give it meaning. (shrink)

Healthism and ableism intertwine through an imperative of normalcy and the ensuing devaluing of those who fail to meet societally dominant norms and expectations around “normal” health. This paper tracks the effect of that imperative of normalcy through current research into gut microbiome therapies, using therapies targeting fatness and autism as examples. The complexity of the gut microbiome ought to encourage us to rethink our conception of ourselves and our embeddedness in the world; instead, the microbiome is transformed into (...) one more tool for controlling unruly bodies and minds. (shrink)

Any theory of health justice requires an account of what areas of social life are important enough to be of public concern. What are the goods that ought to be provided as a matter of justice? This is what I will call the metric problem. The capabilities approach puts forward a particular solution to this problem. In this article I will discuss some issues of such an approach in relation to Sridhar Venkatapuram's well-known theory. Another problem I examine is how (...) to determine a threshold of provision within a theory of justice. What is enough in terms of health justice? I argue that we need such a threshold to avoid healthism, the expansion of the pursuit of health over and above the treatment and prevention of disease. This is an especially pertinent problem in public health, which is also the context of Venkatapuram's theory. (shrink)

Health promotion efforts are commonly directed towards encouraging people to discard ‘unhealthy’ and adopt ‘healthy’ behaviours in order to tackle chronic disease. Typical targets for behaviour change interventions include diet, physical activity, smoking and alcohol consumption, sometimes described as ‘lifestyle behaviours.’ In this paper, I discuss how efforts to raise awareness of the impact of lifestyles on health, in seeking to communicate the need for people to change their behaviour, can contribute to a climate of ‘healthism’ and promote the (...) moralisation of people’s lifestyles. I begin by summarising recent trends in health promotion and introducing the notion of healthism, as described by Robert Crawford in the 1980s. One aspect of healthism is moralisation, which I outline and suggest is facilitated by efforts to promote health via information provision and educational strategies. I propose that perceived responsibility plays a role in mediating the tendency to moralise about health and behaviour. Since I argue that states ought to avoid direct and indirect moralisation of people’s health-related behaviour, this suggests states must be cautious with regard to the use of responsibility-indicating interventions to promote health. (shrink)

Science and technology have vastly expanded the realm of medicine. The numbers of and knowledge about diseases has greatly increased, and we can help more people in many more ways than ever before. At the same time, the extensive expansion has also augmented harms, professional responsibility, and ethical concerns. While these challenges have been studied from a wide range of perspectives, the problems prevail. This article adds value to previous analyses by identifying how the moral imperative of medicine has expanded (...) in three ways: (1) from targeting experienced phenomena, such as pain and suffering, to non-experienced phenomena (paraclinical signs and indicators); (2) from addressing present pain to potential future suffering; and (3) from reducing negative wellbeing (pain and suffering) to promoting positive wellbeing. These expansions create and aggravate problems in medicine: medicalization, overdiagnosis, overtreatment, risk aversion, stigmatization, and healthism. Moreover, they threaten to infringe ethical principles, to distract attention and responsibility from other competent agents and institutions, to enhance the power and responsibility of professionals, and to change the professional-beneficiary relationship. In order to find ways to manage the moral expansion of medicine, four traditional ways of setting limits are analyzed and dismissed. However, basic asymmetries in ethics suggest that it is more justified to address people’s negative wellbeing (pain and suffering) than their positive wellbeing. Moreover, differences in epistemology, indicate that it is less uncertain to address present pain and suffering than future wellbeing and happiness. Based on these insights the article concludes that the moral imperative of medicine has a gradient from pain and suffering to wellbeing and happiness, and from the present to the future. Hence, in general present pain and suffering have normative priority over future positive wellbeing. (shrink)

Responding to Danaher et al. on self-tracking technologies, I argue that human lived experience is becoming increasingly mediated by generalized, statistical information, which I term our "infotality." Drawing on the work of Foucault, I argue that infotality is historically novel and best understood as the product of biopolitics, healthism, and informatics. I then critique the authors' "stance of cautious openness,” which misunderstands the aims of the technology in question and the fundamental ambiguity of the role information plays in the (...) achievement of human wellbeing. Self-tracking technologies are not primarily designed to change behavior; they are designed to create and sustain the desire for their use. I conclude by suggesting that infotality names a new way to fall for an old ruse: the promise that more information means more wellbeing. (shrink)

In the United States, running as a leisure activity continues to grow in popularity. Healthism can explain some of this popularity, but it does not explain ultradistance running. Motivations for running can be seen through the framework of the Kantian beautiful and the sublime. Beauty arises through extrinsic motivation and relates to an economy of form, while the sublime arises through intrinsic motivation and relates to confronting the challenge of infinity. The commercial, casual, and competitive aspects of distance running (...) correspond to the beautiful, while its wilderness, serious, ultradistance aspects correspond to the sublime. This framework is used to explain the resistance of ultrarunning to the would-be detrimental effects of commodification, as well as ultrarunning’s ‘wild turn.’. (shrink)

_Health Education: Critical perspectives_ provides a socio-cultural and critical approach to health education. The book draws together international experts in the fields of health and education who deconstruct contemporary discourses and practices, and re-imagine a health education that both connects with young people and offers a way forward in addressing issues of health and wellbeing. Chapters within specifically link academic work on neoliberalism, healthism, risk and the body to wider discourses of health and health education. They challenge current practices (...) and call for a re-thinking of current health programs in education settings. A unique feature of this book is the analyses of health education from both political and applied levels across a range of international contexts. The book is divided into three sections: the social and political contexts informing health education how individual health issues articulate in education in complex ways alternative ways to think about health and health education pedagogy. The overall theme of the book offers a perspective that the current approach to health education – promoting a fear of ill health, self-surveillance and individual responsibility – can become a form of health fascism, and we need to be cognisant of this potential and its consequences for young people. The book will be of key interest to academics and researchers exploring the political context of health education. (shrink)

In the world of rapid general-social development, due to the emergence of questions about new holders of legal rights and the emergence of new forms of legal rights in general, the discussion about moral and legal rights has always been, is and will be an increasingly topical issue. It is not, however, disputed that law per se, in enabling a wide range of legal rights, has always been centred around the issue of human life and health in the first place. (...) The achievement of human welfare is undoubtedly predicated upon good health, and fostered by a unique “mechanism” – the right to health. Although we live in an era of great glorification of the cult and value of health (healthism), the current epoch raises a series of human-health-focused questions and controversies. However, the primary and very crucial question we can ask ourselves is – what would health even be? Precisely because of the great questionability of the above question, the protection of human health and the exercise of the right to health may represent one of the most challenging matters of law itself. The right to health, as a legal and inclusive right, epitomizes not only the rights asserted by human beings as such, but also environmental and nature protection as an inseparable denominator of the status of human health. Although prominent legal/political philosophers and theorists were pessimist about the realisation and enforcement of the right to (the highest attainable standard of) health, this paper elaborates on the possibility of its realisation, which largely depends on the way in which the concept of health is understood. Health should be understood exclusively as an idea-value category to be aspired to, as a should (sollen), by no means as a pure and categorical reflection of reality (sein). Given the inclusiveness specific to the legal right to health, which undoubtedly contains certain problematic elements, this paper aims to grasp and consider the right to health in its conceptual and normative entirety premised upon the following question: how does law protect human health and its constitutive elements? The same question invokes interesting interdisciplinary (legal and philosophical) points of view. (shrink)

This paper argues that common social narratives about unhealthy eaters can cause significant damage to agency. I identify and analyze a narrative that combines a “control model” of eating agency with the healthist assumption that health is the ultimate end of eating. I argue that this narrative produces and enables four types of damage to the agency of those identified as unhealthy eaters. Due to uncertainty about what counts as healthy eating and various forms of prejudice, the unhealthy eater label (...) and its harms to agency are more likely to stick to some people than others and may reinforce patterns of oppression. I argue that fat people are especially vulnerable to this identification and the damage it can do. I then consider possible “counterstories” about unhealthy eaters, alternative narratives that might be less damaging to agency than the control narrative. I identify one promising counterstory but suggest that it may be limited when it comes to repairing damage to the agency of fat people. Overall, this paper illustrates some of the complex ways that healthism about eating affects agency, and emphasizes the ethical importance of the ways we think about and discuss eating and eaters. (shrink)

Stigma can lead to poor health outcomes. At the same time, people who are perceived as unhealthy may experience stigma as the result of that perception. As part of a larger project examining discrimination on the basis of health status or “healthism,” we explore the role of stigma in producing disadvantage based on health status. Specifically, we look to the principles of health equality and health justice. An intervention violates health equality when it is driven by animus, which can (...) be the result of stigma. Additionally, laws and policies offend health justice when they worsen health outcomes or they create or deepen health disparities. An intervention that produces stigma — whether intentionally or unintentionally — may offend health justice by making people worse off, in absolute or in comparative terms. Stigma-related health laws and policies can therefore be healthist in at least two ways. We therefore conclude that stigma should neither be the basis, nor the product, of efforts to improve health. (shrink)

This book is a qualitative, interpretive, phenomenological, and interdisciplinary, examination of food and food practices and their meanings in the modern world. Each chapter thematically focuses upon a particular food practice and on some key details of the examined practice, or on the practice’s social and cultural impact.

Feminist phenomenology has contributed significantly to understanding the negative impact of the objectification of women’s bodies. The celebration of thin bodies as beautiful and the demonization of fat bodies as unattractive is a common component of that discussion. However, when one turns toward the correlation of fat and poor health, a feminist phenomenological approach is less obvious. In this paper, previous phenomenological work on the objectification of women is paralleled to the contemporary encouragement to discipline one’s body in order to (...) pursue better health. Similar ideologies of free choice in the face of bodily habits run through discussions of health and beauty. The paper uses the work of Merleau-Ponty and Beauvoir as well as the contemporary feminist phenomenologists Diaprose, Bartky, Bordo, Young, Grosz, and Carel to explore how women are constrained by health testing and health normalization. It argues that despite the apparent benefits of a focus on modifying health habits, feminists have good reason to be wary of the good health imperative. (shrink)

Lack of time is a commonly reported barrier to healthy eating, but a literal lack of time is only one way that time may compromise eating well. This article explores how the first-personal lived experience of time shapes and is shaped by eating. I draw upon phenomenology and feminist theory to argue that the dynamic relationship between eating and temporality matters for food ethics. Specifically, temporalities and related ways of eating can be better or worse vis-à-vis key ethical concerns. I (...) highlight the possibility of altering temporalities through strategic eating and consider implications for individual food choice and structural change. (shrink)