What I want to suggest here is that there is a dark underside to all that healthy behavior. The underside is that the healthy behavior encourages the view that individuals are largely responsible for their own health outcomes, and that if people end up unhealthy or diseased, it’s their fault for not having engaged in sufficiently healthy behaviors. Call this a “social truth” of health. This social truth has real consequences. On the one hand, if individuals are to blame for their poor health, then they should bear a lot of the cost of their disease. After all, there is a sense in which they “chose” to be sick because of their unhealthy lifestyle. On the other hand, policies designed to create healthier environments or at reducing structural factors associated with poor health outcomes, like poverty, start to seem less important.
“Healthism,” as a prescient article from 1980 called it, has been a growing part of the American social landscape since the 1970’s, when jogging emerged as a fitness trend. The rise of healthism coincides with the rise of neoliberalism, a loosely-grouped set of policies that aim at analyzing all parts of society in economic terms, expanding the reach of actual markets, encouraging competitive behavior between individuals, and encouraging people to view their lives in entrepreneurial terms (for example, treating education as an investment the value of which is measured in terms of its probable future returns in the form of higher income). Because of the focus on individuals and market behaviors, neoliberal governance tends not to see systemic or public problems except insofar as they can be reduced to the problems of individuals. Neoliberal thinking is so culturally embedded that we don’t realize how historically anomalous it is. Since the 1970’s, however, a number of trends exemplify its emergence. Examples include the deregulation of the finance industry, the decline of collective bargaining power by workers, the end of pension plans and their replacement by 401k and other market-based plans (where workers absorb the risk of a market crash), the rise of temporary employment and the “gig” economy, the decline in state support for universities (leading to higher tuitions and high levels of student debt), and so on. With the exception of the Medicaid expansion, even the Affordable Care Act (“Obamacare”) interpreted health in terms of access to insurance markets, and used government not to provision healthcare, but mostly to attempt to stabilize and regulate those markets.