We know that junk food and too much sugar is bad for your health. Do you wonder why the main convenience stores mainly sell chips, gummies, soft drinks and other over-processed foods? No. But we are advised to make healthy individual choices.
A sedentary lifestyle is known to increase the risk of chronic diseases. Do we regulate urban sprawl and densify cities to curb car dependency? Are we ensuring that neighborhoods where active transportation is possible remain affordable? No. But it is up to everyone to make the choice of daily physical exercise.
Anxiety and depression have been known to be on the rise for years, driven by increasing stress from school and work. Do we implement the four-day week? No. But we download a meditation app or we do yoga. It’s up to everyone to train their “mind” to better endure everyday life.
Neoliberal ideology has so imbued popular discourse in the area of health that it has become difficult to explain how it works. Let’s try it. Neoliberalism believes that a good society is a free society, and that freedom comes through institutions that attempt to leave the private sector free from regulation, and individuals free in their choices.
In a neoliberal society, it is therefore inappropriate to over-regulate companies whose business model makes them downright sick, whether by inviting the population to ingest cheap empty calories, by polluting the air or the waterways , or by exploiting employees with precarious status. Companies must remain as free as possible in their activities, and we, in return, are free to work there or not, to consume their products or not.
In a neoliberal society, health professionals talk to us about changing our life choices, adopting more responsible habits. But it is incongruous that a group of dietitians should make a common stand against the abundance of junk food in convenience store chains and the persistence of food deserts; it is almost taboo for doctors to mobilize for a reform of the Labor Code; and it is unthinkable for the management of a CIUSSS to ask for more green spaces on its territory.
In a neoliberal society, everything is made up of a sum of individuals who must be separately taught to choose foods and leisure activities that maximize life expectancy. Caregivers who would like to “prescribe” laws, policies, regulations, institutional reforms to improve the health of an entire community are considered cranks. Those who advocate action at the source, that is to say on the social determinants of health, are most often on the margins of their professional order.
In a neoliberal society, the individual is a rational agent, responsible for his choices. Individuals who make the worst choices are therefore less rational and less responsible. Social inequalities, particularly in terms of health, are therefore legitimate: the worst-hit populations just have to make better choices. These best choices are especially accessible to the wealthiest? It was also necessary to make the right life choices to reach this level of material comfort which makes it possible to choose organic, to choose the weekend in nature at the chalet, to choose to learn about good foods to prevent cancer. There are winners, and there are losers. In a neoliberal society, there is a good chance of finding a doctor who treats you, of course, but by internally judging you for having made yourself sick, with your choices as losers.
In a neoliberal society, the government’s role in public health is at best to make individuals aware of the importance of making the most winning choices possible. It is certainly not — an example like that — to regulate air quality more strictly in schools and in factories, and to make the public and private environment less conducive to disease.
In a neoliberal society struggling with a health crisis, part of the population will have internalized this gospel of individual and (especially) corporate freedom. People, therefore, will turn against a health measure or a vaccine because by recommending them, the government will overstep its narrow little role of protecting the choices of individuals and (especially) the freedom of business. We rebel, in short, against the threatening specter of a “mother government”.
In a neoliberal society grappling with a health crisis, there will also be people already critical of neoliberal logic who will question whether institutions are too obedient to capital to act in the public interest. So we have a group that can reject a health measure not out of disgust with social solidarity, but because faced with institutions deemed “sold out”, we prefer to trust our own judgment, our “alternative” sources, and cope alone.
With this second group, we can absolutely talk about public health, because the concern for collective well-being is present and shared. But with him, it will not be enough to deplore disinformation or rehash the latest scientific knowledge to rebuild the sacrosanct confidence in institutions. It will also be necessary to admit the flaws in the system, to name what is wrong with it, to alter its logic. Not trying to convince individuals, one by one, to make more centrist “choices”, but rather “prescribing” profound institutional changes. Starting with an examination of this neoliberalism and its consequences.