Addressing the Social Determinants of Health: “Vulnerable” Populations and the Presentation of Healthy People 2020

Abstract

Population health is a concept at the core of national healthcare reform efforts. Population health focuses on the social determinants of health, or the living conditions of people at work, home, and play. To participate in population health initiatives, organizations must collect population-level data, creating a discourse of resilience-as-ability-to-cope through mapping community demographics, as though a counting of bodies and their material conditions creates a foundation for sustained, improved health outcomes. In 2010, the U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion (ODPHP) launched an initiative called Healthy People 2020, a set of ten-year national goals and objectives for health promotion and disease prevention. In this essay, we analyze this data project, arguing that the discourses of resiliency (through improved national, state, and local data collection efforts) and vulnerability (of the people who are reduced to data) create a constitutive rhetoric for U.S. public health officials to rally around the cause of population health yet exclude the very people upon whom such a cause should focus. Specifically, an examination of the ODPHP’s Healthy People 2020 website reveals that the reduction of bodies to quantification in data displays for health professionals, when viewed through the lens of Philip Wander’s Third Persona, objectifies groups of people already historically marginalized and obfuscates pathways to social action. We argue that instead, an ecological, relational definition of resilience must be fostered through autonomy of communities in the decisions they make about their own community members’ health and wellness.