Abstract
As the global challenges posed by chronic, noncommunicable diseases (NCDs) run into longer life expectancies and restrictive fiscal environments, public health programs must respond to these issues. In doing so, health practitioners have framed NCDs as apolitical and largely the product of an individual’s risk behavior. Consequently, governance strategies embraced by public health to address NCDs emphasize the role of the private sector, including opportunities for patient self-management of illness. The Expert Patients Programme (EPP), an initiative of the U.K. Department of Health, applies to a range of chronic conditions. Via a case analysis of the EPP, this article argues that public health governance of NCDs is increasingly a project of individuals’ self-governance, and that although the techniques of the EPP are constructed as politically neutral, they rather demonstrate a pervasive neoliberal political rationality: in devolving public health responsibilities to the private sector and in constructing the healthy, active participant whose primary aim is to return to an economically productive life.
Highlights
In the realm of global health governance, it seems that noncommunicable disease (NCD) is a subject whose time has come
NCD mortality is expected to increase by 17% over the decade, with the greatest increase occurring in the African region (WHO, 2009)
As the burden of NCDs expands globally and public health systems must address them in an increasingly tight fiscal environment, the question emerges, “How has public health evolved to address these challenges?” and “What are the political implications of this evolution?” In answering these questions, we must attend to the discursive norms by which public health as a discipline constructs “truth,” “fact,”
Summary
In the realm of global health governance, it seems that noncommunicable disease (NCD) is a subject whose time has come. On the heels of the World Health Organization’s (WHO) 2009 action plan on the global prevention and control of NCD, in September 2011 the United Nations General Assembly held its first high-level meeting on the growing burden of chronic NCDs worldwide Such phenomena indicate a growing awareness of the severity of the challenge posed by NCDs and of the need to develop a more coordinated governance response. The discursive norm for public health research frames degenerative NCDs as largely apolitical; they are typically construed as the product of an individual’s risk behavior— in the form of tobacco usage, sedentary lifestyle, and poor diet. Too has their solution primarily been understood as existing in the individual body and the choices one makes
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