Social and Political Implications

A critical idea in this book is that worksite health promotion (WHP) is an important mechanism for the successful accomplishment of modern management principles that favor responsibility, commitment and activity. In the previous chapter we argued that the positive side of this enterprise is the empowering of people who are willing and able to work hard and with much dedication. The negative side is its potential of making more transparent those that do not meet the requirements of the present system. That is, health promotion risks breeding intolerance for signs of ‘weakness’ or ‘deviance.’ Furthermore, the health promotion discourse’s emphasis on individual responsibility may also breed a tendency of treating individuals’ ‘failures’ as self-inflicted, the result of the individual’s own choices, behaviors, and attitudes. The ‘problematic’ individuals are seen to be responsible for ‘not having done enough,’ or for just having behaved incorrectly; i.e. for provocatively deviating from norms and codes of ‘healthy and employable behavior.’ Hence, in contemporary society ‘unhealthy’ individuals, constructed as such through modern principles of health promotion (primarily at the workplace but also in other settings), risk eventually ending up as unemployable. In order to become employable again, these people need to undergo a social transformation which involves not only the learning of certain technical skills, but also the adoption of a lifestyle and sets of personal characteristics that make them come forth as ‘healthy.’ In this way measures that are taken in order to promote the health of employees may become constitutive parts of what are considered as ‘good’ and ‘promising’ employees. That is, the healthy employee is seen as the good employee; an increasing number of those individuals that are unwanted by contemporary labor markets are regarded as sick or disabled. As already said, the concern for employees’ health that we witness today

is by itself not a new phenomenon. It has held a central position in political and economic discourses throughout most of the twentieth century. Furthermore, many of those welfare institutions that were formed since the 1940s-public health care, public schools and child care, etc., were more or less directly related to an interest in maintaining a workforce that was healthy and fit to function as employees (Downie et al., 1996). Yet, in

the transformation of the traditional welfare regimes that have taken place during the last decades, the forms of health expertise, the relations between health experts and individuals, and the very notion of health has changed in the direction of health promotion. Even so, the magnitude of these changes should not be exaggerated. In contemporary societies, where production for profit remains the organizing principle of the economy, the concern for employees’ health continues to be a part of a more general concern with securing some kind of correspondence between the principles of producing and selling commodities at a profit and the sets of implicit and explicit rules and norms that govern individual and collective conduct. A stable system for the allocation of a net product between consumption and production implies a corresponding system for the maintenance and reproduction of a population of individuals capable and willing to act as producers, be it in the form of employees, entrepreneurs, self-employed persons or consumers. To be legitimate and successful, any initiative or struggle aimed at improving the competitiveness of a company or a nation will have to be adapted to or find a way of adapting the body of norms, values, laws, infrastructure, etc. that govern individuals’ conduct. Conversely, any attempt to improve the health and well-being of a company’s personnel or a nation’s population will have to consider its effects on the population’s abilities and willingness to adapt to criteria of production and consumption. Hence, political and economic debates and struggles between classes,

interest groups, etc. will either directly or indirectly revolve around this relation between the capitalist system’s specific principles of accumulating profit and the modes and doctrines of governing populations and individuals. Given that a capitalist system is unstable and thus liable to undergo successive transformations, the concern for and the attempts at securing the correspondence between the economy and the lives of individuals and populations will inescapably be tentative. It is well-known that a capitalist system is crisis-prone because of its paradoxical tendency of requiring considerable stability to function while constantly setting in motion destabilizing forces. Its inherent instability then derives from its inescapable growth orientation (crisis is defined as a lack of growth, so it must constantly grow and change); from that growth is pursued in more or less unpredictable competition between corporations; and from that growth in real values rests on the more or less unpredictable control and subordination of living labor to the principles of capitalist production and consumption (cf. Aglietta, 1979; Harvey, 1982). Given these destabilizing forces, the overall problem throughout the his-

tory of capitalist societies has been to “bring the behaviors of all kinds of individuals-capitalists, workers, state employees, financiers, and all manner of other political-economic agents-into some kind of configuration that will keep the regime of accumulation functioning” (Harvey, 1989: 121). Our interest in the maintenance and control of the health of the working

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population is more restricted in that it primarily concerns the general problem in industrial societies to maintain and convert men and women’s capacity to do work into labor processes that generate profit. What’s more, the subordination and control of the working population to principles of production and consumption obviously involves a multitude of different activities-education, the mobilization of social sentiments (loyalty, professional pride, etc.), emotional identifications created via the media, etc., out of which the measures directly and indirectly taken in the names of individuals’ health constitute but a small part. Nevertheless, these measures are important to study because they tend to concern much broader issues than those of maintaining a working population that is ‘fit’ for work in a strictly clinical sense. More specifically, over and above that of securing individuals’ physical and psychological fitness for work, measures taken in the name of the health of employees tend to play a part in the socialization of employees who lead lives which correspond to moral criteria of what is considered ‘a good life’ and ‘a good person.’ However, what can be more beneficial than promoting good health and

reducing sickness and disability? In adopting and carrying out various strategies of health promotion, societies and organizations are seen as acting in the interests of their members, seeking to improve their health and contributing to the overall morale and culture. According to Lupton,

in its reliance upon scientific expertises and emphasis on neutrality, public health discourse conforms to other social policy governmental activities of capitalist states, which are founded on the notion of the neutral and beneficent state acting in the best interests of the majority and standing above vested interests.