Academic journal article Health Sociology Review

Harm Reduction and the Ethics of Drug Use: Contemporary Techniques of Self-Governance

Academic journal article Health Sociology Review

Harm Reduction and the Ethics of Drug Use: Contemporary Techniques of Self-Governance

Article excerpt

Introduction

This paper builds on existing post-structuralist accounts of health regulation by examining the development and operation of public health as a historically specific apparatus of power. Specifically, we seek to locate self-tracking within contemporary regimes of public health as techniques of self-governance. We examine public health as a regime of power that primarily invests in the body and operates from within the body. Lupton (2013, 2014) notes that self-tracking involves varied practices, some of which we argue here may be articulated with sovereign and disciplinary forms of power.

Much of the literature on self-tracking has emphasised digital technologies, which, with the advent of Web 2.0, have articulated what has been referred to as a quantified self (Lupton, 2015; Patron, Hansen, Fernandez-Luque, & Lau, 2012; Swan, 2012, 2013). While technology has assisted in the dispersal of self-tracking practices to broad populations, such practices trace their roots to a modern desire for 'good' health that is at once self-predicated and a social objective. While contemporary self-tracking practices often involve digital technologies, and detailed measurement and sharing of data, self-tracking has been closely aligned with biopolitical governance (Lupton, 2014) and, therefore, can be situated within the broader history of biopolitical technologies. We challenge socio-historical accounts of health regulation that assume that particular forms of domination become redundant at specific historical junctures. In doing so, we emphasise lines of continuity between historical shifts in the practice of power and the contemporary governance of drug use. With reference to drug use, we examine how current regimes of public health deploy technologies which utilise both practices of the self and practices of domination, taking the ethical self and social body as their site of governance. This is highlighted by drawing a distinction between what we term sanitationist and hygienist practices of public health.

Drawing on interview data from people who use drugs, we examine contemporary aspects of public health with reference to the management of drug use. In doing so we provide insights into how the governance of illicit drugs intersects with self-governance, using ethical techniques of self-monitoring, self-management, surveillance and self-tracking. In contemporary regimes of public health, people who use drugs are encouraged to engage in harm-reduction practices in order to improve health and achieve social and economic participation. Following post-structuralist accounts of the 'new public health', this paper locates these contemporary self-governance technologies within broader objectives of self-optimisation, using disciplinary health practices which constitute the body as the object and subject of power.

Theorising power and public health

Post-structuralist accounts of health regulation have been critical of attempts to make totalising or essentialist claims about the operation of power, and have instead examined how multiple localities and institutions of power have been instrumental in the production and governance of the 'healthy' body (see Adkins, 2001; Nettleton, 1997; Petersen & Lupton, 1996; Rose, 1996). For example, recent critical research examining harm minimisation has argued that the construction of the neo-liberal subject as an autonomous, rational and calculating agent fails to account for structural constraints on individual agency or how social and political responsibilities constrain agency (Fraser, 2004). Drawing on the work of Foucault, post-structuralists have been interested in how power has been applied or practised in a series of ongoing and multiple subjugations that operate within the social body rather than from above it (Armstrong, 1993; Foucault, 1990a; Lupton, 1995). Foucaultian criticism has focussed on the body as a site of power, examining ways in which unhealthy or at-risk bodies have been rendered productive and responsible through the strategic mobilisation of disciplinary health practices (Rose, 1994). …

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