Constructing vulnerability: a feminist analysis of Health Canada's population health strategies

Abstract

In recent years, the activities of Canadians have become a major focus of Health Canada and other regulatory agencies, and significant resources have been allocated to examining and modifying people's lifestyles and behaviour patterns. Diet, fitness, exercise, friendship patterns, sexual behaviour, educational experience, drug and alcohol use, community involvement, political behaviour, and so on, have all fallen under intense scrutiny. This scrutiny has resulted in the creation of a multitude of programmes, policies and interventions designed to target specific 'vulnerable populations' and limit what are seen as 'high risk' behaviours. In particular, the perceived links between gender, risk and vulnerability have become key concerns of both policy makers and feminist researchers and activists in the field of health care. Indeed, many feminist researchers and activists have applauded this population health approach as a practical tool for reducing gender disparities in health status. Unfortunately, despite this growing interest, the political ramifications of targeting specific 'vulnerable' populations and 'at-risk' behaviours in the context of health and health care have not been given sufficient scholarly attention. Through an interrogation of the publicly accessible population health documents produced by Health Canada this grounded theory study investigates (1) how the definitions of vulnerability and risk have evolved over time, as demonstrated by the public documents produced by Health Canada, and to what extent these terms are gendered, (2) to what extent health promotion can be seen as a political act that affects women, and, (3) what sort of power relations valuations of lifestyles and behaviours create between citizens, between citizens and the State, and particularly between women and the State. The overall concern of this thesis is to explore the implications that the population health approach has for women with regard to their expectations for full membership in the polity. The findings suggest that, far from being a 'common-sense' approach to removing health disparities, the population health approach has severe political implications for women and other vulnerable populations. A key finding of this study is the link between the development of the population health approach and the expansion of an active federal presence in the management of health and health care in Canada. In this context, the categories of vulnerability and risk appear more as a means of expanding federal regulative practices than as a component of a social justice project. Thus, this grounded theory study argues that the use of predefined categories of vulnerability and risk, the negative valuations of behaviours and lifestyles that are embedded within these categories, and the persistent link between vulnerability, risk and targeted populations operate as a subtle exclusionary process wherein women, and other identified vulnerable populations are disenfranchised.