The Politics of Self-Craft: Expert Patients and the Public Health Management of Chronic Disease

摘要

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 individuala??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 individualsa?? 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.