What choice? Risk and responsibilisation in cardiovascular health policy

摘要

Employing a policy-as-discourse approach, we explore how the language of choice, risk and responsibilisation influences cardiovascular disease policy. We analyse four key pieces of public health literature produced in the UK between 1999 and 2013 that consider the prevention and treatment of coronary heart disease: Saving Lives: Our Healthier Nation; National Service Framework for Coronary Heart Disease; Mending Hearts and Brains and Cardiovascular Disease Outcomes Strategy. This critical discourse analysis problematises how neoliberal discourses of responsibilisation, risk and choice operate to govern health practices. Textual analysis reveals there are multiple dimensions evident in the way that responsibility for health is framed. Organisations are considered responsible ‘for’ illness prevention strategies and service provision, while individuals are conceptualised as responsible ‘to’ maintain healthy lifestyles. Conceptualising individuals as responsible health-conscious consumers enables a backward-looking narrative that holds individuals to account. Furthermore analysis reveals assumptions and messages that demonstrate the operation of moral discourses around patient behaviour. We suggest moral dimensions to public health strategies obscure the structural disparities that influence healthy life chances, imposing a system of limitations and exclusions that lead to allocation of liability and attributing blame for illness.