Nursing, Society, and Health Promotion--Healing Practices: A Constructionist Historical Discourse Analysis

摘要

The purpose of this discourse analysis of health promotion and healing practices was to describe their functioning historically through practices of governance and risk in the context of neoliberal society. The results portray a constructed subjectivity (identity) among citizens and residents of contemporary society who enact expected health promotion and healing behaviors.Two series of texts were analyzed from a Foucauldian perspective: the Healthy People series from the U.S. Department of Health and Human Services; and the series on Uninsurance published by the Institute of Medicine. The findings generated five themes that comprise the reality of current illness care system rationalities:First, the U.S. illness care system, functioning through technology of insurance or wealth extraction, is dysfunctional as a comprehensive illness care delivery system.Second, health promotion and healing have been subsumed under illness care--if they are addressed it is only as discrete indices that comprise compliance monitoring.Third, micro determinants of health (such as behavioral patterns, genetic predispositions, social circumstances, shortfalls in medical care, and environmental exposures), while important, continue to be the single focus of illness care in the U.S. Conversely, macro determinants of health, contingent on macro-level economic and political structures, remain unrecognized as having any bearing on health outcomes. Macro determinants of health frame the configuration of the social infrastructure in which micro determinants of health unfold.Fourth, neoliberal ideology in the U.S. continues to be the status quo for illness care.Fifth, constructed health promotion and healing identity for individuals is one of health anomie, a new prudentialism where access to health promotion and healing has to be acquired from outside the venue of illness care.How can we become different from what we have become? While acknowledging the limitations inherent in this current discourse of heath promotion and healing, other alternatives must be explored for betterment of human health and wellbeing--such as a shift toward "care of the self" or "self care" that encompasses an embodiment of an arché health, a health that moves beyond contemporary illness discourses of mind-body, one that defies society's inscription of our subjectivity.