Lifestyle drift and the phenomenon of ‘citizen shift’ in contemporary UK health policy

Abstract

Despite political change over the past 25 years in Britain there has been an unprecedented national policy focus on the social determinants of health and population-based approaches to prevent chronic disease. Yet, policy impacts have been modest, inequalities endure and behavioural approaches continue to shape strategies promoting healthy lifestyles. Critical public health scholarship has conceptualised this lack of progress as a problem of 'lifestyle drift' within policy whereby 'upstream' social contributors to health inequalities are reconfigured 'downstream' as a matter of individual behaviour change. While the lifestyle drift concept is now well established there has been little empirical investigation into the social processes through which it is realised as policies are (re)formulated and implementation is localised. Addressing this gap we present empirical findings from an ethnography conducted in a deprived English neighbourhood in order to explore: (i) the local context in the process of lifestyle drift and; (ii) the social relations that reproduce (in)equities in the design and delivery of lifestyle interventions. Analysis demonstrates how and why 'precarious partnerships' between local service providers were significant in the process of 'citizen shift' whereby government responsibility for addressing inequity was decollectivised.

Understanding digital health: Productive tensions at the intersection of sociology of health and science and technology studies

“…They argue that while digital inclusion and inclusion in healthcare remain priorities for government, equality is being reassembled in ways that reflect broader discourses of neo‐liberalism, empowerment and the turn to the market for technological solutions which may have the effect of exacerbating inequalities. Thus, digital health policy reflects and reinforces such wider health policy in trying to tackle health inequalities via downstream solutions (reflected in the notion of ‘lifestyle drift’ (Willams and Fullagar ). Rich et al .…”

“…They argue that while digital inclusion and inclusion in healthcare remain priorities for government, equality is being reassembled in ways that reflect broader discourses of neo-liberalism, empowerment and the turn to the market for technological solutions which may have the effect of exacerbating inequalities. Thus, digital health policy reflects and reinforces such wider health policy in trying to tackle health inequalities via downstream solutions (reflected in the notion of 'lifestyle drift' (Willams and Fullagar 2019). Rich et al's examination of the promissory discourse of digital health policy leads them to argue that the discourse enacts specific conditions of actions and types of selfhood, with citizens being positioned as objects of policy interventions in ways that assume particular agential capacities while, at the same time, obscuring the many social, political, cultural and economic inequalities that impede engagement with digital health.…”

The patient–doctor relationship in the transnational healthcare context

“…In the last 40 years, however, against the background of neoliberalism, increasing commercialisation and marketization in the healthcare sector has deprioritised a collective response to health risks (Stiglitz 2009). The logic and practices of the market have promoted consumerism and patient 'choice' that is interlinked to an individualisation of health responsibilities (Mol 2008, Williams andFullagar 2019). In this context, responsibility is increasingly passing from the public to the private sphere, limiting citizens' dependency on the state (Fineman 2004, Wallerstein 1974.…”

“…In this context, responsibility is increasingly passing from the public to the private sphere, limiting citizens' dependency on the state (Fineman 2004, Wallerstein 1974. Less dependency on the state, however, contributes to social and medical inequity as individuals' socioeconomic backgrounds play an increased role in healthcare outcomes (Williams and Fullagar 2019).…”

Is digital health care more equitable? The framing of health inequalities within England's digital health policy 2010–2017

“…Indeed, even in countries where the reduction of health inequalities has been a stated policy priority (Smith and Kandlik Eltanani 2015), disparities persist. Numerous authors note that this is partly due to the 'lifestyle drift' (Popay et al 2010) in which policies begin by recognising the need for upstream action to address wider social and economic determinants of health, only to be reduced to a focus on individual behaviour (Baum andFisher 2014, Williams andFullagar 2018).…”