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Public health and the rhetoric of personal responsibility Brown, Monica (Mono)

Abstract

My dissertation examines the significance of public health messaging to perceptions of responsibility and risk. Central to this research is my view of public health campaigns as rhetorical texts—rhetoric being the art and study of persuasion—that employ discursive strategies of various kinds to achieve their aims. As rhetorical texts, public health campaigns provide a means of involving individuals in health promotion and disease prevention, which makes them a valuable resource amid growing concerns about rising healthcare costs worldwide. In four case studies, on hand hygiene, vaccination, antibiotic use, and “epidemic” obesity, I illuminate the persuasive means through which public health comes to be understood as, in the first instance, a matter of personal responsibility. Given that the rhetoric of personal responsibility places more of the onus for health on individuals than on systems, this rhetoric has long been criticized in health contexts as a form of “victim blaming.” Appeals to personal responsibility, for example, ignore the influence of context on health status. These appeals also induce cooperation among individuals by triggering feelings of anxiety, stigma, and blame. Some public health scholars celebrate these effects as essential to public health; I stress their potential to impede a society’s capacity to cope with infection. Throughout, I examine the relationship of the rhetoric of personal responsibility to neoliberalization—especially its advantages for the private sector, some of which come at the expense of public health. A political-economic theory, neoliberalism prioritizes privatization, deregulation, reduced spending on social welfare, and minimal government interference in the private sector. In each of my chapters, I critique public health’s neoliberalization by documenting consequences or conflicts of interest arising from the rhetoric of personal responsibility. One such conflict is the opportunity to profit from altered perceptions of risk and responsibility, an effect I demonstrate most emphatically in my chapters on hand hygiene and “epidemic” obesity. A rhetoric of personal responsibility also distracts from the reality that some problems—for example, antibiotic-resistant infections (ARIs) and declining vaccination rates—necessitate both societal and individual change.

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