Contemporary public discourse in Western nations stresses personal responsibility for maintaining health and preventing health problems; it exhorts citizens to adopt healthy lifestyles and make healthy choices. In the U.K., for instance, the “Choices” web portal of the National Health Services (NHS) features a banner with the slogan “Your Health, Your Choices” and describes its role as providing “all the information you need to make choices about your health” (2011). Canada’s federal health agency encourages Canadians to “take an active role in their health, such as increasing their level of physical activity and eating well” (Health Canada 2012) while Ontario’s Ministry of Health Promotion asks citizens “to make healthier choices at all ages and stages of life” (Ontario 2012). As Peterson, Davis, Fraser, and Lindsay (2010) argue in “Healthy Living and Citizenship,” the neo-liberal emphasis on individual responsibility for health reflects “the emergence of new forms of citizenship and conceptions of the self” (392). However, although this neo-liberal discourse of health citizenship may be hegemonic, it is not homogeneous: it is taken up, negotiated, and potentially resisted or destabilized in diverse and complex ways by particular citizens in particular times and places and for particular purposes.

In this paper, we explore how some older adults in Canada and the U.K. partially resist or indirectly critique the dominant discourse of individual responsibility and personal “empowerment” and “choice” for healthy living that informs the contemporary ideal of the “good” health citizen (Bella 2010; Veinot 2010). Our analysis is based on 55 semi-structured interviews conducted in 2010 with adults aged 45 to 70 in three Canadian communities and one U.K. community. During these interviews, we asked participants what healthy eating and active living mean in relation to their own lives as well as what they think of the government’s goals and approaches for fostering “healthy communities.” Canada and the UK were selected because of their similar publicly-funded health systems and approaches to public heath promotion. To help ensure that participants already possessed some interest in the topic of healthy living, we recruited through community-based recreational fitness organizations.

Our decision to interview older adults was influenced by our concern for how the civic imperatives of self-care are constituted in especially pronounced ways for older citizens who are urged to stave off the effects (and healthcare costs) of aging and emerging health problems through self-care practices of body monitoring and improvement, risk management, and active lifestyles (Laliberte Rudman 2006; Katz 2000, 2001/2002).1 Health Canada, for example, identifies “healthy eating” and “physical activity” as “determinants” that play “key roles in healthy aging”; the Ministry advises seniors to “look for ways to keep yourself healthy” and reduce the risk of chronic disease by making “positive” lifestyle “choices” (Health Canada 2011). In the UK, the 2010 Healthy Lives, Healthy People policy paper names the “promotion of active ageing” as a central public health strategy (HM Government, 31), while the NHS web portal promotes “Exercises for older people” and how to “Eat Well over 60” as key ways to “help you stay healthy, energetic and independent as you get older” (NHS Choices 2011).

The following investigation of how our participants critically engaged, as rhetorical agents, with normative expectations of personal responsibility for health begins by situating our analysis in the context of contemporary theories of “vernacular” rhetoric, health(y) citizenship, and environmental citizenship (we draw on the latter as a generative source for re-thinking what health citizenship might mean). Working from this theoretical context, we then explore how our participants employed a recurring logic of dissociation in their practical reasoning about the inadequacies of government support for healthy living, as shown in relation to four main issues: the question of providing stronger economic incentives for (tax-paying) citizens to engage in healthy living; the problem of insufficient community infrastructure and investment to support healthy living; the importance of making healthy living affordable and accessible for all citizens; and the problem of insufficient government regulation of unhealthy corporate-industry practices.

Active publics and vernacular rhetoric: engaging dominant public health discourse

Our research approaches participants as rhetorical agents who actively negotiate—rather than simply passively receive and compliantly reproduce—dominant public health promotion messaging. From this rhetorical perspective, we examine how citizen accounts of the meanings and practices of healthy living simultaneously rearticulate the normative discourse of individual responsibility for health along with a more muted but nonetheless significant critical-collective rhetoric concerning the relative roles and responsibilities of government and citizens in making the practice of healthy living possible. Consonant with a significant strand in recent rhetorical studies of science-public interactions, we are interested in how citizens engage, as active publics and through their own symbolic actions, with scientifically-justified medical and health policies (Condit, Lynch, and Winderman 2012, 394).

Gerard Hauser’s (1999) concept of “vernacular rhetoric” informs our perspective on the accounts of healthy living offered by the older adults whom we interviewed. By this we mean that we are concerned with the empirical and everyday realities of one particular public’s “opinions”—or “everyday reasoning”—about a socio-politically significant issue circulating within and shaping contemporary civil society (Hauser 1999, 23–24). These “opinions,” we contend, do not simply passively reproduce dominant public health messaging; rather, they are rhetorically produced through our participants’ discursive negotiation of prevalent public discourses. Of course, these “vernacular” engagements were prompted by the questions we asked, which were themselves motivated by our own critical-scholarly approach to public health discourse; each interview can, in this sense, be understood as an emergent narrative co-constructed between the participant and the interviewer (De Fina and Georgakopoulou 2012). We see the interview protocol and process as affording participants with a valuable—albeit selectively shaped—rhetorical situation in which to articulate localized accounts of healthy living in response to our questions. In so doing, participants engaged discursively and deliberatively with public health discourse in ways that dynamically constitute a particular instance of citizen reasoning about healthy living.

On one hand, participants’ everyday reasoning largely reconfirms the mainstream neo-liberal premise of individual responsibility for health. As we have shown in an earlier analysis, when asked, “in your view, who is responsible for people’s health?” virtually all participants articulate a strong sense of personal responsibility for becoming informed about and practicing healthy living in their day-to-day lives (Harris, Spoel, and Henwood 2012). On the other hand, as we explore here, this primary rhetoric of personal responsibility for health is counterpointed within a number of interviews by the view that individuals cannot always achieve or maintain the ideal of healthy living by themselves; government, our participants argue, should be playing a stronger role in supporting—rather than simply promoting—citizens’ abilities to eat healthily and live actively. These views emerge principally in response to our question near the end of each interview, “if you could give advice to the government about healthy living, what would it be?” but they also surface in response to our opening questions, “what do you think the government is trying to achieve by promoting ‘healthy eating’ and ‘active living’?” and, to some extent, “who is responsible for people’s health?”2,3

We propose that through the discursive construction of this counter-view, participants engage as rhetorical agents in a critical process of argumentation about a matter of public concern. In generally muted, qualified, somewhat tentative ways, they enact—in Raymie McKerrow’s (2012) sense—“dissensus” with the “means” that government does (and does not) use to support healthy living for all citizens. Through this “everyday argumentative discourse,” they constitute healthy living policy and practice as a matter open to disagreement, a set of issues available for debate by “ordinary rhetors” (McKerrow, 95) not only by health experts-authorities. Notably, however, this practice of dissensus frequently occurs alongside—and despite—the primary rhetoric of consensus concerning the premise that individuals rather than government are primarily responsible for choosing a healthy lifestyle. This suggests the dynamic complexity of public opinions about, and negotiations of, dominant health imperatives.

Because interviewees’ critical, collectively-oriented rhetoric highlights some of the weaknesses, contradictions, and basic economic motivations of government support for healthy living, it destabilizes the hegemonic view that individual citizens are essentially responsible for maintaining and improving their own health through informed lifestyle choices, personal behavior, and self-regulation. As a result, participants’ comments implicitly construct a more complex, critical, and structurally-oriented sense of what health citizenship in the contemporary West means and how it is (or should be) constituted. Attending to the specific socio-structural issues commented on by participants along with the particular forms of argument they use to address these issues provides a nuanced analysis of some of the situated, dynamic ways in which they engage, as rhetorical agents, in practical reasoning and civil judgments about the “common problem” of health citizenship in contemporary Western society (Hauser 1999, 76–78).

Theorizing (health) citizenship

How do the participants in our study rhetorically enact not only the “good” individually responsible health citizen constructed through contemporary neo-liberal health promotion discourse but also alternative, potentially competing versions of (health) citizenship? Like Jeffrey Bennett (2009), we approach citizenship not as a fixed, determinate subject category but rather as a fluid, contextually determined, performative subject position that is “always partial in its constitution of identity” (7–8). Our perspective on the “incarnations of [health] citizenship” (Bennett 2009, 8) enacted by our participants is rhetorical in the sense that we analyze their discursive engagements with the issue of government’s role and responsibility in supporting the healthy living of citizens. In other words, we understand their partial, shifting health-citizen identities as rhetorically constituted through their discursive actions. We presume that citizenship (including health citizenship) is in important ways a rhetorical achievement or practice. As the recent Call for Papers for the “Rhetoric in Society 4” conference on “Contemporary Rhetorical Citizenship” argues, “being a citizen in a modern democratic state is in many respects a discursive phenomenon. Citizenship is not just a condition such as holding a passport, it is not just behavior such as voting; citizenship also has a communicative aspect” (Rhetoric in Society 4 2012, 1). In this sense, we explore here how our participants’ “vernacular” (Hauser, 1999) comments about and advice to government on healthy living communicate “discursive aspects of collective civic engagement” (Rhetoric in Society 4 2012, 1) that—at least implicitly and/or partially—constitute a critical counterpoint to the primary discourse of personal responsibility for health which many likewise articulate at other moments during the interviews.

In “Healthy Living and Citizenship,” Petersen et al. (2010) argue that, under contemporary neo-liberal rule, “citizens individually are assumed to be able to assist in the task of governance through acting ‘responsibly,’ taking appropriate preventive action and exercising ‘informed choice’” (394). Rather than imposing external constraints on citizens, this mode of governance functions through the constitution of citizens who regulate themselves and actively participate in the process of (self) governance by voluntarily conforming to the goals of the state and public agencies (11–12). In this context, the discourse of individual citizens’ “duties,” “obligations,” and “personal responsibilities” takes precedence over earlier welfare state and social rights configurations of citizens and healthcare (Petersen and Lupton 1996, 13).

The idea of individuals as actively engaged in “entrepreneurial actions” and personal “lifestyle” choices permeates normative concepts of the health(y) citizen (Petersen and Lupton 1996, 16–17; see also Lindsay 2010; Petersen et al. 2010). Accordingly, public health refers increasingly to individual self-care rather than to collective responsibility for healthy social and physical environments and to health (care) as a fundamental right of citizenship (Bella 2010, 14). Despite their universal, publicly-funded healthcare systems, in countries such as Canada and the U.K. public health is based more and more on the idea that patients should be informed consumers who make their own health care choices and are personally responsible for their own health (Bella 2010, 27). The “good citizen” is thus someone who accepts responsibility for his or her own health (Bella, 14). As Roma Harris, Nadine Wathen, and Sally Wyatt (2010) point out, this model of healthcare and health promotion entails “significant offloading of informing and care work from collectively supported health systems onto the shoulders of ordinary citizens” (221). As part of this process, public health imperatives for healthy living reinforce the normative assumption that it is a “civic duty” to engage in health and fitness regimes, eat and drink healthily, avoid risky behaviors, and self-monitor for signs of potential illness (Lindsay 2010, 477).

Interestingly, recent discussions of environmental citizenship in both public policy and some ecopolitical theoretical work similarly emphasize the responsibility of individuals to practice good behaviors and develop appropriate awareness and attitudes (Latta, 2007). Indeed, Alan Petersen and Deborah Lupton (1996) note how the “duties discourse” of neo-liberal public health intersects with a discourse of “environmental stewardship” that calls on citizens to fulfill their social obligations to care, not only for themselves, but also for the environment on behalf of future generations (12–13). However, an emerging critical literature in environmental studies foregrounds the limited, problematic aspects of this mainstream view of environmental citizenship and calls for a more explicitly politicized collective-rights and social-justice approach to environmental (or, as some say, ecological) citizenship (see, e.g., MacGregor 2007). These critical perspectives offer fruitful ways of thinking—in analogical terms—about the more politically and critically engaged modalities of health citizenship enacted through some of the comments that our participants make concerning the role of government in supporting healthy living.

Critics such as John Barry (2005), Sherilyn MacGregor (2007), P. Alex Latta (2007), and Andy Scerri (2009) argue that dominant conceptualizations of environmental citizenship focus on personal “green duties” and the behavior of individual citizens at the expense of taking a more collective, socio-structural approach to the question of what it means to be a good environmental citizen. This emphasis on individual responsibility, choices, and behavior draws attention away from questions about the “social conditions that make citizenship possible” (MacGregor, 1–3) and about collective rights, action, and resistance (Latta, 378; Barry, 23–24). Echoing critiques of neo-liberal health citizenship, MacGregor explains:

What concerns me is that environmental citizenship as ‘green duty’ dovetails . . . into a dominant neoliberal agenda that employs ‘duties discourse’ to facilitate the reduction of state provision of social services. Since the 1980s, the equation of citizenship with responsibility has become an escape route for governments as they move to dismantle the welfare state. In neoliberal policy discourse, citizenship is increasingly becoming conditional on performance of duties . . . (4)

Similarly to Harris et al.’s concern about the offloading of health work onto ordinary citizens, MacGregor claims that mainstream views of environmental citizenship do not acknowledge how exhortations to adopt green lifestyles coincide with the neoliberal downloading of public services to the personal or domestic sphere (1). Rhetorically, this normative discourse of green citizenship functions to cultivate attitudes intended to influence publics to “do their bit” (Barry, 22) by behaving in ecologically responsible ways (e.g., as individual green consumers) (Latta, 380; Scerri, 477). In much the same way, the discourse of health(y) citizenship aims to shape attitudes that will lead people (or health consumers) to take responsibility for becoming informed about and behaving in healthy ways.

In light of these criticisms, these authors advance more overtly politicized and deliberatively-engaged ways of conceiving environmental citizenship that highlight its potential as a critical-collective process of addressing socio-structural issues and injustices that contribute to unsustainability. These perspectives offer helpful ways for thinking analogically about our participants’ rhetorical engagements with the issue of government support for healthy living (rather than the allied—but not identical—objective of ecological sustainability). Most significantly for our purposes, these counter-theories construct environmental citizenship as a form of “critical citizenship” (Barry 2005) that addresses macro-level socio-political and economic dimensions of unsustainability. For example, Barry (2005) calls for a “multifaceted and challenging mode of green citizenship, which focuses on the underlying structural causes of environmental degradation” and which “challenge[s] dominant state and economic actors, processes, and institutions” with the purpose of transforming “state structure and policy” to enable the creation of “greener states and economies” (33). MacGregor (2007) likewise characterizes environmental citizenship as a political-rhetorical location from which to argue for the “duty of government” to provide enabling conditions for sustainable societies and to address inequitable and unsustainable socio-economic structures and relationships (4–6). In these perspectives, environmental citizenship is (or should be) concerned primarily with structural and systemic change, not individual behavioral or attitudinal change.

These environmental studies theorists do not explicitly invoke the rhetorical idea of “active publics” (Condit et al. 2012, 394) deliberatively engaged, through their vernacular rhetorics, in democratic, agonistic processes of debate about issues of collective social concern. However, their constructions of environmental citizenship nonetheless highlight the role of citizens as rhetorical actors who should and can articulate arguments that challenge dominant socio-political orders and discourses (Scerri 2009, 476). As Latta states, ecological citizenship should foster democratic processes “in which a broad spectrum of citizens can engage in fulsome debate” (379) as “political actors” from diverse “speech locations” (Luque 2005, cited in Latta 2007, 390). Consonant with a rhetorical perspective, Latta defines ecological citizenship as a performative, dynamic, plural, and conflictive process that is continuously contested and reshaped through citizen engagement with questions about “what is to be considered as the common problems, and how they are to be faced” (Jelin 2000, 53, cited in Latta 2007, 389).

In the following analysis of our participants’ everyday argumentative discourse about the roles and responsibilities of government concerning healthy living, we draw on the above conceptualizations of environmental citizenship as a way of understanding the muted but nonetheless significant traces of what we call a critical-collective mode of health citizenship: a mode that counters—or at least complicates—the focus on individual responsibility for health by addressing, in differing ways, some of the structural-political-economic dimensions of healthy living. The term “collective” in the context of this analysis refers to the substance rather than the process of their rhetorical engagements: that is, we use the term to capture the sense of their comments as concerned with how the state is (and is not) addressing the collective needs and rights of its citizens—what it is doing, in MacGregror’s sense, to create conditions that “make [health] citizenship possible for a broad number of people” (10).

The talk but not the walk: arguments about the appearance versus the reality of government support for healthy living

Our earlier analysis of participants’ responses shows that virtually all of our interviewees articulate a strong sense of personal responsibility for healthy living when asked, “Who do you think is responsible for people’s health?” (Harris, Spoel, and Henwood 2012). They say, for example, that “I am,” “Myself,” “We are. Ourselves,” “the individual,” “the person,” “Yourself,” “They are themselves.” One respondent elaborates that, “it behooves all of us to make sure we take care of ourselves. I don’t think it’s anybody’s responsibility but our own.” Within interviewees’ explanations of how they work to achieve the ideal of healthy living, we find a pronounced discourse of self-care, self-surveillance, and self-deprivation (Spoel, Harris, and Henwood 2012). In other words, most participants identify strongly with the imperatives of neo-liberal governmentality discourse in terms of the good (health) citizen that it expects and engenders.

However, in a number of interviews, participants also argue that individuals cannot (always) achieve or maintain the ideal of healthy living by themselves. Especially when asked what advice they might have for government about how to foster healthy living, many participants focus on the importance of macro-level systemic or institutional forms of change, support, and policy that would be required to truly enable healthy living for citizens, understood collectively. In other words, they reconfigure the issue from one of (solely) individual behaviors, knowledge, and attitudes to one of the state’s “social responsibility” (S10)4 to create the necessary conditions for individuals to be able to eat healthily and live actively. As one participant puts it:

The government can provide the environment for active living . . . It’s not good to yell at people and say, ‘Hey! You gotta be more active because you’re fat and you’re out of shape.’ . . . The government carries a huge responsibility because they’re the only ones that have the ability to manage environments . . . I can’t do that as an individual but the government, you know, can if they’re serious . . . (S09)

In this framework, some of the duties of neo-liberal citizenship are repositioned as the responsibility of government to meet the rights of citizens to live in a world conducive to health.

Notably, none of our participants directly questions or counters the value of healthy living as a goal for themselves or for the broader community, though some do argue for the value of only partially rather than fully achieving this ideal in their own lives (Spoel et al. 2012). In the terms of rhetorical stasis theory, the issue of healthy living is taken up by participants almost entirely as a question of procedure and policy, not of conjecture, definition, or quality (Fahnestock and Secor 1988). In McKerrow’s (2012) sense, their dissensus addresses the “means” rather than the “goals” of healthy living as a social objective. In other words, participants appear to take for granted that healthy living is an intrinsically valuable goal whose existence and definition do not require debate. Instead, their comments focus on the question of how the situation could be improved, how things could be done better in ways that parallel discussions of environmental citizenship that posit sustainability or “green” society as the common goal (with disagreement focused mainly on how best to achieve that goal). In this sense, our participants can be seen as fulfilling the civic duty to participate actively as rhetorical agents in discussions about what constitutes the best possible course of action in a given situation. Importantly, the courses of action to which they refer in their vernacular “advice to government” explicitly foreground some of the structural, systemic dimensions of healthy living that reach beyond the level of individual actions or lifestyle. We suggest that these comments enact forms of practical reasoning and civic-political judgment that Hauser (1999) encourages us to attend to when exploring the actual practices of diverse publics’ rhetorics.

Here, we illustrate this rhetorical exercise of civic-political judgment by focusing on a recurring type of claim that participants make when commenting on government goals and support for healthy living. In its generic form, this is the claim that government “talk” about the importance of healthy living and healthy communities is not matched by its actions (it doesn’t “walk the talk”): that is, although most participants seem to feel that government is sincere in its objective to promote healthier communities, many offer that government support for implementing this objective is inadequate and, for some, constitutes evidence of hypocrisy. As one participant succinctly puts it, “what they’re saying and what they do, there’s a great discrepancy” (BH06).

The specific issues (in the rhetorical sense of “issue” as a matter about which there is some disagreement (Crowley and Hawhee 2010)) concerning which participants make this claim range from the question of providing stronger economic incentives for (tax-paying) citizens to engage in healthy living; the problem of insufficient community infrastructure and investment to support healthy living; the importance of making healthy living affordable and accessible for all citizens; and, most radically, the problematic influence of corporate-consumerist culture on citizens’ lifestyles and the consequent need for government to introduce stricter industry regulations. All these issues highlight, in different ways, citizens’ understanding of healthy living as a complex and fundamentally political-economic matter rather than simply a matter of individual choice and personal lifestyle.

In making the claim that (some of) what government says and (some of) what government is doing about healthy living is inconsistent, participants rhetorically enact their civic-political judgment through the logical process of dissociation (Perelman and Olbrechts-Tyteca 1969). Through this technique of argumentation, the “appearance” of government support for healthy living is hierarchically devalued by comparison with the “reality” of what government could or should be doing. According to Chaim Perelman and Lucie Olbrechts-Tyteca, the rhetorical technique of dissociation splits one idea into two in order to avoid or resolve a logical incompatibility, and it typically does so by qualifying, or distinguishing, between the “apparent” and the “real.” The dissociation of concepts “assumes the original unity of elements comprised within a single conception” (such as the public health conception of healthy living) and then “challenges this unity by identifying a source of incompatibility between the elements” (Perelman and Olbrechts-Tyteca 1969, 411–12; Ritivoi 2008, 186). As David Goodwin (1992) explains, the “real” here “stands for whatever a community designates to be the most true, meaningful, relevant, or normal considerations upon the issue under discussion” (13). The argumentative technique of dissociation reconfigures previously constructed integrities by showing them to be unstable, illusory, or deficient. It does so through the construction of “ranked dichotomies that distinguish realities from appearances” (Goodwin 1992, 13). This ranking takes the generic form of

  • Term 1

  • Term 2

in which Term 1 represents whatever the speaker considers to be apparent, illusory, or false while Term 2 represents whatever is actual, true, or real (Goodwin 1992, 13).

While rhetorical critics agree that the technique of dissociation can be formally identified through its logical distinction of a unitary concept (e.g. the idea of government support for healthy living) into unequally valued appearance-reality terms, the specific rhetorical functions of dissociation vary across contexts. As Andreea Ritivoi (2008) explains, the significance and effects of dissociative logic can only be understood by studying how it “actually unfolds in real argumentation contexts” (196). From this perspective, we find that the argumentation technique of dissociative logic functions in our participants’ responses primarily as a means of foregrounding—rather than resolving or avoiding—incompatibilities between what government is doing by contrast with what it should/could be doing. Highlighting the distinction between appearance and reality in this particular context provides, we suggest, an important means for these citizens to exercise political judgment and critical engagement with dominant health promotion discourse.

Issue 1: Why doesn’t government provide greater economic incentives in support of healthy living?

When asked how government could better support healthy living for citizens, a number of participants argue that there should be greater economic incentive (or less dis-incentive) for people who spend time, effort, and money on healthy activities. This argument is far from radical in that is suggests relatively minor modifications to existing political-economic orders, not significant changes; nonetheless, we see it as performing a mild form of critical engagement with the question of how to create better macro-level, state-supported contexts or “enabling conditions” (MacGregor 2007, 4) for healthy citizenship. This argument occurs mainly among Ontario participants and is connected to specific dimensions of the provincial and federal tax systems. In general terms, this argument draws attention to the incompatibility between government saying it wants people to live active, healthy lives but not providing financial stimulus or rewards to all (tax-paying) citizens for doing so. As one participant explains:

. . . they’re [the government] pushing, they’re giving all this great advice, but they’re not supporting it. . . . I think there should be incentives for—If you try and if you are following the [community health center] programs, or if you are using and doing the exercises, then I think they should support people or reward people. (HC 16)

Several participants framed this issue specifically in terms of the incongruity of offering a tax credit for children’s physical activities (as occurs in Canada) but not offering it to all citizens even though government is exhorting or “pushing” everyone to engage in active living. To resolve this incompatibility, one person proposes that:

I would like to see credit given for, you know, for paying memberships, for example, would be, I think that, what they’ve done with kids is a start. I think that could apply to us. It could apply to me, you know, that if, you know, you could get an income tax, something towards income tax for membership of some sort, or whatever, would be a way to do it. (HC 12)

Another variation of this critique of the tax system in supporting healthy living is based on a slightly different incompatibility, in this case linked to the newly introduced Ontario “Harmonized Sales Tax” (HST). Several participants express strong concern and annoyance that the HST would be applied to gym memberships but not to low-cost “fast food.” These participants identify the incompatibility of government adding a tax to healthy living activities (i.e. buying a club membership) while not taxing unhealthy activities (i.e. eating fast food). One participant delineates the contradictory nature of the situation as follows:

Like for instance, there’s a program now, the HST is coming in and the government is supporting any fast food under $4 but they’re not supporting the gyms. Now, the government isn’t really supporting us 100 % because we’re going to have to pay HST for the gym. . . . Can you imagine me going down to Tim Horton’s and buying a coffee with sugar and a nice donut, it’s going to cost me under $4. There’s no HST. I spend $45 a month to go to the [gym] to exercise, to stay healthy. I don’t eat a donut. I don’t have sugar, and yet I’m going to have to pay the penalty of being healthy; so I don’t think the government is really 100 % behind us yet. (HC14, our emphasis)

At the end of this critical commentary, the participant’s use of the modifier “really” enacts a clear appearance-reality distinction: although the government may appear to be “100 %” in support of people who are trying to live healthily, in reality the government is not, as this example of the HST situation illustrates.

For another participant, the contradiction of taxing gyms but not taxing fast foods signals not simply that government is not going far enough in supporting citizens’ efforts to live healthily but—more problematically—that it is actually going about it in a “wrong way”:

One of the things that . . . a lot of us are disturbed about is the tax and the HST, you don’t get any savings in your HST for getting a health membership. . . But if I get a meal under five dollars at McDonald’s, which isn’t healthy eating, I get a perk there. So it’s sort of, going the wrong way I think. (BH04)

Interestingly, this participant’s reference to “a lot of us” invokes the collective dimension of the critique not only as addressed to a collective issue (namely, the taxation system) but as emerging from a group of citizens engaged in vernacular conversation about a political-economic issue of common concern. As suggested by other comments from participants recruited in the same community, fundamentally they are concerned about the gap between government’s words (the appearance of supporting healthy living) and actions (the reality of supporting it). And to achieve “real” support means providing more money: “You know, I think if the government wants this active living, that they really believe in it, then they’re gonna [have to] put up, it’s the dollars and cents that’s gonna do the talking, dollars, and cents, sorry, it’s gonna do the talking.” (BH05)

Issue 2: arguing for more investment in community infrastructure

While the preceding comment refers specifically to tax “dollars,” it could just as easily be applied to the connected but broader theme of the need for increased government investment in healthy living, particularly in the form of more infrastructure to support citizens in practicing healthy lifestyles. Rather than seeing healthy living as something encouraged (or not) through tax credits or incentives, this perspective emphasizes the responsibility of government (whether at regional, provincial, or national levels) to provide community-based resources and appropriate environments to help all citizens live healthily, thus creating healthy communities.

Some participants frame the issue in primarily negative terms, as a problem that exists because government promotes healthy living (appearance of support) but does not actually invest in it sufficiently (reality of insufficient support). According to one participant, “. . . they talk about it [healthy eating and active living] but . . . they’re not investing in it at all. . . . They talk a lot about it and they say it’s an issue but they’re not putting the money there” (HC04). Similarly, another participant highlights the contradiction between spending money on health promotion rather than health infrastructure:

Sometimes I think the money spent on marketing the healthy living and active living might be better spent on actual infrastructure for healthy living. . . . the infrastructure is always struggling, but there always seems to be lots of money for marketing . . . They’ll put a $300,000 ad campaign, or put up billboards that say eat better and you know get moving. Okay, well, where are we going to get moving to? How are we going to get moving? (S01)

For one participant, government’s focus on health promotion rather than providing real “input” is clearly a way of trying to save money by downloading responsibility for health onto individual citizens:

I think that they are thinking, you know, how to really save money and to. . . In a negative sense, you know, I do feel that way about the government. They’re thinking, live in a healthy way, in an active way; you will need less input from the government. . . . I think that they are steering people to think, to give them guidelines to live in a certain way so that they will have less responsibility for picking up the pieces. (UK05)

For this participant, “government initiatives” or investment in healthy living is at best a form of “damage control” (UK05).

Other participants do not directly critique or question government’s motives in not providing sufficient support but instead recommend specific ways for the state to provide better infrastructure and resources for citizens. However, these recommendations likewise emerge from the assumed premise that there is an incompatibility between the government’s promotional discourse of healthy living (appearance) and what it is actually doing to help citizens and communities achieve these goals (reality). Most recommendations address the need for better and/or more facilities and spaces—what one participant calls the “built environment” (S10)—for pursuing healthy activities, as well as the benefit of offering more “programs” to citizens. For example, one participant says that:

They could probably provide better facilities for priorities that need it. . . . They could put a lot more money to areas that need it to provide community centers and places where people can go to exercise, or just play squash, or just get together and have a volleyball game, provide more funding. (HC08)

Others argue that government should provide more “money for infrastructure type projects” (S01) or should “put up free, active classes” in community halls for citizens of all ages (UK01). One participant vigorously claims that the state should fulfill its obligation to “provide the environment” and “the opportunity” for citizens to pursue active living rather than simply to “yell at people and say, “Hey! You gotta be more active because you’re fat and you’re out of shape” (S09). In this person’s vernacular rhetoric, public health promotion is characterized not as a form of helpful advice but, pejoratively, as a form of yelling.

Several other participants discursively construct the contradiction not simply as one between what government says and what government does but between what government is investing in as opposed to what it should be investing in. Some argue that more funding should go toward programs and infrastructure focused on preventing health problems rather than on treating or diagnosing them. As one participant says:

I think if anything, the government should look more towards pro-active efforts to encourage health as opposed to reactive methods. I think, unfortunately, our government spends far too much time and effort on dealing with areas where, you know, we’re sort of closing the barn door after the horse has gone kind of thing. (S08)

Another, who identified herself as working in healthcare, similarly suggests re-allocating funds from expensive and possibly wasteful medical procedures to creating community facilities that support active living:

I think, you know we’re talking about maybe some 60 % of our budget’s going in to health, treating health problems so that means less for community infrastructure and education and I think that’s such a shame. Someone’s got to bite the bullet and say, you know less, there’s lots of waste in medicine, I do know and I mean I shouldn’t say that but I know, there’s probably testing and stuff that’s fairly expensive that doesn’t yield a lot of health gain, compared to putting in another arena pad or putting in another pool or another track facility . . . (S10)

In this framing, the issue is rendered as one that involves redirecting government funds from areas that that are excessively or inappropriately funded to ones that warrant increased investment. This kind of argument indicates, we suggest, a relatively sophisticated exercise of civic judgment about political-economic governance matters: as citizens, our participants not only critique government for not providing enough investment in healthy living and not only offer concrete suggestions about the kinds of infrastructure that would help, they also situate resources for healthy living in relation to other areas of government investment.

Issue 3: healthy living needs to be accessible and affordable

A third way that many participants engage with the question of government support for healthy living concerns the basic matter of whether healthy living is affordable for all citizens. While comments about infrastructure and programming address mainly (though not exclusively) the need to create more opportunities and facilities for active living, comments about the problem of making healthy living affordable tend to focus on the cost of healthy foods as compared to unhealthy foods (though some do also discuss the issue of active living programs being unaffordable for some people.) These comments foreground the incompatibility between exhorting people to eat healthily but not making it affordable.

For one participant, the problem of high prices for healthy foods provides a reasonable (if unfortunate) justification for why some people eat Kraft dinner rather than “good foods.” In this framing of the situation, government—not the individual citizen—is to blame for unhealthy eating, especially in the case of those who are “struggling financially”:

I would ask them [government] to please lower the prices on the good healthy food that we should eat. I find that the good products, the good foods that you should eat are higher in price. . . . And I feel like, not just, not that it’s a problem for myself but for many people that you see in the community and it’s maybe obvious that they could be struggling financially and so I should feel that they need a break. They can’t buy these good fruits and vegetables because of the cost, and that’s why they have a tendency to pick up Kraft dinner. (HC 17)

Others similarly cast the issue as a systemic, socio-economic problem that government needs to address rather than simply a matter of individuals making poor health choices. In the judgment of one participant, telling “poor people” to eat healthily but not making it affordable for them to do so constitutes a form of government hypocrisy:

I suppose my thought is, there is a link between healthy eating and poverty, isn’t there really? Because it—there’s no getting away from it. To eat properly requires a bit of money. . . . So I think there is a link between your ability to eat well and the cash that you have. So it’s a bit of a hypocrisy to tell poor people to eat well, if you don’t provide the cash for them to do it. (UK09)

Another participant forcefully critiques the socio-economic inequities structuring citizens’ abilities to live healthily. As she explains, “most of the food in super markets, the cheap food, is the unhealthy food so . . . [it’s] more available to poor people and therefore it’s usually only middle class and wealthy people who can actually have, be living in a healthy way” (UK10). In her view, the problem is one of systemic inequity not lack of individual awareness or education: “all marginalized people in the society are the ones that have the most obstacles in their way from getting healthy food and exercise” (UK10). Solving this problem requires socio-structural transformation, not simply more health promotion and better individual choices.

Notably, most of the participants who engage this issue make a point of saying that the problem does not affect them personally (they can afford to buy “good healthy food”) but it does affect other (kinds of) citizens: “poor people,” “marginalized people,” those who are “struggling financially” or who are living “on a subsistence income” (HC23). The collective nature of citizenship is thus enacted quite differently in relation to this issue than in relation to the issue of minor tax reforms as an economic method for encouraging healthy living, where citizens are constructed primarily as taxpayers and participants clearly identify themselves with this kind of citizenship. Likewise, participants’ comments about the need for increased investment and infrastructure tend to be framed as directly relevant to themselves and their families as well as the broader community.

The response of one participant on the topic of the cost of healthy food does however enact a rhetoric of identification not dis-identification. With some hesitation, this participant draws on her previous personal experience as a recipient of social assistance as evidence for the impossibility of eating healthily in this situation:

There was a time, let me say it this way, there was a time and I don’t know how to, there was a time where I was on welfare. . . . Okay? And with the amount of money that you received it just . . . was not possible to eat healthy. And I don’t know what program could be made available. I don’t know how that could be judged but, just find a way of making it possible for every member of your country . . . to have access to it, in an affordable way. (S03)

By contrast with how other participants distinguish and externalize those who need access to affordable healthy food (in essence, advocating on behalf of others, of “that group of people”), this participant includes her (former) self in the collective and names all citizens—“every member of your country”—as having the social right to affordable healthy food.

The diverse constitutions of the critical (health) citizen discursively enacted by our participants through their engagement with the issues of affordability, infrastructure, and tax reform indicate, as Bennett (2009) and Latta (2007) argue, that citizenship is a fluid, plural, and contextually determined performance of identity, continuously reshaped through people’s practical reasoning about what the common problems are and how they should be addressed.

Issue 4: advocating for stronger regulation of corporate-industry practices

The question of government’s responsibility to make healthy food available to its citizens is further taken up by several participants in terms of the socio-economic problem of (undue) corporate influence over the production and consumption of unhealthy food. In this framework, the issue is not simply the contradiction between government telling people to live healthily but then not ensuring that healthy food is affordable (though this is an important dimension of the issue); more complexly, the issue is constructed as the incompatibility of government asking individual citizens to purchase and consume healthy food but at the same time permitting the food industry to continue making and marketing foods that government knows to be unhealthy. The problem is thus represented primarily as one of insufficient government regulation or control of corporate enterprise, which allows corporations to make profits at the expense of people’s health.

Rather than supporting a deregulated, “free market” (UK08), consumer-choice approach to food production and advertising, participants argue that it is the responsibility of government to control what the food industry is allowed and—most importantly—not allowed to do. A number of participants urge government to use its authoritative power to implement stronger regulations (laws, policies) because, as one participant says, “you can’t possibly trust that the type of regulation we have now will really protect you” (S09, our emphasis). Articulating a vocabulary of enforcement and external governance, they say, for example, that government “should have a stronger position when it comes down to giving licenses. They should regulate what kind of food restaurants can sell” (S06); that government should “make every manufacturer of food justify anything that they put in the food” (S05); that government should “have a serious talk with food companies and food manufacturers as to what these manufacturers are allowed to put on the market” (HC05); and that government should take more responsibility “around advertising and around promotion of really unhealthy food—food that just should never be allowed to be made” (UK06, our emphasis).

Several participants highlight the incompatibility of allowing the fast-food industry to dominate public space while urging citizens to eat more healthily. Some explicitly note how this communicates a “very contradictory message” (UK06) and argue that government needs to “deal” with the problem of the “endless” unhealthy food industry if they really (not just apparently) want to promote healthy living:

I think it’s a good idea . . . to encourage people to be healthy, and eat well and live well. But I think, that when you’ve got endless McDonald’s, and Burger Kings’, and fatty food chains on every street corner open all night long for kids, I kind of think that you’re sort of setting up with a very, very confused message. . . . You’re kind of giving such a mixed message. . . . To be going on and on about healthy eating and healthy living and then, having these massive temptations in a way just seems like, it’s a bit, you know they just clash, it’s not going to work. (UK02, our emphasis)

Another participant recommends that government “abolish . . . fast food joints because when we didn’t have fast food joints, we didn’t have, you know, the obesity rates, you know, that we have now” (HC05). In other words, if government really—not just apparently—wants to help citizens be healthy, it needs to intervene at a systemic level in the corporate food economy—and this intervention means “challenging” (UK06) or “fighting against” industry (S06).

The critical perspective articulated in comments such as these suggests that (some) participants see the motives of corporate profit and those of citizens’ health as fundamentally incompatible. As one person states, “So there’s no way that I’m gonna believe that a big corporation is going to sacrifice their bottom line to make me healthier” (S09). However, even if individual citizens recognize this incompatibility, the excessive presence and undue influence of the food industry make it very hard, if not impossible, for individuals to resist on their own: “most people don’t stand a chance because of what’s in front of them” (UK08). Hence, government needs to challenge and regulate the food industry on behalf of its collective citizenry. Instead of positioning citizens as individually responsible (and “empowered”) to make healthy food “choices,” this perspective constructs government as possessing both the power and the obligation to act on behalf of its citizens; citizens, thus, are conceived implicitly as entitled to protection by government (the public sector) against the untrustworthy, profit-making motives of the private sector. By contrast with a neo-liberal ideology of the entrepreneurial individual self-managing his or her own health, participants express their concern that government is not doing nearly enough to regulate the food economy and they call on it to “take a very active role” (BH03) in doing so: “I’d say to government, ‘Get back in the business of government’” (S09). Only in this way, they argue, can government really—as opposed to only apparently—support citizens in living healthily.

Despite the political range of issues that participants address—from the fairly conservative argument that government should provide tax-paying citizens with greater economic incentives for pursuing healthy lifestyles to the more radical argument that the state should more strictly regulate corporate-capitalist practices and power—the older adults we interviewed deploy a remarkably similar form of reasoning in their critical commentary on the role of government in supporting healthy living. Using a logic of dissociation, they largely concur that the key problem is that public health promotion “talk” is not matched by its “walk”—that is, the appearance of government support for healthy living conflicts with the reality of inadequate support. To enable all citizens to pursue the communal ideal of healthy living requires changes at a structural, collective level—not simply at an individual behavioral level.

Conclusion

When talking about their own approaches to healthy living in the context of their everyday lives, a strong majority of our participants describe actions and attitudes consonant with the neo-liberal ideal of the individually responsible, good health citizen. But this dominant rhetoric does not preclude a simultaneous, minor chord of critique directed at the issue of how government should or could better enable healthy living, which is developed through the logical technique of dissociation. By highlighting the basic incompatibility between what government says and what government does, our participants show themselves to be much more than compliant recipients of public health advice on healthy eating and active living: they perform a modality of health citizenship that reconfigures the terms of the debate from the simple, reductive question of what do individuals need to do to achieve healthy living to the more complex, political, and structurally-oriented question of what should the state be doing to better help all citizens achieve this goal.

Recent counter-theories of environmental citizenship help to illuminate this alternative mode of health citizenship because they call into question the mainstream neo-liberal focus on the “green duties” of individual citizens as an adequate means for achieving sustainable societies. Instead, they advance a concept of “critical citizenship” (Barry 2005) that attends to collective rights and the “social conditions that make citizenship possible” (MacGregor 2007, 1–3) and that encourages the political involvement of citizens in deliberating about macro-level socio-political and economic dimensions of unsustainability.

Although none of the older adults we interviewed would—to our knowledge—characterise themselves as activist or politicized on the issue of healthy living in the senses invoked by these theorists of environmental citizenship, nonetheless we think that the “actual practices” of their everyday, informal argumentative discourse (McKerrow 2012) or, in Hauser’s terms, their vernacular rhetorics indicate the degree to which citizens who might never participate in direct political action or public debate may be deliberatively engaged in processes of political judgment about what the common problems are and how they should be addressed. These engagements are, of course, always highly situated and particular. As Hauser (1999) argues, there is no such thing as a homogeneous public but instead a reticulate public sphere composed of multiple, shifting localized groups and perspectives. The set of views articulated by participants in our study thus illustrates just one of the many possible ways in which publics might negotiate neo-liberal healthy living imperatives in countries such as Canada and the U.K. For instance, even though our study was not designed to compare differences between responses from Canadian and U.K. participants, the foregoing analysis does suggest that our UK participants were more likely to foreground the state’s responsibility to intervene at a very broad, systemic level by enacting stronger corporate-industry regulation whereas the particular group of Canadians we interviewed tended to address government responsibility less radically in terms of providing incentives and resources to citizens conceived as individual tax-payers. This apparent difference in emphasis suggests the importance of investigating how neo-liberal health governance is taken up and renegotiated by particular publics in particular contexts, rather than making overly general claims about its forms and effects.

Exploring the diverse and particular ways in which our participants enact a modest, indirect mode of critical-collective health citizenship in their responses to our questions enriches our understanding of (health) citizenship as a fluid, situated, multifaceted rhetorical performance that, as Bennett (2009) suggests, is “always partial in its constitution of identity” (8). The fact that many of our participants articulate, at different moments within the same interview, both a mainstream discourse of individual responsibility for health as well as a more skeptical, structurally-oriented rhetoric of health citizenship further underlines how citizenship identities are constituted through complex, ongoing processes of rhetorical negotiation within the context of people’s everyday lives as well as within more formalized public-political spheres.

Authors’ Note This research was funded primarily by the Office of the Vice President (Research) at the University of Western Ontario along with a supporting grant from the Office of Research and Creativity at Laurentian University. We thank our research assistants Josh Osika and Courtney Rae-Duffin for their contributions to the analysis developed here.

Endnotes

  • 1The full project is entitled “Managing Healthy Living in Everyday Life.” We recruited participants from three mid-sized Ontario towns and one mid-sized city in Southeastern U.K. We transcribed and coded the tape-recorded interviews for content and rhetorical themes consistent with the interview questions and with the conceptual categories that emerged during an initial open coding process (Berg 2001). Following this initial process, we identified more thoroughly responses that illustrated each of the main emerging themes, including comments that directly or indirectly enacted a critical perspective on government support for healthy living that we analyze in this paper.

  • 2We intentionally left the definition of “government” open-ended to allow participants to interpret this term as they chose.

  • 3Clearly, our interview questions encouraged participants to reflect, perhaps critically, on the relative roles of individuals and the state concerning healthy living in ways they might not have if they had not volunteered for the study. What we find especially interesting is that many enact some form of critical-collective rhetoric alongside—and despite—the dominant discourse of individual responsibility that they also uttered.

  • 4When citing our participants’ comments, we use letters to identify each interview site and numbers to identify individual interviews.