10. Governmentality & Care (Interactive exercises)

Tackling TB

Imagine it is 1955. You are a government official in Ottawa. Tuberculosis is devastating the Inuit population, and you have been told to bring the epidemic under control. Here are some challenges:

• Inuit live across an enormous, remote area, often moving between camps.
• There are very few hospitals in the Arctic. Doctors generally don't speak Inuktitut.
• Inuit names can change and people don't necessarily have surnames, making it difficult to keep track of patients.
• Housing is often crowded, which helps TB spread.
• You have limited money and staff.

Come up with five practical things the Canadian government should do. Think about: How will you identify people? How will you find and regularly test them? Where will people with TB be treated? Could you change where/how people live to make healthcare easier to provide? How will you know whether your policies are working?

Governmentality

To analyse our responses, let's build a deeper understanding of governmentality. Here's a definition to run with:

 the way modern governments shape the behaviour of citizens using tools like health policy, statistics, and expert advice — not just laws or violence.

It's a way of caring that creates. 

1. People as citizens

The first step is for us to understand what it means to be a citizen these days. If you lived in 1400s England: 

• What are the limits to the power a king has over you? 
• What does he know about your life? 
• What kinds of care would he provide?

You were not a citizen — you were the subject of the king.

• citizen vs subject: what's the difference?
• Now complete the task below

Rulers exercised power in spectacular violence:

• What would be a fitting punishment for someone who tried to kill the king in medieval Europe?

As you know, governmentality is a mentality that developed in the modern era. It is softer and subtler kind of control over citizens not subjects of a monarch.

2. Citizens should live long & healthy lives

In this modern era, we are citizens.

What is the role of government? 

 

To answer that, let's turn to  the 1776 U.S. Declaration of Independence: 

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.--That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed, --That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness.

This Declaration points to a new model of government. But that's not so important here. What is important is the underlined material. This conception of 'the People's' right to life and happiness. 

 

 

• Briefly analyse the underlined words above using Foucault's idea of governmentality.

The role of government is to ensure that citizens live long, happy lives.

 

3. For this healthy population, statistics are required 

The aim is for happy, healthy citizens. For this, governments need knowledge-- a new way of knowing the population through statistics is required. We can see this Stevenson (2014) on the Canadian government's campaign against TB. Inuit in Canada's north were to be tested and those who were infected were evacuate to the south to recuperate in sanatoria. 

 

 

 

Let's consider the importance of statistics in the campaign. The doctor on the ship, visiting the remote settlement Stevenson describes, had a list of Inuit to be tested. The doctor even used the ship's helicopter to assist him in this task. This shows a meticulous attempt to achieve statistical completeness — every possible case had to be found and accounted for.

• What is the advantage of this gathering statistics from an epidemiological perspective?
• What are the side-effects of gathering statistics from Foucault's perspective?
• 
  

a. To gather statistics, populations need to be legible, and...

It was difficult for administrators fighting TB to keep tabs on the Inuit. They didn't have surnames. (Presumably their names were difficult for the administrators to understand or write down as well). To help trace Inuit: 

each Inuit would be given a serial number (much like a social insurance number today) that he or she would be required to wear on a pressed fiber tag around the neck (Stevenson, 2014, 26).

Foucault would say this is not just about health, this makes the population legible.

 If your hand writing is illegible it means no one can read it. If it's legible it means that someone can read. But here legible means something more.

Think of one system (e.g. school, Centrelink, Medicare, uni logins) where you are made legible to the government.

• What do you have to disclose about yourself?
• How are you categorised or standardised?

 

4... b. populations  need to be settled

Being legible was not enough. The Inuit were, in the words of the government, "migratory". Inuit moved from season to season. So to care for the Inuit population, the Canadian government stressed that it was important that the Inuit be settled. One government committee found:

“Tuberculosis rates, infant mortality rates, and the incidence of environmental diseases can be cut by improving housing. Cutting these rates means that lives are saved: failure to cut them means those lives are lost” (Subcommittee on Eskimo Housing Programs, 1964, quoted in Stevenson, 2014, p. 33).

• Again, from an epidemiological perspective, what is the advantage of housing?
• What, according to Foucault is the side effect of this?

 

 

 

5a. Citizens are individualised

The point of the TB eradication campaign was to alleviate suffering. But it had many unintended and harmful consequences. One of these emerged from Inuit people being removed from their families:

In the 1950s, when the tuberculosis evacuations were taking place, the Canadian North was imagined as a laboratory for a massive social experiment that would transform Inuit into bona fide Canadian citizens by, among other things, reducing their death rate. The “experiment” demanded Inuit cooperation with the forms and logics of the bio- political care the state provided—including the evacuation of Inuit sick with tuberculosis, like Kaujak,  to southern sanatoria. Between 1953 and 1964, approximately half of the total Inuit population was institutionalized, and 75 to 80 percent of those institutionalized were sent to southern sanatoria in places like Hamilton,  Toronto,  and Moose  Factory. Such  forms of  care, as I  will  show, hinged on the conception of the Inuit as so many serialized bodies that needed to be brought back to health" (Stevenson, 2014, 6).

Stevenson describes how this forced forced evacuation and separation from kin sometimes resulted in patients dying far from home without their family being notified and without proper burial rights. This the depersonalized or anonymized care provided by the state. 

 

...b. as in schools, prisons, and hospitals

For Foucault, hospitals (including sanitoria) like armies, schools, and prisons are institutions where we can clearly see governmentality operating. Modern institutions train us to be useful and obedient — shaping how we move, think, and behave. 

Consider armies. Once, a warrior was thought of as a man who stood out among men. In the modern period:

the soldier has become something that can be made; out of a formless clay, an inapt body, the machine required can be constructed; posture is gradually corrected; a calculated constraint runs slowly through each part of the body, mastering it, making it pliable, ready at all times, turning silently into the automatism of habit (Discipline & Punish, p. 135)

 

 Can you see this in various institutions?

6. So we are like prisoners in a panopticon

Actually it is the prison that most encapsulates modern life. For Foucault, we are like prisoners in a panopticon. The panopticon is a prison design from the 1700s. Some prisons have actually been built on this design.

 

As such we are:

• Individualised: Each cell would house an individual prisoner, cut off from each other.
• Anonymized: Known by a prison number (not actually mentioned by Foucault, but this help his idea)
• Subjected to the possibility of constant surveillance. The guard in the central tower could view us at any time.
• Docile

We begin to think and act as if the guard is watching us. So much so that we internalise the prison guard; the guard lives in our heads. Indeed, it is unnecessary for a guard to actually ever be present in the tower. This is panopticism. 

 

The end result is a population of citizens with docile minds and productive bodies. In the modern era, we are a new kind of person and a new kind of subjectivity.  

 

Using Foucault's "governmentality":

•  explain which is more powerful--French monarch c. 1500. Australian government c. 2025?
• explain how is there more control in Australia than in North Korea?
• What is the difference between governmentality and a 'big-brother' type surveillance state?

• Who has more power? A medieval "off with his head" king? Or a modern "nanny state"

Application
"Governmentality" (statistics and surveillance): Australia's "Measure up" campaign

Stevenson applies the governmentality idea to Inuit communities in northern Canada, where tuberculosis care efforts disrupted kinship, ignored consent, and turned care into something cold, distant, and even harmful. Now let's try and apply the governmentality concept to an Australian government health campaign.

 

The 2008 "Measure Up" campaign to warn citizens that having a large waist was linked to long term health problems. The campaign's materials were disseminated through various channels, including television ads like this:

If the above doesn't work, try this link instead.

 

As a follow up, the campaign distributed free measuring tapes and provided guidelines on how to measure waist circumference correctly. I remember receiving my measuring tape in the mail! I was supposed to measure my own waist and take appropriate action. 

What kinds of care is the government providing in this campaign?

Use Foucault's governmentality to analyse this campaign. Use concepts of:

• long, healthy life
• statistics
• surveillance
• panopticism
• docile subjects

(Note that there is significant overlap between these concepts)

Comparing the TB Eradication and Measure Up campaigns

 

 

Concept	Canadian TB Campaign	Measure Up Campaign
Legibility through	Names and houses	Names and addresses
Surveillance through	Assigned ID discs	Self-measurement at home
Statistics to	Target TB rates	Target waist cm & chronic disease risk
Subjectification	Inuit become serialised patients	Citizens become self-monitoring bodies

Explain the similarities between the TB Eradication and Measure-Up  campaigns:

• in your own words.
• using Foucault's ideas.

 

Critiquing "Governmentality"

You might think that governmentality is bad--it makes us more governable by the state and makes govern ourselves. You might be in a minority of people who think it is good--it helps us live longer, healthier, and maybe even happier lives. But in doing a critque, your job is not to say whether governmentality is bad (or good). 

 

Instead your task is to analyse the usefulness of the concept of "governmentality". Is it a useful concept for understanding how care works in the modern world? I think I threw the measuring tape from the "Measure Up" campaign straight in the bin!

• Take the "Declaration of Independence", the "Measure Up" campaign, and the Canadian government policies for the Inuit as examples. Does governmentality adequately explain these phenomena?
• Are there better analytical concepts you could use?

 

Ask yourself: When does care stop being empowering—and start being a way to govern life itself?

Conclusion

Main point

We can analyse the Canadian government's response to  TB among the Inuit using govermentality concept. The government attempted to enable Inuit to live, long lives by knowing them in new ways. Settling and resettling them enabled surveillance.  Names, numbers, and tags made them legible. by settling or resettling them. All of this made perfect from a 1950s. epidemiological perspective.

Significance

We can also use governmentality to analyse public health campaigns. Governments encourage us to stop smoking, exercise, eat well, measure our waists and monitor our own health. Here, there may be no need to force us to do anything. We learn to observe, measure and regulate ourselves according to Foucault, at least.