The Promise of Public Health: Vulnerable Policy and Lazy Citizens

In this paper I explore the relationship between the UK New Public Health Policy and one of its enactments. I outline a crucial policy document, Saving Lives (Department of Health, 1999, HMSO, London), and consider the practices that constitute a localised initiative called The Heart of the Shire. This initiative aims to train all members of a rural community in cardio-pulmonary resuscitation in order to prevent deaths from cardiac arrest. I argue that Saving Lives promises a new approach to public health that transgresses traditional boundaries and collapses conventional dualisms. Yet, at the same time it privileges biomedical interventions and conventional modes of care. I argue that the policy is full of incompatibilities but that these incompatibilities are not destructive. Rather, they create a series of tensions that, in turn, expose the fluidity of boundaries and work against the stability of categories and in doing so afford the promise of the policy. I go on to describe the key practices of The Heart of the Shire, focusing on how the tensions of the policy are played out in practice. It seems that the promise of the New Public Health Policy does not survive its practices. The practices are creative and varied and are deeply embedded within the community in ways that make them ‘new’, yet they also enact ‘old’ boundaries and conventional dualisms. They smooth out the incompatibilities that characterise the policy and thereby solidify boundaries and stabilise categories. Hence, my argument is that it is the making of consistencies that leads to the (re)construction of conventional categories and boundaries. I conclude by suggesting that Saving Lives offers us a glimpse of the conditions of possibility for a promising approach to public health but that the practices that constitute The Heart of the Shire suggest the tremendous amount of work that would be required to enact it. Drawing upon Helen Verran's insight about ‘hardening of the categories’ I suggest that the practices of The Heart of the Shire are lazy in their refusal of the vulnerability (and the promise) of tensions and that consequently the approach to public health that is enacted is characterised by stabilised categories and impermeable boundaries.