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HEALTH SOCIOLOGY REVIEW Volume 17, Issue 2, August 2008 141

T
here is increasing recognition among risk
theorists that we are undergoing a paradigm
shift in the way we understand and enact
societys obligations for [ensuring] the physical
security of its members (Ewald 2002:273).
1
Alongside the focus on managing calculable risk,
which Ulrich Beck argued characterised the
organisation of Western societies for much of the
20
th
Century (Beck 1992), there has been an
intensification of what I wil l cal l pol itical
technologies of pre-emption in response to
incalculable threats to physical security threats
that have a low probability of occurring but would
have potentially catastrophic effect.
2
This focus
on preventing l ow probabil ity but high
consequence risks is most obvious in the arenas
of biosecurity and anti-terrorism measures.
However, there are also indications that features
of the paradigm have infiltrated approaches to the
management of public health more generally. The
paradigm presents a special challenge for public
health programs in Australia that involve life style
health problems such as obesity, depression, and
drug addiction (illegal and legal). In pursuing
admirable aims of preventing ill-health in the
population, it is necessary that such programs
avoid reproducing (and indeed would have some
role to play in countering) any deleterious effects
of this pre-emptive approach to health and
physical security. In this paper I will, first, outline
Copyright eContent Management Pty Ltd. Health Sociology Review (2008) 17: 141150
ABSTRACT
KEY WORDS
Biopolitical technologies of prevention
This paper examines the way some public health campaigns in Australia have been
caught within a paradigm shift in the management of risk society. It details this paradigm
shift in terms of an intensification of political technologies of pre-emption in response to
incalculable threats to physical security. The challenge this presents to public health
programs, particularly those dealing with life style health problems such as obesity,
depression, and drugs (illegal and legal), is that, in pursuing admirable aims of the
prevention of ill-health in the population, such campaigns need to avoid reproducing
(and indeed should counter) the harmful effects of the pre-emptive approach to security.
Using the example of quit smoking campaigns of 2006-7, key features of the pre-
emption paradigm are outlined, particularly the conservative comportment toward the
future that it fosters. With reference to Foucaults concept of political technologies of
bodies and Merleau-Pontys ideas about the temporality and intercorporeality of bodies,
the paper also explores deleterious effects of this approach to risk and health on human
agency, well-being, and social relations in general. The negative impact of the pre-emption
approach is outlined in terms of the way it tends to dampen the openness (or potentiality)
of bodies toward the future, the world, and other people. However, the temporality and
intercorporeality of bodies also explains the operation of resistance by human agents to
both the paradigm of pre-emption and the health prevention strategies that employ its
way of thinking. This provides the basis for a gesture toward a more democratic,
respectful, and effective approach to the promotion of health and well-being.
Pre-emptive
paradigm,
embodied agency,
temporality,
intercorporeality,
sociology
Received 10 August 2007 Accepted 5 March 2008
Rosalyn Diprose
School of History and Philosophy
University of New South Wales
Australia
142 HEALTH SOCIOLOGY REVIEW Volume 17, Issue 2, August 2008
Rosalyn Diprose
the key features of the emerging paradigm,
particularly the attitude about the future that it
fosters. Second, I consider the impact of the
paradigm on human agency, the health of human
bodies, and social relations in general. Third, by
pointing to the operation of resistance by human
agents to both the paradigm of pre-emption and
the health prevention strategies that employ its
way of thinking, I will gesture toward a more
ethical and effective approach. The analysis draws
on aspects of the 2006-7 qui t-smoki ng
campaigns in Australia as an example of one
public health measure that takes the pre-emption
approach to risks to health and physical security.
The pre-emption approach to risks
to health and physical security
Different risk theorists describe the principle
underlying this shift in thinking about physical
security in terms of either precaution (Elward
2002), preparedness (Rabinow 2003; Collier and
Lakoff 2008) or pre-emption (Derrida 2003;
Cooper 2006). For the purposes of this analysis, I
adopt the latter descriptor, pre-emption, although
all three share similar features. This approach to
threats to health and physical security is about
being in a constant state of readiness (alert not
alarmed) about possible threats and it is about
being pro-active in preparing for such a threat or
in warding it off. The paradigm of pre-emption
originates in concerns with low probability but high
consequence threats to health and physical
security (such as fear of nuclear attack during the
Cold War of the 1960s and 1970s, actual medical
and industrial accidents and environmental
disasters in the 1980s, terrorism since the 1970s,
and, to take some more recent examples, the threat
of tsunamis and avian influenza). The application
of the approach has intensified since the events
of September 11 2001 and has spread to include
attention to social practices (such as smoking) and
biotechnologies (cigarettes, drugs, etc.) that might
be considered to pose a high probability of some
risk to health, but a risk that is characteristically
incalculable. While the risk to health of such
practices and technologies that come under the
paradigm may be high, the nature and extent of
actual harm in the future remains incalculable.
Hence, i n outl i ni ng four features sai d to
differentiate the new paradigm from previous
approaches to physical security, I include
consideration of how the pre-emption approach
has infiltrated approaches to the management of
population health to turn banal risks into dangers
that are incalculable but deemed to have
catastrophic consequences.
The first distinctive feature of the pre-emption
paradigm is the assumption that risks and threats
to health and physical security are incalculable,
unpredictable, but always imminent (Collier et al
2004; Ewald 2002:285; Luhmann 1993). This
epistemological uncertainty is exemplified in the
field of population health by recognition of the
complexity of relations between biological and
social determinants of health. Second, adding to
this uncertainty is the recognition that, in the
absence of a single cause of harm (such as God,
nature, or a single external enemy) the salient
cause of harm is now taken to be unpredictable
and fallible human agency. That is, harm is said
to be caused by our own decisions and actions,
that of individuals, corporations, and government
agencies charged with managing health and
physical security (for example, harm arising from
risky behaviour of individuals, from the previous
unbridled use of biotechnologies, human error in
the biomedical lab or clinic, or failure on the part
of an individual or health agency to act to ward
off future harm to ones health and physical well-
being). While these first two features alone are
not a problem, and indeed signal a move away
from either biological or social determinism in
understandings of human well-being, when
combined with the third feature, a moral
dimension enters the health agenda with an
attendant return to determinism. This third
distinctive feature of the paradigm is the cautious
and fearful comportment toward the future it
fosters: in the face of immeasurable risk it has
become necessary to take into account what one
can only imagine, suppose or fear [and] to
consider the worst hypothesis (Ewald 2002:286).
A poster of the 2006 quit smoking campaign in
Australia exemplifies this tendency to posit the
worst possible future arising from what is deemed
risky practice: above an image of two cigarette
HEALTH SOCIOLOGY REVIEW Volume 17, Issue 2, August 2008 143
Biopolitical technologies of prevention
packets carrying photographs of a cancerous
mouth and a gangrenous foot is a headline banner
What you see is what you get. The message is
neither subtle nor appropriately qualified: if you
smoke, mouth cancer and gangrene are what you
will get in the future; not: you might get this if a
myriad of other determinants of ill-health are also
in place. Finally, this kind of orientation toward
the future renders responsibility futural and
conservative: against such bleak future-scenarios,
social agents (governments, individuals and
relevant organisations) have a responsibility to
take measures to pre-empt a future that is
continuous with the past (Ewald 2002:284).
3
It is
better to be safe than sorry and preserve what is
deemed good about the past that is still present.
These features of the pre-emption paradigm,
particularly the attitude toward the future it fosters,
are apparent in a series of quit smoking television
advertising campaigns run throughout Australia
in 2006-7. The excuses campaign illustrates the
points well.
4
This depicts four examples of smokers
(probably in their mid to late 30s) expressing
typical excuses for not giving up smoking. Each
excuse involves a gesture toward possible futures
with or without smoking and acknowledges the
incalculability of the future per se. For example,
My pop smoked all his life lived til he was
eighty; or I could be hit by a bus (that is, I could
give up smoking but, if I did, I could be hit by a
bus, so what is the point). Each excuse is followed
by an image of some other person about the same
age who is seriously ill (presumably from smoking)
and who expresses a feeling that mockingly echoes
the consequences of adhering to the smokers
excuse. In the case of the man who says he could
be hit by a bus, the image that follows is of a
man (of about the same age) in a darkened
hospital room who says, weakly: I feel like Ive
been run over by a truck. Two themes about the
future are apparent in these quit-smoking
campaigns. First, scenarios of a bleak future if the
risky practice of smoking continues, juxtaposed
with preferred (healthy, smoke-free) futures, imply
a reductive causal link between risky present
practice and a catastrophic future. Second, the
message that health and future security will be
assured with a cessation of the risky practice
implies the body would be thus returned to a
natural order of becoming thus allowing a
continuous progression from past to future.
Together these themes associate moral prudence,
rational intelligence, and maturity with individuals
who would live in an ideal world of zero risk.
The problem with this paradigm of pre-emption
is that instead of viewing a life-threatening event,
disease, biotechnology, or practice as specific to
context or type, its occurrence is generalised as
prototypical of events threatening to health, physical
security, and biological life of a population in all
situations. (And underlying this tendency to
generalise is that the events, practices and
technologies deemed most risky and irresponsible
are those that are seen to threaten economic
security.) When combined with a general politics
of fear, this way of thinking justifies a move away
from harm minimisation policies toward control
measures and technical solutions to health and
physical security that aim to dampen the
unpredictable aspects of the future, of bio-material
life, and of human agency and to thereby
predetermine a future of a nation, group, or
individual that is continuous with the past.
There are two problematic consequences of
the pre-emption approach to physical security of
most relevance here. First, risk theorists point to
how the paradi gm fosters conservative
government in all senses.
5
Not only is ensuring
continuity of the future with the past counter-
revolutionary by definition (Ewald 2002:284), but
also the proliferation of imagined potential threats
justifies totalising and paternalistic government
characteristic of overmanaged democracy.
Totalising government involves the increasing
saturation of all spheres of life with regulatory
complexes that enframe life in a way that delimits
what is defined within the paradigm as risky
practice and that, in combination with a moralism
about particular forms of risk, discourages
contestati on of the status quo (i ncl udi ng
gover nment pol i cy). Thi s st i f l i ng of t he
unpredictable elements of human agency and
material life can be blatantly anti-democratic
(Hardt and Negri 2005): for example, anti-
sedition measures as part of anti-terrorism
legislation. But, more typically, this dampening
144 HEALTH SOCIOLOGY REVIEW Volume 17, Issue 2, August 2008
Rosalyn Diprose
of agency and dissent is subtle. As Foucault and
others have shown (for example, Rabinow and
Rose 2006), in governance of the health and
security of the biological life of populations,
disciplinary power joins forces with a political
rationality of improving health and welfare
authorising techno-scientific experts (including
within government) to determine what the future
self and healthy nation should look like and
fostering compliance with health-prevention,
security and surveillance measures.
The second problem with the pre-emption
approach is the suspicion that it decreases rather
than ensures health and physical security. Not only
is there the worry that dependence on the techno-
science mobilised against perceived threats
increases our vulnerability or may be ineffective,
6
but also, some argue, strategic protection against
incalculable threats fosters autoimmunity where
a living being works to destroy its own
protection (Derrida 2003:94). Pre-emptive
warfare as an anti-terrorism measure is the most
often ci ted exampl e of how the l ogi c of
autoimmunity plays out in this paradigm, but over-
use of antibiotics would be a comparable example
in the biomedical field.
I suggest, and go on to argue, that, in the
context of the management of life-style illnesses,
the stifl i ng of agency (by prohi bi ti ng or
discouraging par ticul ar practices or by
circumventing democratic participation in
solutions to health problems), as well as fostering
a bleak and conservative orientation toward the
future, contribute to the proliferation of those
illnesses. The mobilising of the paradigm in some
public health campaigns in Australia intensifies the
nexus between medicine and science, on the one
hand, and, on the other, a wider moral rhetoric
about the proper future one should pre-empt for
oneself and for the good of the nation (read
economy). At the same time medicine is given a
central place in a totalising government that
places responsibility for both the health and
security of the population on the shoulders of the
individual and the family in the private sphere.
It is a wider trend that demonises and infantilises
particular groups in the population who fail to
aspire to a specific preferred image of the future
self. In saying this I am expressly not positing a
notion of individual rights and freedom against
this trend (the co-constitutive relation between
human bodies, bio-material life, and socio-political
regimes of meaning, is too complex to posit such
a si mpl i sti c counter-force to total i si ng
government). Nor am I pointing the finger at
health agencies and health workers involved in
designing these campaigns: there is no telling from
the consumers perspective how much these
campaigns are shaped by government or
advertising companies. Further, the pre-emptive
paradigm operates as a general attitudinal
atmosphere rather than being imposed by a single
agency and is most often explicit in the sound-
bites of politicians (Federal and State) reported in
the popular media rather than in the views of
health practitioners. Nevertheless I do want to
draw on two of phil osophies of the body
(biopolitics and phenomenology) to account for
the impact of the wider pre-emptive paradigm on
the health of human bodies. And, by formulating
a model of both embodied agency and resistance
to such to government of life, I want to indicate
why such pre-emptive campaigns are unlikely to
achieve their expressed aims.
Political technologies of bodies
Foucaults reformulation of the political in terms
of disciplinary and biopower, and the link he
makes between political power and technology,
is helpful to account for the impact of pre-emptive
mode of governance on human bodi es,
particularly the way it stifles the unpredictable
elements of human agency and bio-material life.
First, following Foucault and assuming the
Aristotelean meaning of techne as skill or
knowledge directed toward production, the
political is technological by analogy. The target of
both discipl inar y (pol itical ) power and
biotechnologies are bodies and both combine
empirical and calculated methodologies of
intervention with technical knowledge of bodies.
Both are directed toward the production of
particular sorts of bodies. Just as biotechnologies
intervene into bodies at the muscular, neurological
or molecular level to reorganise corporeal
processes, disciplinary power operates at the
HEALTH SOCIOLOGY REVIEW Volume 17, Issue 2, August 2008 145
Biopolitical technologies of prevention
micro-level of the bodys movements, spatiality,
and temporal rhythms to realign the bodys forces
and powers (Foucault 1979:136-8). It is this
combination of the knowledge of bodies with
disciplinary techniques that allows Foucault to
deem regimes for the government of bodies
political technologies of the body (Foucault
1979:26). Pre-emptive approaches to health and
physical security are political technologies of the
body in this sense. Moreover, unlike exercises in
soverei gn power, di sci pl i nary modes of
government operate with the same banality as
technology in general, that is, without a single
coordinating agent with sinister motives.
Second, and conversely, bio-technologies are
political insofar as they are mobilised within these
disciplinary regimes and so participate in the
reproduction of normalised, productive, compliant
subjectivities that are compatible with a neo-liberal
political economy. Technologies of the body
(including cigarettes and other drugs) are political
insofar as they are embedded within what
Heidegger has called an instrumental way of
thinking (or a way of enframing material life)
(Heidegger 1977). Ways of thinking are paradigms
involving a chiasmic relation between socio-political
meaning, technical devices, and human beings and
so reorder the world that produces them.
Instrumental thinking however, orders the world in
a par ticular way. Smokers use cigarettes
instrumentally, for example, to mark time. Similarly,
labouring, productive human bodies can become
instruments of government and the economy.
The pre-emptive paradigm of responding to
threats to health and physical security treats human
bodies in this instrumental way and, in so far as
the paradigm is mobilised to discipline a population
to aspire to reproduce a future continuous with the
past, it involves political technologies that aim
toward political and biological determinism.
Foucault explains how this instrumental way of
thinking and its disciplinary techniques impacts on
the bio-material life of bodies:
Discipline increases the forces of the body (in
economic terms of utility) and diminishes these
same forces (in political terms of obedience). In
short, it dissociates power from the body; on the
one hand, it turns it into an aptitude, a capacity,
which it seeks to increase; on the other hand, it
reverses the course of the energy, the power that
might result from it, and turns it into a relation of
strict subjection (Foucault 1979:138).
But disciplinary power that renders bodies
docile in this way does not exhaust, or even best
characterise, the pol i ti cal dimension of
biotechnologies. While these can be co-opted or
rendered problematic in political paradigms intent
on reproducing useful bodies with enhanced
capacities and aptitudes, biotechnologies rarely
aim at obedience or compliance. Rather,
discourses surrounding biotechnologies (whether
medicinal or recreational) would suggest that they
aim at the enhancement of life for its own sake.
Whatever el se, scientifical l y speaking, a
biotechnology does (stopping the course of pain
or cell disintegration, or speeding up neurological
events, metabolic rates, or whatever), it is more
likely to disrupt the disciplined compliant body
and reopen the bodys forces onto the realm of
potentiality. In other words, biotechnologies
(cigarettes, pain medication, food) along with
anything or anyone that touches a human body
(incl uding visual images of publ ic heal th
campaigns and other mediums of socio-political
meaning), participate in a re-temporalisation of
the body with attendant effects and affects.
The phenomenologist Maurice Merleau-Ponty
explains the complex social, biological, and
physical relations involved in the temporalisation
of the body as follows:
[T]he life of consciousness cognitive life, the life
of desire or perceptual life is subtended by an
intentional arc which projects round about us
our past, our future, our human setting, our
physical, ideological and moral situation, or rather
which results in us being situated in all these
respects (Merleau-Ponty 1962:136).
This temporality of the body and its intentional
arc (meaning-giving and receiving activity
embedded in a world) is, for Merleau-Ponty, the
ground of conditioned freedom where, through
encounters with elements of the life world within
a social horizon, I carry forward to an open future
a collective history intermingled with experience
of my personal history (Merleau-Ponty 1962:433).
146 HEALTH SOCIOLOGY REVIEW Volume 17, Issue 2, August 2008
Rosalyn Diprose
Others from the same philosophical tradition call
this complex relation between the human body and
its biological, environmental and meaningful
situation, bios embodied human being that is at
once historical but also opened (by encounters with
a physical environment, biotechnologies, other
persons etc.) to a undetermined future or
potentiality (Arendt 1998:97, 200-1). Human being
as bios is affective (involves pleasure and pain) in
excess of habit and utility and it is intercorporeal,
that is, directed toward, and intertwined with, things
and other people. And bios is the condition of
agency, the capacity to break with the past or to at
least transform it (as distinct from zoe: mere life
determined by biology alone and the forces of
nature). And the futural paths that human being
as bios takes and the impact of its acts are
necessarily unpredictable.
Smoking is a social practice that temporalises
human being as bios in this way (as does eating,
sexual activity, work, cleaning ones teeth, or any
body ritual). The stubborn ordinariness of
smoking, to coin Helen Keanes phrase, suggests
that the smoker is not a passive victim of addiction
to a substance that will inevitably ruin ones life
(Keane 2006:107).
7
Rather, smoking punctuates
the passing of time with openings to a different
future. People who do not smoke resort to other
biotechnologies and rituals to temporalise the
body. While such body rituals can become habit,
as can any means of introducing duration into
human existence, each repetition of the practice
is marked by this pre-reflective intentional arc or
opening of the body to an undetermined future.
Conversely, it is the intentional arc that goes
limp in illness (Merleau-Ponty 1962:136). Such
are the pleasures and dangers of an intelligent,
rational, and ordinary human life.
While disciplinary power and compliance are
features of the political dimension of
biotechnologies, so is the undoing of disciplined
forces and the attendant opening of new directions
via the bodys temporality. Foucault describes this
differently to Merleau-Ponty: in terms of the
disruption and realignment of corporeal forces or
emergence of the singularity of events from
within the interstices of corporeal and social
struggles with an attendant transformation of
meaning (Foucault 1994:376-8). However, in so
far as biotechnologies are involved in this
enhancement and temporalisation of life itself,
they enter the second political register that Foucault
claims attends disciplinary power in modern liberal
democracies: biopower. Biopower refers to the
idea that modernity is characterised by a bio-politics
of the species body (as distinct from the individual
body), which, alongside the government of
anatomical bodies through disciplinary power,
consists in interventions and regulatory controls
that exercise the power to foster life or disallow it
in the interests of maintaining, not so much
individual bodies, but the biological existence of a
population (Foucault 1980:137-139). Diversity of
biological human existence is not the aim of
biopower. On the contrary, biopower mobilises
modes of governance and technologies of the body
(including generalised technical solutions to health
problems) aimed at achieving overall equilibrium
in a population, an equilibrium that reassures with
the promise of protecting the security of the whole
from internal dangers (Foucault 2003:249). It is in
this context that practices that are deemed to present
internal dangers to health, physical and economic
security, and national uniformity, particularly use
of biotechnologies like drugs (recreational and
illicit), become problematised under the paradigm
of pre-emption.
Taking into account the human bodys
temporal dimension, the harm of political
technologies of pre-emption (apart from any harm
arising from the practices they seek to control) can
be explained in terms of how measures aimed at
limiting the unpredictable effects of human agency
affect a closure of potentiality. Such a closure of
an open future may aim toward producing
compliant subjectivities whose aspirations are
directed toward a particular preferred image of
the future self, but such measures would also make
us sick. That is, just as the potentiality of bios (or
the intentional arc as Merleau-Ponty puts it) goes
limp in illness, it also goes limp in subjection.
Another way to put this is to say that governance
of the health of bodies that pre-empts a future self
that is continuous with the past participates in the
reduction of bios (embodied human being open
to potentiality) to zoe (bare biological life or
HEALTH SOCIOLOGY REVIEW Volume 17, Issue 2, August 2008 147
Biopolitical technologies of prevention
nature).
8
While the human body has a foot in
both camps of zoe and bios, (in both biological
life and the potentiality that is a condition of socio-
political agency), reducing bios to zoe would return
embodied human beings to biological destiny: a
kind of uninterrupted progression of biological
existence or immersion in the timeless present. Any
appeals to a natural body as the proper
determinant of culture (and therefore of the future
self), that is, socio-political appeals to a future
continuous with the past, in turn risks justifying
ideological-political determinism on the basis of
the assumption that elimination of what are now
defined as risky or irresponsible practices will
restore human bodies (and the nation) to
biological destiny. This is a problem for democracy
because ideological-political determinism is its
most obvious adversary. But it is also a problem
for the effectiveness of such public health
campaigns.
The overriding problem with the way the pre-
emptive paradigm configures human agents, aside
from ethical issues related to democratic pluralism
and demonising sections of the population, is that
such measures will meet with resistance from the
bodies they target.
Resistance and ethics
It is widely acknowledged that Foucault, while
recognising that human bodies resist disciplinary
and biopower and any normalising techniques of
government, did not elaborate how and why.
9
There are two ways to think about how this
resistance might arise. Or rather, there are two
ways that we might understand how bodies
transform regimes of control and regulation and
thereby thwar t paradigms of pre-emption
mobilised in public health measures.
The first is the idea that the same political
technologies that aim to pre-empt the future
health and security of human bodies (along with
the biological and socio-political determinants of
health), also participate in the constitution of
consumer agency and, indeed individual
agency in general.
Kane Race has provided a compelling
genealogical analysis of how this consumer agency
works with and against modes of governance aimed
at controlling the consumption of drugs (both
medicinal and recreational) (Race 2005). On the
one hand, he argues, the self-administration of
drugs conforms to the rise of consumer citizenship
in post WWII consumer cultures. Drug consumption
also aligns with discourses of self-administration
applicable to both patient compliance in medicine
and notions of individual responsibility and self-
governance in general. That is, self-administration
of drugs is a practice consistent with disciplined,
compliant subjectivity. On the other hand, this
culture of the individual consumer, not surprisingly,
has also given rise to experimentations in
techniques of consumption and of self-formation,
a kind of excessive conformity, as Race puts it,
where restraint in consumption gives way to
exercises in expressive, erotic, and experiential
pleasure (Race 2005:2). This excessive
consumption can take many forms shopping
beyond need, risking ones savings on the stock
market, smoking, or consumption of illicit drugs.
Once ignited and trained, it is difficult to control
consumer agency and direct it toward one
externally designated end rather than others, even
when attitudes about the moral status of particular
consumption practices change over time. The
inevitable disjunction between compliant,
disciplined productivity that governments would
prefer and excessive conformity, or what would
be deemed risky and irresponsible practice, presents
government with the problem of mediating between
the two. Rather than harm minimisation strategies,
which would arguably be a more effective (and
certainly a more democratic) way of dealing with
the potential risks of consumer agency in general,
a government that finds more comfort in a
conservative recreational state (Race 2005:9)
tends to resort to a paradigm of pre-emption that I
have been discussing. Managing excessive
conformity through a paradigm of pre-emption
involves what Race calls exemplary power:
[Exemplary power] relies on high profile media
and police presence, making certain practices of
cultural consumption a bad example. The sample
and moral example [e.g. of a future self] are its
favorite tools, the sample claiming to measure
objectively the extent to which an individual has
complied with medico-moral regimes making a
148 HEALTH SOCIOLOGY REVIEW Volume 17, Issue 2, August 2008
Rosalyn Diprose
biochemical example of the propriety of individual
behaviour. Exemplary power marks the bounds
of legitimate consumer citizenship by declaring a
stop to (what it designates as) non-medical activity.
It is haunted by the memory of a discipline at once
paternalistic and protective, which it seeks to
supplant by installing as its vision of control a
medico-moral imagery of the self (Race 2005:10).
Extending Races anal ysis to incl ude
consideration of the bodys temporality, we can
suggest that, because government by medico-
moral example appeals to the same regimes of
self-administration and consumer agency that it
seeks to dampen, its examples appear on a stage
of choices of possible futures that are no more or
less compelling than those the consumer is already
living. In this game of presenting a range of
possible futures, the ones that would be most
convincing are those within the individuals past
and present experience. The smoker in the
excuses advertisement could indeed be run over
by a bus tomorrow, as he claims, and there is
nothing to suggest that the alternative future with
which we are presented is any more probable (he
could be in hospital with some life-threatening
smoking-related condition that would make him
feel like hes been hit by a truck).
A second way to explain how human bodies
thwart the pre-emptive paradigm is consistent with
the first but relies more centrally on the
phenomenological view of the temporality of the
embodied self discussed earlier. Like Races idea
of excessive conformity, this account does not
appeal to an original freedom or a self
uncontaminated by biological, social, or
governmental determinants of health. Rather, on
this model, a key precondition of both health and
agency (personal, social, and political) is a body
open to potentiality, that is, a body inclined toward
encounters with others, and with its physical and
social environment, encounters that, in concert with
the bodys temporality, keep open an undetermined
future. It is impossible to completely suppress this
potentiality. It certainly cannot be suppressed by
projecting a threatening future or an ideal future
that are unrelated to a persons current or past
experience. Or as Merleau-Ponty (1962) puts it,
however sick or subjected a body is, it never loses
its futural orientation toward its material, social, and
meaningful world and the unpredictability this
implies. Unless it is dead. A body subjected to
paternalistic, infantilising, totalising modes of
governance will try to emerge from the sense of
timelessness that such governance can effect and
re-orientate itself toward an undetermined future.
It will do this by reaching for material at hand, most
likely what has worked before to punctuate time. It
might be a cigarette.
The question that some biotechnologies and
the corporeal, temporal basis of unpredictable
human agency raise, then, in the context of the
spread of biopolitical and totalising government, is
which kind of approach to governance of the future
of human life is preferable: that which fosters
democratic pluralism and participation of people
in their own health solutions or government by pre-
emption based on faith in someone elses image
of the biological destiny of a nation. What the
analysis above suggests is that strategies of harm
minimisation or health promotion that also cultivate
the political agency (and hence potentiality) of
members of the community being targeted would
be more ethical and more effective. Harm
minimisation programs may contain some elements
of the pre-emptive paradigm: they usually assume,
for example, some causal link between particular
practices (smoking, consumption of illicit drugs) and
ill health. But they also allow that the causal link
between a practice and future (well- or unwell)
being is dependent on a range of factors; that the
relationships between a person, their habits, the
material world, and other persons are open and
indeterminate; and, as a consequence, that it is
impractical (if not unethical) to exclude the person
from participation in their health solutions. Further,
by emphasising education and by considering
health to be a communal and a personal matter,
harm minimisation programs tend not to treat their
subjects like irrational deviants. Scare campaigns
that demonise parts of the population in terms of
health and that resort to moral rhetoric about the
failure of individuals to live up to someone elses
imagined future are counter-productive to the
promotion of well-being and are no more than
pseudo-scientific solutions to incalculable risk that
are badly formulated (Stengers 1997:217).
HEALTH SOCIOLOGY REVIEW Volume 17, Issue 2, August 2008 149
Biopolitical technologies of prevention
There are examples of the more viable
alternative approach to public health already
available in Australia. These include harm
minimisation approaches to heroin addiction
operating in Sydney the 1990s and, in the same
era, some of the grass roots approaches to safe sex
and HIV-AIDS prevention operating in gay
communities (as opposed to the grim reaper TV
advertising campaign of 1987). The former Federal
Minister for Health, Tony Abbot announced (in
February 2007) a ten million dollar budget to
counter the 40% increase in reporting of new HIV-
AIDS infections since 2000.
10
One remains hopeful
that the pre-emption paradigm does not swallow
up that budget. Government would do well to listen
to health workers working with gay communities
who are warning against general scare campaigns
(like the grim reaper ad) and who are urging that
the money be spent within those communities most
at risk, that it be used in educating a new generation
of gay men who, like all youth, tend to think that
they are immortal, and whose friends have not
yet died of the disease, and that any such
education and harm minimisation measures treat
those men with respect (see Rier 2007.) Respect
involves treating members of target groups of
public health campaigns as agents with more than
a passing stake in re-imagining their specific futures
and in deciding what works for them in orientating
themselves toward an undetermined, incalculable
future per se.
Endnotes
1. While Ewald is usually credited with first outlining,
i n ret rospect , t hi s paradi gm shi f t , i t was
foreshadowed earlier by others such as Luhmann
(1993) and Beck (1999).
2. The way I outline the paradigm in the first two
pages of t hi s paper i s adapt ed f rom a
collaborative research project undertaken with
colleagues at the University of New South Wales
and the University of Sydney (see Diprose et al
2008).
3. For similar arguments see, for example, Collier
et al (2004:5), Derrida (2003), and Nowotny
(2006:4).
4. The excuses adver t i sement and si mi l ar
advertisements could be viewed online at http://
www.health.nsw.gov.au/cancer_inst/campaigns/
media/ until the end of 2007. They have since
been removed from websites of both the NSW
Department of Health and the Cancer Institute
NSW.
5. See, for example, Collier and Lakoff (2005);
Ewald (2002); Hardt and Negri (2005), and
Nowotny (2006).
6. For a general analysis along these lines see
Foucault (2001) and, with special regard to
biosecurity and biowarfare, see Cooper (2006).
7. Helen Keane has provided a provocative and
compelling account of the relation between
smoking and time (2006). While drawing on
different conceptual resources to that in this
account, one of Keanes salient points is similar:
that smoki ng i s a compl ex practi ce that
temporalises the body beyond the extended
present rather than simply the act of a passive
body at the mercy of biological forces.
8. Georgio Agamben argues, following Foucault but
with reference to Arendt, that the spread of
biopower is characterised by this collapse of the
classical distinction between zoe and bios where
zoe is included in the polis as bare life, the
subjected target of political power (1998:1-14).
9. Maurizio Lazzarato has provided a useful account
of how a model of resistance to normalisation
can be derived from Foucaults work (Lazzarato
2002).
10. The causes of thi s i ncrease are compl ex.
Significantly, there has been no increase in rates
of infection in Sydney since 2002, and it is in
Sydney that harm minimisation strategies have
had the highest profile. Research suggests that
the increase in the number of HIV-AIDS infections
elsewhere may in part be due to the availability
of treatments that, whi l e unpl easant and
problematic, nevertheless give the impression of
relative safety leading to some complacency (Van
de Ven et al 2002).
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