Health risk analysis and sociomedical technologies of the self: Private health insurance gets into health promotion

In October 1994 the then Australian Federal Minister for Health, Dr Carmen Lawrence, announced that Medicare, the Australian universal national healthcare fund was considering introducing Healthtrac a computerised health promotion program. The change of government in 1995 put paid to this plan, however lifestyle based health promotion programs, including computerised programs, are an increasing trend in contemporary health care. Research from the United States indicates a growing interest by private insurers and Health Maintenance Organisations (HMOs) in funding and encouraging members, particularly older members and retirees, to engage in healthy lifestyle programs, some of which provide written reports, periodic up-dates and checks to members as well as summary advice to employers and insurers. In this article we argue that while many of these programs are well researched programs that rake cognisance of the contradictions surrounding scientific research related to lifestyle behaviours, disease and disability they take a narrow approach to health promotion. Further in the hands of private insurers and HMOs these programs have the potential to become sociomedical techniques (Stone 1989) of dominance, arising out of risk analysis that informs and refines techniques of governance of the self (Burchell 1993; Rose 1993). Consistent with Stevensen and Burke (1991) we see health promotion not as a new social movement, but as a political strategy of the state and capitalism to deal with among other things, escalating health care budgets. Given this, health promotion strategies that overly focus on risk analysis for the individual citizen reinforce techniques of self-governance by linking lifestyle behaviour to immorality as well as potentially creating a culture of anxiety - surely a public health problem in itself.