Enacting community health: Obesity prevention policies as situated caring

Abstract

Drawing on Critical Policy Studies and feminist STS, this article conceptualizes obesity prevention activities as ongoing and precarious practices of relating – rather than as means for ‘getting results’ or vehicles through which normative discourses are instilled. It focuses on ‘community approaches’ within public health, whose aim is to stimulate healthy initiatives from what policy makers term ‘bottom-up’, emerging from the situations, concerns and abilities within neighbourhoods. Drawing on ethnographic research on the ‘Amsterdam Healthy Weight Programme’, I demonstrate that different practices of relating enact particular versions of health and community. I warn that reliance on statistics-based problem definitions, dietary advice and professional hierarchies preconfigures health promotion as a matter of ‘reaching out’ to particular ‘problem populations’ defined around class and ethnicity. I show, however, that community approaches may also foster spaces for ‘situated caring’, where health emerges in the negotiation of heterogeneous goods, including neighbourhood revival, togetherness and fun. Situated caring has effects that cannot be captured by obesity prevalence statistics. The study of health promotion policies as practices of relating highlights that policy is not a monolithic structure of plans and commitments but is continuously done and redone. The article, then, introduces a new evaluative field that critically articulates the diverse ways in which ideals such as engagement and health are enacted in practices.