Targeting healthy weight? How the ideologies and discourses underpinning the policies addressing South Australia’s Healthy Weight Target (2007) affect health equity.

Author: Louise Townend

Townend, Louise, 2016 Targeting healthy weight? How the ideologies and discourses underpinning the policies addressing South Australia’s Healthy Weight Target (2007) affect health equity., Flinders University, School of Health Sciences

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Abstract

This thesis examined the ideological framing of obesity within a government strategy designed to promote healthy weight to explore how ideologies can influence the goal of achieving equity in health. Frame theory and critical theory were used to examine policies addressing the Healthy Weight Target set in the South Australian Strategic Plan, and one of the associated programs, OPAL (Obesity Prevention And Lifestyle). Evidence suggests that obesity follows a general, increasingly steep social gradient. This means obesity is not only a health problem but also an equity problem. This dual nature of the ‘obesity problem’ lies at the core of this study and drives the three research questions. First, what are the ideologies and discourses underpinning policies designed to contribute to achieving the Healthy Weight Target of the 2007 South Australian Strategic Plan? Second, what are the ideologies and discourses underpinning one of the community programs and its practice? Finally, to what extent is the aim of achieving health equity embedded within the ideologies evident in the policies and program? Critical theory facilitates an analysis of power, ideology and hegemony, which is crucial to understanding how dominant discourses construct responsibility for problems and their solution, and what the implications are in terms of equity. Qualitative methods were used to investigate these questions. The discourses and ideologies evident in policy and program documentation were identified using discourse analysis. In-depth interviews were then conducted with key informants from the OPAL program to gain insight into which discourses and ideologies were reflected in their perspectives. The data illustrated how the ideological framing of problems in documents and interviews did not always align with the framing of solutions, and that while obesity was often framed as a socioenvironmental problem requiring socioenvironmental solutions, in practice solutions often also reflected behavioural discourses making individuals responsible for solving their own obesity ‘problem’. It is suggested that this may be one way through which neoliberal governance is practiced as it diverts attention from obesogenic products, production and producers on to consumption and consumers. While capitalist forces of production were not problematised in the documents, they were problematised by some of the respondents, and the social-cultural norms flowing from capitalism were problematised by most; the dominant ideology of individual responsibilisation was also challenged at times. The complex picture painted by the findings supports Gramsci’s theory that hegemony is both culturally pervasive and simultaneously resisted. Equity is identified in both the policies and program as primarily conceptualised as consisting of specific disadvantaged groups. It is argued that this can inadvertently result in blaming individuals who ‘have’ the problem as being responsible for their own disadvantage. In contrast, viewing equity as distributed along a gradient and thus affecting everyone problematises the whole system and social relations of production, making it harder to individualise responsibility. It is suggested that augmenting the current obesity-centred paradigm with one that is equity-centred might support the socioenvironmental framing of obesity, counterpointing the individualising of responsibility in policy that is an ideological pillar of neoliberal capitalism.

Keywords: healthy weight, healthy weight target, healthy weight policies, obesity, ideology, health equity
Subject: Primary Health Care thesis, Health Service Management thesis

Thesis type: Doctor of Philosophy
Completed: 2016
School: School of Health Sciences
Supervisor: Professor Fran Baum