Political geographies of health care
Governmentality of population health in the constitution and transformation of state spatiality
Population health has been inseparable from the development and constitution of the modern capitalist state since the 19th century and particularly after World War II. Healthy citizenry, with its economic and social potential, is arguably a strategically important resource for the strength and prosperity of the state and nation. Since population health plays a decisive role in the success of the state, it is subject to political problematisations and calculations. Perceived as a wide-ranging political problematic beyond the traditional scope of medical systems, population health is seamlessly connected to the socioeconomic processes of the state. Accordingly, it has become one of the most significant objects of political power and governmental interventions.
This doctoral dissertation contributes to the multidisciplinary research on state spatial transformation through new perspectives by conceptualising and investigating political geographies of health care. This involves exploring the ways in which population health is politically problematised in relation to the prevailing social, economic and political circumstances of the state in a given spatiotemporal context. The emphasis is placed also on how population health is integrated into the spatial constitution of the territorial state through state power and related health care practices, and how the historically contingent relationship between the state and population is re-constructed through health care. This thesis is thus focused on the constitution and transformation of state spatiality through an inquiry into health care as one of the key constituents of the state associated with sovereignty and governmentality as two forms of state power. Thus, health care is seen as uniting the territorial management of state spaces and relational spaces of governing a population. In this regard, Finland provides an interesting empirical context for this research, since it can be regarded as emblematic of the state space/health care nexus characterising the Nordic model of statehood.
The thesis at hand consists of three studies, each of which focuses on the state space/health care nexus through different theoretical-conceptual frameworks and research materials. The historical and discursive approaches applied in this thesis have been inspired and informed by poststructural theory and specifically by Michel Foucault’s theorisations and analytical strategies of governmentality, dispositif, power/knowledge and genealogy. The research is based on empirical material consisting of 51 policy documents associated with health care in Finland (e.g. national strategies for health care, committee reports and Government proposals to Parliament) covering the period from the mid-1960s until the present. Empirical material includes also semi-structured interviews conducted in the autumn 2016 with 14 key actors in the Finnish health care sector.
The key findings of the study indicate that health care is an important organising element of the relationship between state power, state space and population. In this capacity, health care plays a crucial role in the historically contingent constitution and transformation of state spatiality. Empirical observations highlight, in particular, that health care is concerned with specific political problematisations of population health, cooperation between sovereignty and governmentality, and the construction of the relationship between the state and citizen. The findings thus propose that the interplay between these issues results in a distinctive spatial organisation of the state during a given time, characterising specific forms of statehood. Therefore, this suggests that population health, state power and citizenship constitute the analytical elements of political geographies of health care through which spatial constitution and transformation of the state can be examined.