Taking Back Control (of Our Health): The Responsibilized Citizen and Post-Brexit Health Governance

This paper is an early output from the ESRC funded Health Governance After Brexit project exploring notions of legitimacy, accountability and responsibility. The project aims to illuminate the governance gap that Brexit has created for health by comparing data from ‘elite’ conversations and ‘street ethnography’ on issues of accountability and responsibility.

Through our ‘street ethnography’ we have recorded conversations with more than 200 people in several locations in North England and Northern Ireland. The theme of alienation, detachment and confusion about Brexit runs through the stories we have heard. The stories suggest that UK citizens are facing an uneasy future, regardless of how they voted in the Brexit referendum. Whilst there is lingering hope that Brexit will fulfil the promise of curbing immigration and boosting sovereignty, the same cannot be said about health governance.

Established health corridors between the North and South of Ireland are under threat from a hard border, and the privatisation of the NHS in England is not only a perceived threat, but a looming reality post-Brexit. The people we have spoken to care deeply about the NHS, but feel no confidence in politicians protecting it, even if Brexit is something that many of them want. Whilst 'elites' have been vocal about any form of Brexit being harmful for heath and hold traditional actors responsible for health governance, the response on the street has been more complex and nuanced. In particular, heightened awareness of one's individual responsibility for one’s own health; or one's responsibility for protecting the NHS by making smarter health choices, or by exposing migrants benefiting from the NHS without contributing, are part of the post-Brexit narratives about health and the NHS.

This paper argues that the narrative on post-Brexit health governance can go beyond an exploration of the new legal and political terrain to incorporate narratives of responsibilisation as an example of resistance to the ‘existential anxiety’ that Brexit has created. The subject of governance is resisting this uncertainty by opening themselves to responsibilisation that exists both at UK and EU levels. Whilst in the UK the ongoing welfare reform and the calls for a ‘health creating society’ focused on disease prevention have been some of the tactics of neoliberal governmentality, at EU level the construction of the EU citizen as a ‘responsible and economically active’ one has paved the way for patterns of exclusion and punishment of perceived irresponsible behaviours, including irresponsible health choices.

Looked through a responsibilisation lens, the ‘take back control’ Brexit slogan is more than political bravado: it is self-responsibilisation and legitimisation of post-Brexit health governance that focuses on personal contributions, risk management, self-reliance, self-monitoring and control. One less spoken about effect of Brexit might be creation of fertile ground for further neoliberal governmentality and free market approaches to health.

Relying on responsibilisation literature, as well as literature on governmentality and post-Brexit governance, this paper calls for a critical approach to post-Brexit health governance.