Bio-spheres of Risk-Aversion and Equitable Health. An Ethnography of Neoliberal Area-Based Public Health Policy Intervention and Physical Activity in a Deprived English Neighbourhood

The aim of this thesis is to explore the relationships between health, place and inequality. The research focuses on area-based public health policy in a deprived neighbourhood - ‘Kingsland’ - in central England. Kingsland attracted a number of area-based initiatives (ABIs) with the overarching aim of reducing national inequality. Between 2000-2010, significant resources were invested in local projects to promote ‘healthy’ living: most notably through physical activity (PA). Kingsland became a relatively novel place: a deprived area with numerous PA facilities and services. A central research concern is how far these services, particularly a new local leisure centre, impact the lives of people of low-SES. Localities transformed in ways designed to promote ‘healthy’ living are conceptualised as ‘bio-spheres of risk-aversion’ and assessed for their potential to address health inequalities. This research took place two years after the ABIs were implemented. Data primarily come from sixteen months of ethnographic observation, but also includes interviews, a survey, and document analysis. Relationships between health, place and inequality are considered within the wider context of neoliberal dominance. The example of the global obesity ‘epidemic’ illustrates the ways in which neoliberal ideology promotes individual responsibility. The ‘oppressive’ and ‘emancipatory’ potentials of neoliberal health policy are explored in relation to the ‘choices’ and embodied experiences of people of low-SES. This research demonstrates that neoliberal policies not only have harmful individual consequences, they also exacerbate structural inequalities. Specifically, analysis indicates the potential for ABIs to exacerbate health inequalities. Findings reveal some direct, detrimental impacts on people of low-SES and highlight the importance of equitable health provision. This thesis makes an original contribution by revealing the paradoxical effects that health policy can have on relationships between health, place and inequality. It offers a set of novel theoretical concepts to better understand this paradox and to guard against it.