Healthcare as Regulation and Social Control of the Poor: By Dan Oudshoorn and Dave Diewert


A few years back a friend went through a rough time. Eventually, he decided to go see his doctor. Hours later, the police escorted him out of the clinic in handcuffs. They took him into an ambulance not a police car, and he was driven with police accompaniment to an emergency room in a psych ward where he was put in four-point restraint. Later, he was transferred into a ward with locked rooms that resembled jail cells, and put under close surveillance. His every move was restricted, regulated, and monitored. He was stripped of his rights and incarcerated because medical experts considered him to be a threat to the safety of himself or others.

The Rule of Law is what is said to govern our social, political and economic life together. But these laws are not objective; they serve particular interests. In the settler colonial state of Canada, laws have been constructed to dispossess Indigenous people from traditional lands that settlers want to acquire. Laws displace low-income people from homes that corporations want to redevelop. Laws support the exploitation of migrant labour for commercial profit.

For the few who rule the many, laws that contain, control and punish Indigenous and low-income people need to be justified in some way. Previously, laws have been rationalized along religious and moral lines. Canada viewed Indigenous, Asian, and Black people as uncivilized and culturally deficient and cast poor White people as immoral and socially deviant. The coercive force of the law could be applied to them without seeming to contradict its protection of personal rights for landowning White men, because of this dehumanizing construction of who they were.

More recently, justifications for coercive legal interventions have shifted to public health concerns. Low-income people are managed not only through the criminal justice system but also through the healthcare system. People experiencing homelessness are still sometimes considered morally deviant or legally criminal, but they are primarily considered sick. It seems almost every time there is a reference to homelessness in the media, it is paired with mental health and addictions. The general perception is that homelessness is an illness in need of medical intervention.

What’s notable is how coercive medical interventions can be and how much they serve the interests of wealth and power. For example, in 2006 the slumlord owner of the Burns Block hotel in the Downtown Eastside allowed his building to completely deteriorate, saving money by not doing repairs or upkeep to the building. When the health and fire department arrived on the scene they declared the building unfit for human habitation, and ordered the residents to leave on the spot. Once the tenants were evicted, the landlord sold the empty building to a developer, who then was clear to renovate and charge hugely increased rents. The law helped the owners profit by enabling the eviction of low-income residents as necessary for the sake of their own health and well-being.

Legal concern for personal and public health is often a powerful tool for the ongoing use of force against people who are in the way of the rich getting richer. This is because when we construct issues of political and economic interest as issues of health, we mask the dynamics of power and whose interests are really being served. Through health (rather than criminal) interventions, wealthy property owners and politicians can parade as concerned citizens and compassionate leaders.

Homeless camps lay bare the grotesque inequality within our society, but they are often forcefully shut down through legal injunctions on the basis of health and safety issues within the camp. It is under the cover of their concern for the health and well-being of low-income people that business organizations and city planners call for the revitalization (gentrification) of poor neighbourhoods and invoke policies of social mix. Low-income communities that are vibrant and strong are cast as unhealthy ghettoes that need to be cleaned up by creative entrepreneurs and corporate developers who benefit significantly from such urban renewal strategies. It’s hard to fight against the logic of “health”; who would want to speak ill of health?

The medical health system is a powerful force of social regulation and control over the lives of Indigenous and low-income people, even as it serves the interests of the wealthy class. We need to reclaim health as a collective responsibility to one another, and build it from the ground up. One of the first steps to doing so is acting on the understanding that the primary cause of illness among people experiencing poverty is the hoarding of wealth by the rich.

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