Pirosa, Rosaria: Dal diritto alla salute all’healthism. Una ricognizione giusfilosofica, Mucchi Editore, Modena, 2021, 105 páginas, ISBN: 978-88-7000-883-8

Casimiro Coniglione

Università degli Studi di Modena e Reggio Emilia

casimiro.coniglione@unimore.it 0000-0003-1663-2187


Vol. 8 • Nº 2 • pp. 174-177

ISSN 2444-8478 • http://doi.org/10.12795/IESTSCIENTIA.2022.i02.14

The book by Rosaria Pirosa, the tenth publication of the editorial collection “Social practice and legal theory” directed by Thomas Casadei and Gianfrancesco Zanetti, analyzes the consequences of the so-called healthist approach from a legal-philosophical perspective.

According to a literal translation in Italian, the expression healthism means health care and would lead to think about a lifestyle based on individual practices to optimize one’s health and well-being. The translations of the words, however, do not fully mirror the meaning of the language of origin, because we try to reconstruct them in a network of meanings rooted in a context: arguing that a policy (or a practice) is marked by healthism does not mean that it has the incentive for the well-being and health of the community as its goal, but – and this is the author’s thesis – that this leaves the individual responsible for caring for his own body and health.

Pirosa’s reflection is intended to bring out the true meaning of the healthist approach conceived as “generative factor of inequalities, introduced within the Welfare State with the aim of concealing social and economic disparities and affirming a vision of health that is anchored to the autonomy myth” (to be understood as the myth of the individual’s self-sufficiency in managing himself in any area of the life, p. 11).

More specifically, in the first chapter (pp. 17-41) the author, after having carried out a historical-social reconstruction of the term healthism (introduced by Irving Kenneth Zola in 1977), identifies the causes of this phenomenon, especially in the United States, in the affirmation of the liberal principle that advocates the incompatibility of social pursuit of economic development: this represents the basis for the privatization of the American health system (see p. 25). All this implies a “disciplinary power” for using a Foucauldian terminology – a power connected to a disciplinary device (that results in social exclusion) for individuals who have not been able to take care of their health or their body. Pirosa exemplifies this concept by observing that in the United States – especially in the 1980s – those affected by the HIV virus were declared unhealthy, guilty of not having been responsible for their own body and, as a result, discriminated against by society and the access to care.

Then Pirosa, starting from the theoretical and methodological approach of Jessica L. Roberts and Elizabeth Weeks, sets out four criteria to verify when we can find a healthist approach: the first parameter, namely that of health welfare – understood as a marker of the system of the protection of social rights – is a diagnostic tool but it is not an autonomous criterion for testing whether discrimination is based on healthist policies; health liberty, on the other hand, investigating aspects of individual freedom and autonomy, focuses on the field of discriminatory practices; health equality, absorbing the first two above-mentioned criteria, is based on the principle of equality and it applies to the promotion of psycho-pshysical well-being (health status) and to healthist discrimination which is a direct consequence of prejudice and stigmatization; health justice, expressing redistributive demands, applies to the field of systematic preconditions, as a direct consequence of healthism and restrictive social policies (see pp. 28-32).

According to Pirosa’s perspective, the privileged observatory for verifying practices based on the healthist approach is the political-legal context of the United States: as a matter of fact, American jurisprudence has granted protection in cases where, for example, obesity is due to a genetic factor, while denying it in cases where obesity is attributable to the lifestyle led by the subject. Furthermore, the author underlines that even company policies are marked by the healthist approach, since the maintenance of psycho-physical requirements and the weight-to-height ratio are a necessary condition for the worker in order not to incur dismissal for cause. (see pp. 33-55).

In the second chapter (pp. 43-62), the author intends to enter into the depth of healthist practices, using the concept of vulnerability as a heuristic investigation tool.

First, it analyzes the consequences of fat-bias for those who suffer from obesity by pointing out that these subjects, more often than not, are not responsible for their physical situation, because studies have shown that obesity is a precise hallmark poverty (think, for example, the food offered at very low prices at well-known fast food chains); the healthist approach, therefore, explaining exclusion on the grounds of an “alleged” lack of responsibility in health case, increases the vulnerability of specific social groups which, already targeted for racial or gender discrimination (cf. pp. 45-60).

Secondly Pirosa – through the lens of Feminist Studies – also intends to investigate the distorted, or rather stereotyped, image of women that healthism intends to offer. As a matter of fact, the healthist approach advocates – especially for women – a compulsive form of self-responsibility, because since the childhood they are educated to respect a precise body standard, which correspond with a certain image and a certain femininity: if a girl did not adequately respect this standard, demostrating lack of self-control, she can be considered unable to express herself in the areas of social life. This vision, as a typical tool of female empowerment in the perspective of white feminism, actually leaves out the causes of vulnerability and discrimination factors (cf. 50-54).

Thirdly, the author – taking a cue, in this case, from Critical Legal Studies – intends to investigate the social effects of weight-based discrimination, highlighting that the fight against obesity is a specific goal for all those who consider health not as a constitutionally entrenched right, but as a person’s duty to protect himself or herself. Therefore, stigmatization due to one’s own weight reinforces and naturalizes a “standard” of subject holder of right, and fat-studies – denouncing weight-based discrimination – intend to highlight how the discrimination implemented for physical weight has no legal relevance (cf. 54-58).

In Pirosa’s opinion, the absence of specific legal provisions centered on weight-based discrimination means that body excess is considered as a further demonstration that the subject, not having been able to take care himself or herself, deserves to be discriminated. Nevertheless, the issue of fat-rights can emphasize how it is necessary to recover the sense of discrimination based on weight, in compliance with the principle of substantial equality. And an opposite perspective, allowing healthism to be present above all in public policies, means widening discrimination against social groups that are already vulnerable (see pp. 61-62).

In the third chapter (pp. 63-80), the author proposes a focus on intersectionality (a term, as is well known, introduced by Kimberlé Crenshaw to express the idea according to which a subject can suffer discrimination in several directions) of healthism emphasizing how this practice is a matrix of inequalities, which also affects subjects and groups for the age, the religious affiliation and the individual position in the work environment.

Concerning the age, Pirosa points out that healthist practices, during the adolescence of girls, are not viewed negatively: it is necessary to educate them in the self-control of food, instilling in them the idea of the Alpha girl, limiting – therefore – autonomy (understood as a range of options to choose) and thus favoring compulsive responsibility (cf. p. 68). The author also intends to reflect on the healthism in the (so to speak) religious sense: just as the faithful of a religion are proud to show their symbols of belonging outside their social group, even those who are “normal weight” must flaunt their symbol, that is physical form. Sport and diets, in fact, are celebrated as fundamental elements of sacrifice to achieve the ethical status of superiority. Making healthy choices and responding to certain canons of thinness, means being superior to unhealthy because those ones lack strength, willpower and spirit of sacrifice.

Pirosa goes beyond this analysis because she investigates through intersectionality the consequences of this approach, combining both gender and the religious factor. In fact, the author shows that if women are unable to be responsible for their own weight they are qualified burdensome for the welfare system since they deviate from social dictates, giving up both personal and group advantages.

A woman who is unable to take care of her body, a fortiori, will not be a multitasking woman (who takes care of the body, home, family and work at the same time) and because marriage – as it imposed in the age of social media – it must be visible, the precise duty of the woman is to adapt herself to any treatment necessary in order to show her healthy. Appropriately, Pirosa notes that this idea is a return to the traditional patriarchy.

In the end, the author focuses her reflection on healthist practices in the workplace. As a matter of fact, company policies are aimed at empowering their employees, making them want to diets, competitions and fitness classes that increase the compulsive responsibility for body care. Discrimination of healthist matrix leads to lower wages and lower chances of professional progression for “lazy” employees. Hence, healthist discrimination has a double effect: it marginalizes individuals and groups and, at the same time, blames them for the reasons for exclusion (see 76-77).

Overall, this volume shows well how weight-based discrimination is creepy and insidious, imposing “alleged” aesthetic standards of society and excluding all those who are not deemed “fit” to take care of themselves.