The Politics of Self-Craft

As the global challenges posed by chronic, noncommunicable diseases(NCDs) run into longer life expectancies and restrictive fiscal environments, publichealth programs must respond to these issues. In doing so, health practitioners haveframed NCDs as apolitical and largely the product of an individual’s risk behavior.Consequently, governance strategies embraced by public health to address NCDs emphasizethe role of the private sector, including opportunities for patient self-management ofillness. The Expert Patients Programme (EPP), an initiative of the U.K. Department ofHealth, applies to a range of chronic conditions. Via a case analysis of the EPP, thisarticle argues that public health governance of NCDs is increasingly a project ofindividuals’ self-governance, and that although the techniques of the EPP areconstructed as politically neutral, they rather demonstrate a pervasive neoliberalpolitical rationality: in devolving public health responsibilities to the private sectorand in constructing the healthy, active participant whose primary aim is to return to aneconomically productive life