Citizenship by vitality: rethinking the concept of health citizenship

Abstract

In this article, we develop a concept of health citizenship that is specific, historically informed, and flexible to use in the analysis of different domains of medicine and healthcare. Our starting point is that health citizenship is rooted in notions about the vitality and biological existence of populations and individuals. Key tensions in citizenship vis-à-vis health and illness emerge when ideas of membership of a nation, rights and responsibilities, and the related ethical principles of access, equality, and participation encounter 'truths' regarding the vital capacities and characteristics of individuals and populations. Drawing from historical and contemporary examples from Finland, we analyse how biological and medical facts and related expert knowledge enter into and influence the domains in which citizenship is defined and contested. Our concept shares the Foucauldian tenet of biological citizenship, but we expand its scope beyond the focus on recent developments in life sciences and biotechnology, situating it in a broader historical trajectory. Our approach also stresses the specificity of health within the field of social citizenship and offers a more balanced account of the historical development of health citizenship, as compared to the liberal reading focused on the right to health.