The World Health Organization, physical activity and the contradictions of neoliberal health promotion

Abstract

This article constitutes the first holistic exploration of how neoliberalism permeates and manifests in Physical Activity Health Promotion (PAHP). It synthesises a critical analysis of neoliberalism with the sociological concepts of medicalisation and healthism and draws on three distinct phases and methods of data collection, to more adequately understand the development, prominence and largely uncritical acceptance of this domain of global public health. Specifically, it demonstrates how the World Health Organization’s (WHO) initial promotion of PAHP coincided with the organisation’s strategic re-alignment with neoliberal principles within a changing geopolitical landscape. Then, deploying a critical discourse analysis of the recent and globally significant WHO (2020) Guidelines on Physical Activity and Sedentary Behaviour, it shows how the underlying logics of neoliberalism continue to inform not only the intended policy goals but the inclusion and exclusion of certain types of evidence used to justify and evaluate policy. Subsequently, drawing on qualitative interview data and time-series survey data the article details how neoliberalism fosters the ideology of healthism, how this promotes forms of exercise which diverge from health maximising behaviours, and how this extends differences in physical activity uptake across the population, and therefore embeds the health inequalities PAHP is explicitly claimed to address. Outlining why PAHP, in particular, holds appeal for the WHO, we conclude that neoliberalism has both enabled the rapid development and broad political acceptance of PAHP, but concomitantly leads to outcomes which limit and confound the broader policy goals.