This article, “On care infrastructures and health practices: How people in health promotion programmes try to change their everyday life,” by Francesco Miele, a research fellow at the University of Padova, Italy [1, Author biography], presents a compelling challenge to common behavioral or cognitive explanations for health and wellbeing outcomes. Published in Health in 2023, the paper aims to renew the debate about health promotion by focusing on the complex social practices through which individuals, supported by both human and non-human elements, endeavor to improve their health.
The author positions his work at the intersection of the sociology of health and illness (SHI) and science and technology studies (STS), adopting and consolidating the relevance of the concepts of care infrastructures and health practices. Critiquing traditional approaches in public health that often individualize poor health and assign blame, Miele argues that adopting a ‘healthy lifestyle’ is profoundly influenced by broader social conditions and contexts, including factors like social class, familial resources, gender roles, and national culture. The paper builds upon an emerging body of studies in SHI and STS that move beyond individualistic views to explore the sociomaterial dimensions of daily life.
Methodology and Research Setting: The article draws on a qualitative study concerning a Workplace Health Promotion (WHP) programme in north-east Italy. This program was specifically designed to reduce the risks of Type-2 diabetes and cardiovascular diseases among sedentary workers. The research involved a multi-phase qualitative approach, including preliminary focus groups with workers and stakeholders during the design phase, participant observation of design processes, and in-depth interviews with project participants (workers identified as ‘at risk’) and healthcare professionals (occupational physicians and a lifestyle counsellor) after the project’s launch. The focus of the interviews with workers included their motivations, practices for self-measurement, feelings about being ‘at risk’, and the daily readjustment or rejection of new health practices.
Key Concepts and Findings: Miele employs the concept of care infrastructures, defined as “pervasive enabling resources” that are sociotechnical, material, distributed, and de-centered phenomena. These infrastructures are the “tracks” on which care “runs,” shaping and being shaped by actors and settings. The article also emphasizes health practices as locally situated and composite actions that emerge from interactions in specific contexts, rather than being direct results of mental processes or mere individual behaviors. The relationship is symbiotic: care infrastructures comprise heterogeneous elements that enable certain health practices, while the enactment of health practices, in turn, establishes relations that define the qualities of these elements.
The findings illustrate how a care infrastructure in health promotion is designed, put to work, repaired, and ‘put aside’.
- Initial Architecture: The program’s initial design, primarily grounded in a behaviorist paradigm, defined workers as ‘users’ and included standardized questionnaires, healthcare professionals, digital technologies (a mobile app and fitness trackers), and public activities (gym classes, seminars).
- Care Infrastructure at Work: The project revealed the ‘worried well’ phenomenon, where individuals with good health nonetheless became ‘ready subjects for health discourses’ after being labeled ‘at risk’. When technologies were adopted, appropriation processes occurred, transforming their ideal use and the practices within which they were embedded. For example, the mobile app gained a peripheral role due to its general recommendations and time-consuming data entry, while fitness trackers were used creatively or even avoided for certain functions. Crucially, the enactment of health practices also involved incorporating new people (relatives and colleagues) into the infrastructure, leading to the overlapping of health practices with other daily routines like parenting and mundane tasks. This was particularly complex for female workers navigating multiple ‘shifts’ of labor.
- Repairing and Putting Aside: Workers actively engaged in repairing the infrastructure by substituting provided elements with their preferred alternatives (e.g., using a mobile phone for step counting instead of a fitness tracker, or attending Zumba classes instead of project-offered gym classes). Furthermore, workers demonstrated the ability to temporarily put aside the care infrastructure when health practices conflicted with vital social engagements (e.g., social rituals involving food and drink) or other overwhelming life demands (e.g., family issues, work pressure). This highlights the unreality of continuous adherence expectations in health promotion.
Discussion and Implications: The article raises three cross-cutting topics:
- Multiplicity of Care Infrastructure: The empirical case demonstrates that the initial protocol’s “illusion of the single answer” is ‘betrayed’ in practice, leading to multiple, diverse versions of the care infrastructure as it is continuously reshaped by workers and professionals. This multiplicity highlights the durability of adjustable systems and the incomparability of individual health outcomes.
- Emergent Hierarchies: While initially designed for horizontal cooperation, the counsellor often emerged as the ‘guardian’ of the infrastructure, centralizing control, while digital technologies became increasingly peripheral. This dynamic reflects a tendency to reaffirm the supremacy of human agency over non-human elements in discourses about health practice.
- Role of Affect: Affect is shown to play a significant role in motivating involvement in health practices (e.g., anxiety, surprise from risk assessments). It also supports the enactment of practices by fostering positive emotions among participants. Conversely, affect can destabilize care infrastructures when the intense feelings connected to other vital daily practices (e.g., love, joy from family) conflict with health promotion demands.
In conclusion, Miele’s paper effectively demonstrates that the change in daily habits concerning nutrition and physical activity is fundamentally a collective effort, deeply intertwined with various spheres of life, connecting both human and non-human elements, and driven by complex affective intensities. By adopting a post-humanist perspective, the study challenges the notion that individuals are solely responsible for their health status, thereby moving beyond individual blame.
Reference: Miele, F. (2023). On care infrastructures and health practices: How people in health promotion programmes try to change their everyday life. Health, 27(6), 980–997. https://doi.org/10.1177/13634593221093503
