# Abstract The formation of identity and subjectivity in relation to [[health is]] a fundamental issue in social science. This overview distinguishes two different approaches to the workings of power in shaping senses of self and other. Politics of identity scholars focus on social movements and organizations concerned with discrimination, recognition, and social justice. The biopower approach examines discourse and technology as they influence subjectivity and new forms of sociality. Recent work in medical anthropology, especially on chronic problems, illustrates the two approaches and also points to the significance of detailed comparative ethnography for problematizing them. By analyzing the political and economic bases of health, and by embedding health conditions in the other concerns of daily life, comparative ethnography ensures differentiation and nuance. It helps us to grasp the uneven effects of social conditions on the possibilities for the formation of health identities and subjectivities. # Introduction We are concerned to specify: What particular political, historical, technological, and cultural circumstances facilitate, shape, and constrain the working of health identities? How and when do specific situated concerns move some social actors, but not others, to think and act in terms of health? What resources are at stake? # [[Identity politics]] From the civil rights movement to Black power, feminism, gay rights, and multiculturalism, the politics of identity put recognition of difference on the agenda. Recognition was a first and necessary step toward action for change. As Terence Turner argued concerning multiculturalism, identity politics was about “collective social identities engaged in struggles for social equality” (Turner 1993:412). There is always a possibility that politics of identity can fetishize difference and tend toward separation, but it can also make a critical contribution to politics in the sense of discussion and action among a plurality of people. [[Three-stage lifecycle for norm contestation. First, introduce the idea. Second, ideas cross the threshold and socialization period. Third, when the norm settled in and taken-for-granted (internalised)]] In the arena of health, the disability movement is perhaps the clearest example of identity politics. The militant campaign for disability rights in many countries was accompanied by an increased sensitivity about identity and respect, as expressed in anguage, law, and even architecture. In the academy, the field of Disability Studies emerged with a strong focus on recognition, personal experience, and the social and cultural processes of disablement. The interest in identity spread beyond the “classic” motor, sensory, and intellectual handicaps to encompass obesity, chronic illnesses, infertility, old age, and even traumatic experiences like being raped or tortured (see the range of contributions in Ingstad and Whyte 2007). Ethnography does not assume identity politics but questions the conditions for its existence, as exemplified by a study of diabetes in Beijing by Mikkel Bunkenborg (2003). ==In the liberalizing political economy of China, where multinational drug companies play an important role in providing information about diabetes, patients become consumers and are rather left to their own devices to manage their condition.== They feel unjustly treated, and they carry a heavy economic burden in having to finance their own treatment while they also risk losing their jobs. Bunkenborg describes the informal circles of fellow patients who support one another and pass on knowledge. But he doubts whether there is a politics of identity at work here. It is not a case of diabetic identity as a basis for a social organization of equals with common interests making claims for recognition and rights. Rather he sees these networks as part of the politics of the self in which people cultivate moral character and interact in differentiated and more hierarchical networks of particularistic relations. This is not just a legacy of Confucianism, but a function of the difficulty of forming civil society organizations in China, the insecurity of an unregulated market, unequal access to health care and knowledge, and the management of a disease that requires discipline of the self (Bunkenborg 2003:89–91). Bunkenborg’s analysis leads on to the second way of approaching the link between health and identity, which is perhaps better phrased as a relation between health and subjectivity. # [[biopower]] Foucault's concept of biopower on discourses and practices that work both at the level of the self and at the level of whole populations. In this sense, it is relevant to consider biopower in relation to health and the politics of [[Identity politics|identity]]. However, unlike identity politics, biopower approaches are not generally concerned with explicit political action and debates about social justice. Rather they point toward the much more subtle shaping of subjectivity, of assumptions and bodily practice and attentiveness. Knowledge, technologies, and control are the watchwords. Inspired by his writings and deeply immersed in the significance of new developments in biological science, Paul Rabinow (1996) launched the term biosociality to capture the ways that biological nature, as revealed and controlled by science, becomes the basis for sociality. His examples are the ways that genetic testing and other kinds of medical technology yield social–biological classifications that are practiced in new kinds of organizations. > I will underline ... the likely formation of new group and individual identities and practices arising out of these new truths. There already are, for example, neurofibromatosis groups whose members meet to share their experiences, lobby for their disease, educate their children, redo their home environment, and so on. That is what I mean by [[biosociality]]. [Rabinow 1996:102] Whereas an older generation of social scientists was concerned with the relation between health and bioidentities like race, gender, and age, ==we must now, according to Rabinow, examine the ways that diagnostic technology actually creates social difference and social groupings==. [[biosociality]] will also create groups such as people who have had mastectomies, colostomies, and transplants, or who are on lifelong antiretroviral therapy. [[biosociality]], “the forging of a collective identity under the emergent categories of biomedicine and allied sciences” (Rapp 1999:302) was one possibility for the parents of Down syndrome children. But it was mostly for a minority: mothers from twoparent families, middle-class, white, having resources of time and income. Although Rapp describes with sympathy the communities of difference, the friendship, the sharing of experience that these parents found in support groups, she also conveys critical voices, like that of Patsy DelVecchio, a recovering alcoholic who expresses resentment of class and of what she sees as self-promotion through identifying with difference. The influence of Foucault is further refracted in the notion of biological, or biomedical or therapeutic) citizenship. Two sociologists, Nikolas Rose and Carlos Novas (2005), use “[[biological citizenship]]” to call attention to the way that conceptions of citizens are linked to beliefs about biological existence. Like Rabinow, they are interested in the implications of new biomedical technology for forms of [[biosociality]], although they also note that biosocial groupings are far older than recent developments in genomics and biomedicine—and they make the link to earlier forms of activism and identity politics. Biological citizens are “made up” from above (by medical and legal authorities, insurance companies). [[@novasGeneticRiskBirth]] The active biological citizen informs herself, and lives responsibly, adjusting diet and lifestyle so as to maximize health. “==The enactment of such responsible behaviors has become routine and expected, built in to public health measures==, producing new types of problematic persons—those who refuse to identify themselves with this responsible community of biological citizens” (Rose and Novas 2005:451). [[Communicable disease control]] Interesting that in COVID-19 pandemic we saw group of people emerged that were anti public health measures such as mask, vaccine, social distancing, etc, when, at that time, responsible community consist of identifying with those behaviors. Adriana Petryna’s original concept of biological citizenship was developed to analyze the struggles and strategies of Ukrainians exposed to radiation when the Chernobyl nuclear reactor exploded in 1986 (Petryna 2002). Skillfully she weaves the original Soviet denial of extensive damage together with the acceptance of state obligations to its citizens by the new government of independent Ukraine. She shows how damaged biology became the basis for making citizenship claims in the difficult conditions of a harsh market transition, increasing poverty, and loss of security. [[biopower]] is part of her story, in that access to treatment, pensions, and other welfare benefits was based on medical, scientific, and legal criteria: “ ... science has become a key resource in the management of risk and in democratic polity building” (Petryna 2002:7). > Citizens have come to rely on available technologies, knowledge of symptoms, and legal procedures to gain political recognition and access to some form of welfare inclusion. Acutely aware of themselves as having lesser prospects for work and health in the new market economy, they inventoried those elements in their lives (measures, numbers, symptoms) that could be connected to a broader state, scientific, and bureaucratic history of error, mismanagement, and risk. The tighter the connections that could be drawn, the greater the probability of securing economic and social entitlements—at least in the short term. [Petryna 2002:15–16] [[Insights]] [[biosociality]] This is VERY interesting. From COVID-19 we also see, apart from the vulnerable identity which was explained in the lecture notes, developing countries or Global South also forms an identity to ask for equal access to medical countermeasures. The inequality and gap resulted from [[Intellectual Property Rights (IPR)|intellectual property regime]] banded these countries together for making global citizenship or global solidarity claims in the difficult conditions. In that sense, these Global South countries formed a group, and contest the global policymaking regime with a very specific [[biopower]] as part of the story to leverage their ask for equal access to [[soft power of vaccines|vaccines]]; because their people bear the brunt of the abuse of [[Power asymmetry|power]] the pandemic. In a sense Petryna is describing what Rose and Novas call “making up biological citizens.” To “make the Chernobyl tie” and thus gain recognition by the state, people have to identify themselves in terms of certain symptoms. But Petryna is not talking about some general biopower; she specifies in terms of Ukrainian political history and the international humanitarian aid that made a disabled identity a survival strategy. Biehl (2004), writing about the activist state in Brazil, shows that “[[biomedical citizenship]]” includes those who identify themselves as having AIDS and actively struggle for treatment from public services. Those who do not assert their AIDS identity and rights to treatment—people marginalized by poverty, drug use, prostitution, homelessness—are excluded and made invisible. Community-run houses of support provide a chance for some of these “disappeared” people to be included in the “biocommunity” of AIDS patients: “in such houses of support, former noncitizens have an unprecedented opportunity to claim a new identity around their politicized biology” (Biehl 2004:122). In a similar approach Nguyen analyses access to antiretroviral drugs in Burkina Faso in terms of a kind of biopolitics that he calls “[[therapeutic citizenship]].” Unlike Brazil, most African states have so far been unable to include those identified as having AIDS within a supportive national community. Instead, local mobilization appeals to a global therapeutic order. [[therapeutic citizenship]] is “a form of stateless citizenship whereby claims are made on a global order on the basis of one’s biomedical condition” (Nguyen 2005:142). Activism on behalf of a wider community—a kind of identity politics—is one outcome of identification as HIV+ in Burkina Faso. # Toward Comparative Ethnography Nancy Fraser (1998), for example, argues that neither the politics of recognition, nor that of redistribution, can stand alone in the pursuit of social justice. Both are necessary. In the same classic style, I could point out that newer work on biocitizenship combines identity politics with biopower. The Foucauldian interest in the state and the self, the two poles of biopower, is enlarged with a focus on biosocial groups that make claims for inclusion and justice. > “Moreover, focusing narrowly on relations among people with the same health condition excludes all the other relations and domains of sociality that actually fill most of their daily lives.” (“Health Identities and Subjectivities:”, p. 13)