Healthy Citizenship beyond Autonomy and Discipline: Tactical Engagements with Genetic Testing

In recent decades a model of healthy citizenship has emerged, which construes citizens as autonomous, responsible and active participants in the management of their health. While proponents view this as an empowering discourse, critics claim that it creates new forms of discipline and social control. This article argues that there is a need for a shift in the conceptual framework surrounding this discussion – beyond autonomy versus discipline understood as heteronomy – because it obscures the many ways in which individuals engage with healthy citizenship discourse that are not governed by principles of autonomous choice and that do not corroborate fears of normalization and discipline. Michel de Certeau’s theory of the creative tactics of everyday life is offered as a useful alternative framework, insofar as it is concerned less with individual autonomy than with the rendering ‘habitable’ of a given space. Drawing on existing empirical research on people’s engagements with genetic risk information, four tactics are identified that escape both healthy citizenship discourse and its critique: translation; selective mobilization; non-disclosure; and a refusal to engage. Thinking in terms of tactics and habitability, it is argued, provides a vocabulary with which to articulate other modes of reasoning, action and moral conduct that are at work.