The ventilator and the vaccine: Necropolitics and fat in the Covid-19 pandemic
DOI:
https://doi.org/10.55016/ojs/jcph.v1i1.77900Keywords:
obesity, Covid-19, Necropolitics, Biopolitics, EugenicsAbstract
During the Covid-19 pandemic, the fat body was caught up in complicated logics of life and death in the North American context, where “obesity” was regarded as an “underlying condition” for greater risk of severe disease and death from Covid. As such, bodies with high Body Mass Indexes (BMIs) were refused Intensive Care Unit (ICU) ventilator care in certain jurisdictions, which fat activists classified as eugenics. At the same time, in some jurisdictions, vaccination campaigns prioritized people with higher BMIs for scarcely available Covid vaccinations, also on the basis of fat bodies’ higher risk status for Covid death. This paper explores the seeming tension between two articulations of fat during the Covid pandemic, whereby fat bodies were simultaneously worthy of life and of death in the same moment. Using MBembe’s conceptualization of necropolitics, which draws out and expands upon Foucault’s notion of biopolitics, I argue that the two perspectives on fatness operated in tandem, within an overall temporal shift in classification of obesity: from that of a risk factor for eventual death to that of an emergent threat. Such a temporal shift, I argue, relied on well-worn eugenic patterns in Canada, through which “normative” white bodies were prioritized for life through a complex necropolitical practice by which fat bodies were both made live and let die.
Downloads
References
#NoBodyIsDisposble (2020) Know your rights guide to surviving Covid-19 triage protocols for fat disabled people. Ontario, Canada. https://nobodyisdisposable.org/know-your-rights/on-ca/
Adams, V., Murphy, M., & Clarke, A. E. (2009). Anticipation: Technoscience, life, affect, temporality. Subjectivity, 28, 246-265. https://doi.org/10.1057/sub.2009.18
Alberga, A. S., McLaren, L., Russell-Mayhew, S., & von Ranson, K. M. (2018). Canadian Senate report on obesity: focusing on individual behaviours versus social determinants of health may promote weight stigma. Journal of Obesity, Article ID 8645694. https://doi.org/10.1155/2018/8645694
AODA Alliance. (2020). In a second Covid-19 wave, if there aren’t enough ventilators for all patients needing them, a new draft Ontario Medical Triage Protocol would continue to discriminate against Covid-19 patients with disabilities. AODA Alliance. https://www.aodaalliance.org/whats-new/in-a-second-covid-19-wave-if-there-arent-enough-ventilators-for-all-patients-needing-them-a-new-draft-ontario-medical-triage-protocol-would-continue-to-discriminate-against-covid-19patients-with-d/
Bailey, M. M. (2013). Butch queens up in pumps: Gender, performance, and ballroom culture in Detroit. University of Michigan Press.
Baker, M., & Fink, S. (2020, March 31). At the top of the Covid-19 curve, how do hospitals decide who gets treatment? New York Times. https://www.nytimes.com/2020/03/31/us/coronavirus-covid-triage-rationing-ventilators.html
Bashford, A. (2010). Epilogue: Where did eugenics go?. In A. Bashford & P. Levine (Eds.), The Oxford handbook of the history of eugenics (pp. 539-554). Oxford University Press.
Bashford, A., & Levine, P. (Eds.). (2010). The Oxford handbook of the history of eugenics. Oxford University Press.
Beausoleil, N. & Ward, P. (2009). Fat panic in Canadian public health policy: Obesity as different and unhealthy. Radical Psychology, 8(1), 5-25.
Blair, K. L. & Pukall, C. F. (2015). Family matters, but sometimes chosen family matters more: Perceived social network influence in the dating decisions of same- and mixed-sex couples. The Canadian Journal of Human Sexuality, 24(3), 257-270. https://doi.org/10.3138/cjhs.243-A3
Bombak, A. E., & McPhail, D., with Ward, P. (2016). Reproducing stigma: Interpreting “overweight” and “obese” women's experiences of weight-based discrimination in reproductive healthcare. Social Science & Medicine, 166, 94-101.https://doi.org/10.1016/j.socscimed.2016.08.015
Bombak, A., Monaghan, L.F., & Rich, E. (2019) Dietary approaches to weight-loss, Health and Every Size and beyond: Rethinking the war on obesity. Social Theory & Health, 17, 89-109. https://doi.org/10.1057/s41285-018-0070-9
Braziel, J. E. and LeBesco, K. (Eds.). (2001). Bodies out of bounds: Fatness and transgression. University of California Press.
CDC (Centers for Disease Control and Prevention). (2023). Covid-19: People with certain medical conditions. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html
Clarke, E. (2021). Indigenous women and the risk of reproductive healthcare: Forced sterilization, genocide, and contemporary population control. Journal of Human Rights and Social Work, 6, 144-147. https://doi.org/10.1007/s41134-020-00139-
Conrad. R. (2014). Against equality: Queer revolution, not mere inclusion. AK Press.
Dalhousie University. (n.d). Clinical frailty scale. https://www.dal.ca/sites/gmr/our-tools/clinical-frailty-scale.html
Dummitt, C. (2011). The manly modern: Masculinity in postwar Canada. UBC Press.
Egale & Innovative Research Group. (2020, April 6). Impact of COVID-19: Canada’s LGBTQI2S community in focus. Egale. https://egale.ca/wp-content/uploads/2020/04/Impact- of-COVID-19-Canada’s-LGBTQI2S-Community-in-Focus-2020-04-06.pdf.
Ellison, J. (2020). Being fat: Women, weight, and feminist activism in Canada. University of Toronto Press.
Ellison, J., McPhail, D., & Mitchinson, W. (2016). Introduction: Obesity in Canada. In J. Ellison, D. McPhail, & W. Mitchinson (Eds.), Obesity in Canada: Critical perspectives (pp. 3-30). University of Toronto Press.
Erdman Farrell, A. (2011). Fat shame: Stigma and the fat body in American culture. NYU Press.
Flegal, K. M., Graubard, B. I., Williamson, D. F., & Gail, M. H. (2005). Excess deaths associated with underweight, overweight, and obesity. JAMA, 293(15), 1861-1867. https://doi.org/10.1001/jama.293.15.1861
Foucault, M. (1990a). The history of sexuality: An introduction, volume I. (R. Hurley, Trans.). Vintage.
Foucault, M. (1990b). The history of sexuality, volume II. (R. Hurley, Trans.). Vintage.
Gard, M. (2011). The end of the obesity epidemic. Routledge.
Gard, M., & Wright, J. (2005). The obesity epidemic: Science, morality and ideology. Routledge.
Gardiner, F. (2020). Fatphobia, ableism, and the Covid-19 pandemic. Disability Visibility Project. https://disabilityvisibilityproject.com/2020/03/30/fatphobia-ableism-and-the-covid-19-pandemic/
Geary, A. (2021, January 21). Manitoba to allow 2 visitors in homes starting Saturday for all but northern region. CBC Manitoba. https://www.cbc.ca/news/canada/manitoba/manitoba-covid-19- restrictions-1.5882114
Geary, A. (2020, January 8). Manitoba lockdown extended 2 weeks after 355 cases tied to holiday gatherings. CBC Manitoba. https://www.cbc.ca/news/canada/manitoba/manitoba-covid-19-public-health-restrictions- 1.5866120
Goffman, E. (1963). Stigma: Notes on the management of a spoiled identity. Simon & Shuster.
Green, J., Fischer, E. F., Fitzgerald, D., Harvey, T. S., & Thomas, F. (2022). The publics of public health: Learning from COVID-19. Critical Public Health, 32(5), 592-599. https://doi.org/10.1080/09581596.2022.2077701
Hansen, N. (2020, April 5). Who gets medical care during the coronavirus pandemic – and what does that mean for people with disabilities? CBC Manitoba. https://www.cbc.ca/news/canada/manitoba/manitobans-disability-health-care-coronavirus-1.5520589
Harrison, D. (2020). We are witnessing the CDC’s violent eugenicist history in real-time. Da’Shaun L. Harrison. https://dashaunharrison.com/we-are-witnessing-the-cdcs-violent-eugenicist-history-in-real-time/
Harvey, D. (1999). Time-space compression and the postmodern condition. In W. Malcolm, [Ed] Modernity: Critical Concepts, 4. (pp. 98-118). Routledge.
LeBel, J. (2021, March 17). Canada lacks cohesion over obesity as a Covid-19 vaccine priority. Global News. https://globalnews.ca/news/7701619/canada-obesity-covid-19-vaccine-priority/
Lupton, D. (2013). Fat. Routledge.
Lux, M. K. (2016). Separate beds: A history of Indian hospitals in Canada, 1920s-1980s. University of Toronto Press.
Maher, B. (2020, July 31). New rule: The quarantine 15. https://www.youtube.com/watch?v=vDaQOy7ML38.
Malone, K. G. (2020, November 7). What went wrong? Surging COVID-19 cases in once-spared Manitoba seen as a cautionary tale. The Toronto Star. https://www.thestar.com/news/gta/2020/11/07/what-
Manitoba (2021). Restart MB: Pandemic Response System. Province of Manitoba. https://www.gov.mb.ca/asset_library/en/restartmb/pandemic_response_system.pdf
MBembe, A. (2019). Necropolitics. Duke University Press.
McAuley, P. A., & Blair, S. N. (2011). Obesity paradoxes. Journal of Sports Sciences, 29(8), 773-782.
McClintock, A. (1995). Imperial leather: Race, gender and sexuality in the colonial context. Routledge.
McFarland, J., Slothouber, V., & Taylor, A. (2018). Tempo-rarily fat: A queer exploration of fat time. Fat Studies, 7(2), 135-146. https://doi.org/10.1080/21604851.2017.1376275
McPhail, D. (2017). Contours of a nation: Gender and race and the making of “obesity” in Canada, 1945-1970. University of Toronto Press.
McPhail, D., Bombak, A., Ward, P., & Allison, J. (2016). Wombs at risk, wombs as risk: Fat women’s experiences of reproductive care. Fat Studies, 5(2), 98-115.
McPhail, D., & Mazur, L. (2019). Medicalization, maternity, and the materiality of resistance: “Maternal obesity” and experiences of reproductive care. In M. Friedman, C. Rice, & J. Rinaldi (Eds.), Thickening fat : Fat bodies, intersectionality, and social justice (pp. 122-136). Routledge.
McPhail, D. & Orsini, M. (2021). Fat Acceptance as social justice. Canadian Medical Association Journal, 193(35), E1398-E1300.
McLaren, A. (1990). Our own master race: Eugenics in Canada 1885-1945. University of Toronto Press.
Mitchinson, W. (2018). Fighting fat: Canada, 1920-1980. University of Toronto Press.
Mosby, I. (2013). Administering colonial science: Nutrition research and human biomedical experimentation in Aboriginal communities and residential schools, 1942–1952. Histoire sociale/Social history, 46(1), 145-172. https://doi.org/10.1353/his.2013.0015
NAAFA (National Association to Advance Fat Acceptance). (2021, April 24). Covid-19 pandemic special edition: Lifesaving activism to protect fat and disabled people, Part 3 of 3. NAAFA Official. https://www.youtube.com/watch?v=ijipH66jG5M
Nuttall, F. Q. (2015). Body mass index: obesity, BMI, and health: a critical review. Nutrition Today, 50(3), 117-128. DOI: 10.1097/NT.0000000000000092
O’Connell, L., Quigley, F., Williams, O., West, H., Metolli, S., & Pitham, H. (2021). ‘It’s all right for you thinnies’: ‘Obesity’, eating disorders, and COVID-19. In P. Beresford, M. Farr, G. Hickey, M. Kaur, J. Ocloo, D. Tembo & O. Williams (Eds) Rapid responses: COVID-19 and Co-production in health and social care research, policy, and practice. Volume 1. (pp. 143-152). Policy Press.
Ontario. (2020, March 28). Clinical triage protocol for major surge in COVID pandemic. https://med.uottawa.ca/pathology/sites/med.uottawa.ca.pathology/files/clinical_triage_protocol_for_major_surge_in_covid_pandemic_-_march_28_20205.pdf
Padwal, R. S., Pajewski, N. M., Allison, D. B., & Sharma, A. M. (2011). Using the Edmonton obesity staging system to predict mortality in a population-representative cohort of people with overweight and obesity. Canadian Medical Association Journal, 183(14), E1059-E1066. https://doi.org/10.1503/cmaj.110387
Pausé, C., Parker, G., & Gray, L. (2021). Resisting the problematisation of fatness in COVID-19: In pursuit of health justice. International Journal of Disaster Risk Reduction, 54, 102021. https://doi.org/10.1016/j.ijdrr.2020.102021
Pederson, A., Rootman, I., Frohlich, K.L., Dupéré, S., & O’Neill, M. (2017). The continuing evolution of health promotion in Canada. In I. Rootman, A. Pederson, K.L. Frohlich, & S. Dupéré, (Eds.), Health promotion in Canada: New perspectives on theory, practice, policy, and research, 4th Edition. (pp. 3-19). Canadian Scholars.
Rice, C. (2007). Becoming “the fat girl”: Acquisition of an unfit identity. Women's Studies International Forum, 30(2), 158-174. https://doi.org/10.1016/j.wsif.2007.01.001
Ries, N. M. (2006). The 2003 SARS outbreak in Canada: Legal and ethical lessons about the use of quarantine. In J. Balint, S. Philpott, R.,Baker, R., & M. Strosberg (Eds.) Ethics and Epidemics (Advances in Bioethics, Vol. 9), (pp. 43-67). Emerald Group Publishing Limited. https://doi.org/10.1016/S1479-3709(06)09003-0
Rockwood, K., Song, X., MacKnight, C., Bergman, H., Hogan, D.B., McDowell, I., & Mitnitski. A. (2005). A global clinical measure of fitness and frailty in elderly people. Canadian Medical Association Journal. 173 (5): 489-495. https://doi.org/10.1503/cmaj.050051
Senate Canada. (2016). Obesity in Canada: A whole-of-society approach for a healthier Canada; Report of the Standing Senate Committee on Social Affairs, Science and Technology. Ottawa., Canada. https://sencanada.ca/content/sen/committee/421/soci/reports/2016-02-25_revised_report_obesity_in_canada_e.pdf
Spika, J. S. & Butler-Jones, D. (2009). Pandemic influenza (H1N1): our Canadian response. Canadian Journal of Public Health, 100, 337-339. https://doi.org/10.1007/BF03405264
Statistics Canada. (2022). Indigenous population continues to grow and is much younger than the non-Indigenous population, although the pace of growth has slowed. The Daily. Statistics Canada. https://www150.statcan.gc.ca/n1/daily-quotidien/220921/dq220921a-eng.htm
Stearns, P. (1997). Fat history: Bodies and beauty in the modern West. NYU Press.
Stote, K. (2015). An act of genocide: Colonialism and the sterilization of Aboriginal women. Fernwood Publishing.
Thille, P., Friedman, M., & Setchell, J. (2017). Weight-related stigma and health policy. Canadian Medical Association Journal, 189(6), E223-E224. https://doi.org/10.1503/cmaj.160975
Tidgwell, T. & Shanouda, F. (2023). #NobodyIsDisposable. Acts of care and preservation: Reflections on clinical triage protocols during COVID-19. In A. Taylor, K. Ioannoni, R. Bahra, et al. (Eds.), Fat Studies in Canada: (Re)Mapping the Field (pp. 514-535). Inanna Publications.
Tidgwell, T., Friedman, M., Rinaldi, J., Kotow, C., & Lind, E. R. (2018). Introduction to the special issue: Fatness and temporality. Fat Studies, 7(2), 115-123. https://doi.org/10.1080/21604851.2017.1375262
Trans PULSE Canada. (2020). Social and economic impacts of COVID-19 on transgender and non-binary people in Canada. COVID Cohort Working Group on behalf of the Trans PULSE Canada Team. https://transpulsecanada.ca/results/report-social-and-economic-impacts-of-covid-19-on-transgender-and-non-binary-people-in-canada/
Truth and Reconciliation Commission of Canada. (2015). Honouring the truth, reconciling the future: Summary of the final report of the Truth and Reconciliation Commission of Canada. Truth and Reconciliation Commission of Canada. https://ehprnh2mwo3.exactdn.com/wp-content/uploads/2021/01/Executive_Summary_English_Web.pdf
Usher, K., Jackson, D., Fatema, S. R., & Jones, R. (2023). Domestic violence against women has increased during the COVID‐19 pandemic: A perspective paper about the need for change to current and future practice. International Journal of Mental Health Nursing, 32(5), 1439-1445. https://doi.org/10.1111/inm.13200
Ward, M. (2020). Are coronavirus triage protocols sacrificing fat people? Should they? IJFAB Blog: Official blog of IJFAB; The International Journal of Feminist Approaches to Bioethics. https://www.ijfab.org/blog/2020/05/are-coronavirus-triage-protocols-sacrificing-fat-people-should-they/
Weston, K. (1997). Families we choose: Lesbians, gays, kinship. Columbia University Press.
Wharton, S. (2021, March 29). Why people with obesity need priority access to the Covid-19 vaccine. Globe & Mail. https://www.theglobeandmail.com/opinion/article-why-people-with-obesity-need-priority-access-to-the-covid-19-vaccine/
White, D.B. & Lo, B. (2020). A framework for rationing ventilators and critical care beds during the Covid-19 pandemic. JAMA, 323(18), 1773-1774. doi:10.1001/jama.2020.5046
Published
Issue
Section
License
Copyright (c) 2024 Deborah McPhail
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
All articles in the Journal of Critical Public Health are published under a CC-BY-NC-ND license, or a CC-BY license if authors or their funders require this. The default CC-BY-NC-ND license means that authors and users may copy and distribute the material in any medium or format in un-adapted form only, for non-commercial purposes only, and only so long as proper credit is given (as is customary in academic work). Authors retain copyright of their work published in Journal of Critical Public Health.
