Different forms of power have evolved in history and to talk about them, one must examine the history of medicine too. In Foucault’s view, the shift from sovereign power to biopolitics may be seen alongside the evolution of medicine. However, it is difficult to link Foucauldian forms of power directly to specific historical moments of medicine, because forms of powers are loosely defined, do not correspond to strict chronological periods, and often overlap with each other (Mills 2018, 26).

A parallel reading of Foucauldian power and modern medicine reveals their reciprocal connection. This leads us to see how contemporary medicine, through the use of preventive methods, is in fact a tool of political power. I try to answer how medicine has come to intervene not only in public health issues but also in individual lifestyles. Moreover, I seek to answer the question of how we can resist this intervention in our lives.

From Sovereign Power to Biopolitics

For Foucault, the first stage of power is sovereignty: a top-down, restrictive force that defines what is legal or illegal and targets individuals rather than entire populations (Mills 2018, 24). This form of power decides who may live or die and who should be segregated from society. A medical example of sovereign power is “exclusion of lepers in the Middle Ages” through laws and regulations (Foucault 2009, 9). Toward the end of the classical period (referring to early modern Europe, not antiquity), a new form of political power, biopower, emerged that aimed to manage and promote life. Unlike the repressive nature of sovereignty, this new power is productive and positive, operating both on individual bodies through ‘discipline’ and on entire populations through ‘biopolitics’ (Mills 2018, 15, 16, 24, 26).

The first pole of biopower, disciplinary power, emerged in the late 17th century and views the human body as a machine that can be optimized (Mills 2018, 15). In medicine, this form of power emphasizes controlling the physical environment and enforcing quarantine measures—what may be termed a disciplinary medical system; for example, regulations on movement, home life, diet, contact, and inspections to control the plague (Foucault 2009, 10). 

Disciplinary medicine developed in three main directions. First, “state medicine” in the 18th century connected population health to national wealth. It was influenced by 16th-century German medical police and led to the opening of many clinics and hospitals in the 18th century (Nadesan 2018, 95, 98). Second, “urban medicine” emerged in the late 18th and 19th centuries and focused on sanitation in response to growing cities and industrialization (Nadesan 2018, 95–96). Third, “labor-force medicine” targeted the working poor, who were increasingly seen as a source of public health problems (Nadesan 2018, 96).

The relationship between medicine and politics became much closer as the 20th century began, by pursuing state security through a form of medicine which encompassing the entire society, not merely the poor labor force. Public security was implemented through mass vaccination and the maintenance of hygiene at home. Hence, personal health was now linked to moral responsibility—someone who cared about his or her personal health would be considered a responsible citizen with regard to public security (Nadesan 2018, 96, 97, 100).

The second aspect of biopower, biopolitics, emerged in the late 18th century. Unlike disciplinary power, which focuses on individual bodies, biopolitics views humans as a species and is concerned with the health, birth rates, and mortality of entire populations (Mills 2018, 15). It addresses the biological characteristics of the human race and uses tools like social medicine and vital statistics to manage life, aiming to reduce illness and death across society (Nadesan 2018, 93–95). Its goal is to keep most people alive, making survival a political priority. In biopolitical societies, life is no longer a personal right but an obligation, which is why actions like suicide are no longer seen as private choices.

Conceptualizing Preventive Medicine as Biopower

In the late 18th and early 19th centuries, the birth of clinics and institutionalization of medicine (shifting focus from disease treatment to health preservation) gave rise to biopower, which guaranteed public safety by identifying both the causes of illness and the factors that weakened populations (Mills 2018, 16, 21). The new focus on identifying threats to health can be seen as an early precursor to the concept of ‘risk factors.’ The growing concern with risk also paved the way for the development of health insurance systems, along with regulatory measures and security strategies aimed at the optimizing life of the population (Mills 2018, 16–17). 

The security problematic can provide a comprehensive framework for understanding preventive medicine; as the goal of a security apparatus is to prevent harm before it occurs, rather than respond to it afterward. Foucault’s later works on the broader biopower framework, which unites disciplinary power with security mechanisms, have been underappreciated by many thinkers. Deleuze’s (1990) ‘control societies’ attempts to address the limitations of the disciplinary model. Nevertheless, his critique is not acceptable; since Deleuze acknowledges only the disciplinary aspect of biopower and overlooks its security dimension as developed in Foucault’s later Collège de France lectures.

To explore the political dimensions of risk factors in preventive medicine, the concept of biopower is especially useful for two main reasons: it regulates how people live and operates as a form of ‘internalized power.’ Biopower offers a strong theoretical framework for understanding lifestyle changes promoted in preventive care, because it is concerned with all aspects of life (Buchanan 2010) and is absorbed into everyday routines (Nadesan 2018, 93).

Moreover, lifestyle modification, the most important strategy of preventive medicine, cannot be imposed by force or external control, as prevention requires individuals to recognize risks and willingly change how they live. In this regard, biopower functions as an internalized form of governance in modern security societies and leads people to accept medical advice and take responsibility for their own health. As Lemke quotes Hart and Negri, biopower is “an integral, vital function that every individual embraces and reactivates of his or her own accord” (Lemke 2011, 70).

As a positive and productive force, biopower shapes new health behaviors such as regular exercise, physical fitness, healthy eating, and proper sleep. Even when it discourages harmful actions like smoking, drinking alcohol, or engaging in unprotected sex, it does so by promoting healthier alternatives rather than by banning them, as sovereign power would. Surprisingly, some scholars seek to return medicine to a more sovereign and negative power by proposing taxes on unhealthy processed foods industries to protect public health (Fox 2024). These theses implicitly suggest that governments should once again take direct responsibility for the population’s health by relying on centralized authority to manage public health and reinforcing the role of state power in shaping life.

Individual Freedom and Public Health

Primarily, preventive medicine focused on diseases with direct transmission that posed a public threat—contagious infections such as STDs, tuberculosis, cholera, and conditions with visible symptoms like skin rashes and coughs. The concept of ‘health politics’ emphasizes infectious disease control, reflecting the limited medical focus on non-contagious conditions during Foucault’s era. 

By the late 20th century, however, the scope expanded to include imperceptible risk factors such as high cholesterol, high blood pressure, and cancer screenings. It was only with the 1998 edition of Harrison’s Principles of Internal Medicine that an independent chapter titled “Principles of Disease Prevention” was introduced, and it has remained and been expanded in subsequent editions (Connelly and Inui 1998). To address the gap between 20th- and 21st-century preventive medicine, I propose the term ‘medical politics,’ rather than health politics, to encompass the broader range of medical concerns now governed by biopower.

One explanation for why preventive medicine was concerned only with communicable diseases is the epistemic effect of John Stuart Mill’s (1991, 30) harm principle: “That the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not a sufficient warrant.” The medical interpretation of the harm principle under the influence of 19th-century germ theory, initially restricted state intervention in health issues to contagious diseases, as these were seen as direct threats to others. 

By the late 20th century, however, medical advancements identified risk factors (e.g., smoking, poor diet) as indirect threats to economic productivity and welfare systems. As a consequence of the arrangement between medicine and economics (Adorno 2014, 99), the harm principle expanded to include any condition affecting capital, including workers’ health status. Thus, the boundary between personal health and collective responsibility was erased, and preventive medicine eventually expanded its domain to include non-communicable diseases.

Resisting Biopower

Current medicine connects the individual health to the public and thus raises a serious conflict over the limits of private health and freedom of choice in health, which continued into the COVID-19 pandemic. To regain the right to individual health or the right to choose unhealthy behaviors, as Foucault suggests, one must resist by liberating oneself ‘from the state and from the type of individualization which is linked to the state. We have to promote new forms of subjectivity through the refusal of this kind of individuality which has been imposed on us for several centuries’ (Mills 2018, 31).

As freedom comes with responsibility, the first step in liberating from biopower is that each person takes responsibility for their own health rather than relying on welfare states to manage their health. When individuals fund their own healthcare, they maintain decision-making autonomy over their health. By reducing intervention in people’s health choices, a neoliberal healthcare system provides more freedom in healthcare. Such a system constitutes a political state in which decisions about life and death belong to the individual rather than society, allowing one to reclaim the right to life and death.

While some consider neoliberalism as an agent of biopolitics (Nadesan 2018, 108), the potential of neoliberalism to guaranteeing liberal health rights is almost overlooked. The libertarian left wing is against the neoliberal healthcare system and at the same time protests state control over individuals’ private health. This paradox will be dissolved if one defines neoliberalism in its precise sense as a new rise of classical liberalism, rather than the negative meaning it has acquired in recent decades (Boas and Gans-Morse 2009). Then the resistant potential of neoliberalism against biopower will be evident.

Yet, it is not enough to merely seek neoliberal freedom as the way out of biopower. To resist biopower, one must also get free of oneself and practices freedom differently (Mills 2018, 32). For Foucault (2003, 248), the only way to get out of the limit of power is by entering the territory of death. As the ideal biopower society is where all risk factors known to medicine are avoided if not eliminated, resisting agents must change the medicalized meaning of death, pain, illness, and risks, and builds their new self-governing health; they need to ‘practice dying’ (Adorno 2014, 110). Therefore, a new individuality must define new risk factors, in order to be free from biopower. 

Those who redefine the limits and meanings of risks, define life and death by their own new individuality. As a practical example, skateboarding requires courage and acceptance of risks. Street skateboarders set new rules of risk and health for their own bodies. Skateboarding reveals a paradox by simultaneously improving health as a sport and posing high risk of injuries to the body (Shuman and Meyers 2015). In other words, the risk itself helps to be healthy; skateboard players endanger their bodies to improve their health. That might be the reason why skateboarders feel a sense of liberty and of being outside the limits of power through the organization of a new body (Schaffer 2016, 19).

Conclusion

Biopower, operating through both discipline and biopolitics, converts modern medicine into the prevention and maintenance of health for individuals and populations. The historical shift from sovereignty to security mechanisms explains how medicine has extended the harm principle beyond contagious public health threats to include non-communicable conditions like cardiovascular disease. This expansion dissolves the individual right to make health choices. Resistance to the biopower control requires rejecting state-mediated definitions of risk factors while simultaneously crafting a new concept of health and risk for oneself, as demonstrated in practices like skateboarding.

Works Cited

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Boas, Taylor C., and Jordan Gans-Morse. 2009. “Neoliberalism: From New Liberal Philosophy to Anti-Liberal Slogan.” Studies in Comparative International Development 44 (2): 137–61. https://doi.org/10.1007/s12116-009-9040-5.

Buchanan, Ian. 2010. “Biopower.” In Oxford Reference. Oxford University Press. https://www.oxfordreference.com/display/10.1093/oi/authority.20110803095507415.

Connelly, Maureen T., and Thomas S. Inui. 1998. “Principles of Disease Prevention.” In Harrison’s Principles of Internal Medicine, edited by Anthony S. Fauci, 14th ed. New York: McGraw-Hill.

Deleuze, Gilles. 1990. “Postscript on the Societies of Control.” In Negotiations, 1972-1990, translated by Martin Joughin, 177–82. New York: Columbia University Press.

Foucault, Michel. 2003. Society Must Be Defended. Translated by David Macey. New York: Picador.

———. 2009. Security, Territory, Population: Lectures at the Collège de France, 1977–78. Edited by Michel Senellart. Translated by Graham Burchell. Basingstoke and New York: Palgrave Macmillan.

Fox, Nick J. 2024. “Capitalism and the ‘Commercial Determinants of Health’: A More-than-Human Micropolitics.” Social Science and Medicine 350 (June). https://doi.org/10.1016/j.socscimed.2024.116925.

Lemke, Thomas. 2011. Biopolitics: An Advanced Introduction. . Translated by Eric Frederick Trump. New York: New York University Press.

Mill, John Stuart. 1991. “On Liberty.” In J.S. Mill’s On Liberty in Focus, edited by John Gray and G. W. Smith. London: Routledge.

Mills, Catherine. 2018. Biopolitics. Abingdon: Routledge.

Nadesan, Majia Holmer. 2018. Governmentality, Biopower, and Everyday Life. New York: Routledge.

Schaffer, Bill. 2016. “No One Standing above You: Rodney Mullen and the Ethics of Innovation.” In Skateboarding: Subcultures, Sites and Shifts, edited by Kara-Jane Lombard. London and New York: Routledge.

Shuman, Kristin M., and Michael C. Meyers. 2015. “Skateboarding Injuries: An Updated Review.” The Physician and Sportsmedicine 43 (3): 317–23.