Statistics and sovereignty: the workings of biopower in epidemiology

S ifting through recent public health literature, an urgent need and an intense enthusiasm for the opportunities of civil and vital registration become apparent (1Á3). Without intending to question the validity of the arguments calling for the improvement of civil registration in low-income countries, we want to take the opportunity to elucidate a critical perspective on registration-related issues, which draws on long-established debates in the social sciences. The national census performed in Uganda in August 2014 illustrates our first criticism. In line with international scientific and political arguments in favor of civil registration , the Ugandan government emphasized the great importance of robust data for budget allocation and (among other issues) health planning (4). The census was presented as a chance to update statistics and thus improve Uganda's position in discussions with international donors (5). However , while the enumerators were roaming the country, almost every day, national newspapers reported that people were trying to evade the census, with some even resorting to violent means to disturb enumeration (6, 7). A number of religious leaders who rejected the census for spiritual reasons were arrested and charged for sabotage, while the enumeration of their followers was enforced by armed police (8, 9). Clearly, not everybody was happy about being granted the right to be counted. From the perspective of a social scientist, this is by no means surprising. After all, considering the cultural appro-priateness of surveys as well as taking into account the possible misuses of registration data has been a topic of discussion in the biomedical literature (10). Meanwhile, our argument aims to make a more general point: we want to consider some of the implications which epidemiologic work carries with regard to the sociological notion of biopower. First made popular by Michel Foucault, the term bio-power defines those forms of power that aim to control, regulate, and monitor a population's biologic life and subject it to governmental interventions (11). The health of individuals and populations becomes a concern of politics. Taking a historical perspective as the starting point, Fou-cault contrasts power in the modern state to power in the premodern state, which considered the sporadic enforcement of unrestricted and arbitrary power as its right. The premodern sovereign's prerogative was death due to his right to take life (in the form of punishment, torture, or execution), but he did not have power over everyday life (12). In contrast, power in …