This study presents a qualitative analysis of some of the governmental rationalities that guide Vancouver Coastal Health's (VCH) service delivery in Vancouver's Downtown Eastside (DTES). High concentrations of urban poverty, illicit drug use, and protracted crises conditions in the area sustain a multitude of welfarist and medical interventions. How specific rationalities of care and variable power relations create conditions for the possibility of service operation in the area, ever-increasingly defined as a formalized space of population management, are investigated. Data employed in this analysis consists of interviews with 8 VCH directors and public domain policy documents. The topic is explored through the theoretical lens of biopolitical governmentality, whereby the affirmation of particular kinds of life-making strategies are understood as key elements in practices of governance, place-making and subject formation. Deficits in similar services in other locales throughout the city are identified to underserve communities outside the DTES. Contingent circumstance was shown to affect planned practices of governance. Bias in conceptualizations of harm reduction as public health measures to mitigate contagion risks have neglected mental health, undervalued housing as a therapeutic intervention, and underestimated the risks of a poisoned illicit drug supply. Further, essentialist or siloed thinking about practices of government and technologies of intervention are recognized to limit their efficacy.
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