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Abstract

While the academic literature on biopolitics has investigated how the life of the population and its biological capacities have increasingly become the target of political concern and intervention largely at the scale of the nation, the literature on nations and nationalism has explored nations as cultural-territorial units including questions of their emergence, ongoing production, and impacts. What these share is a similar if not nearly identical object of analysis: the nation or national population. These, however, are realms of scholarly debate that have largely, and quite surprisingly, bypassed one another. This paper advances the concept of biocultural nation making to bridge these debates and illustrate that nation making is at once biological and cultural-territorial and that these are deeply intertwined. We ground this in the experience of Canadian national parks, highlighting how “natural” environments like national parks are key sites of biocultural, and increasingly neoliberal, national production. Here, state conservation organizations promote park visitation as a means of, first, enabling an active, healthy, and economically productive national population. Second, parks are promoted on the grounds that they enable the experience of distinctively Canadian landscapes and places of national inclusion especially as park visitorship is expanded to include nontraditional visitors including immigrants, urban communities, and the youth. Parks, in short, have become vehicles of biocultural, and increasingly neoliberal, nation making. While there are indeed affirmative aspects to this, we also highlight hidden exclusions tied to the embrace of neoliberal logic, the limits of multiculturalism, and the ongoing erasure of Indigenous communities.

Keywords

Nation making biopolitics nations and nationalism national parks settler colonialism neoliberalism

Introduction

Debates on the rise, constitution, and impacts of nations have been heavily shaped by interventions in the fields of biopolitics, on one hand, and nations and nationalism, on the other. If the former has uncovered how life itself has become the target of political concern at the level of the population, the latter has addressed fundamental questions of the cultural-territorial constitution of nations including their emergence, ongoing production, and impacts. While they share a common if not identical object of analysis—the nation or national population—these debates have largely and quite surprisingly bypassed one another, missing an important opportunity to better understand the complex and interconnected facets of nation making. We advance the concept of biocultural nation making to bridge these debates and make sense of the fact that nation making is simultaneously biological and cultural-territorial and indeed that these intimately dovetail. We show that such practices are also increasingly neoliberal wherein interventions aim to produce a nation and national subjects that are economically productive, a move enabled by promoting national health. Especially in this time of intensifying and resurgent nationalism and growing biopolitical regulation of life, better grasping their intersections is timely. But rather than rejecting contemporary nation making as inherently regressive, we show its moral ambivalence.

We ground these insights in the case of Canadian national parks. Reflecting concerns over declining visitorship, national parks around the world have worked aggressively to expand visitation. In Canada, this has translated into state conservation organizations promoting visitation as a means of enabling an active, healthy, and economically productive national population and equally the experience of distinctively Canadian landscapes, which enable the production of national subjects and feelings of national belonging. The former works to create a biologically robust and economically productive national population, with the latter facilitating national inclusion and nation making on a cultural-territorial register especially by expanding park visitorship to include nontraditional visitors including immigrants, urban communities, and the youth as they commune with “Canadian nature.” Canada’s parks, in short, are vital places in which to nurture a healthy, industrious, and diverse yet unified national population. A focus on parks, in addition, allows us to examine the extent to which they may enable affirmative, inclusive forms of nation making.

We begin with a review of the literatures on biopolitics and nations and nationalism designed to introduce the debates to readers who may not be familiar with both. We build from here to further develop the concept of biocultural nation making, which we ground in the case of Canadian parks. We close by drawing attention to the more limiting and indeed concerning aspects of Canadian parks as biocultural national projects, including their embrace of neoliberal logic, the limits of multiculturalism, and the ongoing erasure of Indigenous communities. Our aim here is not to dismiss parks as tools of regressive nation making—especially in a global age of growing anti-immigrant and anti-environmental sentiments—but rather support possibilities for less exclusionary, more genuinely affirmative nation making.

Nations/nationalism and biopolitics: A long overdue meeting

Foucault introduced the concepts of biopower and biopolitics in his 1975–1976 lecture series Society Must Be Defended (2003) at the Collège de France and in the first volume of The History of Sexuality (1990 [1976]). Here, he describes the historical emergence of biopower as a gradual transition through which the sovereign right “to take life or let live” came to be complemented and permeated by the right to “make live or let die” (Foucault, 2003: 241). Due to population growth and capitalist industrialization, sovereign power was losing its grip on the individual and population and hence began to be supplemented by a new form of power. Termed biopower, its aim was not to extract from and extinguish life as with sovereign power but rather produce, maintain, and regulate life. Biopower came to operate at two interrelated scales: a first modification in the 17th and early 18th centuries was directed at the individual body by means of disciplinary surveillance and training. This was followed at the end of the 19th century by a move in which “the mechanisms [of power] are adjusted to phenomena of population, to the biological or biosociological processes characteristic of human masses” (Foucault, 2003: 249–250). In addition, this population was a national population, whether Germany, France, England, or Russia (Foucault, 1990 [1976]; Foucault, 2003). As Painter explains, “The emergence of biopolitics was thus intimately connected with the ongoing formation of the nation-state … The society that ‘must be defended’ is above all a national society” (2013: 1236). While more recent biopolitical scholarship has examined biopolitical interventions at different scales from the regional (Painter, 2013) and global (Braun, 2007) to the molecular (Rose, 2001; Waters, 2019), there is still a strong focus on the nation across these and the broader scholarship (e.g. Ibrahim and Howarth, 2019; Kotsila and Kallis, 2019). Biopolitics, in short, is an apparatus of power that takes the life of the (national) population and its vital qualities (of health, well-being, reproduction, etc.) as its object of intervention, regulation, and ultimately improvement.

Running along a parallel and largely nonintersecting line is the literature on nations and nationalism. Drawing from Smith’s (1991: 14) influential definition, a nation is “a named and self-defined community whose members cultivate common myths, memories, symbols and values, possess and disseminate a distinctive public culture, reside in and identify with a historic homeland, and create and disseminate common laws and shared customs.” In this sense, the nation is a cultural-territorial political body, with nationalism being the often-chauvinistic affiliation or attachment to this cultural-territorial unit. Here, the nation (i.e. the people or the population) conceptually bonds with the state (i.e. government) and territory (i.e. land and resources) to form nation-states, or what we colloquially refer to as countries. And even though there is no genuine nation-state—in the sense of a homogenous population represented by a singular government covering an unambiguous territory—these are the predominant building blocks of our contemporary political system (Antonsich, 2015; Özkırımlı, 2017). The literature hence investigates key questions concerning the emergence of nations as cultural-territorial units, their transformations and reproduction, who is included/excluded and on what grounds, and their related impacts.

While largely not in conversation, the debates on biopolitics and nations and nationalism importantly share a common object of analysis: the nation or national population. Beyond this, the fields similarly understand these objects as actively produced and explore vexing question of their moral worth.

The population/nation as produced

More than enabling a political intrusion into life, biopolitics for Foucault captures how the population itself—as a legible, manageable biological collective—emerged through these practices and related disciplines like statistics and demography, as these made it possible to visualize populations and identify their calculable regularities and deficiencies (Foucault, 2007; also see Curtis, 2002; Scott, 1998). The crux is that once the population could be known through advances in various disciplines, it could be governed to maximize its vitalities, capabilities, and potential. Moreover, these biopolitical interventions produce the population as a national population (Curtis 2002; Foucault, 2007), with such practices also productive of national (and subnational) subjectivities (e.g. Agarwal, 2005) and notions of national exceptionalism (e.g. Puar, 2017). The biopolitical reproduction of the nation is equally indispensable to the development of capitalism and its ongoing functioning: as the national population is adjusted, augmented, and reinforced, its members are rendered available and docile to capitalist relations enabling the exploitation of labor and circulation of capital (Foucault, 1990 [1976]: 140–141) both historically (Foucault, 1990 [1976]; Rose, 1999) and today (e.g. Krupar and Ehlers, 2017; Lin et al., 2018). In short, the population for Foucault is less a cultural-territorial “imagined community” that understands itself as a collective (see below) and more of a malleable, massified national collection with biological features and regularities. In addition, while Foucault’s work on biopolitics is rightfully critiqued for its tight focus on collective human life (Cavanagh, 2018; Luke, 2000; Rutherford, 2007), he did innovatively yet largely in passing grasp that biopolitical interventions require controlling human–environment relations including transforming the “geographical, climatic, or hydrographic environment” given that environmental factors impact human well-being (Foucault, 2003: 244--245; also see Foucault 1991; Wrigley, 2018). Biopolitics, in short, is a more-than-human enterprise.

Paralleling biopolitics, the nations and nationalisms literature similarly theorizes the nation as actively produced. Rejecting popular and scholarly perspectives that trace the roots or “essence” of nations back to a deep past (Smith, 1991, 2009; also see Özkırımlı, 2017), the more commonly embraced work of the modernists and social constructivists sees nations as distinctly modern constructions. This is most famously captured in Benedict Anderson’s contention that nations are “imagined communities” “because the members of even the smallest nation will never know most of their fellow-members, meet them, or even hear of them, yet in the minds of each lives the image of their communion” (2006: 6). It is precisely through this imagining of and affiliating with a national community that the nation comes into being and endures across time and space, stretching across a deep past, into a shared future, and across space as members of the nation come to feel attachment to an inherently limited or bounded territory (Anderson, 2006; Antonsich, 2015; Bhabha, 1990; Hobsbawm and Ranger, 1983; Özkırımlı, 2017). The nation as a cultural-territorial collective, in other words, does not pre-exist this national imagining and the related practices through which it emerges. And, as with biopolitics, the emergence and reproduction of the nation and capitalism are theorized as inseparably linked via, for example, print capitalism, agrarian rural-to-urban transformation, and uneven capitalist development (Anderson, 2006; Nairn, 1977; Özkırımlı, 2017). Even today, national subjects are groomed to be economically productive and hence good citizens who grease the wheels of their national economy, itself an act of nation making.

Given the shared understanding of nations as constructed, a central focus of the literature has been inquiry into how nations are reproduced and through what practices (e.g. Balibar, 1990; Billig, 1995; Brubaker, 2004; Calhoun, 1997). These range from symbolically charged celebrations of national independence, military campaigns, and populist nationalist rhetoric that creates an “us” and “them” to more hidden, everyday and even banal practices of flag-waving, census-taking, and map-making (Anderson, 2006; Billig, 1995; Edensor, 2002; Hobsbawm and Ranger, 1983). In this respect, scholars have chronicled the centrality of the more-than-human in nation making including the symbolic deployment of “nature” and “natural” landscapes that stand in for or embody the nation, its culture and values, its temporalities, and its space or territory (Braverman, 2019; Jones and Fowler, 2007; MacEachern, 2009). For instance, in the United States, it has been the unsettled, i.e. depopulated, lands captured in national parks like Yellowstone that ostensibly embody what is distinctively “American,” i.e. sturdy masculine individualism (Clark et al., 2020; Cronon, 1995; Stinson, 2017). And in Canada it has been the vast, rugged, and explicitly nonurban lands of the “Great White North” and related notions of Canadian wilderness that play this role (Kobayashi et al., 2011; Mackey, 1999; Shields, 1991; Youdelis et al., 2020).¹ Indeed, these iconic landscapes enable the feeling that nations share a common time and space as they allow for members who do not and cannot know one another to experience and affiliate with symbolic landscapes that embody national culture and a common past, present, and future (Anderson, 2006; Edensor, 2002). We show below how these broader crosscutting debates on biopolitics and nations and nationalisms inform how nations are actively produced as joint biological-cultural units.

The good and bad of nations/national populations

If debates on biopolitics and nations and nationalisms both see the nation/national population as produced, they also engage in parallel debates on the moral standing of such production. Scholars have paid substantial attention to the deadly or let die side of biopolitics (Agamben, 1998; Foucault, 2003; Mbembe, 2003). For instance, even modern states that derive their legitimacy in protecting and advancing the interests of their inhabitants have turned deadly on subsets of these peoples—and certainly on “outsiders”—routinely in the name of protecting the broader population, its health, and general well-being (Agamben, 1998; Doty, 2011; Foucault, 2003; Mbembe, 2003). Biopolitical investigations into settler colonialism have added that such necropolitical moves aimed at annihilating Indigenous groups enable the initial and ongoing development of colonial nation-states (Belcourt, 2017; Brodie, 2012; Morgensen, 2011; also see Mbembe, 2003). Others, however, have stressed that overemphasizing this exclusionary and even deadly side misses the life-affirming potential of biopolitics where populations are formed, cared for, and optimized (Esposito, 2013; Hannah, 2011; Hardt and Negri, 2004; Rabinow and Rose, 2006). Here, attention shifts to practices of public health, education, and other commitments to protecting group vitality. Still others draw attention to the limits of more progressive forms of biopolitics even as they promote well-being (Krupar and Ehlers, 2017; Lin et al., 2018), insisting a truly affirmative biopolitics is a more radical endeavor that actively opposes authoritarian forces interpreting aspects of the collective or individual bodies as dangers that require “immunization” or eradication and subsequently seek to dominate life processes (Esposito, 2008). A genuinely affirmative biopolitics emerges as a power of life rather than power over life (Esposito, 2008), a “horizon of meaning … in which life would no longer be the object but somehow the subject of politics” (Esposito, 2013: 87).

Debates on nations and nationalisms similarly grapple with the question of moral worth, with much of this spinning on distinctions between ethnic and civic. With ethnic nations, national belonging is generally criticized as exclusionary given that belonging is rooted in common descent and hence factors like race, ethnicity, and blood (Antonsich, 2015; Smith, 1991). The recent concern over the resurrection of populist movements, especially deeply racist ethno-nationalism like Trump’s Make America Great Again and Brexit, fits here (Gusterson, 2017). Civic nations, in contrast, are typically seen as more inclusive as they base national belonging in shared values and culture (Antonsich, 2015; Brubaker, 2004). However, the division between civic and ethnic is blurry with all nations containing elements of each (Antonsich, 2015). Even multiculturalism, with its embrace of difference as core to nation making and national cohesion, has been criticized for merely taming, containing, and depoliticizing difference (Kobayashi et al., 2011). More broadly, while some critics routinely write off nations as inherently regressive and ultimately exclusionary (e.g. Billig, 1995), others see them as enabling civic engagement, care for others, and the building of inclusive populations (Brubaker, 2004: also see Antonsich, 2015). Offering a third path, Nairn (1977: 348) sees nations as morally and politically ambiguous with all having the seeds of both progress and regress (also see Anderson, 2006; Bhabha, 1990; Painter, 2013). In other words, it is how nations are reproduced and deployed that matters. We take this more ambivalent approach seen here and in debates on biopolitics in our analysis of nations as joint biological-cultural productions.

Biocultural nation making

Despite their close parallels, the literatures on biopolitics and nations/nationalisms have continued along mostly separate paths, with the former focused on intervention into the biological or vital aspects of the national population and the latter on the cultural-territorial. Even while they engage with the debates on biopolitics almost entirely to the exclusion of nations and nationalism, several lines of investigation have begun to shed light on their intersections.

First, several studies in medical anthropology have coined the term bionationalism to highlight how national health projects simultaneously build a healthy population and national identity and culture. This is the case with state-sponsored high-tech interventions involving stem-cell manipulation (Gottweis and Kim, 2010), low-tech practices of traditional medicine (Wahlberg, 2009), and broader measures to improve the quality of the population especially as a labor force (Greenhalgh, 2009). Reinforcing the latter, bionationalism for Wahlberg “relates to different forms of practice which aim at strengthening the collective vitality of a nation state – as regards its population, culture, economy and ecology – as a matter of competition … as compared to other nations” (2009: 343–344, italics in original). Other examples of bionationalist projects include eugenics programs, selective immigration policies, and “new public health” campaigns (Wahlberg, 2009). Moving in a different direction, work on the biopolitics of settler colonialism has shown how the attempted biopolitical annihilation of Indigenous nations through genocide and ongoing abandonment—e.g. “dumping biological risk” onto reserves in the form of health disparities (Belcourt, 2017)—enable settler colonial nation making by freeing up land and hence territory on which the colonial nation-state can take root (Brodie, 2012; Morgensen, 2011). More than this, in a liberal multicultural nation-state like Canada, settler colonial identity and institutions then recognize, accommodate, and even embrace Indigenous groups as part of the “inclusive” nation-state but do so on their own exclusionary, asymmetrical terms (Brodie, 2012; Morgensen, 2011), underscoring a perverse politics of recognition (Coulthard, 2014). Additionally, Biermann’s (2016) work draws in more-than-human nature to show how biopolitical anxieties over the iconic American chestnut tree mask anxieties over the changing racial-cultural-environmental constitution of the nation. While not their main focus, these interventions show that nation making happens on both biopolitical and cultural-territorial registers. Building upon these insights, our aim is to develop a broader understanding of nation making as simultaneously and interconnectedly biological and cultural-territorial. This enables a more explicit bringing together of the fields of biopolitics and nations/nationalisms and a better understanding the complexities and dynamics of nation making. We now ground this in the case of Canadian national parks.

Canadian parks as vehicles of biocultural nation making

A brief history of Canadian parks

The emergence of Canada’s national parks can be traced back to the Progressive Era of the late 1800s, a period characterized by growing concern for the rational use and preservation of nature, often anti-modern and anti-urban sentiment, and appreciation of the healing properties of nature (Lieffers, 2013; Sandlos, 2013; Tyrrell, 2012). The earliest parks, like the iconic Banff, emerged from this context and were promoted by the Canadian Pacific Railway and the Canadian government to encourage tourism and generate profit where visitors could escape the urban-industrial cities of the East and find leisure and adventure in the mountains of the West (Campbell, 2011; Mortimer-Sandilands, 2009; Sandlos, 2011). Less well recognized, the early parks can also be traced back to a growing appreciation for the health benefits of nature. The early development of Banff was shaped by 19th-century health theories and spa culture that saw healing properties in the hot springs and surrounding environment (Johnson, 1975; Lieffers, 2013). Importantly, the creation of parks as spaces of leisure, adventure, health, colonial consolidation, and capital accumulation went hand in hand with processes of Indigenous displacement and elimination as parks were carved out of Indigenous territory (MacLaren, 2011; Sandlos, 2013; Youdelis, 2016, 2019).

Parks as vehicles of (Euro-Canadian) nation making did not arrive until the interwar period, which saw the dramatic eastward expansion of the park system through the Prairie Provinces and into the forests and waterways of Ontario and Quebec. This expansion “was an act of rationalized nationalism” through which a chain of landscapes reconceived as icons of national natures with relatively identical meanings were instituted across the country. Parks were designed to preserve Canadian landscapes, understood as such, and ensure a patriotic sense of pride and belonging through recognition with these landscapes (Mortimer-Sandilands, 2009: 169). The hope was that as visitors entered these spaces, they would be able to commune with Canadian nature, which would educate and embrace them as national subjects. Articulating with this role in nation making, parks in the interwar period were also promoted on the grounds they enabled national health. As J.B. Harkin, Canada’s first Commissioner of National Parks, explained in 1915, “The most important service which the parks render is in the matter of helping to make Canadian people physically fit, mentally efficient, and morally elevated” (quoted in Mortimer-Sandilands, 2009: 169), a benefit that would also facilitate the nation’s economic security “by adding to the efficiency and vitality of the nation” (Rettie, 2017: 8).

Reflecting the strengthening environmental movement of the post-WWII period, the focus of park management shifted once more, this time to protecting ecosystems and habitats. This was reinforced in later decades by the adoption of a primary commitment of protecting ecological integrity (Mortimer-Sandilands, 2009), but the other rationales never disappeared. Throughout this history, the justifications for designating, expanding, and protecting parks have encompassed colonial state-building, nation making, health and wellness, capital accumulation, and ecological protection, with the relative emphasis of each shaped by the political-economic-cultural climate of the day.

The neoliberalization of Parks Canada: Enhancing the visitor experience

The period since 2005 has been a time of significant challenges and change for Parks Canada, the agency that oversees the country’s system of national parks. Stephen Harper’s Conservative government (2006–2015) prioritized fossil fuel extraction and positioning Canada as an international energy superpower (Peyton and Franks, 2016). This led to a relaxing of environmental regulations and funding cuts for scientific research and environmental protection, with Parks Canada’s budget cut by over $50 million (Rettie, 2017). In addition, parks faced declining visitation, with visitor numbers falling by 15.2% from 1995 to 2007 even while the Canadian population grew (Shultis and More, 2011). In response, Parks Canada has worked to improve visitor numbers in large part through a renewed focus on tourism, marketing, and attending to what has become known as the “enhanced visitor experience” (Jager and Sanche, 2010; Rettie, 2009; Youdelis, 2019).

Critics of this policy shift have interpreted it as a neoliberal prioritization of tourism revenue at the expense of the environmental and nation building functions of parks (CPAWS, 2016; Rettie, 2009, 2017; Youdelis, 2019). Rettie (2009: 72) states, for instance, that these changes demonstrate that Canadian national parks are “under pressure to cease being sites of nationhood and natural beauty, and start being businesses.” Others have argued that the prioritization of visitation has been driven by a neoliberal commitment to austerity, small government, lower taxes, privatization, and market mechanisms (Shultis and More, 2011; Youdelis, 2019). While these criticisms indeed have merit, they overlook the extent to which Canadian parks are being re-presented as sites where national attachments are forged and through which a biologically and culturally robust, not to mention economically productive, population is fostered, both of which are intricately tied to the drive to increase visitor numbers. To make sense of this, we break apart how Parks Canada found itself with a “population problem” responsible for declining visitorship—but at a deeper level a problem ostensibly tied to declining national health and cultural belonging—and subsequently hence how the organization worked to Connect Canadians to Nature as a population-based solution.

Biocultural nation making through parks: Connecting Canadians to Nature The (population) problem: Nature deficit disorder and changing demographics

Decline in park visitation has been coincident with economic recession, social instability after 11 September 2001, and at times the high value of the Canadian dollar, which made visitation to foreign parks more attractive (Wright and Matthews, 2014). Research has also traced the decline back to two related phenomena that Parks Canada would have more power to address: nature deficit disorder (NDD) and changing demographics. On this front, Parks Canada found itself with a population problem.

In the early 2000s, concern over widespread declines in park visitation around the world spurred a wave of research examining the causes of what came to be interpreted as a growing social disconnection from the natural world (Pergams and Zaradic, 2006, 2008). This field of research was widely popularized by Richard Louv in his bestselling book Last Child in the Woods (2005) where he coined the term “nature deficit disorder.” Here, Louv likens NDD to the medical condition attention deficit disorder (ADD) and claims that alienation of people, and particularly children, from nature results in a wide range of problems including dulled senses, behavioral difficulties, obesity, stress, declining academic performance, and decreased emotional and physical well-being. While the premise of the NDD concept has been criticized (Dickinson, 2013; Fletcher, 2017), the discourse of NDD was widely adopted by parks agencies around the world, including in Canada and the United States, as it served to buttress the reframing of parks as important sites of health promotion (Shultis and More, 2011).

While NDD is referenced routinely by Parks Canada staff (e.g. Jager and Halpenny, 2012; Jager and Sanche, 2010; Latourelle quoted in Canadian Geographic, 2011), a particularly telling example is found in the 2014 report Connecting Canadians with Nature: An Investment in the Wellbeing of our Citizens (Parks Canada, 2014). The report begins with a recognition that a disconnect with nature, and by association Canada’s parks, has emerged from and reinforces sedentary lifestyles that privilege modern convenience and technology at the expense of health. This has led to high blood pressure, obesity, and other ailments often recognized as “lifestyle diseases.” Not merely a problem facing discrete individuals, this is a matter of national health: obesity is a national epidemic affecting one in four Canadians, obesity and other related diseases are shortening lives and leading to lower quality lives, these diseases along with stress and anxiety are overtaxing the country’s generous healthcare system and leading to lost productivity, and Canadian children are overmedicated with behavior-modifying drugs for conditions like ADD. In short, this is a biopolitical crisis, one in which the vitality—both physical and economic health—of the population is under threat. By extension, the biopolitical health of the natural environment is also facing undue pressure: sedentary lifestyles, especially indoors and in front of screens, means that children lack exposure to nature and possibilities of “nurturing environmental ethics.” Within this context, “[o]nce our children become adults, how will the next generation of Canadian children learn to love nature, understand our reliance on it, and actively care for it over time?” (Parks Canada, 2014: 21).

Parks Canada and other conservation organizations also traced declining visitorship back to a deeper cultural problem, one tied to NDD. This begins with Parks Canada’s understanding, as laid out in its 2005/2006–2009/2010 corporate plan, that “Experiences gained through visits to well-conserved and accessible national parks … leave visitors with a clear and strong sense of connection to nature and history, adding to the well-being and health of Canadians” (Parks Canada, 2005: 47; emphasis added). Of concern here is the fear that this connection will be lost when fewer Canadians visit the parks and hence lose out on opportunities to develop “ties with the land that are centuries old” (Parks Canada, 2014: i; also see Sullivan, 2015). This is the second half of Parks Canada’s population problem: a cultural disconnection from distinctively “Canadian landscapes” as sites of national belonging and nation making.

The problem ties back to concerns over Parks Canada’s changing constituency and the country’s broader shifting demographic makeup. Parks Canada’s core constituency—middle class, predominately white Canadians—has been aging, less able to participate in nature-based recreation, and is increasingly less representative of the overall population (Parks Canada, 2012; also see Jager and Halpenny, 2012). Making matters worse, Parks Canada polling data from 2003 indicated a decline in the importance Canadians placed on national parks relative to other national symbols (Parks Canada, 2004). An equally vexing challenge—and later we will see what amounts to a remarkable opportunity—was to be found in the country’s changing demographics. As we are told in a report that seems to leap from the pages of the nation making literature: “Canada’s natural environment has been a unifying feature of the country’s cultural identity for centuries. … National parks are one of the top … symbols of Canadian identity.” The report then adds a twist:

Canada’s social dynamic is undergoing change, blossoming into a rich multicultural society with a diverse mix of views, perceptions, and experiences with nature. How will future generations engage with nature and integrate it into an expression of their newfound cultural identity? (Parks Canada, 2014: 15)

We are then told: “Although Canada’s natural environment is often touted as a unifying symbol of national identity, for many of the country’s first and second generation Canadians, Canadian nature can be a wild and frightening place” (Parks Canada, 2014: 6). While Parks Canada is supportive of immigration in general, the fear here is that New Canadians do not have the same view or appreciation of Canadian nature and so miss important opportunities for supporting parks, necessary for their financial viability, and for national belonging (also see Jager and Halpenny, 2012; Jager and Sanche, 2010; Parks Canada, 2008).

Drawing a link with NDD, urban Canadians and youth, as those who tend to suffer most from NDD, are also at risk for missing out on the experience of nation making afforded by parks (Parks Canada, 2014). In the words of Parks Canada’s then CEO Alan Latourelle:

Connecting Canadians to nature and history, broadly speaking, is still a challenge. And it is becoming more and more of a challenge because of leisure‐time limitations that people have. People refer to a nature deficit and a history deficit in the younger generations, so we are working with young Canadians, one of our key audiences, to really connect them with the stories of Canada and the magnificent places of Canada. (Canadian Geographic, 2011)

Similarly, in their review of Parks Canada’s Visitor Experience program, Parks Canada staff also explicitly link the program’s origin to the need to address this growing (Canadian) history and nature deficit tied to increased urbanization, immigration, and an aging population (Jager and Halpenny, 2012; Jager and Sanche, 2010).

In short, Parks Canada and related conservation organizations found themselves facing not merely the challenge of declining visitorship but a deeper population problem responsible for this decline, one tied to NDD and changing demographics. In biopolitical terms, Parks Canada began to identify deficient or risky segments of the population (Rose, 2001): those with NDD along with new, young, and urban Canadians, with significant overlap between these. These populations certainly harm the economic viability of parks by not visiting but also harbor deeper biocultural threats relating to the declining physical and cultural health of the nation.

The (population) solution: Connecting Canadians to Nature in Canadian national parks

In order to address these growing concerns, Parks Canada began to shift its policies and programs to emphasize an “enhanced visitor experience” mentioned earlier. This is a core component of a broader project to “Connect Canadians with Nature,” itself part of a global Healthy Parks Healthy People (HPHP) initiative. Before diving into the details of what this enhanced visitor experience looked like in practice and the type of solutions it afforded, let us provide some context regarding the larger global discourse out of which it emerged and came to be applied in Canadian parks.

In 2000, Parks Victoria (Australia), in collaboration with Deakin University, launched an HPHP initiative to encourage the connections between a healthy environment and healthy society and began by compiling a literature review of research that linked nature to human health (Maller et al., 2002). Since 2000, the HPHP framework, which is inseparable from discourses around NDD, has been widely adopted and become a dominant paradigm in park management around the world (Romagosa et al., 2015). In 2005, the Canadian Parks Council (CPC)—an umbrella organization representing national, provincial, and territorial parks in Canada—set out to develop its own HPHP initiative and adapt it to the Canadian context (Canadian Parks Council, 2006). This move also reflected Canada’s Health Ministers' parallel decision to develop their own Healthy Living Strategy, aimed at

improv[ing] the health of Canadians by supporting them in making positive health choices. It is founded on a population health approach, which recognizes that healthy behaviours are strongly influenced by the social, economic and physical environments where Canadians live, work, learn and play. (Canadian Parks Council, 2006: 1)

Commenting on the opportunity provided by the Healthy Living Strategy to Canadian parks, CPC explained:

Emphasis on health is on the upswing and Canadians love their parks. The link is a natural one and park agencies throughout Canada have a tremendous opportunity – individually and collectively – to reposition parks as an integral facet of a healthy population. (Canadian Parks Council, 2006: 2)

Then, in its Board Meeting in Inuvik on 9 August 2005, the CPC, with Parks Canada as a core member, announced their “made in Canada” HPHP initiative called Healthy by Nature. The program, emerging in response to concern over national health but also declining park visitorship, was envisioned as a communications and marketing campaign designed to encourage Canadians to visit and connect with natural areas with the national parks playing a pivotal role (Canadian Parks Council, 2006).

This was joined by Parks Canada’s creation of a Visitor Experience Directorate, also in 2005, tasked with creating a robust slate of fresh visitor opportunities to attract new visitors and stem visitation decline. Emerging from the Directorate, Parks Canada recognized, in good biopolitical fashion, that to make these changes viable and attractive, it would first need to better understand the population. So it began to fund social science research to better understand the country’s changing demographics and “the motives, values, and interests of visitors and non-visitors” (Parks Canada, 2012: 22). This was made possible by sophisticated market analysis tools including the Explorer Quotient (EQ) Toolkit and the PRIZM-C2 tool (Parks Canada, 2018b; Rettie, 2009). As explained by Parks Canada,

To engage the next generation of Canadians in their natural and cultural heritage, Parks Canada must use modern market analysis and social science to design and offer new and innovative visitor experiences and use new approaches to promotion to reach new audiences. (Parks Canada, 2018b)

In response to these assessments, Parks Canada was then able to design and implement the new initiatives to connect Canadians, now better understood, with their parks. These included Learn to Camp programs, oTENTik tents, the development of the Rouge National Urban Park, cultural events like citizenship ceremonies, and other opportunities to increase physical activity ranging from hiking to horseback riding. While the explicit goal of this new programming was to increase visitorship, at a deeper level, these initiatives were directed at seemingly risky populations to enable biocultural forms of nation making through the parks. Let us explain.

On the cultural front, the new programming was designed to enable a deeper sense of affiliation with the Canadian nation. Central to this was Parks Canada’s development of the 62.9 sq. km. Rouge National Urban Park to enable easy visitorship for the Greater Toronto Area’s 7 million people (Parks Canada, 2020b). As Sandilands (2013: 99) explains, the Rouge is “part of a nationalist nature pedagogy” in which “nationalist understanding of nature is still strongly invoked … in order to position the Rouge as a sort of beginners’ wilderness, the experience of which on a day trip will eventually lure Toronto’s urban masses to the more authentically wild, ‘storied’ places of Parks Canada’s historical reputation.” In other words, if it is difficult to bring an increasingly urban and potentially disinterested population into the parks to expand nation making opportunities, then bring a park to the city. Parks Canada also developed novel oTENTik tents, which are a hybrid of a tent and rustic cabin designed to appeal to a more diverse Canadian population looking for a less traditional camping experience (Parks Canada, 2017a). Their name celebrates Canada’s bilingual multiculturalism with the clever neologism anchored by the English “tent” yet pronounced like the French authentique, meaning “authentic,” suggestively offering authentic experiences of nature and nation.

Core to the enhanced visitor experience is Parks Canada’s Learn to Camp program. Offered across the country including in Rouge, Learn to Camp is designed to provide inexperienced campers with the knowledge, skills, and confidence to enjoy the outdoors and reap the physical and mental health benefits of connecting with nature (Parks Canada, 2020a). But as Sullivan (2015) found through an ethnographic study of the program, it promotes and reinforces particular notions of “Canadianess” as it directs new Canadians to have distinctively Canadian experiences within Canadian landscapes. Learn to Camp therefore promotes and reinforces a particular model of Canadian subjectivity that accords with a white, Euro-American wilderness ethic (also see Kobayashi et al., 2011).

Additional projects aimed at forging cultural connections through parks include free one-year passes for recent immigrants or “New Canadians,” and Parks Canada is even performing citizenship ceremonies within parks and national historic areas (Parks Canada, 2018a). The symbolism could not be more profound; here parks literally become sites in which new members of the nation are brought into being. Children under 18 are also given free admission to national parks, with the goal of “creat[ing] a future generation of stewards for Canada’s natural and cultural heritage.” In terms of nation making, Minister of Environment and Climate Change Catherine McKenna elaborates: “These youth and new Canadian initiatives [including free entry and citizenship ceremonies in parks] are helping to build the stewards of tomorrow” (Parks Canada, 2018a: 2). In short, these projects enable a new generation of Canadians to help safeguard and protect their national parks, in the process bringing the nation and its iconic, storied landscapes into the future.

These examples further underscore the temporality and territoriality of nation making. Connecting Canadians to Nature through the enhanced visitor experience works to generate a sense of national attachment by having visitors identify with particular natural landscapes as stand-ins for the country and its territory, reflecting a core insight of the nations and nationalism literature (e.g. Edensor, 2002). Through identifying with these spaces rendered nationally symbolic, visitors can connect to nation through its essence and history. Visitors are also invited to connect with the nation’s present by communing with other national subjects in these spaces, as well as the nation’s future, for instance, as environmental stewards of the parks (e.g. Anderson, 2006). To summarize the importance of these places for nation making—and why it is important to target seemingly risky populations and bring them into these places—we can cite Parks Canada’s vision statement: “Canada’s treasured natural and historic places will be a living legacy, connecting hearts and minds to a stronger, deeper understanding of the very essence of Canada” (Parks Canada, 2017a).

If these projects to Connect Canadians to Nature improve the nation culturally, they do so biologically as well as they aim to get the sedentary Canadian population suffering from NDD off the couch and into parks. Hence, other core activities of the enhanced visitor experience include horseback riding, zip lines, paragliding, hiking, cross-country skiing, snow shoeing, geo-caching, and mountain biking, all aimed at enhancing physical activity (Jager and Halpenny, 2012; Jager and Sanche, 2010). In addition, as Sullivan (2015: 44) discovered with Learn to Camp programs,

Park staff expressed that combatting nature deficit disorder [by getting participants active and outside] is one of the greatest benefits coming out of Learn to Camp. In particular, staff commented that new Canadians in urban cities might be more inclined to experience NDD due to feelings of isolation. (Sullivan, 2015: 44)

More broadly, getting Canadians into parks, and in turn creating a biologically robust nation, also solves an economic problem and does so in a starkly neoliberal way. We see this explicitly in a CPC report cowritten with Parks Canada:

Canada is facing complex social challenges that will strain the public purse, be a lag on economic growth, and challenge the country’s enviable socio-economic position on the world stage. Connecting Canadians to nature through their parks, locally and nationally, is a critical component in addressing these challenges in the decades to come. We need to curb the escalating costs of health care associated with sedentary lifestyles — Canada’s parks have an important role to play in outdoor recreation and active living. We need to stimulate a strong economy that provides good jobs and fosters innovation for long-term benefit — Canada’s parks are economic generators for hundreds of communities from coast to coast. We need to develop safe inclusive communities that stabilize public safety costs — Canada’s parks help foster social capital, acting as focal points for community life and pride. We need to lead by example and invest in the physical and emotional development of our children — Canada’s parks are natural classrooms, nurturing creativity, skills development and personal resilience. (Parks Canada, 2014: 4)

Here, park visitation enables a healthy population that is physically and mentally fit, avoiding obesity, heart disease, and diabetes, and in so doing economically benefits the nation. This links back to earlier rationales for expanding Canada’s park system in the interwar period. Here, Nation making during this time happened not only on a cultural-territorial front by facilitating attachments to iconic landscapes but also on a biological register by promoting national health and, through this, economic productivity and national economic health. In short, contemporary biocultural nation making through parks has a long lineage.

This linking of health and economic productivity also parallels other forms of neoliberal biopolitics (Krupar and Ehlers, 2017; Lin et al., 2018). Here, an obese sedentary population is less productive and innovative than a fit population, leaving Canada less economically competitive on the world stage. These lifestyle diseases also overburden the country’s public health care system, which is costly to the economy and the nation’s physical health as less support is available to treat other ailments. And to the extent that a robust universal healthcare system is one of the defining features of Canada, sedentary lifestyles attack the nation at this level as well, so both at its physical health and well-being and global reputation in the eyes of other nations. Here, neoliberal dictates demand the production of biologically healthy and thereby economically productive members of the nation. To draw on the words of Wahlberg (2009: 343–344), this “strengthen[s] the collective vitality of the nation-state … as a matter of competition.”

What this also shows is that these interventions are not merely neoliberal in a cost-cutting/revenue-generating way. The mainstream critique of Parks Canada’s transformation as neoliberal draws from a neo-Marxist reading whereby neoliberalism is an ideological smokescreen concealing an economic project of accumulation by dispossession aimed to employ free-market policies for private appropriation of the commons (CPAWS, 2016; Rettie, 2009, 2017; Shultis and More, 2011; Youdelis, 2019). What the focus on parks as vehicles of nation making shows, however, is that the neoliberalization in question amounts to far more than austerity, budget cuts, and privatization. It includes a fundamental discursive repositioning of parks as key to the economic health and vitality of the Canadian nation. It is instructive here to return to Foucault who, in addition to promoting economic growth as a core logic, describes neoliberal governmentality as operating through the construction and manipulation of environmental incentive structures within which individuals, understood as self-interested rational actors, make decisions among alternative courses of action (Foucault, 2008; also see Fletcher, 2010). Thus, while classical laissez-faire liberalism posited free market subjects with rights and interests that should not be interfered with by governments, neoliberal rationality frames the choices of economic-rational subjects as points of intervention that can be influenced through the manipulation of incentives in order to shape human conduct in desired ways (Fletcher, 2010; Stinson, 2017). What the analysis above shows is that the transformation of Parks Canada including an increased focus on attracting visitors and/through an enhanced visitor experience is neoliberal; but core to this is the rational attempt to govern and shape the behavior of Canadian citizens and bring them into the nation, doing so in a particularly physically active and economically productive way. In short, the neoliberalization of Parks Canada has been articulated within and through a biocultural reframing of parks as sites key to maintaining the health and vitality of the Canadian nation.

Stepping back, Connecting Canadians with Nature, supported by an enhanced visitor experience, has been instituted to increase park visitorship and revenue, which is important for the viability of parks. But, at a deeper level, the project enables and promotes nation making that simultaneously targets the cultural-territorial and biological aspects of the nation. These interventions amount not to a negative biopolitics aiming to eliminate or constrain underrepresented visitor groups to improve the overall health of the population, but rather target them through affirmative intervention. In biopolitical terms, Parks Canada began to identify deficient or risky segments of the population understood to be particularly susceptible to NDD—namely new, young, and urban Canadians—and target them for improvement (Rose, 2001). Such intervention facilitated nation making that is at once cultural-territorial, biopolitical, and increasingly neoliberal.

The possibilities and limits of affirmative biocultural nation making

In many ways, Connecting Canadians to Nature is an affirmative form of nation making, both biopolitically and cultural-territorially, reinforcing the point that nation making more generally is not inherently exclusionary but can be life-affirming. This is particularly welcome in light of the populist anti-immigrant and increasingly violent anti-regulation and anti-conservation agendas and related profound loss of biodiversity we see unfolding globally. We support conservation on ecological grounds and efforts to get folks outside and into greenspaces. We also applaud Parks Canada’s efforts to make protected areas more inclusive to reflect the changing demographics of an ever-more diverse Canada. Canada never was the Great White North, and it certainly is not today. Even if this commitment to diversify park visitorship emerged initially out of economic necessity, the end result is a welcome change from previous exclusionary and even white-supremacist understandings of conservation, including the very rise of the Western conservation movement (Kashwan, 2020). In many ways, Parks Canada’s commitment to diversifying visitorship is precisely the type of nation-making project we support. But, in the spirit of realizing a truly life-affirming nation making, it is necessary to examine the limits of Parks Canada’s approach, which sheds light on the broader limits and possibilities of affirmative nation-making interventions.

First, reflecting its neoliberal commitments, Connecting Canadians to Nature is a relatively technical and anti-political fix to addressing the alienation and ill-health experienced by Canadians. We may momentarily escape this through a walk in nature, and this is appreciated. The problem is that we are left to return to our alienation at the end of our trip, and certainly this is alienation felt more acutely by some members of the nation than others (also see Dickinson, 2013; Fletcher, 2017). This also underscores Cronon’s (1995) concern regarding the “trouble with wilderness” in which visiting wilderness as an escape distracts us from valuing and improving the human–environment relations of our everyday lives. To truly stem this alienation and develop healthier and more just human–environment relations, we must address what threatens these, what we see as an intensifying system of capital accumulation, related austerity measures, and erosion of economic safety nets and environmental protections. Such recognition additionally stands in sharp relief to the call to support parks and nature because they make us more productive members of the nation. Related, in its vision to create a robust biological-cultural nation, Connecting Canadians to Nature does not address the socio-economic factors, including cost and poverty, preventing people from accessing nature in the first place (also see Stevens et al., 2014). And even if park entry is free for the youth and new Canadians, there is still the issue of adequate time off and the cost of travel and other park-related fees for accommodation and growing for-pay programming including quite expensive private/privatized programming (see, for instance, Youdelis, 2018). Hence, targeting “risky” populations may not pan out if the understanding of risk mistakenly treats connection to nature as a matter of interest rather than possibility.

And then there are the limits of multiculturalism. Connecting Canadians to Nature through an enhanced visitor experience reinforces exclusionary forms of nation making. As Sullivan (2015) points out in her analysis of Learn to Camp, participants, who are almost entirely new immigrants, appreciated their new skills and felt a better connection to the Canadian landscape and culture. Nonetheless, the type of nation making in question reflects Euro-Canadian ways of knowing and being within national parks (also see Sandilands, 2013). The same critique can be made of the other visitor experience projects that similarly reproduce a European-Canadian aesthetic, reflecting a larger critique that multiculturalism can dangerously contain difference rather than embrace it as a needed challenge to exclusionary nation making (Kobayashi et al., 2011). What is more, assumptions that immigrants can be a threat to Canada’s historic European heritage, especially by opting out of it, are deeply problematic. But this need not be the case. Minister of Environment Catherine McKenna hints at this in a speech highlighting efforts to get New Canadians into parks: “In Canada, we are fortunate to have natural and cultural landscapes as diverse as the citizens that call it home” (IFCC, 2018). While work needs to be done, McKenna’s words, along with projects like the Parks for All Initiative (Parks Canada, 2017b), show it may be possible to rewrite Canada’s national parks as spaces of national belonging and reproduction for all Canadians in all their diversity, upending the racist myth of the Great White North.

Finally, the affirmative nation making of Connecting Canadians to Nature rests on a deeper exclusion. Here, the privilege of being in many of Canada’s protected areas has been made possible by the prior and ongoing displacement of Indigenous peoples, especially in the older and more nationally iconic parks like Jasper and Banff (Campbell, 2011; MacLaren, 2011; Youdelis, 2016, 2019). This is a key feature of how nations were created and continue to operate in the context of settler colonialism. As white settlers ourselves, our ability to reconnect with nature through parks, have a healthy body mass index and blood pressure, be happy, be part of the Canadian nation in a deeply symbolic space, and then return refreshed to our economically productive lives is largely enabled by Indigenous expulsion. Emerging from pressure from Indigenous communities and a larger commitment to reconciliation, Parks Canada is working in earnest to address this (Parks Canada, 2015, 2017b), for example, through new parks run in partnership with Indigenous communities such as the Thaidene Nëné National Park Reserve in the Northwest Territories (Parks Canada, 2019). These and other commitments are most welcome and will be key to a truly affirmative nation making within and beyond protected areas. Notwithstanding these improvements, there must be greater space for Indigenous voices, perspective, and critiques into what protected areas in what is today Canada should look like, who they should serve, how they should be managed (ICE, 2018), and indeed whether they should play a role in optimizing what is essentially a settler nation.

Returning to broader debates on affirmative biopolitics, what these exclusions show is that a truly affirmative nation making must be aware of and reject efforts to enhance the life of (segments of) the population by continuing to exclude others. At issue is not only how efforts to optimize and vitalize populations happen through “immunizing” or excluding others (e.g. Esposito, 2008) but also how the exclusion of Indigenous groups becomes a precondition to the health and well-being of the larger settler population, in this case by freeing up land and resources that then enable opportunities for settler health. In the case of a settler nation like Canada, moving forward requires recognizing this relationship along with detethering historic notions of Euro-Canadian belonging from the country’s parks and other spaces rendered as nationally iconic. These landscapes, what they represent, who they embrace, whose histories and experiences they acknowledge and celebrate, and legal structures dictating who has decision-making capacity and even recognized land rights need to be revised. More broadly, there is a real possibility that settler nation making, even as it aims to be more inclusive may be fundamentally incompatible with a truly affirmative biopolitical project.² Drawing on a rich tradition of Indigenous thought and scholarship, such a project may need to embrace at its core notions of Indigenous sovereignty along with radically different notions of health, well-being, and relation to the more-than-human world (Carroll, 2014; Simpson, 2017; TallBear, 2019). Despite genuine efforts made by Parks Canada to be more inclusive, it is Indigenous nations and not state institutions who can decide whether a truly affirmative biocultural nation making is possible through Canada’s parks and, if so, what this might look like. This may be easier in the co-managed parks of the North where Indigenous groups are leading the charge and not simply partners. It will be a greater challenge in the older, more established and storied parks like Banff and Jasper.

Conclusion

There has been surprisingly little traffic between the literature on nations and biopolitics even though there is substantial overlap with their main object of study: respectively the cultural-territorial nation and the national population as a biological unit. Both are fundamentally concerned not only with a collective that exists predominantly at the national scale but also its emergence and the practices through which it is intervened upon and reproduced. Through the concept of biocultural nation making, we bring these together to capture the complexities of nation making as a jointly biopolitical and cultural-territorial project. Canadian parks are a particularly compelling site in which to ground the concept given how they enable interventions into segments of the population—including immigrants, the youth, and urban residents—seen as risky culturally, for not identifying with the nation, and biologically, for failing to maintain their health, and do so within a more-than-human landscape. By targeting these populations through an enhanced visitor experience and larger project to connect them to Canadian nature, parks are deployed to help create a national population that more strongly identifies with Canada through exposure to its iconic landscapes, that is healthier through opportunities afforded by parks, and that is more economically productive because it is healthier. The goal of the initiatives is hence not only increased revenue but also bringing forth a Canada that is stronger culturally, biologically, and economically. These life-affirming interventions, however, meet the limits of a truly affirmative nation making, drawing attention to hidden exclusions tied to neoliberal anti-politics, inadequate multiculturalism, and the ongoing erasure of Indigenous communities. It is through upending these exclusions that a truly life-embracing nation making, both culturally and biopolitically, may potentially emerge within and beyond national protected areas.

Highlights

Literature on biopolitics and nation making address similar phenomenon but are rarely brought into conversation with each other.

This paper advances the concept of biocultural nation making to bridge these debates and illustrate that nation making is at once biological and cultural-territorial and that these are deeply intertwined.

National parks and other protected areas are increasingly rationalized through a biocultural discourse that situates national parks as central to both health promotion and nation making.

Footnotes

Acknowledgements

Earlier versions of this paper were presented at the 2017 meeting of the Canadian Association of Geographers and 2020 meeting of the American Association of Geographers (AAG). We thank attendees and in particular Geoff Mann in his role as discussant at the 2020 AAG meeting for their constructive comments. We also thank the anonymous reviewers of this paper and Leila Harris for their generous and insightful feedback.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was generously funded by the Social Sciences and Humanities Research Council of Canada (SSHRC).

Note

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Biocultural nation making: Biopolitics,cultural-territorial belonging,and national protected areas

Abstract

Keywords

Introduction

Nations/nationalism and biopolitics: A long overdue meeting

The population/nation as produced

The good and bad of nations/national populations

Biocultural nation making

Canadian parks as vehicles of biocultural nation making

A brief history of Canadian parks

The neoliberalization of Parks Canada: Enhancing the visitor experience

Biocultural nation making through parks: Connecting Canadians to Nature The (population) problem: Nature deficit disorder and changing demographics

The (population) solution: Connecting Canadians to Nature in Canadian national parks

The possibilities and limits of affirmative biocultural nation making

Conclusion

Highlights

Footnotes

Acknowledgements

Declaration of conflicting interests

Funding

Note

References