Health and Illness in the Neoliberal Era in Europe

Despite the increasing evidence on the effects of the economic crisis and austerity policies on the health of the population, we lack knowledge of how the young population is being affected. High unemployment rates, labour instability, high housing costs and cuts in public policies have placed the young in a vulnerable situation. We explore changes (2006–2017) in the both physical and mental health of young people in Spain using a selection of health indicators. By doing so we draw the reader’s attention to three elements with a close relationship to neoliberalism: the prominence of social determinants of health, the importance of inequalities and the accumulation of multiple sources of disadvantage in certain groups and individuals which ultimately condition the course of their lives; and the use of medicalization as a common and legitimised response to poor mental health.

The aim of this chapter is to discuss the complexities and ambiguities of health-related citizenship in the neoliberal era. The scholarly discussions investigating the impact of neoliberalism on health and health care have primarily focused on the power of the neoliberal system. At the same time, the capacity of patients and citizens to act against neoliberal principles has been rarely discussed. Against this backdrop, we explore the ways in which civically engaged patients and citizens cope with neoliberal governance. To do so, we focus on the Czech context, as one that is not narrowly dominated by market-driven neoliberal logic but that blurs the distinction between marketisation and social protection. More specifically, we address the following two questions: What are the reactions of citizens and patients to the imperatives of neoliberalism? What are the implications for our understanding of health-related citizenship in the neoliberal era? Our analysis is underpinned by interviews and observations of public and patient involvement in the Czech Republic. Furthermore, the data gathered from interviews were enriched through a review of available documents, including media articles, policy briefs, political statements and websites. We conclude that the neoliberal era is not only connected with the emergence of individualised, conscious citizens whose health is governed at a distance, but also with the occurrence of collectively organised, health-care conscious citizens who problematise the nature of contemporary health-care governance. We thus explain and illustrate how neoliberal ideology is imprinted on the behaviour of patients and citizens, as well as how they resist and strategically appropriate neoliberal imperatives.

One of the aspects that characterises neoliberal societies is the increasing attribution of individual responsibility. Citizens are required to commit themselves to adopting ‘appropriate’ lifestyles and to self-managing their health. Individual responsibility translates into a set of knowledge and techniques of self-governance, through which individuals learn and are expected to act in an increasingly autonomous way in order to prevent or mitigate health risks. This fostering of self-governance and individual responsibility affects both children and adults; in accordance with it, adults are required to transmit a sort of model of “pedagogy of responsibility” (Neyrand & Mekboul, 2014), through which children learn to acquire self-management of their health. This scenario becomes complicated if we take into consideration the two usual and contrasting representations of childhood in western societies: children as active subjects, or children as vulnerable subjects. Our work explores these contrasting representations through the narrations of adults and children of their experiences of Type 1 Diabetes.

Illness narratives provide a useful lens for analysing neoliberal citizenship at a micro level, from the point of view of patients, family caregivers and healthcare professionals. Indeed, they reveal how people think about and act on their health and disease; they also tell us something about the social context in which illness is experienced, thereby illuminating dominant discourses.

According to Mol (2008), health and illness can be thought about and acted on according to two logics: the logic of choice and the logic of care. The logic of choice entails the neoliberal principle that people should be allowed to make their own autonomous choices. The logic of care implies an interpersonal process of co-responsibility over one’s health and illness.

Drawing on Mol’s work, the chapter presents a thematic content analysis of 20 illness narratives of patients with multiple sclerosis and their caregivers, questioning whether these two logics conflict with each other or whether they are intertwined.