The articulation of neoliberalism: narratives of experience of chronic illness management in Bulgaria and the UK

Abstract

The shift from social democratic to a neoliberal consensus in modern welfare capitalist states is characterised by an emphasis on individual responsibility, consumer choice, market rationality and growing social inequalities. There has been little exploration of how neoliberalism has shaped the environment within which chronic illness is experienced and managed. This article explores the different articulations of neoliberalism manifest in the arena of personal illness management in Bulgaria and the UK. People with type 2 diabetes discussed their experiences in terms of struggling with diet, diabetes as a personal failure, integrating illness management and valued activities, and the trustworthiness of the healthcare system. The UK narratives were framed within an individual responsibility discourse while in Bulgaria lack of resources dominated discussions, which were framed as structurally generated and unrelated to individual capabilities and choices. Respondents faced personal management challenges related to consumer and healthcare market failures in both countries. Differences in market regulation and emerging stakeholder and interest coalitions influenced users' expectations and their navigation and adaption to market failures in managing their everyday illnesses. The UK and Bulgarian articulations of neoliberalism can be described differently: the first as a logic of managed choice and the second as a logic of unmanaged consumerism.

Supporting self‐management after traumatic brain injury: Codesign and evaluation of a new intervention across a trauma pathway

“…However, when underpinned by neoliberal philosophy of individual self-governance, this policy focus may seem to place preference on individual responsibility for managing a condition. 14 describing someone who uses services "appropriately," uses knowledge to manage risks and actively applies information to make decisions. 15 This focus also aligns with the move towards measurement of "patient activation," where those deemed "more activated" are considered to have greater self-management capability.…”

“…Frameworks for SSM encompass a range of strategies at levels of individual, health‐care professional, organization and systems. However, when underpinned by neoliberal philosophy of individual self‐governance, this policy focus may seem to place preference on individual responsibility for managing a condition . This idea is supported by Ellis et al in their work on conceptualizations of the “good self‐manager,” describing someone who uses services “appropriately,” uses knowledge to manage risks and actively applies information to make decisions .…”

The work and relatedness of ties mediated online in supporting long‐term condition self‐management

“…, Vassilev et al . ). Those lacking either access or the ability to draw on online resources in this way, may lack the necessary network infrastructure to be able to adapt to this refashioned patient role and in being more reliant on support being available through offline networks, are likely to be further marginalised if issues of access and use are not addressed.…”

“…, Vassilev et al . ). Indeed, whilst policy has increasingly promoted the importance of individual responsibility, the foundational work of Christakis and Fowler () amongst others, disrupted the assumption that individual behaviours are the cornerstone of health practices.…”

“…Peoples' own self-management strategies extend beyond narrow, professionally advocated forms of management, which in primarily focussing on disease control being achieved through adherence to tightly defined ways of managing, often poorly align to what people themselves see as important (Entwistle et al 2018, Morgan et al 2017). People's own preferential strategies are influenced by the value ascribed to certain activities, social and contextual factors and the inclusion of wider personal network involvement and access to relevant network resources (Greenhalgh et al 2011, Vassilev et al 2017. Indeed, whilst policy has increasingly promoted the importance of individual responsibility, the foundational work of Christakis and Fowler (2007) amongst others, disrupted the assumption that individual behaviours are the cornerstone of health practices.…”