Healthcare choice: Bourdieu’s capital, habitus and field

Abstract

The promotion of choice is a common theme in both policy discourses and commercial marketing claims about healthcare. However, within the multiple potential pathways of the healthcare 'maze', how do healthcare 'consumers' or patients understand and experience choice? What is meant by 'choice' in the policy context, and, importantly from a sociological perspective, how are such choices socially produced and structured? In this theoretical article, the authors consider the interplay of Bourdieu's three key, interlinked concepts -capital, habitus and field -in the structuring of healthcare choice. These are offered as an alternative to rational choice theory, where 'choice' is regarded uncritically as a fundamental 'good' and able to provide a solution to the problems of the healthcare system. The authors argue that sociological analyses of healthcare choice

Pierre Bourdieu's Theory of Practice offers nurses a framework to uncover embodied knowledge of patients living with disabilities or illnesses: A discussion paper

“…Seven research teams demonstrated that a central struggle for patients with disabilities and illnesses is the embodied knowledge of marginalization (Cowdell, ; Edwards & Imrie, ; Gibson et al., ; Kelly, ; Thibodaux, ; Townsend, ; Westergren & Lilleaas, ). This may be further exacerbated when nurses and advanced nursing practice internalize a medical paradigm and would manage a patient by controlling access to knowledge and moving the patient through the medical system as an abnormal body and not as an individual experiencing illness or disability (Collyer et al., ; Nairn & Pinnock, ; Rhynas, ). Bourdieu's theory complements the dominant mechanistic medical paradigm with an approach considering “patients’ everyday practices” in the light of their disabilities and illnesses—and can assist nurses in grasping the dual nature of everyday (health) practice in both its objective and subjective aspects.…”

“…The embodied knowledge of various healthcare fields in hospital structures has been insufficiently investigated in disability and illness literature. Yet patient “choices” between, for example, treatment with conventional drugs, an operation or even radiation are formed not just by the price of each choice or the accessibility of each service in their local community, but through the continuing rival practices between the differing specialties of medical practice (Bourdieu, ; Collyer et al., ). Bourdieu's concept of fields provides nurse researchers with the possibility to uncover a theoretically informed understanding of “patients” embodied knowledge’ or way of living that brings into consideration both structure and human agency.…”

Saines habitudes de vie, inégalités sociales de santé et vieillissement : réflexions critiques et nouvelles perspectives en développement des communautés

“…Or, cette perspective centrée sur la responsabilité individuelle a été grandement remise en question. Divers auteurs ont souligné le fait que ce discours élude l'influence de la structure sociale et des inégalités socioéconomiques sur le mode de vie, et dénoncé ses effets négatifs sur les individus (Massé, 2009;Collyer et al, 2015). Tel que le mentionne Massé (2009 : 62), en Occident, les « [...] habitudes de vie [sont] désormais promues au rang de normes, voire de vertus ».…”

Knowledge matters: producing and using knowledge to navigate healthcare systems

“…To begin, examination of prevailing discourses about 'choice' in healthcare and the accompanying policy context, reveals that the notion of choice is based on a view of decision-making as a process of cost benefit assessment. Such discourses and policies take a rational choice approach to human behaviour and do not accord well with sociological understandings of social action (Collyer et al, 2015;Greener, 2003). Three assumptions about human behaviour are well captured within rational choice theory.…”

“…Further, the pressure on individuals to take an active role in the healthcare system, the popularity of the discourse of choice as a mantra of government, and the government's growing investment in the private healthcare industry, are not coincidental developments. Elsewhere (Collyer et al, 2015) we have argued that policies to encourage 'greater choice' do not seek to offer a broad range of alternatives, but are strategies aimed at enouraging citizens into 'going private'.…”