The individual and primary care: service user, reflexive choice maker and collective actor

Abstract

Many health policy interventions re ect implicit assumptions of cause and effect, contestable values and partial rationales-particularly in healthcare systems based on notions of entitlement and obligation. The objective-oriented nature of policies and the potential cacophony of narratives that underpin such interventions are not, though, explicable solely in terms of the achievement of particular ends envisaged by different policy actors. These ends re ect, often opaquely, notions of responsibilities, rights and ideas of social justice-issues central to perennial debates around 'welfare citizenship'. But, just as notions of entitlement, rights and obligations are open to challenge and change, so too are discourses around the meaning and implications of far more fundamental phenomena: the individual and individualism. In this paper we focus on the evolution of primary healthcare in the UK in order to demonstrate that changing ideas of the 'individual' and individualism are central to the implicit and explicit narratives and parameters that underpin the formulation of health policy. The individual and individualism are seen as malleable phenomena that can act as the focus for renegotiations of the relationship between systems of healthcare and the patient-citizen at a personal and collective level. Contestable and contested notions of the individual are thus, at one level, fundamental to the meanings and thus the ultimate nature and outcome of health policy interventions.

Citizens' participation in primary healthcare planning: Innovative citizenship practice in empirical perspective

“…Account also has to be taken of the proliferation of advocacy organizations, networks and movements that have arisen to challenge existing ideas and values in healthcare planning and delivery (Rose 1990;Farrant, 1991;Pilgrim and Rogers, 1991;Jeyasingham, 1992;Begum et al, 1994;Kendall & Knapp, 1995;Ahmad et al, 1998;Milewa et al, 1998;Tovey et al, 2001). Rose, for example, considers the 'women's health movement' in the United Kingdom.…”

`I'd forgotten about me in all of this'

“…Largely, conceptual debate has tended to espouse wider societal shifts including those related to postmodernity, late modernity and new conceptions of well-being (e.g. Bakx, 1991;Doel and Segrott, 2003;Eastwood, 2000;Rayner and Easthope, 2001;Siahpush, 1998;Sointu, 2006;Tovey et al, 2001;Wray, 2007). Australian sociologists have been particularly influential in pressing the potential applicability of notions of postmodernization to increased CAM consumption and the shape and form of contemporary therapeutic landscapes (e.g.…”

Cancer Patients' Negotiation of Therapeutic Options in Pakistan

“…First, interpretations concerning the growth or use of nonbiomedical practices are frequently extrapolated from broader theory rather than being CAM specific. This is evident in, for instance, work on the diversification of health care, which is couched in terms of the postmodernization of the social world (Eastwood, 2000); the emergence of reflexive modernization (Low, 2004;Tovey, Atkin, & Milewa, 2001); and new forms of identity work and selfhood (Sointu, 2006). Second, as yet, few of the theoretical assumptions have been challenged empirically.…”