Universalism, diversity and norms: gratitude, healthcare and welfare chauvinism

Abstract

Access to universal healthcare is a normative expectation of citizens in European welfare states. As part of a comparative study of healthcare in diverse European neighbourhoods, we met women who described failures of the public healthcare system, together with gratitude for that system. Challenges to European welfare states of ageing populations, the retraction of resources available for healthcare, and globalised migration streams have been linked to xenophobic 'welfarist' attempts to restrict access to services for new arrivals and those seen as failing to contribute sufficiently. Stories of healthcare systems' failure to treat symptoms, pain, and suffering in a timely and caring fashion came from eight women of non-European migrant backgrounds as part of a wider interview study in four European cities (Birmingham, Uppsala, Lisbon, Bremen). These accounts suggest that a normative aspect of welfare provision has been reproducedthat is, the expression of gratitudedespite inadequate services. Where welfarist attitudes to migration meet normative aspects of healthcare, suffering may be compounded by an expectation of gratitude. The regrettable unmet healthcare need of the eight women whose cases are presented suggests that other marginalised healthcare users may also be under-served in apparently universal healthcare systems.

Teaching global health from the south: challenges and proposals

“…In this sense, teaching global health in the global south calls for programs that understand health as stemming from social and cultural foundations, resisting 'the use of facile notions of the social, but also facile methods of apprehending the social ' (Adams et al, 2019, p. 13). In this sense, most epidemiological approaches, despite including social factors in their analysis of health at the global level, can hardly grasp the everyday aspects that impact upon health, the historicity of local communities and health interventions and the societal values and norms upon which the interaction between communities and health systems is embedded (Bradby et al, 2020). A focus on this dimension challenges the analytical molds of epidemiology, calling for 'experience-near' (Biehl & Petryna, 2013) ethnographic and qualitative approaches.…”

‘If there were doctors who could understand our problems, I would already be better’: dissatisfactory health care and marginalisation in superdiverse neighbourhoods.

“…Some women, marginalised by migration, austerity and xenophobia with their entitlement to services questioned, have great difficulty in expressing criticism of the public health system, even when in receipt of highly inadequate services (Bradby et al . ). This article considers negative healthcare experience, attendant dissatisfaction, how such disappointment is understood and responded to and related to aspects of marginalisation.…”

“…Patients who are marginalised in terms of migration, education and employment status, gender, local language ability and mental health and whose entitlement to health care is challenged, can find it difficult even to express dissatisfaction (Bradby et al . ). Capturing disappointment and dissatisfaction with healthcare experience among highly diverse samples of users, particularly when some people's entitlement is politically contested, represents a significant challenge.…”

“…Low levels of trust and delimited social participation may increase patients’ levels of dissatisfaction (Lindström and Axén ), and patients seen as lacking entitlement (Hill ), who have lost hope and trust (Bradby et al . ) may be more disposed to withdraw from services.…”

“… This contrasts with another analysis where healthcare users explicitly expressed satisfaction with their health care, although we assessed the services that they described as being inadequate (Bradby et al . ). …”