Health and Illness in the Neoliberal Era in Europe

Health and illness in the Neoliberal Era in Europe discusses the impact of neoliberalism on public health and the social construction of health and illness in Europe, analysing case studies at a European and national level. The book focusses on three main topics: health inequity, self-responsibilisation and organisational reforms. Increasing inequity is one of the main outcomes of neoliberal policy in Europe and here the authors examine the impact of neoliberal policies on health inequality, providing a European comparative data analysis of healthy life expectancy and mental health issues in Spain. The book looks at self-responsibilisation, as part of neoliberal citizenship, through topics such as crowdsourcing medicine and citizen science. Finally, it analyses organizational reform in Europe using three case studies: Italian national health care reforms, mental health policy in Italy and maternal care in Russia. The book includes contributions from the Czech Republic, Italy, Russia and Spain and fosters the development of sociological debate in such countries within a European framework. It presents quantitative data analysis as well as ethnographic research and outlines a complex scenario affecting the everyday life of European citizens, their health and illness. Half Title Page 2 Title Page 4 Copyright Page 5 Dedication Page 6 Contents 8 List of Figures and Tables 10 List of Contributors 12 About the Editors 18 Acknowledgements 20 Introduction 22 References 29 Inequities 30 Chapter One-Neoliberal Epidemics: Etiology, A Bit of History, and a View from Ground Zero 32 1. Introduction: Why Neoliberal Epidemics? 32 2. The Analytical Indispensability of Neoliberalism 34 3. Observations from Ground Zero: Austerity in the UK Post-2010 36 4. Conclusion: Future Directions 44 References 47 Chapter Two-Health Inequalities in Europe: Policy Matters in the Neoliberal Era 52 1. Introduction 52 2. Theoretical Framework. Health Inequalities in Europe: Places Matter 53 3. Inequalities in Healthy Life Expectancy for the Older People in Europe 55 4. Data and Analysis 56 4.1. Changes in HLY65+ within Each Member State and Welfare Regimes 56 4.2. Correlation between Income Inequality and HLY65+ 61 5. Conclusion: Policy Matters in the Neoliberal Era 61 References 64 Chapter Three-Economic Crisis, Young Adults and Health in Spain 68 1. Introduction 68 2. Methodology 71 3. Results 73 3.2. Mental Health 76 4. Conclusions 88 References 89 Self-responsibilisation 94 Chapter Four-Citizenship, Neoliberalism and Healthcare 96 1. Introduction 96 2. Healthcare, Neoliberalism and Citizenship 97 3. Neoliberalism and Healthcare in the Czech Republic 99 4. From Neoliberal Citizenship to Citizenship in the Neoliberal Era 102 4.1. Patient Compliance with Neoliberalism 102 4.2. Patient Appropriation of Neoliberalism 103 4.3. Patient Resistance to Neoliberalism 105 5. Discussion and Conclusions 107 Bibliography 109 Chapter Five-Crowdsourcing in Medicine in the Neoliberal Era 112 1. Crowdsourcing in Medicine 112 1.1. The Conceptual Background 112 1.2. Experiences and Platforms for Crowdsourcing in Medicine 114 2. Bottom-Up and Top-Down: The Neoliberal Roots of Crowdsourcing in Medicine 116 3. The Client, Citizen and Expert Patient, and the Crowd 121 4. Conclusions: Data Philanthropy and the Neoliberal Form of Participation 122 References 124 Chapter Six-Adjusting Life to Illness or Illness to Life? Reflections on Children’s Competences in the Neoliberal Era 128 1. Children and Health from the Neoliberal Perspective 128 2. Children and Adults in the Process of Diagnosing Chronic Illness 131 3. Children and Strategies of Illness Management: The Contextual Nature of Competences 136 4. Conclusion: How to Adjust Illness to Life, Despite Adults 139 References 141 Chapter Seven-Neoliberalism and Illness Narratives: The Intertwined Logics of Choice and Care 144 1. The Place for Illness Narratives in the Neoliberal Era 144 2. The Logic of Choice and the Logic of Care 145 3. Research Question and Methodology 147 4. The Patient’s Work 148 5. The Family Caregiver’s Work 153 6. Conclusions 156 References 158 Cost Containment Processes 162 Chapter Eight-The Italian NHS Between Latent Paradoxes and Problematic Sustainability 164 1. The Three Phases of the Evolution of the Italian NHS 164 2. First Paradox: A Public Healthcare System Between De-Financing and Creeping Privatisation 168 3. Second Paradox: Corporatisation without a Market and Leopard-Like Managerialisation 172 4. Third Paradox: A Schizophrenic Regionalism Between Devolution and Re-Centralisation 174 5. Fourth Paradox: One of the Highest Levels of Performance in the World, Despite Everything 176 6. Conclusions: What Future Sustainability is There for the Italian NHS? 178 References 180 Chapter Nine-The Neoliberal Politics of Otherness in Italian Psychiatric Care: Notes on a Team Ethnography in Six Acute Psychiatric Wards 182 1. Prologue: Psychiatric Care in Italy Before the Psychiatric Reform 182 2. Psychiatric Care in Italy after 1978: The Outcome of De-Institutionalisation 183 3. Psychiatric Care in Italy Today 184 4. Two Persisting Politics of Otherness Emerging from a Team Ethnography 185 4.1. Inappropriate Hospitalisation 185 4.2. Extreme Physical Restraint: Mechanical and Anaesthesiological Restraint 190 The Construction of ‘Unmanageable Disruptive Behaviour’. With the expression ‘construction of unmanageable disruptive behaviour’ we refer to the social process occurring in all acute wards that is likely to lead towards the use of extreme physical restrai 191 The Heterogeneity of Extreme Physical Restraint Techniques. ‘Implicit coercion logic’ (Gariglio, 2018, pp. 81–101) is a key feature of coercive organisations: anyone involved in any particular interaction knows that staff can use coercion when the situati 192 Mechanical Restraint Versus Anaesthesiological Restraint. Extreme physical restraint techniques aim to take control of the embodied otherness of psychiatric patients. The first technique is mechanical restraint. In Italy, it has persisted over the years o 192 5. Conclusion 194 References 196 Chapter Ten-Some Symptoms of Neoliberalisation in the Institutional Arrangement of Maternity Services in Russia 198 1. Introduction 198 2. Changing Health Services and Professions in the Context of Neoliberal Reforms 199 3. Background to Maternity Care in Russia 201 4. Methodology 204 5. Institutional Contradictions in the Field of Maternity Care 205 6. Organisational Constraints and Fragmentation of Maternity Care 207 7. Conclusion 211 References 212 Index 216