Health and Citizenship: Political Cultures of Health in Modern Europe

Harry Oosterhuis (Editor), Frank Huisman (Editor)

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Since the 1980s the modern welfare state is under attack. For the first time in its history, there is a strong and widespread feeling that the state should withdraw – in part or even altogether - from the public domain. After a century of growing state intervention in the social-economic domain, there appears to be a general feeling, both on the left and the right of the political spectrum, that the state has become almost omnipresent. This is said to have led to a passive, consumerist and dependant population, relying on care from the cradle to the grave and, secondly, to an overloaded bureaucratic system that is no longer affordable in a competitive global economy. Collective arrangements are being critically reconsidered; consequently, they are either reformed, or abolished or left to ‘the market’.
However, these changes entail new problems and questions. Rationalisation and commercialisation involve a new managerial class taking over control from professionals and creating new, and (in the public view) opaque bureaucracies that withdraw from democratic control. Costs may rise, and as far as solidarity and responsibility are concerned, the emphasis is shifting from the collective to the individual, from passive citizenship (social rights) to active citizenship (individual responsibility), and from democratic control to market forces. The ‘neo-liberal revolution’ in the Western world not only has social and economic dimensions, but political and moral ones as well. In this respect, there have been gains and losses: whereas it may be considered beneficial that people are challenged to think afresh about their role as citizens with an awareness of their democratic rights and duties, the decline of the welfare state has resulted in a crisis of citizen confidence in the state and in democracy. Because our very concept of civil society is at stake, a historical reflection on the relationship between state and citizen in the public domain seems urgent.
An important domain in which the relationship between citizens and the state is currently being reconsidered is health care. Over the last decades, costs have increased due to improved technological possibilities, the rise of chronic disease and the aging of the population. As a result, the last decade has witnessed heated political debates with regard to the organization and financing of national health care systems. In many countries, the state is withdrawing, pointing at the individual responsibilities of citizens, reversing state intervention and expecting much - if not all - of market dynamics. This can be said to be a reversal of a process that originated in the nineteenth century. Health care was among the first domains in which state intervention took shape. More than a hundred years ago, the same questions with regard to the relation between citizen and state were asked: was the state allowed to interfere with the lives of its citizens? If so, to what extent was it responsible for their health? How far did individual responsibility of citizens go? What did citizen rights mean in this context? Was it the right to stay free from state intervention? Or the right to collective arrangements in the field of health care? Then as now, there is a strong feeling that these questions are relevant. It is therefore surprising that the connection between ‘health and citizenship’ has never been researched by medical historians. This volume aims to do just that.
We suggest that national health care systems are embedded in and reflect different national traditions of state-craft and citizenship that are subject to change over time. Health and disease concern key-issues like life and death, collective and individual well-being, coercion and liberty, professionalism and self-help, commercialism and social security, and humanitarianism and technocracy. For this reason, we would qualify the health care system of a particular country as a pars pro toto for the more general conceptualisation of the role of the state, civil society and individual citizens.
Our call for reflection on citizenship and health (care) does not of course imply that we claim that knowledge of the past leads to clear-cut political prescriptions for the present. The proposed volume does not intend to ‘solve’ current socio-political problems, but rather to analyse different national traditions of health care (the British, German, Dutch, and Belgian), using a concept that is suggested by contemporary developments. As is indicated in the Introduction, both ‘health’ and ‘citizenship’ have several meanings and connotations, which partly coincide with historical developments in the last two centuries. The current crisis of the nation state has made us aware of the urgency of such questions as: What draws a body of citizens together into a coherently organised political community? What keeps that allegiance stable and meaningful to its participants?
In the course of the nineteenth and twentieth centuries, medicine and politics became mutually entwined to an increasing extent. Having said that, it may very well be that national cultures are not as homogeneous as we tend to think, and that social cohesion is shaped at the level of groups or subcultures. What was the role of the state in (public and individual) health care? What was the relationship between conceptions of (democratic) citizenship and the definition of health and illness and the practice of health care? What was the relationship between state, democratic citizenship and professional expertise? Did citizens play an active role in defining health and illness and in individual and public health care, and, if so, in what way? How were the responsibilities of state, civil society and individual citizens delineated as far as health and illness were concerned? Did the framing of health and disease and the health care system contribute to or impede the shaping of democratic citizenship? Did the relationship between health and citizenship change? If so, in what way and why?
Original languageEnglish
Place of PublicationLondon/New York
PublisherRoutledge/Taylor & Francis Group
Number of pages304
ISBN (Print)978-1-84893-432-0
Publication statusPublished - 2016

Publication series

SeriesStudies for the Society for the Social History of Medicine

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