The articulation of neoliberalism: narratives of experience of chronic illness management in Bulgaria and the UK.
The shift from social democratic to a neoliberal consensus in modern welfare capitalist states is characterised by an emphasis on individual responsibility, consumer choice, market rationality and growing social inequalities. There has been little exploration of how neoliberalism has shaped the environment within which chronic illness is experienced and managed. This article explores the different articulations of neoliberalism manifest in the arena of personal illness management in Bulgaria and the UK. People with type 2 diabetes discussed their experiences in terms of struggling with diet, diabetes as a personal failure, integrating illness management and valued activities, and the trustworthiness of the healthcare system. The UK narratives were framed within an individual responsibility discourse while in Bulgaria lack of resources dominated discussions, which were framed as structurally generated and unrelated to individual capabilities and choices. Respondents faced personal management challenges related to consumer and healthcare market failures in both countries. Differences in market regulation and emerging stakeholder and interest coalitions influenced users' expectations and their navigation and adaption to market failures in managing their everyday illnesses. The UK and Bulgarian articulations of neoliberalism can be described differently: the first as a logic of managed choice and the second as a logic of unmanaged consumerism.
Faculty of Health Sciences, University of Southampton, UK.
Ivaylo
I
Vassilev
Faculty of Health Sciences, University of Southampton, UK.
Anne
A
Rogers
Department of Economic Sociology, University of National and World Economy, Sofia, Bulgaria.
Elka
E
Todorova
Faculty of Health Sciences, University of Southampton, UK.
Anne
A
Kennedy
Department of Geography, Bulgarian Academy of Sciences, Sofia, Bulgaria.
Poli
P
Roukova
D002031:Bulgaria; D002908:Chronic Disease; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy; D019468:Disease Management; D006801:Humans; D011057:Politics; D012648:Self Care / Q000379:methods* / Q000523:psychology*; D012944:Social Support; D006113:United Kingdom
Europe and European health systems; chronic illness; experience of illness; long-term illness; political economy