Rose’s statement that “it is no longer expected to resolve the society’s need for health” is a source of much controversy. Many scholars have varying views on the argument, some supporting it , while others strongly condemn it. While I am in favour of a more welfarist view that disagrees with the statement, I do believe that individuals should take a certain amount of responsibility for their health with their life choices to ensure they make choices that enhance their health.
The roles and responsibilities of individuals have shifted from those of a passive person, cared for by the welfare system and medical experts in 1980 to an active, autonomous individual responsible for their health choices today. Various notions have been associated with ill people, explained by Parsons as a ‘sick role’ in the 1950s. The rise in technology, the increase in biomedicine and access to knowledge led to this change for citizens, however not all individuals have the same access to these improvements, which means that not all individuals will follow this anticipated new citizen. (Taylor, 2020b)
Talcott Parsons came up with a notion of the sick role in which the sick person was able to commit an act of deviance as long as they fulfilled the role of the sick person in ensuring that the associated rights and responsibilities were upheld. A person is allowed an act of deviance such as loss of productivity for the period he or she is ill as long as he or she is certified by a medical profession. There are four key aspects of the role of the sick: rights are not the fault of the person and they are excused from everyday responsibilities, but the responsibility of the individual is to get well as soon as possible and to seek medical professional assistance. This is an important notion to mention as Parsons produced this as a sick person is seen to disturb the social function of society, thus highlighting the importance of healthy individuals. (Taylor, 2020b)
States have a need to address society’s need for health because of the influence of states on all the different agencies involved in an individual’s life. For example, the state participates in education, the economic market, marriage, immigration and crime. Consequently, all of these agencies directly or indirectly impact health, indicating that the state is one of the most influential factors in health. Moreover, changes are not expected, meaning that individual precautions are not always in place to deal with the consequences of these changes, so individuals are left more precarious and vulnerable.
There are many reasons why it is impossible to hold individuals fully accountable for their own health when there are so many external influences at play. Individuals are limited in their choices about health when cultural pressures and ignorance are so influential. In addition, because diseases and disabilities are the result of a combination of genetic and environmental factors, it is difficult to have a system that makes individuals responsible for their own health. Society has a role to play in promoting health and disease prevention before it increases its financial burden on the healthcare system. The influence of Individuals choices is limited to themselves and therefore the state must have an influence on external factors such as disease monitoring, minimising environmental risks like pollution, and sponsoring biomedical research. (Resnik, 2007)
Neoliberal policies are growing globally, with more unsuccessful than successful. Biological citizenship is defined as a category of persons who share certain biological characteristics. This concept has been increasingly used in illness, particularly by neoliberals, in order to reduce government expenditure. However, increased use of biological citizenship has led to an increase in the experience of biological sub-citizenship globally demonstrated by exclusion, exploitation and experimentation, which has led to a decline in life (Taylor, 2020b). Neoliberal policies have not benefited all of us, leaving many more vulnerable. Greece is a key example of this, with the neo-liberal policies coming into play after the 2008 recession. The neo-liberal principles of deregulation, stabilisation and privatisation have been key to the reform of Greece. The effects of this were severe and those with a lower socio-economic status were disproportionately affected by extreme poverty reaching 15% of the total population, the overall unemployment rate was 23% and pensions were drastically reduced in 2015. (Sakellariou and Rotarou, 2017)
Moreover, marginalised populations are already at a disadvantage in life, including in the occupation of low-paid jobs and their living conditions, which present their own difficulties. The difficulties associated with dealing with their own health care would have a much larger negative health effect. If an individual is already in a low-income job facing financial struggles, out of pocket healthcare costs such as prescriptions may simply be unaffordable. Some may prioritise food and bills over their health, resulting in an increase in the severity of their illness resulting in them being unable to be a productive working citizen. The consequences of this don’t stop at the individual. If more individuals are in this position and find themselves prioritising other things over their health, then more individuals will end up being so ill that they will no longer be able to work, leaving more individuals reliant on state benefits. This increases the pressure on the government to provide benefits, a decline in the value of the country, both economically and socially. For example, countries with more economic and social value are attractive for clinical trials and therefore reduce potential relations with other countries and position in the pharmaceutical industry (Taylor, 2020a).
The U.S’ shift in political influence from welfarism to neoliberalism is an example of why the state is important in its influence. After that, life was much more precarious, with the health of the population deteriorating. The number of households living in extreme poverty increased from 636,000 to 1.46 million between 1996 and 2011, the number of children living in extremely poor households rose from 1.4 million to 2.8 million, the number of families receiving aid dropped dramatically and the overall poverty rate rose to 15% in 2011. (National Low Income Housing Coalition, 2013)
These examples again point out that the effects of neoliberal policies are more disproportionate than any other group, affecting marginalised populations. This is strongly linked to the fact that neoliberal policies encourage privatisation and reduced government involvement, which only those with money could afford.
Although the example of the USA highlights the importance of the welfare system provided by the state, a number of points need to be addressed which support the declaration. First of all, welfare programmes are more problematic. Welfare programmes have exacerbated the problem of poverty by providing more to the poor, creating a problem of increased poverty through a state of dependency. Dependency is said to be the root cause of poverty. People become lazy and complacent, relying on the state as a safety net if they need support, resulting in less responsible decisions. Individuals lacked self-discipline and competence to function as responsible adults, producing a passive, lazy mentality lacking moral character and self-management. Examples of laziness are people who are less productive in finding jobs, choosing a path of unemployment and relying on the state as the primary source of subsistence. It is important to understand it is unfair to apply this to all individuals as well as appreciate the benefits the state provides, because as with anything the welfare system has its risks, the benefits outweigh the positive ones. (Rose, 2000)
Charles Murray argues that the benefits of the welfare offer preserve incentives that reward irresponsible or anti-social behaviour (Webb et al, 2016). For example, unmarried teenage mothers offered council houses are encouraging young girls to become pregnant; the issue with this is there are more risks associated with adolescent pregnancy, such as poor health for both mother and children, so increasing their risks to ill-health. (Cunnington, 2001)
Concluding this essay, the responsibility of health, whether it is the individual or the state, is a difficult decision. Both approaches have their benefits and risks, but I do believe that the state taking responsibility for the health of society is the best method. Overall, the state can have a much larger impact on the various factors that influence the health of the individual. This is not to say that an individual should not be responsible for some of their life choices, but that a balance is established between the state and the individual. For example, safe sex education is provided by the state, but the individual must take responsibility to ensure that this happens. It is important to address this statement as the current political influences of the policies have not reduced health inequalities. Health inequalities are still prevalent, exacerbated by the neoliberal principles of privatisation and deregulation that are currently being demonstrated in the US by the unequal impact of coronavirus on ethnic minorities due to their lack of health insurance highlighting the issues associated with neoliberalism’s influence. (Johnson and Buford, 2020)