5 - Public health, emergency settings and end of life care

Summary

Introduction

Previous chapters have outlined the theoretical and conceptual frameworks underpinning this book. Chapter 2 laid out the theoretical groundwork, examining how neoliberal discourse has shaped global and national health and social care policies. A shift in health responsibilities, driven by the rhetoric of choice, has paved the way for the marketisation of health and social care systems in most countries in the Global North. The dominant discourses of ageing – biomedical, social-gerontological and the idea of ‘successful ageing’ – were subsequently discussed. The chapter went on to review concepts of capital and field as developed by Bourdieu, making the point that higher levels of capital can protect against precariousness in the field of health and social care. Following this, I discussed feminist intersectional analysis, together with the importance of how different identities related to gender, social class and ethnicity can produce inequalities that compound along the years of a person's lifecourse. Finally, the shift in ageing paradigms from welfare to active ageing to precarious ageing was discussed (Grenier et al, 2020).

Chapter 3 applied social theory to analyse global perspectives on the crisis in health and social care, particularly examining neoliberalism and globalisation, and their effect on health and social care models in countries in the Global North. Key concepts of competition, choice and consumerism were central to these discussions. Chapter 4 analysed national perspectives on health and social care in the UK, discussing the impact of globalisation and neoliberalism on health and social care policy. It discussed austerity policy and the ensuing erosion of social protections in relation to employment and working rights of health and social care staff. Both these chapters demonstrated how global changes through globalisation and neoliberalism have impacted nations’ welfare states, health and social care systems, leading to marketisation, fragmentation and complexity, particularly in the UK.

This chapter links the global and national perspectives discussed in the previous chapters to individual empirical data in three case studies. The first two case studies (located in public health and pre-emergency care) employ different methodologies, which are detailed in appendices 1 and 2. All names used in them are pseudonyms. The research team for the second case study is acknowledged in Appendix 2.