Academy for Health and Working Life, University of Gävle, Sweden.
Sociol Health Illn. 2010 Sep;32(6):930-47. doi: 10.1111/j.1467-9566.2010.01262.x. Epub 2010 Jul 23.
In recent years, the notion of individual responsibility for one's health has been introduced into Swedish medico-political debate. Formerly expressed as a recommendation, it has now taken on the form of expectations. In a Swedish context, this shift from collective to individual responsibility is novel because it implies a break with well-established welfare state practice of comprehensive care for their citizens. Using a systems-theoretical approach, we interpret this shift of expectations as a political solution to the problem of legitimate allocation of scarce resources. A more inclusive medical conception of illness has facilitated the introduction of many new diagnoses that, in turn, have lead to a strong increase in claims for medical treatment and for compensation. This semantic change in medicine aggravates the budgetary situation of the welfare state. The political solution lies in a reorientation of the expectations the medical system can have on citizens as well as a shift of the expectations regarding the rights and obligations citizens can have on the medical system. Individuals are increasingly expected to live healthy lifestyles and to avoid hazardous habits. If they do not live up to these expectations, they have to face low prioritisation or denial of treatment.
近年来，个人对自身健康负责的观念已被引入瑞典的医学政治辩论中。这一观念最初只是作为一种建议提出，现在已演变成一种期望。在瑞典语境下，这种从集体责任向个人责任的转变是新颖的，因为它意味着与福利国家为其公民提供全面医疗保健的既定做法决裂。我们运用系统理论的方法，将这种期望的转变解释为对稀缺资源进行合理分配这一问题的政治解决方案。更具包容性的医学疾病观念促进了许多新诊断的引入，而这些新诊断反过来又导致了对医疗和赔偿的强烈诉求的大幅增加。这种医学语义上的变化加剧了福利国家的预算状况。政治解决方案在于重新调整医疗体系对公民的期望，以及转变公民对医疗体系的权利和义务的期望。人们越来越期望过上健康的生活方式，避免危险的习惯。如果他们不能达到这些期望，他们将面临低优先级或治疗的拒绝。
