The Limitations of Patient Empowerment: Diabetes Self Management Programs and Neo-liberal Notions of Individual Responsibility

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Abstract

One result of the rise of patient consumerism in health care in recent decades has been a shift in care models, from physician focused to patient focused, whereby patients are conceptualized as active participants in the determination and outcomes of their own care. A particular manifestation of patient centered care is patient empowerment initiatives, also referred to as self management programs, aimed at helping patients individually manage chronic disease in order to improve population health. Critics have however pointed to the potential double edged nature of patient empowerment programs, which give patients not only rights but responsibilities. This paper examines the case of type 2 diabetes self management programs in order to explore the limitations of patient empowerment as a way to meaningfully improve patients’ chronic disease management. More specifically, this paper explores how common language and components of diabetes self management programs reinforce neoliberal notions of individual responsibility for health while disregarding larger social structural determinants of disease. The implications of these findings are especially important within the context of diabetes, a condition characterized by severe prevalence and outcome disparities across race, ethnicity and socioeconomic status gradients.

Author

• Rachael Lee, Northeastern University