The anti-politics of healthcare and its blurring effercts on care work in Norway

Abstract

The aim of this article is to explore discourses of public healthcare sector transformation in Norway. These discourses are part of a wider European neoliberal discursive terrain shaped by policies that focus on competition, choice and ‘integration’ in healthcare. The method applied here is a combined Foucauldian and post-Marxian discursive approach with a political theoretical focus on how issues are given meaning in specific contexts, emphasising discourse as a situated social phenomenon that encompasses a materiality constituted by and constitutive of discourse. Person-centred care has emerged as a new trend in healthcare in Western countries over the past decade, and is in Norway articulated at policy level as ‘the patient’s healthcare service’. This article recognises person-centredness as a valuable ideal in care relationships and practices at the individual level. However, the article argues that the focus of person-centredness, embedded in a broader ideological trend of individualisation, may also mask a change in the relationship between the state and its citizens that has a depoliticising effect on healthcare at the institutional and structural level of society. As a result, in Norway one of the effects of recent healthcare policy and intervention has arguably been a depoliticisation of care work. Depoliticisation through the trajectory of naturalisation, has the effect of re-informalising care work, clouding its socioeconomic value and making it ‘invisible’. This process is discussed as representing a potential challenge to the key societal value of gender equality, since care work is thereby domesticised and re-feminised. The contribution of this article regarding implications for practice development is to inspire professionals to reflect critically on both contemporary discourses and policies of healthcare and some of the potential effects on care work. Finally, the article also aims to provide practitioners with a framework for understanding policy and its articulations at various levels, and thus, it is hoped, contribute to their empowerment.