Everyday Practices of Primary Healthcare: A Consumer Perspective on Tactics and Empowerment

Driven by a need for optimising resource allocation in public health, nation states in Northern Europe are
increasingly viewing healthcare as a market, with health professionals in the role of service providers and
patients in the role of consumers. Health policies aimed at involving and empowering patients as well as
broader societal trends such as consumerism and the proliferation of information and communication
technologies into everyday life are assigning a more active role to patients. These joint developments are
resulting in a significant redistribution of medical responsibility, one that poses opportunities and challenges
to healthcare systems.
This study adopts the view of patients as consumers to explore the everyday practices of primary healthcare
beyond the institutionalised and well-studied consultations with general practitioners, paving novel ways to
understand the role of consumerism in healthcare and patient empowerment as well as initiating a discussion
of the positive and negative consequences of considering patients as consumers. The qualitative data
underlying this thesis was collected through anthropological methods from a total of 44 key informants in the
context of the tax-financed egalitarian Danish healthcare system in the years 2012–2017.
The findings suggest that individuals’ everyday practices of primary healthcare outside of institutionalised
settings are governed by at least four different tactics, two of which are based on consumerism and provide
fertile grounds for empowerment. Practices of medicine and medical services consumption seem to be at
least as much explained by logics based on consumer choice and self-care as by logics based on professional
care and patient choice. The online access to medical information and peers increases consumer choice,
cultivates community building, fosters practices of self-care, and facilitates the production of counterexpertise.
The latter enables individuals to resist medical authority, thereby challenging existing norms of the
patient-physician relationship.
The thesis employs de Certeau’s distinction between strategies and tactics to arrive at a view of individual
empowerment as emergent from a bricolage of tactical interactions with social environments rather than as
the result of strategic initiatives. In order to distinguish between the tactics found, an existing model of
patient empowerment is extended to encompass the autonomous healthcare capacity of individuals. These
results are generalised by introducing a notion of “health capital” as a field-dependent capital capturing the
capacity of an individual to nurture their health, extending previous purely economic and cultural notions by
unifying economic, social, and cultural assets.
These results demonstrate the value of combining multiple research perspectives for the study of societal
challenges. Everyday practices of primary care provide an interesting and societally relevant context for
consumer research, opening a path for consumer research on health away from more commonly explored
contexts such as chronic disease management and healthy eating. Furthermore, the thesis demonstrates how a
consumer perspective allows for understanding health-related everyday practices incorporating resistance to
medical authority as empowered acts of self-care rather than as non-compliance.
Two key contributions of the thesis, tactical empowerment and health capital, provide a framework for
understanding the mixed success of strategic patient empowerment initiatives as misalignments and
misconceptions about the boundaries of professional and individual medical responsibility. Consumerism as
well as information and communication technologies are rapidly expanding the latter, shattering the modern
medical institutions in the process. This thesis provides a ground for nuancing the understanding of the role
of consumerism and empowerment in the field of primary healthcare, creating new opportunities for an
informed realignment of the boundaries of medical responsibility and, ultimately, a renegotiation of the
social contracts surrounding the socially constructed sick role.