Neoliberalism and the Political and Economic Embedding of the Experience of Diabetes Chronic Illness Management in Bulgaria and the United Kingdom

The shift from social democratic to a neoliberal consensus within modern welfare capitalist states has been characterised by a growing emphasis on individual responsibility, consumer choice, and market rationality, and associated with growing social inequalities. There is variation in how these macro level processes have played out across nation-states and shaped the contexts within which long-term conditions are managed. 

Building on Mol’s distinction between logics of care and choice (2006) we explore the interaction of macro and micro level processes and investigate the different articulations of neoliberalism in Bulgaria and the UK in order to illuminate the new illness management landscapes that have emerged as a consequence of contemporary neoliberal shifts.

In biographical interviews conducted with people with diabetes, respondents discussed their experiences of chronic illness management in terms of struggling with diet; diabetes as a personal failure; integrating illness management and valued activities; trust and trustworthiness of the healthcare system. While respondents in both countries faced challenges related to failures of consumer and healthcare markets, there were differences in how these markets were regulated, what stakeholder and interest coalitions emerged, and how users navigated markets, and experienced, expected, and adapted to market failures in their everyday chronic illness management practices. We argue that UK and Bulgarian articulations of neoliberalism can be described as logic of managed choice and logic of unmanaged consumerism.