Egenvårdens ansikten : Om egenvård från kvacksalveri till patientdemokrati och e-health

Sammanfattning: The aim of this dissertation is to analyze the relations between self-care and the Swedish state, certain authorities and professional health care organisations Self-care is defined as “the speech of the knowledge and activity of layman related to medicine”. The traditional narrow medical perspectives on self-care are broaden to political conditions, patient democracy and other aspects of social science. In the thesis the analysis focuses on the major actors in the health care field as well as the discursive changes of self-care during the period of 1930 – 2000.Two different methods are combined in the analyse: 1 A historical analysis where different contextual and period related conditions in the development of self-care are considered and 2. A pragmatic discourse analysis. The first method is based on an actor related analysis by a strong focus on the contextual circumstances. In the second method the object is the various discourses concerned with self-care. Discourse is specified as the social dialogue and struggle over self-care as a phenomen of society and health politics. The analysis is based on the speech of self-care from key actors, and not on the implementation of the politic.During the total period four relatively dominant discourses of self-care appear. Together with the fifth – a dominant discourse of health care – self-care follows several historical and extraordinary phases of change. Within the fifth discourse of self-care there are during the turn of the 21th century two strong and new discourses – the Information technology and the Swedish conservative and other liberal parties critiques of the state as well as the welfare state model. The last one is encompassed by an argument for a shift of the system to a market based health care organisation. There has been a dramatic shift during the seven decades of self-care. The developmental process, concerning the changing relationship between health care, sick care, patients and the public, can be described as one from paternalism to autonomy.