Health is about responsibility. I am not sure of the situation in other countries, but in Sweden I get the feeling that people in general have given up their responsibility for their personal health. They expect someone else to be liable if their health fails them.
Of course, there might be more or less reasonable explanations for this and the Swedish well-known high taxes does give us citizens a lot of valuable benefits. Our schools are completely free of charge, including higher education like universities. In fact, the government actually gives university students an allowance of around 1,000 USD (7000 SEK) per month to support higher education.
When it comes to healthcare in Sweden, we are fortunate to have a reasonably good access to high quality healthcare at a very low cost. Swedish citizens pay no more than about 130 USD (900 SEK) per year for primary and secondary healthcare and for tertiary care the fee is not very high either. For prescription medication, an individual pays no more than 260 USD (1800 SEK) per year, regardless of the price of the drug. The balance up to the actual cost for the care and medications is covered by the social security system.
I have absolutely no reason to complain, this system really benefits me personally, since I take medication at an actual cost of approx 15 USD (100 SEK) per day or over 5000 USD per year. Of course, to me personally, this system is a life-saver, since I would be more or less completely unable to move without my medication. But I definitely think that this system also gives Sweden a reasonable ROI, since this investment actually enables me to work and contribute actively to society as well as reduces my use of other healthcare resources.
Naturally, this system also has downsides. In my opinion, a healthcare system where the individual pays practically next to nothing of the actual cost for care directly, makes people a bit spoilt. Services that are free of charge are not really valued in Sweden. But this is to me a very light burden to bear, since it provides us Swedes with an usually equitable healthcare system.
The other major problem I see with the “Swedish model”, where the government basically has taken a very large responsibility for its citizens, is exactly that; responsibility. In my opinion, most people in Sweden have actually, more or less consciously, given up the responsibility for their own health and expects someone else to take it for them. To me, health is about responsibility, responsibility for your body, responsibility for your wellbeing, responsibility for your life. I am not saying that I have the responsibility to heal myself, but I definitely have the responsibility for acquiring the necessary knowledge for my own health issues and manage them accordingly. To me, health is about being responsible for knowing when I can manage a health issue myself and when I need professional help.
I have the responsibility to take care of myself, because no-one else can be expected to and that is the way it should be. I am fully aware of my responsibility, but that doesn’t mean that I can always manage by myself. I need help, but it is my responsibility to seek it when I need it. And in my opinion, healthcare has the responsibility to meet my needs. But not necessarily in full.
There has to be a balance between 1) my expectations or hopes for improvements in my personal health, 2) what is medically and technically feasible and 3) what is economically reasonable.
To me, this forms the basis for Shared Decision Making in healthcare.
I really like your article, and I agree to a large extent to the argument of responsibility. But I think it’s too easy to talk about just responsibility. I would like to spice it with a little more: Isn’t it also about understanding or grasping the situation?
I think most of us largely know what we need to do to support our health (which of course supports your argument). But that doesn’t necessarily mean that we are capable of doing it. Understanding or grasping the consequences of my actions today concerning my own health (or lack of health) in ten, twenty or fifty years, is very abstract.
Imagine if we could get people to FEEL the facts that we today theoretically have. Imagine if you today were slightly overweight and could ‘dream’ yourself into a future scenario in 20 years with obesity, diabetes and painful knees. Imagine if you could live and feel the consequences of obesity for a moment or even days. Then imagine if you could live your future-self with normal weight, no diabetes or knee pain for a while.
What if healthcare (or a new imaginary service provider) would be able to convey this? Support people to REALLY understand, rather than to give them facts and expect them to take responsibility – all alone by themselves?
A good movie can evoke feelings and emotions. What if something similar could convey future scenarios of individual health in the future? Simulating different scenarios connected to what today is in the realm of ‘my own responsibility’.
Just knowing things isn’t enough. We need to grasp, feel and understand the knowledge.
Thank you for your comment Anna, the concept you describe is very interesting and I think it would be an extremely powerful tool for motivating people. I also totally agree with you; dealing with chronic illness IS a lot about knowledge and insight as well as your own responsibility and we all could benefit enormously from the kind of tool you describe.
I strongly agree with your sentiments Sara. The abducation of personal responsibilty to the state seems to be the downside of social health systems.
The way i read Anna’s response and forgive me if i mis interpret is that the state is in some measure lacking because it does not adequately convey the consequencies of poor health decisions. It gives facts but needs to touch emotions. Isn’t this again saying the system is at fault?
I don’t currently nor expect in the future that i will make wise personal health decisions and i do not want a system that will judge me or deny me treatment but for my part i strive not to allocate blame to the health system for my health problems be they due the consequencies of my choices or just mis fortune.
Thank you Dilys, your reasoning really resonates with me. And I agree with you, a lot of people do blame the faulty healthcare systems all over the world. I do think however, that a more constructive approach is to simply accept that the systems have potential for improvements and work toward making them better and I think that is what Anna is describing.