Chapter 6: Cost-cutting, co-production and cash transfers: neoliberal policy, health and gender
Neoliberal policy has an impact on health through several channels: through health policy, economic policy, health policy and social protection policy. This chapter provides an overview of these. Evidence on health reform suggests that health access has become more dependent on income and unpaid time. Women, especially poor women, have been particularly affected. To understand why this is, it is also necessary to investigate the way that economic and social policies provide women and men with income, alter time constraints and change health claims. Underlying neoliberal policy is a particular vision of health rights and responsibilities, with growing emphasis on the health-seeking behaviour of individuals. The libertarian paternalist strand of neoliberal thought has been particularly keen on intervening to change individual behaviour and this has led to a new health emphasis on cash transfer interventions. The chapter argues that cash transfers have been associated with increased use of health services and improvements in nutritional outcomes, although there are less clear impacts for other health indicators. Libertarian paternalist interventions focus on decision-making about health, rather than the way that gender and class intersect to shape health outcomes. Such interventions obscure the social and economic factors leading to poor health, appear easily implementable and place responsibility on the ill for being sick. As such they are the apotheosis of a neoliberal approach to health that ignores the socio-economic production of poor health.
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