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Public policy and inequalities of choice and autonomy

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  • Tania Burchardt
  • Martin Evans
  • Holly Holder
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    Abstract

    This article explores the conceptualisation of choice as autonomy using three components - self-reflection, active decision-making, and quality and range of options - and investigates empirical inequalities in autonomy, using newly-collected data for the UK. 'Choice' has been promoted in social policy across many developed welfare states, often on the grounds that it is instrumentally valuable: choice by service users is said to incentivise providers to enhance quality and efficiency. But egalitarian and capability-based theories of social justice support the idea that choice - understood in the deeper sense of autonomy - has an intrinsic value. The empirical findings indicate that disabled people are most likely to experience constrained autonomy in all respects, while being from a low socio-economic group and/or lacking educational qualifications is a risk factor across several components. The fact that limited autonomy maps onto existing socio-economic disadvantage is not surprising, but points to the importance of taking into account underlying inequalities when developing choice-based policies. We conclude that improving the 'choice' agenda for policy requires opportunities for people to reflect on their objectives throughout the life course and that the removal of barriers to active decision-making would require effective support and advocacy, especially for disabled people. We suggest that major structural inequalities associated with restricted autonomy should be addressed - poverty, ill health and geographical inequality - because they place significant restrictions on the autonomy of those who are already disadvantaged as well as their immediate effects on living standards and quality of life.

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    File URL: http://sticerd.lse.ac.uk/dps/case/cp/casepaper174.pdf
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    Bibliographic Info

    Paper provided by Centre for Analysis of Social Exclusion, LSE in its series CASE Papers with number /174.

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    Date of creation: Jun 2013
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    Handle: RePEc:cep:sticas:/174

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    Web page: http://sticerd.lse.ac.uk/case/_new/publications/default.asp

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    Keywords: choice; autonomy; inequality;

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    1. Fabbri, D & Robone, S, 2008. "The geography of hospital admission in a National Health Service with patient choice: evidence from Italy," Health, Econometrics and Data Group (HEDG) Working Papers, HEDG, c/o Department of Economics, University of York 08/29, HEDG, c/o Department of Economics, University of York.
    2. Grytten, Jostein & Sørensen, Rune J., 2009. "Patient choice and access to primary physician services in Norway," Health Economics, Policy and Law, Cambridge University Press, Cambridge University Press, vol. 4(01), pages 11-27, January.
    3. Tania Burchardt & Holly Holder, 2012. "Developing Survey Measures of Inequality of Autonomy in the UK," Social Indicators Research, Springer, Springer, vol. 106(1), pages 1-25, March.
    4. Frances Stewart, 2005. "Groups and Capabilities," Journal of Human Development and Capabilities, Taylor & Francis Journals, Taylor & Francis Journals, vol. 6(2), pages 185-204.
    5. Tania Burchardt & Polly Vizard, 2011. "'Operationalizing' the Capability Approach as a Basis for Equality and Human Rights Monitoring in Twenty-first-century Britain," Journal of Human Development and Capabilities, Taylor & Francis Journals, Taylor & Francis Journals, vol. 12(1), pages 91-119.
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