The household context for women's health care decisions: Impacts of U.K. policy changes

Since the Conservatives came to government in 1979 the policy climate generally in the U.K. has been one of the privatization of public provision and tighter controls on public spending. A re-positioning of health and social care has taken place in the light of this pre-eminence of market forces with the assumption increasingly being made that potential service users operate on a 'level playing field' of opportunity. A major consequence has been the expansion of household health responsibilities through measures which include a greater emphasis on preventative screening and healthy lifestyles and a general shift in the locus of care to the 'community'. Not only has the last decade seen this intensification of pressure on women in their social role as family carers, a restructuring has taken place of the U.K. labour market such that the 'double burden' of paid and unpaid work is an increasingly common experience. Contrary to the policy view of equality of access, in-depth interview evidence from Liverpool shows that the health care behaviour of many women is increasingly constrained by their social roles and availability of economic and social network resources. This paper distinguishes between groups who are and are not well equipped to cope in the light of changing structures of provision and discusses the implications of the research for the design and implementation of health and social care.