Health Consumers, Bio-citizens, or (Yet Another) Third Way? How NGOs Negotiate State and Individual Responsibility for Health in Croatia

Abstract

Non-governmental organizations (NGOs) have become integral to health care in post-socialist transitional settings. This mandates attention to how such organizations address disparities in health and access to care that have accompanied privatization of services and growing economic inequalities in these areas. Central to their role is how NGOs represent those seeking care and, in particular, the models they invoke to advance both individual and collective claims on state and provider systems.

This paper examines health-related NGOs in Croatia in order to assess models of citizenship rights and health consumerism. The concept of bio-(logical) citizenship denotes a broad project of medically-based demands for state support and collective entitlements. Policies based on models of health consumerism promote rational and informed individual decision-making.  These perspectives originally arose as part of anti-professional movements and more recently trace to neoliberal assumptions of individuals as self-managed consumers. Critical analysis has yet to unpack the different bases for these models and their possible relationship to sources of health inequalities.

Based on participant observation, interviews, and public documents, this analysis assesses the applicability of these models to Croatian NGOs addressing health and disability concerns. NGOs adopt diverse approaches, ranging from a focus on rights – including claims to care, support, or recognition – to those centered on personal responsibility and consumer choice. Contextual elements centrally shape the meaning of NGOs’ claims and thus the nature of bio-citizenship and health consumerism in their practice. Factors unrelated to health or disability, including the security of institutionalized entitlements and connections with health professionals, appear influential to the framework(s) NGOs deploy.  In terms of their importance to NGO missions, questions of social justice, distribution of health resources, and social inclusion eclipse identity claims based in either model.  Moreover, notwithstanding the differences among them, NGOs remain subsidiary in a system increasingly affected by health disparities cutting across the categories of people they represent.  For NGOs to play a role redressing this would require transformation of their organizational status and missions.