Empowering patients: issues and strategies.

Over the past few decades perspectives derived from critical social theory and other critical perspectives have infused the discourse on health, illness and healing, and have heightened awareness of the ways in which social and economic inequities experienced by particular groups determine their health. The influence of these paradigms in the health sciences occurs, simultaneously, with other movements in health care services and delivery. There has been major overhauling of health care delivery systems in many western nations with concomitant call for greater public participation and individual responsibility for health and health care (self-care). As these movements have gained momentum, ideas that suggest how people will be enabled both to attain greater social equality and to take increased responsibility for their health have flourished, and patient/consumer empowerment has become a central concept in the discourse on health. Drawing on research data from multiple sources I begin to interrogate what the notion of empowerment might mean for patients living with a chronic illness, particularly women who have immigrated to Canada; I examine the multiple layers of contexts that organize their experiences of illness. Building on earlier research that explicated the unstated ideologies that underpin the self-care movement. I extend this analysis to examine the conceptual underpinnings of "empowerment". While not dismissing the idea of "consumer empowerment" I question whether unreflexive use of this notion within the "health care industry" might deflect our attention from the structures that perpetuate social inequities. I conclude by arguing for a perspective that will allow us to address issues pertaining to the notion of empowerment in the lives of patients, generally, as well as those who are marginalized and disadvantaged.