Introduction

Caring for ‘ourselves’ forms part of the broad definition of care outlined by Tronto and Fisher as one aspect of ‘everything we do to maintain, continue and repair our world’ (Tronto, 1993). But thinking about what exactly ‘self-care’ means and the ways in which it has been interpreted and mobilised in different contexts tells us that this is a term with multiple and contested meanings. Over recent years the concept of ‘self-care’ has been mobilised by policy makers and governments in the deepening of neoliberal objectives to dismantle public welfare resources and shift responsibility for care onto individual citizens. Yet ideas about self-care have a longer and wider history as part of collective struggles – for recognition of the experiences of disabled people, of women's health movements challenging medical hierarchies and in contexts of community-led peer support and self-help groups. This chapter examines the origins and contexts of self-care and how it is currently deployed in neoliberal restructuring of welfare systems. I illustrate this by specific reference to UK health and welfare policies and interventions to offer an analysis, grounded in care ethics, of the wider political implications for responsibilities for care in the dismantling of welfare states.

In advanced capitalist welfare states, such as the UK, the restructuring that has been underway since the late 1970s has eroded the conditions of the post-war social contract between states and citizens. Over time, part of this process has been to change people's expectations about the respective responsibilities of state and citizen. More recently and under the cloak of austerity measures and financial crises, the justification for further cuts to welfare and health budgets has been framed, at least in the UK, through the repeated articulation of discourses that present immutable ‘facts’ as to why the reforms are necessary. Firstly, that public-funded welfare systems are unsustainable and we simply cannot afford them as health and social care needs increase; secondly that welfare systems that are too ‘generous’ create dependency, and thus stifle innovation and creativity; thirdly, that individual ‘choice’ is paramount and freeing people from paternalistic welfare will lead to individual ‘empowerment’.

Self-care has increasingly been used in health and care policies in this context, often presented as a logical response to demographic change, particularly population ageing, and the anticipated increased demand on health and care resources.