The role of chronic pain and suffering in contemporary society

The structure and organization of health care is a salient political issue across nations and welfare states. It is important not only from an economic perspective, but also from a social and political perspective regarding the possibility of maintaininga proper qualitative level of health care as well as a system that is broadly accessible to the citizenry. Equal access to health care and social care is thus a key factor when the general quality of public life is discussed, not only in Denmark but also in many other welfare states. A common prerequisite for the existence of such a system is a strong general norm of reciprocity in social and political contexts. The norm states that everybody should contribute to our common welfare by working, paying taxes and participating in political institutions and in return be treated as equal members (citizens) of the state. However, not all citizens are capable of working, and far from everybody has equal access to health care and social care. In theory everybody should enjoy the same rights and access to common services, but in reality the boundary between being considered entitled to and deserving of public assistance and being perceived as responsible for one’s condition is more a political than an objective measure (Stone, 1984: 26; Møller, 2009b: 235). In practice, the principle of equal access is interpreted and implemented by doctors who treat patients, health care professionals promoting health strategies, caseworkers who manage clients and schoolteachers teaching children and at the end of the day it is professionals like them who decide who is given access to services, transactions, preventive interventions and treatments.In health care the diagnostic system works as a platform for deciding who should treat which citizens with what, but in social care such a system is more invisible. Instead the main criterion for access to services and transactions is a systemdesigned to detect and measure the workability of every assistance-seeking citizen. The method of evaluating assistance-seeking citizens’ workability seeks to differentiate between needs and claims because an absolute main reason why citizens cannot maintain a job and need to apply for public support is health problems such as chronic pain, for which they seek medical, psychological or therapeutic help. On an economic level this demand of public support is often seen as creating incentives to exploit the social sector to reduce labor costs; on a practical level it constitutes a difficult and paradoxical interplay between the role of the doctor, the social worker and the idea of the independent citizen, in theory, the equal member of the state. This volume focuses explicitly on the case of chronic pain in such different social and political contexts.