EHealth strategies and platforms – The issue of health equity in Sweden

Abstract

ObjectiveThis paper critically reviews the national strategies on e-health development in Sweden during the last decade. The aim is to identify the discourses that drive the development and implementation of eHealth in Sweden, with a particular focus on the rationales behind the government initiated PHR platform HälsaFörMig (HealthForMe), and discuss them in relation to health equity. MethodsThe empirical base for this study is government policy documents and interviews made with policy makers in the e-health sector in Sweden. The research design builds on qualitative text analysis method drawing on epistemological and ontological assumptions from discourse analysis. ResultsOur framework for analysis focuses on governing aspects of the eHealth sector drawing on the works of governmentality theorists. We have identified how the eHealth sector is increasingly governed through market mechanisms, healthism and responsibilisation and is forming individuals into self-managing health-conscious consumers in a way that may undermine reaching other core values in society such as health equity. It also shows that the design and administration of HälsaFörMig aim to stimulate innovation in the eHealth sector thereby illustrating the interrelationship between the governing techniques of market mechanism and healthism. ConclusionIn order to close health gaps in a population the core governing rationalities driving the development in the eHealth sector have to be identified, monitored and evaluated to foresee if they help or hinder health equity.