Burdening patients: qualitative analysis of healthism in community-based hypertension care in China

Healthism, a neoliberal ideology that frames health as an individual responsibility and moral duty, inherently operates as a blame-the-victim framework, attributing health outcomes primarily to personal choices and behaviours. This qualitative study critically examines healthism's influence on community-based hypertension care in China, particularly its reinforcement of individualised blame and patient distress. Based on semi-structured interviews with 18 community health professionals and 17 hypertensive patients in Shenzhen, the study reveals that while self-care is promoted as essential to hypertension management, it often fosters feelings of inadequacy and social isolation, particularly among patients struggling to meet the expectations set by healthcare providers. Participants also report emotional distress exacerbated by socio-economic challenges that remain unaddressed within the healthcare system. Moreover, the individualisation of health responsibility erodes trust between patients and providers, as patients internalise failure when unable to adhere to prescribed lifestyle modifications. This study critiques the reductive association between patient autonomy and improved health outcomes, advocating for a more holistic approach to hypertension care that acknowledges broader social determinants of health and prioritises structural support for patient well-being.