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Health care systems all over the world are undergoing rapid and profound transformations. These changes are the result of a broad array of economic and social trends including neo-liberal economic policies that are contributing to the trend toward privatization, the commodification of health services and products, institutional restructuring (e.g., managed care) to contain costs in the context of technological advances, globalization and demographic changes such as population aging in post-industrial societies. Questions about the accessibility and quality of health care delivery in the face of persistent health disparities, growing numbers of medical errors, and new and uncertain risks posed by emerging infectious diseases, some of them drug-resistant, have also contributed to rethinking about health policy.

Since 2000, there has been a dramatic increase in the number of individuals using the Internet, including for health purposes. Internet usage has increased from 46% of adults in 2000 to 79% in 2010. The purpose of this chapter is to examine changes in one type of Internet usage: online health searching. We examine the impact of traditional digital inequality factors on online health searching, and whether these patterns have changed over time.

Using data from five surveys ranging from 2002 to 2010 (n = 5,967 for all five surveys combined), we examine changing patterns of online health searching over the past decade.

Effects vary by inequality factor and time period examined. Despite the diffusion of the Internet, most of these gaps persist, and even strengthen, over time. Gender, age, and education gaps persist over time and appear to be increasing. An exception to this is the importance of broadband connection.

Since these data were collected, the use of mobile devices to access the Internet has increased. Research is needed on types of access and devices used for online health activities.

Larger scale inequalities play important roles in online health searching. Providing access and skills in evaluating online health information is needed for older and less educated groups. The results of this study have implications for the de-professionalization of medical knowledge.

This is the first study to examine digital inequality factors in online health information seeking over the breadth of this time period.

This study examines how collective identities change when the political opportunity structure becomes more favorable to a social movement. Activists within the complementary and alternative medicine (CAM) movement in the San Francisco, California Bay area have traditionally competed with physicians by criticizing Western medicine and providing an alternative medical model for consumers. Physicians are increasingly interested in CAM given financial changes within Western medicine, and increased consumer interest and governmental recognition of CAM. Activists in the Bay area are beginning to form networks with physicians to develop an integrative model of medicine, which combines Western and alternative approaches. Consequently, some activists are changing their collective identity now that they are advocating an integrative, rather than alternative, model of medicine. Activists within any social movement do not always agree on goals and strategies, however. The aim of this research is to contrast the collective identity of “alternative” and “integrative” activists, and to show that the latter identity is gaining prominence as political opportunities become available to the movement. This research contributes to the work of contemporary social movement theorists who are examining the relationship between the political opportunity structure and collective identities.

A new medical model has emerged due to the public's increasing awareness and acceptance of alternative medicine. As a result, alternative practitioners have joined with physicians in a variety of professional settings to explore ways to integrate Western medical techniques with alternative medical techniques and ideology. For example, clients with chronic lower back pain may receive treatments in an integrative clinic from the physician, chiropractor, and massage therapist. Yet, they are also encouraged to make changes in their daily routines at work and home to lessen the stress on their back. Thus, practitioners use both Western and alternative techniques in accordance with a key component of alternative ideology: the belief that individuals must take responsibility for their health.Political and cultural changes have made integrative medicine possible, yet there are some key issues that activists need to resolve as they develop this new model of medicine. Many alternative practitioners are interested in working with physicians, because it brings legitimacy to their work. Yet, it is important to understand why some physicians are now interested in working with alternative practitioners. Political changes, such as the rise of managed care, have eroded physicians' authority. Consequently, some physicians are searching for new ways to practice medicine without these structural constraints. Other physicians are drawn to the connection that alternative ideology makes between spirituality and medical practice, reflecting a new cultural emphasis on spirituality. Finally, physicians and alternative practitioners need to develop a team approach where all practitioners have equal power and maintain the ideological integrity behind their techniques. These elements are critical for integrative medicine to be successful and effective.

Purpose – This chapter examines medical consumerism and the changing relations between patients as consumers and the medical system across two women's health contexts, breast cancer and infertility.

Methodology/approach – The analysis draws on two qualitative studies: The first explores the experiences of 60 breast cancer survivors through in-depth interviews and participant observation (Sulik, 2005), and the second uses in-depth interviews to analyze 18 women's experiences with infertility (Eich-Krohm, 2000).

Findings – The medical consumer is an individualized role that shifts attention away from the quality problem in health care and toward the quality of the person as a medical consumer who is characterized to be optimistic, proactive, rational, responsible, and informed.

Research limitations/implications – As medicine has become a form of mass consumption, the category of medical consumer has elevated the individual in medical decision-making. The shift from patient to medical consumer is an ongoing process that is grounded in a tension between medical control and individual agency, and is exacerbated by the intensity and incomprehensibility of modern medicine.

Practical implications – The proliferation of medical information and personal illness narratives through the Internet, advice books, and self-help groups have advanced lay knowledge about preventive medicine and medical treatment while simultaneously introducing new fears and anxiety about the multitude of options and outcomes.

Originality/value of chapter – This study contributes to our knowledge on medical consumerism and its impact on illness experience and the synthesis of lay and professional knowledge.

Purpose – This chapter assesses the role of self-help groups within the emerging civil society in two transitional economies, Croatia and Slovenia, focusing on the impact of relationships with health or social care professionals and the state.

Methodology – Methods include participant observation, interviews, and document analysis of 31 groups studied intermittently from 2001 to 2007.

Findings – Self-help groups range from those three decades old to those dealing with “new social problems.” Groups, and the third sector generally, remain essentially dependent on the state. Few exist separately from formal service organizations. Those closely linked with medical institutions are challenged by state retrenchment and privatization. Others contend with funding instability, and Western models of non-profit development are expanding. Relationships with professionals are neither subservient nor independent; instead, groups act as corollaries and educators to the professional realm.

Implications, limitations, and value – Findings suggest more nuances in self-help groups' relations with the state and professionals than found in Western settings. This may illustrate both the potential and the limits of citizen involvement in new non-governmental sectors. It also demonstrates how relations between professionals and self-help groups depend on social and material relations well beyond the domain of systems of care. While specific findings cannot be generalized beyond the research settings, the study shows the importance of understanding such groups within social and political contexts. Contributions to civil society here included re-making public meanings, identities, and relations with professionalized systems. Further comparative assessment of self-help associations is essential to theory on the third sector in civil society.