Patient Empowerment: Consequences for Pharmaceutical Marketing and for the Patient–Physician Relationship - Innovation and Marketing in the Pharmaceutical Industry - page 422

14.2.1 Modernization and Self-Expression

Modernization theorists posit that a society's value system is determined by its state
of economic development and cultural heritage (Inglehart and Baker 2000 ). In par-
ticular, post-industrialization triggers important cultural changes, notably an incli-
nation for more participatory values and for self-expression (Inglehart and Baker
2000 ). This means that as societies modernize, patients will be more inclined to
actively participate in their treatment decisions, which promotes patient empower-
ment. Consequently, the level of patient empowerment in different societies or
social groups will also be influenced by the degree to which such societies or groups
value self-determination. Models of patient-physician dyadic decision-making
therefore need to become culturally sensitive (Charles et al. 2006 ).
For instance, a recent study among undergraduates from large California univer-
sities shows that American students of European ancestry believe in the value and
practice of self-expression more than their East Asian peers (Kim and Sherman
2007 ). Religious people also tend to value conformity more than autonomy and
self-direction (Saroglou et al. 2004 ). I would also expect patients from countries
with higher self-expression values (Protestant Europe and English-speaking cul-
tural zones) to value patient empowerment more than patients from countries with
lower self-expression values (Catholic Europe, ex-Communist countries, Latin
America and South Asia). These topics deserve further scientific scrutiny.

14.2.2 Demographic and Lifestyle Changes

Demographic and lifestyle changes also reinforced the current trend towards more
patient participation in medical decisions. Population aging and lifestyle changes such
as increased urbanization and exposure to pollutants have contributed to an increasing
prevalence of chronic conditions like ischemic heart disease, respiratory infections,
chronic obstructive pulmonary disease, cerebrovascular disease, the continued spread
of HIV/AIDS and several forms of cancer (Murray and Lopez 1996 ). In addition,
increases in people's longevity mean that the 65-and-older population will dramati-
cally increase in the coming decades globally, which will accelerate the focus on
patient self-care and access to health-related information (Bodenheimer et al. 2002 ).
Both the increasing prevalence of chronic diseases and the aging population
helps reinforce the patient empowerment trend. Patient self-management is pro-
moted as a solution for containing the rising costs of healthcare systems and is seen
as an inevitable phenomenon in modern medicine (Bodenheimer et al. 2002 ).
Chronically ill patients tend to discuss their health concerns with peers and build
their own habits and networks to secure easier access to health and therapy-related
information. As a consequence, chronically ill patients are more knowledgeable
about their diseases than the average patient suffering from an acute disease. Such
knowledge facilitates active patient participation in therapy choice and collabora-
tion with the physician, i.e., this knowledge facilitates patient empowerment.