Healthcare policies and provision should meet the needs of all chronically ill and disabled people, as opposed to privileging the most prevalent conditions, reflecting the needs of more socially advantaged patients, or reflecting the interests of power structures. In the field of long Covid, advocates are foregrounding patient narrative in pushing for multi-disciplinary services to accommodate multi-system conditions, thorough biomedical investigations, and patient involvement in research and clinical service commissioning (Alwan et al.
Citation2020; Nurek et al.
Citation2021). It is important that any strategies of inclusion for people with long Covid, likely facilitated by the prevalence of long Covid and relative social power of advocates, are extended to the wider disability and chronic illness community (see Hunt, Blease, and Geraghty
Citation2022). Current healthcare resource allocation (allegedly needs-based) requires critical scrutiny: there is somewhat of an inverse or disproportionate care law as regards chronic illness provision within many health systems, including the UK NHS, whereby conditions with comparatively low quality of life, such as ME/CFS (Falk Hvidberg et al.
Citation2015), receive amongst the lowest levels of biomedical research funding and appropriate healthcare (Radford and Chowdhury
Citation2016). Systems such as the Quality and Outcomes framework (NHS Digital
Citation2021), which may contribute to the neglect of certain chronically ill and disabled people (Hannon et al.
Citation2012), require scrutiny in this regard.
Health interventions that are currently typically considered biopsychosocial and holistic should include recognition of socio-structural influences in chronic illness and disability (see Karadzhov
Citation2021b). For example, psychoeducation, psychosocial health management and talking therapies should acknowledge socio-structural injustices, where appropriate ‘normalising’ (as opposed to pathologising) psychological distress as an understandable response (Johnstone and Boyle
Citation2018). Such interventions should also assist chronically ill and disabled people in asserting their rights, in recognising and addressing internalised oppression and self-stigma, whilst encouraging positive identity-building through connections with empathetic others (Olkin
Citation2017; Reeve
Citation2002). Patient-centred care is of course crucial, though critically reflexive approaches might shed light onto why hitherto that has been so difficult to achieve. Finally, for people with primarily physical conditions (mind-body interface debates acknowledged), psycho-social-structural interventions should be considered a supportive adjunct to biomedical care, as opposed to a treatment. A bio-psycho-socio-structural approach to chronic illness and disability is thus consistent with bringing the body back into disability studies, whilst integrating disability studies’ focus on social oppression into the medical sociological (mainstream healthcare) conceptualisation of disability.
