Welfare State Research Articles

Strategic coupling of administrative rationality and cultural imaginaries in municipal amalgamations

Municipal amalgamations are widely applied interventions for enhancing policy delivery in a political-economic context of devolution, austerity, and decentralization of welfare states. This paper studies how public stakeholders in the Netherlands walked the tightrope between ‘hard’ political-administrative logic and ‘soft’ cultural-historical discourse to justify, institutionalize, and legitimize municipal amalgamations. It uses a theoretical approach that combines literature on the rescaling of state governance and cultural political economy. Based on a discourse analysis of amalgamation reports, the paper traces the constructed political-economic and cultural imaginaries of the 26 municipal amalgamations that took place in the country between 2018 and 2023. Imaginaries underpinning the Dutch decentralization discourse were purely political-administrative in content, both regarding the necessity to act and the solutions (i.e., municipal amalgamations). Alternative, relational forms of spatial decision-making were covered by an imaginary of inefficiency and limited democratic control. Cultural imaginaries were locally mobilized to retain the top-down political-administrative logic, and to allow the municipalities to position themselves in between the citizens and the state. The amalgamation reports reflected a sometimes-difficult discursive negotiation between administrative efficiency and culture, future and past, vigour and softness, and external and internal visibility of the new municipalities. The paper concludes that the spaces of territorially bounded ways of policymaking, including municipal mergers, are intrinsically relational, jointly material-discursive/symbolic, and fluid (i.e., process-based). The cultural political economy framework provides a useful interpretative framework for debates on politics of scale, state rescaling, and (re)territorialization.

Big bang in the middle of a storm: Lessons from implementing health system reform in Finland

Abstract Introduction Finland is often defined as a Nordic welfare state, characterised by universal access to healthcare and an emphasis on national and local politics in the governance of the system. In 2023, the Finnish health system was reformed by centralising organisation (purchasing and service delivery) to regional entities, as well as funding and overall governance to the state from 200 local organisations. The aims of the reform were to improve accessibility, decrease inequities, promote population health and curb growing costs. In the Finnish health system, as in other fields of society, we “find a huge number of very small changes, and a very small number of huge changes” (Cairney 2016). This makes the Finnish health system reform a rare opportunity to use a large-scale reform as a context for a study on reform implementation. Methods This research is based on document analysis and interview data collected from top regional managers. The data was analysed using a political determinants of health framework and thematic analysis. Findings The Finnish reforms were introduced by a left-centre government but implemented by a right-wing government with strong opposition to the reforms, which made full implementation challenging. The results highlight the importance of political commitment to implementation, demonstrate that reforms shape power relations at all levels of the health system and highlight how health system reforms are essentially about redistributions of power between different actors. The results also highlight the importance of contextual factors and suggest that large-scale reform should be treated as a system shock for which health systems need to prepare. Conclusions Understanding the political determinants of health and political commitment to reform is essential to implementation, as is the importance of resilience and preparedness to unexpected circumstances either due to reform-related factors or to external and contextual factors.

The Elderly Bias of the Spanish Welfare State (1958–2012)

Abstract The Spanish welfare state is strongly biased toward sustaining the elderly’s welfare, rather than children’s. We study the evolution of that bias since 1958 through National Transfer Accounts (NTA). NTA disentangle how people produce, consume, and save along their life cycle, and how resources move among generations through different mechanisms (families, markets, and governments). We extend the available NTA (2000–2012) to the past and show that Spanish social policies were biased toward the elderly since their early stages. The gradual increase in social expenditure and the aging of Spanish society have turned such bias into a serious challenge for the economy.

Developing mental wellbeing promotion practices in Finnish primary schools: The CONSENSUS project

Abstract Issue/problem Schools constitute a key arena for promoting mental wellbeing among children and adolescents, and the Finnish welfare state has many beneficial structures in place for promoting mental wellbeing in schools. However, as mental health problems are prevalent, the need to advance this work is vital, ideally applying a holistic approach focusing on school-family interaction. Description of the problem The Finnish CONSENSUS project (2021-2025) focuses on the development of new practices and collaboration models in mental wellbeing promotion, targeting pupils in 13 primary schools in the Ostrobothnia region. The project answers question such as: What focal areas are prioritized by stakeholders in the development of mental wellbeing promotion in schools? How do participatory principles contribute to the development process and related outcomes? Results In 2024, a synthesis of previous project results (interviews, focus groups and longitudinal survey data collected among pupils, school personnel, school health care services and parents) was generated. The synthesis encompasses 20 possible priority areas to focus on in the development of mental well-being promotion actions, which are ranked by stakeholder representatives utilizing Delphi methods. Some pinpointed priority areas are implemented and evaluated in collaboration with self-selected schools during the academic year 2024-2025. Lessons Results highlight priorities in the development of mental wellbeing promotion in Finnish primary schools and describe focal areas being piloted, also illustrating opportunities and challenges when implementing participatory principles in action research projects. Key messages • Project results highlight prioritized areas in the development of mental wellbeing promotion in Finnish schools, as well as new initiatives currently being piloted. • The project approach emphasising participatory principles provides lessons for other initiatives focusing on mental wellbeing promotion development in schools.

7.X.1. Providing BoD estimates on a regional level – necessity in assessing health inequalities

Abstract Burden of disease indicators, such as Disability-adjusted life years (DALY), Years lost due to disability (YLD) and Years lost due to death (YLL) have become standard indicators in public health reporting systems. Due to the combination of morbidity and mortality, the DALY provides valuable information on the burden due to specific diseases. These tools are employed by policymakers to devise intervention programs with the objective of enhancing the collective health of the population. Studies at the subnational level offer a greater added value to the public health information systems. Identifying variations in health outcomes and disease burden across different regions is a key factor when introducing targeted interventions and allocating resources. Health inequalities persist also in countries with good health systems and well-developed welfare state. There are notable contrasts in the political, economic and social environments across Europe. Moreover, the European countries are at different stages of the epidemiological transition, which encompasses a range of factors influencing health and modifiable risk behaviours. These differences are determined by socioeconomic inequalities at national and sub-national level, such as municipalities, counties and others. It is therefore imperative to provide BoD indicators at the most possible detailed regional-level and to link this information with further indicators such as deprivation indexes or Gini coefficients. Obtaining regional-level data for BoD analysis and health inequalities is not straightforward and can pose many challenges. Data availability is usually scarce and may involve significant resources in collecting it. Data quality and data completeness can also pose challenges in the reporting systems, which can result in under-reporting of certain diseases and overlooking health problems in the population. Also, countries with smaller populations are confronted with the challenge of a limited number of cases, which poses difficulties in obtaining regional estimates. The following workshop presents examples from European BoD studies, that have analysed health inequalities at regional level. The first presentation shows a country comparison study of the overall YLL and their association with socioeconomic and geographical inequalities. The second is from an Estonian study, representing a country with a small population that has developed its own methodology for assessing regional health issues. The third presentation from the German BoD study presents results on 96 spatial planning regions, which have been combined with the German index of socioeconomic deprivation. The final presentation brings example from Norway, where the association between YLL and education and income is examined at municipality level. Key messages • By comparing BoD estimates at the regional level, policymakers and public health officials can identify areas with higher disease burdens, indicating potential health inequalities. • Linking information on BoD indicators with data on regional and socioeconomic inequalities is essential when monitoring developments and tailoring strategies in public health outcomes.

What’s pension got to do with it? Mortality inequality at older ages

Abstract Background The potential role of social protection systems and welfare states for population health and mortality has attracted increased interest in recent decades but mostly focused on overall characteristics or clusters of countries. Moreover, often neglecting older people even though the great majority of all deaths in high-income countries occur at later ages. We focus on the key social protection scheme for old adults: the generosity of the level of pensions. We compare pensions based on previous work history to basic minimum pensions. Our study is novel both by linking pension system to remaining life expectancy at age 65(LE65+), but also by studying the association to variation in LE65+, since that gives a measure of inequality. We do so across countries and over time. Methods and Materials Our sources of data are from the Human Mortality Database and the Social Policy Indicator Database. Data for OECD countries are matched over a long period of time and analysed by pooled time-series regression analyses with fixed effects. Results Although the results indicate that the generosity of pensions based on both pervious work history and basic minimum income our results primarily show the importance of basic minimum income. Here the effect sizes are larger and especially for women than for men (0.149*** vs. 0,.0715***). Concerning the variation in LE (65+) we find that more generous basic pensions are associated with reduced variation for women -4.64e-05**. Conclusions We provide new insights in how pension policies potentially influence mortality among older persons especially by extending our analyses also to inequality in mortality. Our results points to the importance of basic pensions. The gendered division of labour is a plausible explanation for the findings and to have an adequate pension for all should be of primary concern for public health. Key messages • Adequate basic pension for all of importance for remaining life expectancy among older people. • Adequate basic pension for all of importance for reducing mortality inequality among women.

Challenges of People With Disabilities With the Medical Commission of the State Welfare Organization

Background and Objectives: The international classification of functioning-disability and health (ICF) has been used by the State Welfare Organization in the medical commission in recent years. The present study was conducted with the aim of understanding the challenges of people with disabilities with the medical commission of the State Welfare Organization. Methods: The research method was qualitative and content analysis type. The method of data collection was done through in-depth and semi-structured interviews while respecting ethical considerations. The current research field of Tehran City and the medical commissions of the welfare organization departments in Tehran City and the samples were people with disabilities referring to this commission or their companions. To select a pooled sample, snowball sampling and theoretical targeted sampling were used. Data analysis was done using the method of qualitative content analysis with conventional approach. In order to ensure the reliability of the research, the four pillars of reliability, validity, transferability and verifiability were used. Results: In this research, 86 codes were finally extracted, which formed the theme of “challenges of people with disabilities” in two sub-topics: “Executive problems of clients with medical commission” and “communication problems of clients with members of medical commission". Conclusion: The findings of the research showed that those referring to the medical commissions of the welfare organization face problems related to the implementation of classification of function, disability and health, which need to be addressed by the authorities.

The lived experiences of the welfare state of platform workers: The barriers to accessing social protection in Italy, Sweden and the United Kingdom

AbstractThe recent literature on platform work and the welfare state has stressed that, despite being affected by high‐income insecurity, platform workers cannot easily access social protection. However, it is unclear why platform workers encounter such barriers. This article offers an inductive and empirically based theoretical framework to investigate the obstacles faced by platform workers. It shows that the barriers experienced by platform workers depend on the eligibility criteria, the assessment criteria and the trade‐off between taxation and social protection. The article substantiates these claims by offering both a policy analysis of formal arrangements and a qualitative analysis of the lived experiences of welfare of 101 platform workers in Italy, Sweden and the UK during COVID‐19. The research found that, while many platform workers attempted to access social protection during COVID‐19, platform workers' access to social protection was affected by their positionality as outsiders, which clashes with the eligibility criteria (in Sweden and Italy); by the irregular nature of platform work, which contrasts with the rigidity of the assessment criteria (in the UK, Italy and Sweden); and by the implicit trade‐off experienced by platform workers between minimising taxation and accessing to social protection (in the UK and Italy).

Parenthood and poverty risk within couples: individual and household poverty risks by gender and education in four European countries

Abstract This study examines how the presence of children is associated with poverty risk within different-sex couples across welfare state regimes, using no- and full-income pooling scenarios. It focuses on whether partners can achieve an adequate living standard without relying on family ties, and how the costs of children shape poverty risk within these scenarios. Using cross-sectional EU-SILC data (2016–2019) on 30,150 coresidential couples from Austria, France, Spain, and Sweden, I use linear probability models (LPM) to estimate household and individual poverty risks among partners with/out children, by education, gender and country. The results indicate that poverty risks vary by gender, income pooling scenario and country. While partners bear household poverty risks together, there is a pronounced gender gap in individual poverty risk across countries. Men, regardless of their education and fatherhood status, have a relatively low individual poverty risk, with little difference between income pooling scenarios. Conversely, women, especially low-educated mothers, have a higher individual than household poverty risk. Observed cross-country variations highlight that the relationship between motherhood and poverty risk is context-specific. Although education is often promoted as a shield against poverty, in some countries, such as Austria, highly educated mothers also face a high individual poverty risk.

Shifting the gaze on welfare-state sustainability in Norway: a proposal for a relational global view

Norway is an excellent case for studying the ambiguities and competing interests attached to climate change and global sustainability. The country is at the forefront in the use of “clean energy,” yet has long been one of the world’s largest oil exporters and its dominant ideas have been challenged given the climate-change crisis. The article offers a preliminary review of the historical and current connections that exist between the development of national welfare states in Europe (and Norway in particular) and the long-standing practice of extractivist efforts that have harmed nature in indigenous lands within Norwegian borders and colonized, or previously colonized lands, outside Europe). As a comparative exercise, this article mobilizes the idea of social imaginaries to conceptualize and explore how the Norwegian welfare state has, in the social policy literature and in public discourse, been linked to the notion of sustainability, given the context of rapid climate change. By drawing on three illustrative cases, the article demonstrates how such imaginaries are present in current discussions. It suggests that unpacking such imaginaries within a historical and relational global view may contribute to understanding the role of nationalism and colonialism in Norway’s sustainability narratives, to potentially trigger change in the way we conceptualize welfare-state sustainability.

“It's not that we Feel Incompetent, We Simply Lack the Institutional Solutions” Applying a Collective Capabilities Perspective to Voluntary Organisations in the Homelessness Field

ABSTRACT In today’s changing care and welfare landscape, voluntary organisations play an important role in providing care to homeless people. The limited literature on such initiatives is often sceptical about their effectiveness, although they do point to their positive contributions. In this paper, we use a Collective Capabilities lens to analyse the role, value, and limitations of volunteer initiatives addressing homelessness. We apply this framework to four case studies of volunteers-only initiatives providing care to homeless people in Brussels, Belgium. Data were collected through participant observation, interviews and document analysis. Our results highlight the trade-offs that voluntary organisations make between organisational capacities and agency. While formalisation and cooperation may contribute to an organisation's mission, these processes are sometimes avoided to preserve the unique contributions these organisations believe they make, such as providing care for people who fall between the cracks of the welfare state. Our results suggest that while voluntary organisations working with homeless people are aware of their limited capabilities regarding structural solutions, they do respond to unmet needs precisely because of their agency. However, there is a risk that fledgling organisations may take reckless and unsustainable actions.

Divergent rhythms of motherhood. Patterns of paid and unpaid work and domestic outsourcing among mothers in the United Kingdom and Western Germany

Objective: This article investigates class differences in mothers’ daily organization of paid and unpaid work, and how they are associated with domestic outsourcing in the United Kingdom and Western Germany. Background: Operating hours of schools and daycare facilities often conflict with long working hours in high-skilled jobs and nonstandard working hours in low-skilled jobs. However, little is known on whether advantaged mothers rely on domestic outsourcing to resolve such scheduling conflicts, and how disadvantaged mothers reconcile their daily care responsibilities with paid work, depending on the welfare state context. Method: The study uses sequence and cluster analyses on time-use data to identify typical patterns of paid and unpaid work (N=1,947). Regression models predict how these patterns differ by the mothers’ education and household income, and how they are associated with outsourcing housework and childcare. Results: In both contexts, disadvantaged mothers were more likely to have unpaid workdays rather than nonstandard workdays. However, British advantaged mothers were considerably more likely to outsource childcare to pursue standard workdays. By contrast, the pattern of partial workdays in the morning, combined with more unpaid work allocation, prevailed among Western German mothers. Conclusion: In the United Kingdom, more market-oriented as opposed to conservative family policies, stronger labor market deregulation, and more consistent policy incentives for domestic outsourcing seem more effective than in Western Germany in promoting advantaged mothers’ careers. However, this comes at the expense of greater class differences in how mothers organize their time.

Becoming ‘more like a Finn’: In‐visibility and the struggle for belonging in Finland

AbstractNationalist practices and visionaries have a profound influence on those who are categorized as ‘foreign’ or ‘non‐belonging’ to the nation. Based on ethnographic explorations among Russian‐speakers and people with diverse Middle Eastern backgrounds in Finland, this article revisits the concept of in‐visibility as one possible avenue to expose the everyday struggles for belonging that these populations experience. We explore how dynamics of exclusion and inclusion at work in the wider society engender specific identification patterns that ultimately reproduce and reshuffle hierarchies between people. We argue that in their struggle for belonging, people categorized as ‘foreign’ in the nationalist imagination develop responsive tactics of becoming visible and invisible to cast themselves as full members of the society. However, in doing so, they find themselves tangled into hierarchies and power dynamics of exclusion at the core of strategies of visioning embedded into the social structures of the securitizing racial welfare state.

The body politic has private parts: market creation as a policymaking tool

Abstract Philosophical arguments about government contracting either categorically oppose it on legitimacy grounds or see it as largely anodyne. I argue for a normatively distinct kind of contracting – the advance market commitment, or AMC – and show that it is justified by the same liberal values that justify the welfare state.

Crisis-proof households? How social policy responses to the COVID-19 pandemic imagined work and care in Germany

Abstract Social policies convey normative assumptions about how households should make ends meet and organise care, but how do these ideals withstand crises such as the coronavirus disease 2019 (COVID-19) pandemic? Previous research shows continuity of welfare state models in the crisis, but mostly looked at single policy fields and produced mixed findings regarding the role of pre-crisis reform trajectories. This paper contributes a detailed analysis of assumptions about the ‘standard productive household’ in terms of three dimensions: labour market participation, coverage of economic needs and coverage of care needs. Drawing on original policy documents enacted in 2020 in Germany – which had dismantled many of its institutional strongholds for the male-breadwinner model before the crisis – we provide two novel insights. First, social policy responses to the pandemic were relatively coherent regarding assumptions about labour market participation, but expectations towards households’ abilities to make ends meet and parents’ care involvement were less coherent. In addition to relaxing conditions on stable employment and income, policy responses normalised patchwork incomes and relied on parents to compress paid and unpaid work. Second, we propose that crises may slow down reform processes that are already underway by reverting to ideas that were dominant in the past.

The welfare state

The first keyword, Welfare State, sets out to problematise the term itself. The welfare state is a national construct, a ‘national social state’ as Etienne Balibar calls it. Thus, transnational or global migration is often construed as a disruptive force, potentially destabilising the welfare state and the nation. This keyword entry critically examines common conceptions of what the welfare state should provide. It delineates some of the ways that migrants (and, more broadly foreign nationals who are not themselves necessarily migrants) are excluded or partially included, with a focus on contemporary EU social policies.

Governing poverty and migration in European nation-states – keywords revisited

This article introduces a collaborative publication exploring the intricate interplay between poverty governance, migration control, and welfare provision. Adopting a ‘keywords’ approach, we investigate the terminology and concepts around which academic discussions revolve when addressing poverty and migration. Central to this examination is the figure of the ‘poor migrant’, whose experiences of inclusion and exclusion intersect along lines of race, gender, and legal status. Using an intersectional lens, the publication dissects key terms and concepts : Welfare State, Welfare Governance, Citizenship, Solidarity and Deservingness, Suspicion and Surveillance, Discipline, and Banishment. We thus aim to conceptualise and critically discuss the constant renegotiation of state power and the nation-state induced in ex/inclusionary aspects of welfare and migration policies and law. The contribution reveals how notions of belonging shape access to rights and services, particularly along racialized and classist lines. Moreover, it explores how migration policies exacerbate scrutiny and exclusion faced by non-citizen populations within contemporary welfare systems.

Pro-immigration Norwegian Church élite: what explains the pro-immigration attitudes and are alleged welfare challenges acknowledged?

ABSTRACT Unlike political and business élites, few studies address attitudes among members of the church élite. Faced with politicians who refer to Christian heritage and values to justify restriction on immigration, we want to understand the attitudes of church leaders. This article draws on data from the Norwegian Leadership Surveys, conducted in 2000 and 2015, to identify attitudes to immigration and to the Norwegian welfare system among the Norwegian Church élite. The church élite respondents were recruited among bishops, deans, and members of the National Church Council in the Lutheran majority church, the Church of Norway. Finding that a pro-immigration position characterizes the Church élite, we explore how these attitudes can be understood by introducing various variables. As immigration allegedly represents challenges to socio-economic integration and to upholding the welfare state, we investigate whether pro-immigration attitudes correlate with attitudes to promoting integration and upholding the welfare state. We find that pro-immigration attitudes are correlated with concern for those not able to provide for themselves, stronger trust in the State than in markets, and no particular concern for the impact on the welfare state. Opposing a nationalist protection discourse, the church leaders express a humanistic or human-centered protection discourse, which we term ‘human-centered cosmopolitanism’.

Banishment

Banishment concludes the keyword discussion by arguing that we can understand the exclusionary practices of welfare states as a politics of destitution, which ultimately leads to the banishment of unwanted individuals. It argues that banishment can be helpful as a conceptual lens through which to understand the purposeful strategies that render individuals deportable, whether citizens or non-citizens.

The origins of social protection in healthcare: classifying healthcare systems at introduction in 165 countries

ABSTRACT While the emergence of welfare states, and the origins of social protection in healthcare, have been examined extensively for Global North countries, there is much less research with a global perspective. Addressing this gap, this study provides a descriptive and analytical account of the characteristics of healthcare systems as they were introduced worldwide. Using original and unpublished data, the study classifies healthcare systems according to the main actor type in regulation, financing, and service provision. We find two worlds of healthcare regulation – a state-regulated and a societally-regulated. Adding the financing dimension yields six clusters of healthcare regulation and financing. Based on regulation, financing, and service provision the classification reveals the existence of 12 healthcare system types. While systems that rely on societal actors mainly emerged prior to the mid-twentieth century, state-based systems have characterized system introductions since then. The classification of healthcare systems in 165 countries shows that only a limited number of actor combinations can be found empirically. However, it still presents greater variety than previous studies focusing on the Global North. The notable historical and regional patterns in the choice of healthcare system types can serve as a starting point for further research on healthcare system development.