The role of civil society in health and social services: the Swedish case

• Magnus Jegermalm, PhD, Associate ProfessorErsta Sköndal UC, Sweden

• Cecilia Henning, PhD, Associate Professor

Department of Behavioural Science and Social WorkSchool of Health Sciences, Jönköping University, Sweden

• International Federation on Ageing Conference in Prague28 May- I June 2011, Theme: Ageing Connects

Aim of this presentation

• Discuss the Swedish case by analysing the possible role for civil society in health and social services with focus on patterns of change over the two last decades regarding scope and character.

• As an empirical illustration for this discussion we will use results from a national survey in Sweden repeated four times 1992-2009 by the Department of Civil Society Studies, Ersta Sköndal UC

We describe and analyze the role for civil society by using four ‘engagement profiles’ that we have identified

1. Those volunteering in organizations, 2. Those involved in informal helpgiving outside

organizational settings, 3. Those involved both in volunteering and in informal

helpgiving,

4. and those not involved in either of these activities.

Contextual factors

• Sweden is characterized as a country with high levels of taxation and a social policy system with ambitions of having universal welfare schemes

• Sweden has one of the oldest populations in the world. Around the turn of the new millennium, 17 percent of the population in Sweden was aged 65 and over.

• In the year 2000, Sweden was the first country in the world to have reached the 5 percent level for people aged 80 or over

Contextual factors

• Home help has been considered a cornerstone of the Swedish public care system for older persons

• The 1980s and 1990s saw a fall in the proportion of older people (65+) receiving home help from about 16 percent to less than 10 percent

• Housing issues are closely connected to the organization of eldercare. “Aging in place” has been the dominant policy in Sweden

Contextual factors

• Since the late 1990s informal caregiving has been ‘re-discovered’ by the state

• Since 2009 the municipalities are legally obliged to offer support for an informal caregiver who provides care for someone with chronic illness, an elderly person or a person with functional disabilities

Voluntary work in Sweden

• Voluntary work in Sweden in 1992, 1998, 2005 and 2009. Percentage of the adult population (16-74 years) involved

Year 1992 1998 2005 2009

Percentage of population

48 52 48 48

Informal caregiving in Sweden

Informal caregiving in Sweden as a whole 1992, 1998, 2005 and 2009 (%)

1992 1998 2005 2009Percentage of population

28 30 52 45

Unpaid engagement and non-engagement among different groups in

1992, 1998, 2005 and 2009 (%)

1992 1998 2005 2009

1. Engaged in volunteering only 33 36 21 24

2. Engaged in informal helping only 12 13 23 20

3. Engaged in both volunteering and informal caregiving

17 16 30 24

4. Engaged neither in volunteering nor informal caregiving

38 35 26 32

Some preliminary conclusions

• Repeated surveys over a span of 17 years indicate that Sweden has a strong stock of social capital at the national level,

• From the studies of unpaid activities in Sweden, we see that there may be more of a ”crowding in” effect on social care instead of informal helpgivers and volunteers ”crowding out” the government programs

Our most important empirical finding: the fact that a large group of Swedish citizens engage in both voluntary and informal efforts

• The double involvement, leading to an increase of both volunteering and informal caregiving, is an example of a cumulative citizenship

• Here we find a civic main-force creating as well bonding as bridging social capital.

Some preliminary conclusions

• One explanation for the parallel existence might be that the public welfare system and civic involvement in the form of unpaid help are involved in different forms helping tasks, especially concerning older people

• After cutbacks and changed priorities concerning home help the public system have focused more on helping people with ‘heavier’ tasks involving personal care

Some preliminary conclusions

• This development have most likely led to that informal caregivers and volunteers commonly carries out ‘lighter’ tasks for someone who is a relative but might also be a neighbour or a friend

• Many of these contacts could probably be described as weak ties or thin ties

• The linkage between weak ties and ‘light tasks’ is mostly an invisible part of the helping patterns, and we need more knowledge about the significance of these patterns

Some preliminary conclusions

• We argue that it is important to challenge the widespread view of unpaid help work as being instrumentally related to the country’s welfare system and to changes in the welfare state

• Sweden gives an example of a country where there does not seem to be any simple contradiction between having a vital civil society and a welfare state including a substantial public sector.

Who is responsible?

State

Civil Society Market (Including voluntary organizations

and informal help/caregiving outside organizationalframeworks)