Hanne Marlene Dahl in this text is discussing how capitalism, underfunding and specific forms of governance of care are shaping the care crises in the Nordic welfare states.
Hanne Marlene Dahl is a political scientist who works as a Professor at the Department of Social Science and Business at Roskilde University (RUC) in Denmark where she also is head of the PhD school. Her research interests are in the governance of care, feminist theory and theories of justice, and she has published extensively on these issues in the contexts of Denmark and Europe. One of her latest publications is as co-editor of the anthology from 2022: A Care Crisis in the Nordic welfare states?
This text is a part of the miniseries following up on the Crises of Care event organized by GRIP in collaboration with the Centre for Care Research west (HVL). This miniseries include texts that were presented at the event and engages with wider explorations of labour and inequality topic that GRIP currently focuses on.
People often wonder when I start talking about a care crisis in the Nordics. The Nordics are usually seen as universal, generous welfare states with tax-financed creches, kindergartens, nursing homes and health care. Universalism implies free care provided for all (and across class divisions) and of good quality. As care is free, of good quality and used by all parts of the population, it’s an unlikely place for a care crisis to take place. The Nordic welfare states are internationally looked upon as heaven on earth – a feminist Nirvana – with their caring welfare states.
When I talk about a care crisis in the Nordic welfare state, it depicts a rather gloomy, dystopic picture of the Nordics. This is a picture that doesn’t mean that all care in the welfare state is bad. The emerging care crisis is different than in liberal welfare regimes (UK and USA) and different from a care crisis in the Global South. Its different as the Nordic welfare states are an unlikely place for a care crisis to occur, that of generous, universal welfare regimes of the Nordic countries – or what Helga Hernes called ‘potentially women friendly welfare states’, and Mia Vabø and Marta Szebehely have labelled ‘caring welfare states’. The care crisis in the Nordics is different from the Global South with its export of global care workers. The care crisis in the Nordics is about care professionals leaving the welfare state, not the country.
Currently, politicians in the Nordic welfare states are worried about the increasing recruitment problems, what is termed a recruitment crisis. To recruit and keep care professionals, so they don’t leave their professions. A recruitment problem is part of the larger picture of a care crisis and indicates a serious, and hitherto unseen problem of the sustainability of the Nordic welfare states.
Theoretically, I together with a colleague define a care crisis as ‘…inadequate resources for care and the absence of ‘good enough’ care’ (Dahl and Hansen, 2022: 8).
This contextualized conceptualization of a care crisis refers to a major, structural problem. The care crisis has two dimensions. A quantitative and a qualitative dimension. The quantitative dimension refers to the extent of care services. In a care crisis it becomes more difficult to get access to services. There is a stricter assessment. The second dimension, the qualitative dimension is about the characteristics of care delivered. Is it good enough care? The care provided is ‘thinner’ than previously and instrumentalized to serve the ends of the state e.g. active ageing and social investments in kindergartens. We witness elements of care disappearing out of the care provision such as social elements of care. Care takes place in intensive, production-oriented welfare services.
In the international literature such as in Nancy Frasers Cannibal Capitalism there is an analytical focus upon capitalism and its negative effects on care and commons such as our emotional ties, social exhaustion, and time poverty. In another book by Emma Dowling, The Care crisis, there is also a focus upon neoliberal capitalism. Dowling combines the explanation of a care crisis with underfunding of the British welfare state. Although capitalism and underfunding of the welfare state shape the care crisis in the Nordic welfare states, this is not the full story.
Inside the welfare state
In the Nordic Welfare state, we need to supplement global stories about care crises with a contextual, story, that is concerned about what happens inside the welfare state: the governance of care. This is about how care is governed in paradigms of governance. These paradigms form how we think about care, how we think we can govern care and what this means for the way time is used within the state by care professionals. Alongside paradigms of governance, we can also identify more specific policy logics that governs publicly financed care in a detailed way. These policy logics are overall concerned with efficiency, quality and innovation which forms the care provided, so that care is downgraded and sometimes even silenced.
When we move inside the welfare state, we meet the care professional. The nurses, pedagogues, care assistants, home helpers, physiotherapists, midwives, and many other professionals. Currently, they experience an increasing high pace of work/intensification, increasing cross pressures, having to prioritize between various needs and prioritize people. And increasingly, they have to postpone the fulfillment of needs, or even to neglect some needs and some patients/children or elderly persons. There is moral distress, exhaustion, burnout – and fear of forgetting things that could be vital. Sometimes ‘forgetting things’ become care failures. The care professionals experience moral distress due to not being able to provide the necessary – or good quality care.
Governance of details
Experiences like these tend to become part of a vicious circle. Especially when understaffing is combined with what I have named a governance of details (Dahl, 2009). A logic of details is a very detailed way of describing what kind of care is provided. This logic of details and underfunding can feed into processes of mental, emotional. and physical exhaustion —that might lead to early retirement—that again might mean staff shortages—that again might have an impact upon the work pressure and results in more exhaustion and sickness—and it then becomes a vicious cycle.
We witness a care crisis that is related to working conditions as formed by underfunding and by a predominance of a logic of details. Work conditions that have detrimental impact upon care professions and care. Exhaustion among care professionals and vicious cycles in care work imply that not all care needs are met even in a ‘thin’ model of care. It also means that the care provided is not always good enough.
Making care assemblage work
Those that aren’t met in their needs and/or don’t receive good enough care – permanently or temporarily – are elderly, fragile people, children, patients, young people living in sheltered residences. They are victims of the two-sided retrenchment that is taking place: underfunding of care and its rearticulation as a narrower, more instrumentalized care. Those outside also consist of those people taking responsibility for care in a care assemblage: making the care assemblage work. ‘Those’ stitching the holes of the care patchwork together. Who are ‘those’ people stitching holes together? Despite changing masculinities – and the emergence of a caring masculinity – those providing the care outside of the welfare state, are also primarily women. Women face an intensified double burden: they must care at work and outside work: in families, for friends/significant others, local communities etc. The care crisis increases the double burden and depletes women’s resources. As care is increasingly downloaded to those in need (self-responsibilizing), families and communities, inequalities are on the rise. Although women are not a homogenous category, but intersected with, for example, class and race, there is an increasing depletion of women’s ressourcer. Depletion refers to the overuse of women’s resources (Rai et al., 2014).
This depletion is related to the way the Nordic welfare state embodies a class- and gender compromise. This compromise is now challenged as the care provided is not of (sufficiently) good quality – and for some groups, not available to all in need. Universalism is restricted. Another element of this compromise refers to its gendered aspects: of enabling women to be mothers, daughter/daughters-in- law and combining it with (full time) paid work throughout their life cycle. This gender compromise is seriously impaired as the burdens in the caring professions – and in unpaid care work – has increased for the population in general and especially for women. This structural element questions the sustainability of the Nordic welfare state in the short and long run. The inability to recruit and retain care professionals within care is a serious problem for its sustainability.
The care crisis in the Nordics is strongly related to the form of universalism that has so far been applied. A universalism that doesn’t valorize care to the same extent as other occupations and doesn’t understand the unpredictability and complexity of care. Care is misrecognized and governed on a par with other activities like car production where production is split up into smaller functions and monitored. The care crisis is strongly related to what I in my earlier work has referred to as a gender-insensitive universalism (Dahl, 2010). A gender-insensitive universalism is a universalism devoid of gender sensitivity. Gender sensitivity refers to an institutional ability to understand and counteract the specificities of gendered inequalities. Universalism without gender sensitivity leads to the ignorance of gender and how gender is strongly related to the misrecognition – and lack of understanding – of care and how it can be governed. Misrecognition is about pay, being seen and heard and understanding how care cannot be governed. A gender-insensitive universalism is a useful concept for us to understand how the Nordic welfare state has ended up in a situation of an emerging care crisis. A care crisis that is not like care crises in other parts of the world. It’s not like the care crisis in parts of the Global south – or in Eastern Europe. The Nordic care crisis is unique and needs to be understood in a particular institutional context. The care crisis in the Nordics is emerging – and should not be likely to happen – but it is happening.
Dahl, H.M. & L.L. Hansen (2022): “Introduction: A care crisis in the Nordic Welfare States?” in Hansen, L.L.; Dahl, H.M. & Horn, L. (eds). A care crisis in the Nordic welfare states? Care work, gender equality and welfare state sustainability. Bristol: Policy Press: pp. 9-37.
Dahl, H.M. (2009) ‘New Public Management, care and struggles about recognition’, Critical Social Policy, 29 (4): 634-654.
Dahl, H.M (2010) ‘An old Map of State feminism and an insufficient recognition of care’, NORA, 18 (3): 152-166.
Rai, Shirin, Hoskyns, Catherine and Thomas, Dania. 2014. Depletion – the cost of social reproduction, International feminist Journal of Politics, 16:1, 86-105.
Image: Who really cares? by Matt Kieffer, Flickr. License: CC BY-SA 2.0 Deed | Attribution-ShareAlike 2.0 Generic | Creative Commons
Other texts from the Crises of Care event: