What makes a welfare state

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Measure content performance. Develop and improve products. List of Partners vendors. The term "welfare state" refers to a type of governing in which the national government plays a key role in the protection and promotion of the economic and social well-being of its citizens. A welfare state is based on the principles of equality of opportunity, equitable distribution of wealth, and public responsibility for those unable to avail themselves of the minimal provisions of a good life.

Social Security , federally mandated unemployment insurance programs, and welfare payments to people unable to work are all examples of the welfare state.

Most modern countries practice some elements of what is considered the welfare state. That said, the term is frequently used in a derogatory sense to describe a state of affairs where the government in question creates incentives that are beyond reason, resulting in an unemployed person on welfare payments earning more than a struggling worker. The welfare state is sometimes criticized as being a "nanny state" in which adults are coddled and treated like children.

The welfare state has become a target of derision. Under this system, the welfare of its citizens is the responsibility of the state. Some countries take this to mean offering unemployment benefits and base level welfare payments, while others take it much further with universal healthcare , free college, and so on.

Despite most nations falling on a spectrum of welfare state activity, with few holdouts among the most developed nations, there is a lot of charged rhetoric when the term comes up in conversation. There is a small risk that other studies of welfare states and health inequalities are to be found in e. We have set the starting point for the literature search to and relevant studies prior to this year have been missed in our search.

However, we started off by revising the three large reviews [ 3 , 4 , 9 ], which are based partly on studies prior to , and their results are also somewhat inconsistent regarding welfare research and health inequalities.

This indicates that studies prior to would not contribute much to the overall picture. In addition, the Publication timelines [see Additional file 2 ] indicate that the number of studies increases over time, which means that the risk that we have missed important studies prior to is small. Most importantly, however, it is necessary to notice that the three approaches identified are unbalanced; the Regime approach is by far the largest.

While this means that our conclusions regarding the Regime approach are fairly well underpinned, conclusions regarding the merits of the Institutional and Expenditure approaches are based on a small number of studies. While this reflects the reality, it is important to keep in mind when evaluating our conclusions. For example, if more studies are produced using these two approaches it may well be that less consistent results emerge also for them.

The wider social determinants of health, the causes of the causes, are of great importance for health and well-being, and the collective resources in terms of social protections and services provided by the welfare state are likely to be more important for those that have fewer resources in their own control.

From this follows that a range of welfare state policies are important for health and health inequalities, but the question is how we best can study this in more detail. Most likely, there is not one answer to that question. However, earlier reviews and our own attempts to find some consistency strongly suggest that further studies of the Welfare Regime approach and health inequalities do not seem to lead us much further.

Instead, we will need a multitude of different types of studies, including larger analyses of social spending and social rights in various policy areas and how these are linked to health in different social strata.

There are many roads that will take us forward towards a better understanding of how health inequalities are generated and how policies directed to the social determinants of health can prevent or amplify these processes.

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Correspondence to Kersti Bergqvist. KB had the main responsibility for drafting the manuscript. OL wrote part of the introduction and discussion. All authors participated in discussions regarding methodology and findings, and reviewed drafts of the manuscript and approved the final version. This file contains a table with descriptive characteristics of the articles included in the Regime approach.

It includes details of publication year, countries under study, health inequality measures, health outcome variables, and number of times each typology group has been used. Additional file 2: Timelines of publication year. This file contains four timeline figures of publication year of the selected studies. The first shows all studies included in the review, the remaining timelines display the publication dates of the studies selected for the three main approaches to comparative welfare research; the Regime approach, the Institutional approach, and the Expenditure approach.

Additional file 3: Table of the different typologies used in the studies included in this review. This file contains a table illustrating the different welfare regime typologies used in the studies.

It shows the different clusters, which countries are included in each, and the number of studies that have adopted each. Additional file 4: Tables of studies used in the review sorted by welfare regime typology.

Additional file 5: Tables of studies used in the review sorted by Institutional approach. The tables in this file illustrate the different institutional approaches used in the studies. Additional file 6: Tables of studies used in the review sorted by Expenditure approach. The tables in this file illustrate the two Expenditure approaches used in the studies. This article is published under license to BioMed Central Ltd.

Reprints and Permissions. Bergqvist, K. Understanding the role of welfare state characteristics for health and inequalities — an analytical review. BMC Public Health 13, Download citation. Received : 25 June Accepted : 02 December Published : 27 December Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative.

Skip to main content. Search all BMC articles Search. Download PDF. Abstract Background The past decade has witnessed a growing body of research on welfare state characteristics and health inequalities but the picture is, despite this, inconsistent. Methods Three reviews and relevant bibliographies were manually explored in order to find studies for the review.

Results Three main approaches to comparative welfare state research are identified; the Regime approach, the Institutional approach, and the Expenditure approach. Conclusions Based on earlier reviews and our results we suggest that future research should focus less on welfare regimes and health inequalities and more on a multitude of different types of studies, including larger analyses of social spending and social rights in various policy areas and how these are linked to health in different social strata.

Background In the area of health inequality research, as well as in the wider fields of social and public health sciences, there is an on-going and ever developing discussion on macro versus micro level explanations. Methods Search strategy This review adopted several search strategies to detect relevant studies [see Figure 1 ]. Figure 1. Full size image. Results The total number of studies selected for this review is 54 [see Figure 2 ]. Figure 2. Table 2 Descriptives of the Esping-Andersen group Full size table.

Table 3 Descriptives of the Ferrera group Full size table. Table 5 Descriptives of the geographical comparisons group Full size table. Discussion The starting point for this review has been the mixed and contradictory findings arising from research on welfare state characteristics and health and health inequalities. Limitations This review was based on empirical studies published in peer-reviewed journals.

Conclusions The wider social determinants of health, the causes of the causes, are of great importance for health and well-being, and the collective resources in terms of social protections and services provided by the welfare state are likely to be more important for those that have fewer resources in their own control. References 1. Article PubMed Google Scholar 4. Article PubMed Google Scholar 5. Article PubMed Google Scholar 6. Google Scholar 7.

Google Scholar 8. Google Scholar 9. Article PubMed Google Scholar Article Google Scholar Google Scholar Chapter Google Scholar View author publications. Additional information Competing interests The authors declare that they have no competing interests. Electronic supplementary material. About this article Cite this article Bergqvist, K. Copy to clipboard. The welfare system in the United States began in the s, during the Great Depression.

After the Great Society legislation of the s, for the first time a person who was not elderly or disabled could receive need-based aid from the federal government. Aid could include general welfare payments, health care through Medicaid, food stamps, special payments for pregnant women and young mothers, and federal and state housing benefits. In , a woman receiving welfare assistance headed 4. In the s, California was the U.

The federal government pays virtually all food stamp costs. In , Modern welfare programs differed from previous schemes of poverty relief due to their relatively universal coverage.

The development of social insurance in Germany under Bismarck was particularly influential. Some schemes were based largely in the development of autonomous, mutualist provision of benefits.

Others were founded on state provision. The term was not, however, applied to all states offering social protection. The sociologist T. Marshall identified the welfare state as a distinctive combination of democracy, welfare and capitalism. Examples of early welfare states in the modern world are Germany, all of the Nordic countries, the Netherlands, Uruguay and New Zealand and the United Kingdom in the s.

The welfare system in the United States was created on the grounds that the market cannot provide goods and services universally. Compare and contrast the social-democratic welfare state, the Christian-democratic welfare state and the liberal welfare state. Modern welfare states include the Nordic countries, such as Iceland, Sweden, Norway, Denmark, and Finland which employ a system known as the Nordic model.

The welfare state involves a transfer of funds from the state, to the services provided — examples include healthcare, education and housing — as well as directly to individuals.

According to the Political Scientist Esping-Andersen, there are three ways of organizing a welfare state instead of only two. Esping-Andersen constructed the welfare regime typology acknowledging the ideational importance and power of the three dominant political movements of the long 20 th century in Western Europe and North America: Social Democracy, Christian Democracy and Liberalism.

The ideal Social-Democratic welfare state is based on the principle of universalism granting access to benefits and services based on citizenship. Such a welfare state is said to provide a relatively high degree of autonomy, limiting the reliance of family and market. Christian-democratic welfare states are based on the principle of subsidiarity and the dominance of social insurance schemes, offering a medium level of decommodification and a high degree of social stratification.

On the other hand, the liberal regime is based on the notion of market dominance and private provision; ideally, the state only interferes to ameliorate poverty and provide for basic needs, largely on a means-tested basis. The American welfare state was designed to address market shortcomings and do what private enterprises cannot or will not do.