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Public Money & Management
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Debate: Covid-19 and Sweden’s exceptionalism—a spotlight on the cracks in the social fabric of a
mature welfare state
Mikael Granberg , Malin Rönnblom , Michaela Padden , Johanna Tangnäs &
Andreas Öjehag
To cite this article: Mikael Granberg , Malin Rönnblom , Michaela Padden , Johanna Tangnäs &
Andreas Öjehag (2021): Debate: Covid-19 and Sweden’s exceptionalism—a spotlight on the cracks in the social fabric of a mature welfare state, Public Money & Management
To link to this article: https://doi.org/10.1080/09540962.2020.1866842
© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group
Published online: 12 Jan 2021.
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Debate: Covid-19 and Sweden ’s exceptionalism—a spotlight on the cracks in the social fabric of a mature welfare state
Mikael Granberg 1,2, Malin Rönnblom1, Michaela Padden1, Johanna Tangnäs1and Andreas Öjehag 1
1Department of Political, Historical, Religious and Cultural Studies, Karlstad University, Sweden;2The Centre for Societal Risk Research, Karlstad University, Sweden
Welfare state exceptionalism and reform Sweden is often perceived as an exceptional welfare state and among the most advanced nations in terms of welfare service delivery and quality of welfare production and organization. The Swedish welfare state has been characterized by tax-financed and equally distributed healthcare, high-quality and free public education and ambitious social security systems. However, restructuring reforms have resulted in an equally ambitious but highly decentralized, deregulated and liberalized welfare state. A main component of these reforms has been the marketization of key parts of the welfare state (Andersson & Kvist, 2015), which has given private actors a prominent position in the provision of public services and impacted the ethos of public sector organizations (Öjehag & Granberg, 2019). The political reason for marketization was the notion that it would make welfare production more efficient and provide greater choice for people.
Covid-19 and Swedish exceptionalism
Despite evidence of a decline in Swedish welfare exceptionalism (Pierre,2016), Sweden’s exceptionalism has resurfaced in a slightly different manner in its response to Covid-19 (Pierre, 2020). The Swedish Covid-19 policy has been scrutinized in international media and research due to Sweden’s high per capita death rate and international comparisons have considered Sweden’s response as less successful (Capano et al.,2020). It is therefore worthwhile taking a look at Sweden as a critical case to query what the spotlight of Covid-19 can tell us about vulnerabilities inherent in the organizational structures of this mature welfare state after years of reform.
Covid-19, the Swedish strategy and eldercare Sweden’s Covid-19 strategy had two primary goals (Ludvigsson, 2020): first, to keep the pressure on
healthcare down by ‘flattening the curve’ and, second, to protect the elderly from infection. The Swedish strategy has been widely misrepresented as doing nothing: Sweden closed high schools and universities in the spring of 2020; advised those over 70 years old to self isolate; stopped visitors to eldercare facilities (residential facilities for people with long-term care needs); restricted public gatherings to 50 people; installed restrictions for serving procedures in restaurants; urged all employees to work from home if possible; made strong recommendations on social distancing in supermarkets and shops; and advised against non- essential local and domestic travel. The goal of flattening the curve has been reasonably met so far, while the protection of the elderly, primarily in eldercare facilities (both institutional and home care), has failed—with high incidences of infection and death in this demographic.
Since the onset of the pandemic, governmental responsibilities have basically remained unchanged.
Regional governments in the 21 Swedish regions are in charge of the healthcare system and the 290 local governments handle the bulk of welfare services, including care of the elderly (Ludvigsson, 2020).
Municipal eldercare facilities are not allowed to employ medical doctors, who only can be employed by the region, so nurses and care staff are the ones who need to judge if an elderly person needs medical attention and then consult a doctor.
Of Sweden’s Covid-19 death rate, 90% of the fatalities has been among people aged 70 years or older. The number of 70+ individuals in Sweden in 2019 was 1.5 million—roughly 15% of the total Swedish population. On 1 January 2020, 13% of individuals over 70 were receiving support in their homes, and 5% were living in eldercare facilities. On 28 April 2020, there were 19,430 confirmed Covid-19 cases. Of these 38% were 70 years or older, 39% of whom were living in eldercare facilities (Socialstyrelsen, 2020a). On 28 April 2020, the total number of individuals who had died due to Covid-19
© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by- nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.
PUBLIC MONEY & MANAGEMENT
https://doi.org/10.1080/09540962.2020.1866842
in Sweden was 2,075 persons and 90% of these were 70 years or older. Of the deceased who were aged over 70, 50% lived in eldercare facilities while 26%
had support at home. It is clear from this brief summary that the group aged 70+ who became infected and died are clearly overrepresented and, within that group, the individuals in eldercare facilities are also overrepresented. However, at the same time, protecting this group was a high priority in the Swedish Covid-19 strategy. What happened to this message? In the past, the receiver of this call to protect the elderly would have been a state agency imbued with the ethos of the universal welfare state.
In this case, the traditional receiver of such a message was notably absent.
A public report from the National Board of Health and Welfare highlighted issues such as the high numbers of different care workers meeting elderly people during a day, an average of 16 during a 14- day period, and high rates of sick leave taken by staff (Socialstyrelsen, 2020b). The Health and Social Care Inspectorate drew attention to the lack of adequate competence concerning safety and equipment among the staff treating the elderly (IVO,2019). But maybe the answer is not to be found in the organization of eldercare per se but is, instead, more complex, as well as fundamental.
Swedish healthcare governance and the impact on eldercare
Swedish healthcare governance can be interpreted as based in a neoliberal political rationality (Brown, 2003). Reforms have resulted in a highly deregulated and liberalized welfare state based in a supply-and- demand system, just-in-time supplies (including staff), and a strong focus on economic efficiency entailing far-reaching cost-cutting in the public sector. One part of this restructuring is a distinct division of labour between the national government, regions and municipalities. This has led to a fragmented public sector, with many policy fields dominated by a client–contractor model and managed by a mixture of private and public actors with the citizens as individual consumers of services and with a focus on freedom of choice. The results of this development are clearly evident in the Swedish eldercare system. This leads us to ask the following questions:
. Are the highlighted vulnerabilities during the current pandemic in fact a litmus test of cracks in the fabric of a deteriorating welfare state?
. What if Swedish exceptionalism is constituted by far-out neoliberalist principles rather than a classic welfare state ethos?
At the end of 2020, the State Commission on the Corona Pandemic published its first report focused on Swedish eldercare performance during the pandemic. The conclusion of this report supports the findings in this article—the Commission stated that Sweden had failed to protect its elderly due to well- known structural problems leading to an eldercare that was unprepared and ill-equipped to deal with a pandemic (SOU,2020:80).
Disclosure statement
No potential conflict of interest was reported by the author (s).
ORCID
Mikael Granberg https://orcid.org/0000-0002-5356-4112 Andreas Öjehag http://orcid.org/0000-0003-4820-278X
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