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Power, intersectionality and the life-course: Identifying the political and economic structures of welfare states that support or threaten health

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Abstract

The insights provided by Gøsta Esping-Andersen’s Three Worlds of Welfare Capitalism on the origins and characteristics of social democratic, conservative and liberal welfare states make explicit many of the political and economic structures and processes that can impact on health and create health inequalities. Broad stroke analysis of welfare state differences indicates social democratic welfare states may fare better at promoting health and limiting health inequalities in specific instances. This article builds on Esping-Andersen’s insights to theorize how differences in sectoral power across and within forms of welfare states can shape the resources and supports available to those occupying various social locations during important periods of the life-course. It also specifies the specific health outcomes of special relevance to those situated in vulnerable social locations across the life-course.

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Notes

  1. There is emerging consensus that the Latin welfare state represents an undeveloped form of the conservative welfare state (Saint-Arnaud and Bernard, 2003). Recent economic crises in Greece, Italy, Portugal and Spain direct attention to these nations as having distinctive aspects. There are numerous typologies of welfare states, but many take as their starting point the Esping-Andersen typology (Bambra, 2007).

  2. ‘An individual’s social locations consist of her ascribed social identities (gender, race, sexual orientation, ethnicity, caste, kinship status, etc.) and social roles and relationships (occupation, political party membership, etc.). Partly in virtue of their different ascribed identities, individuals occupy different social roles that accord them different powers, duties, and role-given goals and interests’ (Anderson, 2011).

  3. It has been noted that Engels in 1845 identified similar processes by which the working class came to die prematurely (Raphael, 2011b).

  4. This view represents a departure from the work of theorists such as Pfau-Effinger (2005) who give priority to ideas related to cultural traditions as shaping public policy-making. These no doubt represent receptivity to public policies as any given point in time, but we see these as reflecting the historical and contemporary organization of power and influence by differing classes and genders, and even dominant races.

  5. Women may live longer but women are sicker than men during adulthood and the later years (Pederson et al, 2010).

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Correspondence to Toba Bryant.

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We regret that an incorrect citation year was stated in this article, originally published 17 June 2015. The correction has been made in this final version.

Appendix

Appendix

Four forms of the welfare state

The social democratic welfare states (for example, Finland, Sweden, Denmark and Norway) emphasize universal welfare rights and provide generous benefits and entitlements. Their political and social history is one of political dominance by social democratic parties of the left, a result of political organization initiated by industrial workers and farmers that later came to include the middle class (Esping-Andersen, 1985). Through universal provision of a range of benefits, these states have historically secured the loyalties of a significant proportion of the population (Esping-Andersen, 1990, 1999). The strong influence of organized labour contributes to the stability of the social democratic welfare state by moderating the influence of the business sector on public policymaking. Their key feature of this welfare state is greater social expenditures – possible through generally higher taxation rates – that provide universal benefits across the life-course.

The conservative welfare state (for example, Belgium, France, Germany, the Netherlands and Switzerland) also offers generous benefits but does so through social insurance plans based on employment status (Esping-Andersen, 1990, 1999). Emphasis is on supporting the primary wage earner, usually male. Their political and social history is one of political dominance by Christian Democratic parties where traditional Church concerns with maintaining the family merges with conservative upholding of status differences among citizens. These tendencies sometimes manifest in corporatist approaches (for example, Germany) where business interests are major influences or Statist approaches (for example, France) where the State plays a key role in provision of citizen security (Pontusson, 2005).

The liberal welfare states (for example, Australia, Canada, Ireland, New Zealand, the United Kingdom and the United States) provide modest benefits such that the State usually provides assistance when the market fails to meet citizens’ most basic needs (Esping-Andersen, 1990, 1999). Their political and social history is one of dominance by business interests resulting in the population relying on the employment marketplace rather than the State as the source of economic and social security. These liberal welfare states are the least developed in terms of provision of citizen economic and social security. A key feature is their use of means-tested benefits targeted only to the least well-off. They are also distinguished by lower social expenditures accompanied by generally lower tax rates (Raphael, 2012a).

Nations identified as Latin welfare states (for example, Greece, Italy, Spain and Portugal) are described by Saint-Arnaud and Bernard (2003) and others as less developed and even more family-oriented versions of the conservative welfare state (Bambra, 2007). Benefits are less generous and programmes more fragmented than is the case for conservative welfare states. These nations are of special contemporary interest as they are experiencing severe financial crises that led to adoption of severe austerity measures that have health implications.

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Raphael, D., Bryant, T. Power, intersectionality and the life-course: Identifying the political and economic structures of welfare states that support or threaten health. Soc Theory Health 13, 245–266 (2015). https://doi.org/10.1057/sth.2015.18

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