Joakim Palme is a Swedish political scientist and sociologist, currently Professor of political science at Uppsala University and former Director of the Institute for Future Studies in Stockholm between 2002 and 2011. Between 2003 and 2009, he was Adjunct Professor of sociology at Stockholm University. In 2009 he was appointed Adjunct Professor at the Centre for Velfærdsstatsforskning at the University of Southern Denmark.
1) Could you tell us about your work?
For almost ten years my work has focused on comparing welfare states, trying to work out how welfare state programmes, excluding healthcare, impact on inequalities in society. Several years ago my colleagues and I started working as part of the Marmot Commission on Social Determinants of Health, looking at how welfare state programmes relate to people’s health and health inequalities. We took a life-cycle approach and looked at how family policies affect child mortality, how social insurance affects mortality among the working-age population and the links between pension systems and mortality among older people. This led to interesting analyses, and saw us move beyond the welfare regime approach towards examination of specific welfare programmes. That’s the background to my involvement in DRIVERS.
2) How do welfare programmes affect health and health inequalities?
Income is important because it allows people to pay for products that are good for health, such as food and quality housing. It’s therefore not surprising that levels of income are important for health. The welfare state can play a part in this, because it ensures a consistent stream of income, even when people are temporarily unable to secure them, for example when ill or unemployed. Welfare programmes can also be important in terms of reducing societal inequalities. Large income inequalities put stresses and strains of people’s lives, and the welfare state can help reduce inequalities in society. Moreover, work coming out of DRIVERS shows that welfare programmes are even beneficial to those who are not currently benefiting from them directly. This seems to be because it reduces feelings of insecurity, and provides assurance that unemployment or illness does not necessarily lead to economic disaster.
3) We are just coming out of a period of crisis, and labour markets and social protection policies have been reformed quite drastically. What trends in social policy and social spending do you observe?
The crisis is still on, so we don’t have a final answer, but it does appear to have triggered increased diversity between European countries. This seems to come out very clearly in a recent report from the European Commission on the Employment and Social Development in Europe . We see that the countries most severely affected by the economic crisis have also been those most severely affected in social terms. In order to secure loans, these countries have had to implement nationally and internationally imposed reforms to their social protection systems.
5) When you talk about diversity, are you talking about divergence between northern and southern European member states?
Yes. So while northern European countries have been comparatively less affected by the crisis, southern ones have been more severely damaged in a number of ways. One could rightfully say that these countries performed worse before the crisis, but that the crisis has been unhelpful in terms of raising the level of their welfare spending ambitions and in putting welfare state financing on a more sustainable path.
6) So does the economic crisis really matter for health and health inequalities, and if so, how?
Poverty has been aggravated and this increases risks to health. In addition, some groups have been more affected than others. We can see that in southern Europe youth have been severely affected by the crisis and that many have become unemployed. Many older workers have been affected by falling incomes. There have also been cutbacks in a number of countries in terms of generosity of benefits. This was not something seen in the initial phase of the crisis, but became prominent in more recent years. As public deficits increased and unemployment increased, this put a strain on welfare protection budgets and there were consequent overall cutbacks in generosity. We know that youth are a clear at-risk group. Moreover, we know that those who are not covered by welfare programmes are at risk. Worryingly, we can also see that when people do find work, their jobs often don’t provide decent pay. The phenomenon of in-work poverty seems to be increasingly important, and this is a surprise to many European policy makers who have so-far stressed the primary role of employment in combatting poverty and inequality.
7) Would it be fair to say that the crisis has exacerbated thirty years of stagnant or even real-term cuts to many people’s wages?
I actually think the current crisis is more than that. In fact, in some countries income development has been mixed. Take Sweden, for example. While income inequalities have increased a lot we also see that pay increases among the low paid have been good, and that collectively bargained minimum wages have improved a bit, at least in terms of relationship to median income. Another example is Germany. Here we see the results of labour market reforms that were enacted at the turn of the millennium, and which have resulted not only in increased employment but four million working poor. That’s not a middle-class problem in my view, but a problem concerning the emergence of a new underclass.
Overall, situations differ between countries. In some we see large numbers of people who borrowed money to buy a house before the crisis and now run the risk of becoming homeless. Such people constitute a group that were considered comfortably well-off before the crisis, but who find themselves in a very different situation today. In fact, it is possible to say that the crisis has been of such a magnitude that it has affected very broad parts of the overall European population, though groups traditionally at risk remain so: less education people, newcomers to the labour market, youth, migrants and also women.
8) What kinds of social policies could help reduce health inequalities?
It is important not to demand the complete overhaul of the system of social protection, because more modest improvements could lead to improved health. First I would suggest a minimum income safety net. The second thing is unemployment protection, with wide coverage and replacement rates. The European Commission has done interesting work on minimum income safety nets and unemployment insurance, showing that they are important not only for the health of a population but also for macro-economic stability . Countries without protection systems fared much worse in the crisis, and social protection systems can be built up on this basis.
Youth is an extremely important issue. It is the only area where the European Union has mobilised common resources to help victims of the crisis. In my view, youth is the big social question of our time. We already know how to combat poverty among children and old people and about how to maintain good unemployment insurance systems, but less about how to facilitate the transition from youth to adulthood and from education to the labour market. I fear that the resources being mobilised will not match needs, and that there will be a scarring effect on the generation entering the labour market for decades to come unless something much more ambitious is attempted.
9) You mentioned the importance of wages earlier. Do you think collective bargaining is important in maintaining decent levels of pay? Or are legislated levels more important?
Different European countries have very different labour markets. Some countries have national legislation on minimum levels of pay that is important, while in others such as the Scandinavian countries, collective bargaining is important. However, when we look at risk factors for poor health we also see that job quality is important. It should not be forgotten that collective bargaining is a way to ensure a decent level of income and a means of ensuring job quality.
10) What role does scientific research have in all of this then? Does science have a primary role in informing policy?
This is what we hope, that politicians are informed and willing to take action on the basis of research. I’m quite optimistic on this. We know that the collection of health statistics was tremendously important in the emergence of the first welfare state programmes a century ago; this was the case in Britain, Norway, Sweden, and other countries. I think it is hard for politicians today to run away from facts, and communication of research is very important. In this respect I’m certainly hopeful that research can be a trigger for political change. If we take climate change, for example, we can see that for a time it was possible for politicians to deny the science, but eventually it could barely be denied. I think that health is of real importance, and I hope that research on health will help in terms of promoting desirable policy change.
11) What kind of research methodologies are needed to help science progress on these issues?
I’m very much in favour of what might be termed mixed-methods. It is important to compare countries because it is often at the country level that policies differ, and it is important to study and evaluate when countries reform their policies because that’s a source of important evidence. I also think it’s important to combine country-level information with detailed information at the individual level. The European Union can be seen as a kind of laboratory for different kinds of policy, between nations, and I think that there is great potential for exploiting this laboratory for enhancing our understanding of what policies are good and bad for health.
12) We’re nearing the end of the interview. Is there anything you would like to add?
In relation to your question on the links between research and policy, I’d like to stress the importance of having policy advocates, who do not necessarily belong to the political establishment, but who can challenge political parties aiming to get into government. It always takes a lot of time and effort to make reforms, and governments often find there is very little room for manoeuvre. However, there are windows of opportunity when politicians open their minds to what is possible, and when advocates can persuade them that policy change is possible and desirable too.
13) We are currently involved in a strand of research within DRIVERS focused on advocacy for health equity. What risks do scientists face when involved in policy advocacy?
The risk for scientists is being associated with particular political strategies, rather than being associated with the ambition to reduce ill-health or mortality. However, researchers regularly have to formulate policy recommendations, whatever the research question. I think the more serious risk is that researchers detach themselves from policy making because they’re afraid of losing their integrity as a scientist. That would be an unfortunate development, and in my view unnecessary. I think we should challenge the research community much more when it comes to advocacy and policy making. Speaking from the Swedish perspective, I think the research community is too isolated from policy. We need to work and create an arena for interactions between researchers and policy makers. This arena could play an important role in provoking both politicians and researchers to address the same kinds of issues.
 European Commission (2014), Employment and Social Developments in Europe 2013 http://ec.europa.eu/social/main.jsp?catId=738&langId=en&pubId=7684
 European Commission (2013), Paper on Automatic Stabilisers