Alexandra Kaasch

The shock routine: economic crisis and the nature of social policy responses

ABSTRACT The idea that moments of crisis form opportunities for fundamental policy change is widespread in political science and public policy. It is usually associated with historical institutionalism and the notion of ‘critical junctures’. On the basis of an in-depth analysis of social policy responses in Australia, Belgium, the Netherlands and Sweden over the course of four global economic shocks, we ask whether the notion of critical junctures is useful in understanding the nature of change triggered by crisis. The main empirical finding is that fundamental change in the aftermath of an exogenous shock is the exception rather than the rule. Instead, incremental ‘crisis routines’ based on existing policy instruments are overwhelmingly used to deal with economic hardship. We discuss these findings in the light of the psychological ‘threat-rigidity’ effect and reflect on their consequences for theories of comparative policy analysis and institutional change.

Political Parties and Social Policy Responses to Global Economic Crises: Constrained Partisanship in Mature Welfare States

Based on empirical findings from a comparative study on welfare state responses to the four major economic shocks (the 1970s oil shocks, the early 1990s recession, the 2008 financial crisis) in four OECD countries, this article demonstrates that, in contrast to conventional wisdom, policy responses to global economic crises vary significantly across countries. What explains the cross-national and within-case variation in responses to crises? We discuss several potential causes of this pattern and argue that political parties and the party composition of governments can play a key role in shaping crisis responses, albeit in ways that go beyond traditional partisan theory. We show that the partisan conflict and the impact of parties are conditioned by existing welfare state configurations. In less generous welfare states, the party composition of governments plays a decisive role in shaping the direction of social policy change. By contrast, in more generous welfare states, i.e., those with highly developed automatic stabilisers, the overall direction of policy change is regularly not subject to debate. Political conflict in these welfare states rather concerns the extent to which expansion or retrenchment is necessary. Therefore, a clear-cut partisan impact can often not be shown.

Contesting contestation: Global social policy prescriptions on pensions and health systems

This article discusses the conceptualization of global social policy in its dimension of prescriptions on national social policy. By studying the global health systems discourse and comparing it to the discourse on pensions, the applicability and validity of common notions of contestation and struggle between global social policy actors and their ideas are discussed. On the basis of conceptual considerations on global social policy ideas and discourses, the reasons for the differences between the two discourses are elaborated on. The article offers conclusions as to the conceptualization of global social policy prescriptions with regard to notions of the ‘war of positions’ and the promises of the ASID (agency, structure, institution, discourse) framework.

Commentary: From the primacy of safe passage for refugees to a global social policy

In a commentary on Europe’s refugee crisis published in this issue of the International Journal of Public Health, James D. Smith rightly criticizes the international community for failing to adequately deal with humanitarian needs of people in transit (Smith 2016). We agree. But we wish to extend Smith’s argument: providing better access to appropriate health care during the process of migration will not suffice. The European Union (EU) radically fails with regard to three other fundamental obligations: Firstly, ensuring safe passage for refugees; secondly, implementing liberal laws regulating immigration to EU countries; and thirdly, putting their global health strategies into practice along with developing broader global social policies. The ‘‘right to seek and to enjoy in other countries asylum from persecution’’, enshrined in the Universal Declaration of Human Rights (UDHR) of 1948, implies that people seeking shelter are traveling under often excruciating conditions (Razum and Bozorgmehr 2015). Abandoning refugees in these conditions contradicts the European Convention on Human Rights (ECHR) (Gilbert 2015). Many EU countries such as Germany have instigated global health policies which stress the commitment to humanitarian aid and to strengthening UN bodies. It appears, however, that this commitment is interpreted as primarily related to development aid to poor and middleincome countries, instead of focussing at any place where need arises. Humanitarian emergencies have predictably developed again this winter on the Mediterranean Sea when refugees—now more frequently women and children—continue trying to reach Western Europe, often with fatal consequences: 410 deaths have been reported in the first 6 weeks of 2016 (http://missingmigrants.iom.int). To provide safe passageways on these routes is vital—merely offering basic medical care seems insufficient in view of the harsh physical conditions refugees face. EU must fulfill commitments based on international refugee law (Gilbert 2015) and support UN bodies in accomplishing their mandate. This should become a priority over internal disputes on right to asylum and strict refugee quota, which anyhow will be difficult to implement in a fair way (Bozorgmehr et al. 2016). At the same time, people seeking shelter or tolerable living conditions need predictable opportunities for migration based on liberal EU immigration laws. In their absence, migration processes will continue to be chaotic, and people will continue taking life-threatening routes to Europe because they worry that borders will be closed for good. Attempts to stop them physically are unlikely to succeed: social networks facilitate international migration in various ways (Dekker and Engbersen 2012)—even providing up-to-date insider knowledge on how to circumvent fences and border controls. The refugee crisis is a consequence of massive inequalities between countries and of an increasingly complex and conflict-ridden geopolitical situation. In 2014, 40 armed conflicts, of which 11 reached the intensity level of war, were active worldwide—the highest number O. Razum Department of Epidemiology and International Public Health, School of Public Health, University of Bielefeld, Post Box 100 131, 33501 Bielefeld, Germany

Global Social Policy in the Context of Global Inequality

This chapter concerns the attention given to matters of inequality by global social policy actors and discusses how their ideas and mechanisms may—potentially—affect inequalities. This section introduces the concept of global social policy and demonstrates how inequality is addressed in different dimensions of that concept.

Global social redistribution in the context of the refugee crisis

Since 2015, European countries have been facing the biggest inflow of asylum seekers in recent history. In the first phase at the national level, the focus has been on how to register refugees, how to facilitate smooth asylum-seeking procedures, and ‘emergency (social policy) measures’ such as the provision of health care, basic means for living, and other practical issues. Medium-term discussions focus on language and literacy, schooling, inclusion into higher education institutions, and labor market integration. Their inclusion into national systems of social protection and questions of the portability of benefits will be another important issue in the years to come. While issues concerning the migrants’ social inclusion confront national governments, they are not limited to the national scale. They also point to global social problems, global inequality, global justice, and needs of global redistribution. Nevertheless, instead of a clear commitment by high-income countries and worldregions to the protection of refugees and the inclusion of those migrating because of conflict as well as highly unequal living conditions across the world, national and European public discourse has shifted in the opposite direction. In several European Union (EU) countries, the ‘refugee crisis’ has led to de-legitimation of the practice of providing social assistance benefits to EU migrants, and many countries have looked for ways to close their borders and keep the number of refugees staying within their territory to a minimum. The EU is unable to arrive at a common approach toward the protection of refugees, which has put the union at greater risk than the global economic and financial crisis in 2008. This tendency has been strengthened by the results of the United Kingdom’s Brexit vote. Accordingly, the sense of responsibility and solidarity among European states and toward migrants is even weaker. At the same time, in the context of development cooperation, the past few years have witnessed important acknowledgements of rising global inequality, generated by the

Conclusions: Multiple Actors, Uncertain Ideas, Nested Discourses

This book has presented some of the key global social policy actors that frequently provide, in different ways, prescriptions for national health care systems. It has been structured as to first characterise activities and actors within the UN system, most prominently the WHO, the World Bank and the ILO. Chapter 3 considered the different but not necessarily less powerful roles of the OECD and WTO respectively. This rather traditional type of global social policy actor, the international (governmental) organisation, has been increasingly joined (and to some extent challenged) by other types of actor, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, and groups of countries (G7/8, G20, the BRICS) that have been discussed in chapters 4 and 5. Non-governmental actors, or CSOs, are plentiful in the field of global health more generally; however, concerning complex and explicit concepts of health care systems, Chapter 6 focused on one specific initiative, the Global Health Watch. Chapter 7 discussed the Polish health care system and external engagement in its reform by a number of these actors, showing how a number of international organisations have applied their ideas or concepts to specific prescriptions for this country in transition after the 1980s, and how global actors engage at a country level.

Non-Governmental Organisations and Health Care System Ideas

The picture of global social policy in the field of health care systems is even more complex when taking into account yet other global health actors, such as business organisations and civil society organisations (CSOs). Given the specific focus of this book, namely on models of health care systems, the number of such non-governmental actors, generating and disseminating knowledge and ideas on health care systems, and being able to join in related discourses, is much smaller, though. On the one hand, among business actors, for example, health receives relatively little attention (Farnsworth, 2005: 75); and business actors impact on health care systems instead through other related policy fields, rather than through a direct engagement in the health sector (via insurance companies, pharmaceutical companies and so on). These actors might, however, also have an impact on supranational health regulations, and may try to influence trade agreements in their own interest. Looking at CSOs, many of their activities are either concentrated on very specific health issues, in specific regions, or such organisations may be primarily active in on-the-ground activities (for example in the direct provision of health services and medicines). CSOs might be directly engaged with international organisations, and might try to influence their ideas and activities. However, their scope for producing comprehensive or complex ideas, models and reform suggestions for health care systems independently appears to be rather limited.

The Polish Health Care System Under Global Scrutiny

So far, this book has focused on actors, ideas and exchanges at global — or transnational — policy levels only. Making direct connections between global discursive spheres and national social or health policy reforms is a difficult task. It has, however, been shown in numerous studies that particular groups of countries, at particular historical times, have been prone to significant external influence in their social and health policies. These have taken different shapes, including contextual influences, policy learning and conditional aid. The organisations and their ideas and activities discussed above relate to national health care systems, on the one hand, through possible application of the general concepts (undertaken by national policymakers and bureaucrats); but on the other hand, the organisations also apply their work to specific countries in separate publications, programmes, country loans and so on.

UN Organisations: Health for All and All for Health Care Systems?

International organisations have a key role in global discourses about various kinds of policy issues, as well as potentially influencing national social and health policymaking by other means. This is also the case with regard to concepts and prescriptions for health care systems. This chapter focuses on ideas and activities related to health care systems that have been developed by a wide array of international organisations within the UN system. It discusses respective engagements, roles, competences and power of a number of agencies within a complex and, at times, chaotic institutional setting. The chapter first introduces and discusses some of the UN bodies on more general issues of social development; namely, the UNDP, the United Nations Department of Economic and Social Affairs (UN DESA) and the Economic and Social Council (ECOSOC). The chapter then discusses the role of the WHO (section 2.4) as it tackles health care systems as part of a broader mandate to improve health globally. The shift over time in the significance of the WHO’s role in questions concerning health care systems is particularly important, as it is only one expression of the difficult role the WHO is given, with great tasks and expectations, on the one hand, and notoriously limited funding, on the other.