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FU-BEST 17: Who Cares? On the Politics and Funding of Health, Care and Ageing in Europe

InstructorSaskia Duchow
Credit Points6 ECTS

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Questions of care have long been central to societal debates. The delegation of care raises fundamental questions such as: who cares for whom? Who is deemed worthy of care, and who is not? Who holds power over the delegation of care, and under what conditions?

Within this course we will look at various care systems and ways in which European societies are trying to tackle this Herculean task in the 21st century. We will explore what lies beyond those systems: European welfare systems are not only systems of redistribution; they are systems of organizing, delegating, and obscuring care - thus making the central question of this course not whether societies care, but rather how care is distributed, who performs it, and which forms of care remain invisible or unpaid.

Scholars within the social sciences have identified the entanglements of care with capitalist and patriarchal systems as a highly relevant issue, placing many contemporary societies under significant strain.

Societies of the Global North are – amongst others – characterized by a turn away from “the family” as the structure taking care of the individual in sickness and old age. In the wake of the Industrial Revolution, structures such as social insurance systems, religious or welfare institutions, or “the state” began taking on the responsibility of providing health care for all and support for people no longer active in the workforce. Whether financed by taxes, contributions by employers and employees, or other resources, health care and pension plans in Europe have long been connected to the economically productive segment of society, while “welfare” has been provided by churches or other social institutions.

With the influence and size of the latter waning since the mid-20th century, and life expectancy thankfully increasing over the decades, societies all over Europe have had to reformulate and recalculate who cares for whom, and how to finance health and age care for ideally all members of society. Different intellectual approaches and economic models of how to ensure people’s well-being (on varying levels of comfort) have since been developed and are presently all faced with comparable challenges such as:

  • How to prevent good health and a dignified old age from becoming luxury items for only a wealthy few?
  • How to generate sufficient funds in ageing societies where people live longer and retirees increasingly outnumber younger working cohorts?
  • How to counter the loss of jobs (and thus funds for social insurance and pensions) due to rising technological standards?
  • How to cover the rising costs of health care in general, and where to find people willing to work in health or social care under the often precarious circumstances developing there?
  • How to distribute the cost and burden for health and age-related services evenly in society, and how to ensure that these services reach those who really need them?
  • Eventually, how to avoid societal and/or generational cleavage in the wake of debates on solidarity, entitlement, and generational justice?

While the first half of the course will focus on how care is formally organized through welfare institutions and policies, we will then turn to what lies beyond these structures: care as labor, social expectation, and moral responsibility that is frequently privatized and rendered invisible.

We start by comparing different philosophies and historical approaches to who cares, and why, and follow their development in the 19th and 20th centuries through changing demographic, political, and economic times. During this course questions such as the following will be discussed:

How do population size, economic strength, and political organization factor into the ability of a society to provide health care and dignified retirement to the majority of its members? Has it perhaps become a responsibility that “the state” can no longer take on, and will caring turn more and more into a private matter (and business) that only the wealthy can afford in the future? How are different genders affected differently by the challenges of health care and retirement in (post-)modern societies? How can care be rethought in ways that do not reinforce inequality or serve as a mechanism of social control?