maggio 2, 2021

Healthcare chauvinism in Denmark during the outbreak of the COVID-19 pandemic


A welfare state depends on its citizens´ mutual trust and solidarity to successfully protect the health and welfare of its population. However, in recent years welfare chauvinism, the view that welfare (and healthcare) benefits should be restricted to the ethnic majority, has become a salient public opinion and entered national parliaments in several European countries; some governments even implemented policies that entail limited access to benefits for immigrants and especially refugees. European social scientists have also paid growing attention to the phenomenon, because of the expectation that citizens will turn to welfare chauvinism as a response to continuing immigration.

Denmark and welfare chauvinism

Following Esping-Andersens classification, Denmark can be characterized as a social-democratic welfare regime providing universal and generous welfare to those in need. High levels of trust and solidarity are the usual explanations for why Danes are willing to pay the high redistributive taxes that finance these costly welfare provisions. In international comparison Denmark is one of the happiest populations, has a high labor force participation among women, and high levels of social spending. Nevertheless, the country is still another case in point of welfare chauvinism.

In 2002 the right-leaning government of the time significantly cut welfare benefits for refugees and recent immigrants with the declared goal to incentivize fast employment and to further their assimilation into the mainstream. While these reforms were revoked in 2012, a new right-leaning government reinstated them only three years later when millions of refugees sought rescue throughout Europe. Especially Muslim immigrants and their descendants stand center stage in Danish public discourse surrounding these policies. It can even be argued that some welfare sanctions implemented over the past decades have implicitly targeted Muslim immigrants (e.g. the 225-hour rule).



Healthcare chauvinism during the COVID-19 pandemic

In a study conducted by myself and my colleague Merlin Schaeffer, we investigated welfare solidarity towards recent immigrants and Muslims using the case of hospital treatment for an acute COVID-19 infection at the outset of the COVID-19 pandemic in Denmark. The fact that the number of hospital beds and especially intensive care beds per capita is one of the lowest in the European Union raised concerns among medical professionals and the public about whether hospital capacities would be reached. This also primed the cost-considerations of whether to share healthcare resources as much more immediate than usual concerns about tax burdens of welfare spending. In our article, we argue this case provides a test of welfare chauvinism proper for two reasons. First, because it is an acute and atypical situation for which the individual cannot be held responsible and, second, it is not meaningful to justify non-treatment of acute COVID-19 as incentivizing labor market integration or assimilation more generally.

We argue that citizens rely on the five criterias of deservingness, when assessing the degree to which an acute COVID-19 patient deserves hospital treatment. The traditional deservingness model is composed of five criteria commonly labelled the CARIN-criteria: Responsibility for own disadvantaged situation (Control), compliance with rules and regulations (attitude), reciprocity with respect to the welfare system (reciprocity), ethnic background (identity), and level of need (need). Social-psychological studies show that to the degree that these cues are available, people use them as the basis for decision-making. Moreover, recent focus group research find that people in fact apply and attach importance to these different deservingness criteria, that they do not work independently from each other but rather act in concert, and that, when drawing on the dimension of reciprocity, people consider past and not potential future contributions to the welfare system. To expand on the existing deservingness criteria, one study has considered whether the person shows effort to get out of their situation of need, however, it is questionable if this is different from the dimension of control.

Still, it is only welfare chauvinism proper, if immigrants are regarded as less deserving because of their ethnic background, which defines them as not ‘our own’. That being said, people also use group stereotypes in their deservingness evaluations, and, consequently welfare chauvinism could be rooted in stereotypes about immigrants, where they face extra penalties because certain shortfalls are regarded as symptomatic for them but exceptional for the ethnic majority. Initial studies on welfare deservingness investigated the existence of a universal rank-order of deservingness by comparing different groups in society, showing that immigrants are consistently ranked as the least deserving group of welfare support by Europeans. Still, these comparisons are biased, because being an immigrant does not necessarily imply a situation of need. Social scientists have therefore moved on to conducting survey experiments in which respondents are presented with fictional vignettes of individuals who are comparable in terms of need, attitude and control but differ with respect to their ethnic background and level of reciprocity with the welfare system.

Consequently, we formulated three hypotheses, focusing on the dimension of reciprocity and ethnic background, to capture reciprocity-driven and racism-driven welfare chauvinism respectively. First, if healthcare chauvinism is motivated by concerns about low contributions to the welfare system, acute COVID-19 patients who have recently migrated are perceived as less deserving of hospital treatment than patients who were born domestically. Second, if concerns about ethnicity drives welfare chauvinism, acute COVID-19 patients with a typical Muslim name are considered less deserving of hospital treatment than patients with a typical Nordic name. Third, if reciprocity and racism reinforce each other, acute COVID-19 patients with a Muslim name who have recently migrated are perceived as least deserving of hospital treatment. Since acute COVID-19 patients are in an unequivocal situation of need and individually not responsible for their hardship, we argue that the need and responsibility dimension are constant in the case we study. For reasons of brevity, I refer to the published study on our discussion of the attitude dimension.

Study design and findings

To test our arguments about healthcare chauvinism during the Spring 2020 COVID-19 pandemic in Denmark, we conducted a pre-registered online survey experiment among a representative sample of the Danish population (N=1208). We confronted the survey participants with a single vignette describing a fictitious male COVID-19 patient, where we randomly varied three pieces of information: the name (Muslim-sounding or Nordic-sounding name), length of residence (lived in Denmark for one year or lived in Denmark all his life) and age of the patient (59 or 83 years old). The time which the patient has lived in Denmark identifies reciprocity to the welfare state, especially given the patient’s potential age. The patient’s name captures the ethnic background dimension. The dimension of need is generally high since the vignette explicitly states that the patient has been examined by a medical doctor, who assessed that he needs treatment. After the vignette, participants were asked to evaluate the degree to which the fictitious patient should potentially be prioritized a hospital bed over someone else on an eight-point Likert scale. For further details on the experimental design and empirical strategy, I refer to the published article.

Our results do not indicate blatant racism-driven healthcare chauvinism against patients with a Muslim name who were born in Denmark. Yet, we find reciprocity-motivated healthcare chauvinism, which doubles in strength if the recent immigrant patient has a Muslim rather than a Nordic name. Thus, the findings reflect an aversion towards immigrants and particularly Muslim immigrants; especially when keeping in mind that all patients are diagnosed with acute COVID-19 and a medical doctor has assessed that the patient requires hospital treatment. The general insight from this study is that typical prejudices and stereotypes prevail amid a pandemic and extend to crucial measures of healthcare. It is important to mention that our unique focus on healthcare chauvinism during a pandemic means that our results do not easily generalize to other welfare policies. Still, we can conclude that, even in these dire times, welfare chauvinism is a pervasive public opinion where a considerable share of native-born citizens would like to treat recent immigrants as second-class citizens when it comes to hospital treatment for acute COVID-19.


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About Mikkel Haderup Larsen

Mikkel Haderup Larsen

Mikkel Haderup Larsen is a PhD fellow at the department of Sociology, University of Copenhagen. In his dissertation he investigates welfare solidarity in Europe, with an explicit focus on the concept of welfare chauvinism.

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