Healthcare Chauvinism in Denmark

class: center, middle, inverse, title-slide

# Healthcare Chauvinism in Denmark
## During the Outbreak of the COVID-19 Pandemic
### Mikkel Harderup Larsen & Merlin Schaeffer<br> Department of Sociology
### 2020-10-19

---

layout: true
# Denmark .font70[One of the world's happiest countries]

.push-left[
<img src="https://media.lex.dk/media/33397/standard_Islands_Brygge.jpg" width="100%" style="display: block; margin: auto;" />
]

---

.push-right[
<img src="media/Happy1.png" width="100%" style="display: block; margin: auto;" />
.center[...]
<img src="media/Happy2.png" width="100%" style="display: block; margin: auto;" />
.center[...]
<img src="media/Happy3.png" width="100%" style="display: block; margin: auto;" />
.center[.backgrnote[*Source*: Helliwell, Layard, and Sachs (2019)]]
]

---

.push-right[
<iframe src="https://data.oecd.org/chart/67KE" width="860" height="500" style="border: 0" mozallowfullscreen="true" webkitallowfullscreen="true" allowfullscreen="true"><a href="https://data.oecd.org/chart/67KE" target="_blank">OECD Chart: Social spending, Public, % of GDP, Annual, 2015 – 2018</a></iframe>
]

---

.push-right[
<iframe src="https://ourworldindata.org/grapher/female-labor-force-participation-OECD?country=USA~DEU~DNK" loading="lazy" style="width: 100%; height: 500px; border: 0px none;"></iframe>
]

---

.push-right[
.center[Union density rate]
<img src="media/Union1.png" width="100%" style="display: block; margin: auto;" />
.center[.backgrnote[*Source*: ILO (2019)]]
]

---
.push-right[
.bg-washed-green.b--transparent.ba.bw2.br3.shadow-5.ph4.mt2[
.center[**Why doesn't the US have such a happy Scandinavian-style welfare state?**
]]]

---

.push-right[
<img src="media/Alesina.png" width="100%" style="display: block; margin: auto;" />
.center[.backgrnote[*Source*: Alesina, Glaeser, and Sacerdote (2001)]]
]

---

.push-right[
> Every industrial and commercial centre in England now possesses a working class divided into two hostile camps, English proletarians and Irish proletarians. **The ordinary English worker hates the Irish worker as a competitor who lowers his standard of life.** [...] His attitude towards him is much the same as that of the “poor whites” to the Negroes in the former slave states of the U.S.A..

> Marx in a letter to Engels (Marx and Engels, 1975 [1870])
]

---

.push-right[
<img src="media/Union2.png" width="100%" style="display: block; margin: auto;" />
.center[.backgrnote[*Source*: ILO (2019)]]
]

---
layout: false
class: clear
# .font80[Shouldn't Denmark have a US-style welfare state by now?]

.push-left[
<img src="media/StatsDK1.png" width="100%" style="display: block; margin: auto;" />
.center[.backgrnote[Denmark (2019)]]
]

.push-right[
<img src="media/StatsDK2.png" width="100%" style="display: block; margin: auto;" />
.center[.backgrnote[Denmark (2019)]]
]

---
class: clear
# No, Denmark introduced welfare chauvinism `\(^1\)`

.left-column[
In Scandinavia, the far-right is pro welfare; their policy is:
> 'welfare state chauvinism' - the welfare services should be restricted to 'our own'

> Andersen and Bjørklund (1990a)

<br>
<br>
.backgrnote[
1 Along with Canada, Germany, Finland, France, the Netherlands, Switzerland, etc. (OECD, 2018).
]]

.right-column[
- By 2001, 0.83% of GDP on welfare transfers to "ikke-vestlige" immigrants and descendants. .backgrnote[(Matthiessen, 2009)]
  + .backgrnote[As reference: DK spends ca. 1.3% of GDP on military.]

Some examples of chauvinistic social policies: <br> .backgrnote[(cf. Jørgensen and Thomsen, 2016a)]

- **2002, "Start Aid"**: Welfare benefits to refugees & recent immigrants but by ca. 50%.
- **2018, “Ghetto Pakken”**: welfare sanctions for anyone moving into a “Ghetto”.
- **225 hour rule**: Both partners in a union need to have worked 225+ hours over past 12 months to receive welfare benefits.

.push-left[
<img src="https://api.time.com/wp-content/uploads/2019/01/denmark-immigration-mjolnerparken.jpg" width="75%" style="display: block; margin: auto;" />
]

.push-right[
<img src="https://images.sn.dk/43/1315243_1100_3150_17_0_965_667_2.jpg" width="73%" style="display: block; margin: auto;" />
]]

---
# Who is regarded as *deserving* welfare?

.push-left[
Theory of Deservingness <br> .backgrnote[(Feather, 1999; van Oorschot, 2000)]
1. Need,
2. Responsibility,
3. Good citizen,
4. Reciprocity,
5. Ethnic background.

<img src="https://thebossmagazine.com/wp-content/uploads/2016/12/iStock-106586892-2.jpg" width="55%" style="display: block; margin: auto;" />
]

---
# Who is regarded as *deserving* welfare?

.push-left[
Theory of Deservingness <br> .backgrnote[(Feather, 1999; van Oorschot, 2000)]
1. Need,
2. Responsibility,
3. *Good citizen*,
4. **Reciprocity,**
5. .alert[Ethnic background.]

`\(\rightarrow\)` Immigrants are typically seen as less deserving than elderly, unemployed, sick, etc. <br>
.backgrnote[(van Oorschot, 2006; van Oorschot, 2008; van Oorschot and Uunk, 2007)]
]

.push-right[
> Immigrants are not needy, however: being an immigrant does not indicate an inability to work or generate income. Comparing immigrants to elderly, unemployed, or disabled people is therefore problematic.

> Kootstra (2016a)

<img src="./media/Kootstra.png" width="60%" style="display: block; margin: auto;" />
]

---
# We claim .font70[Comparison remains invalid]

.push-left[
- Policymakers justify welfare chauvinism as integration policy. 
   + .backgrnote[
   Although evidence shows opposite (Andersen, Dustmann, and ø, 2019; Jørgensen, 2020).]
- As newcomers to polity, immigrants are seen as obliged to integrate.
- `\(\rightarrow\)` Study policy area not subject to this confound to identify welfare chauvinism *proper*!
]

---
# We claim .font70[Comparison remains invalid]

]

.push-right[
- Acute COVID-19 patient:
  + Unequivocal situation of need,
  + Individually not responsible.

- `\(\rightarrow\)` .alert[No COVID-19 treatment is no incentive to integrate!]
- Real and widely-debated threat:
  + Few hospital beds (esp. intense care) p.c.,
  + `\(\rightarrow\)` .alert[Sharing healthcare resources more immediate concern than typical welfare scenario.]

<img src="media/covid.jpg" width="70%" style="display: block; margin: auto;" />
]

---
# Pre-registered hypotheses .font70[ [osf.io/wu6jk](https://osf.io/wu6jk) ]

.push-left[
1. **Reciprocity:** Acute COVID-19 patients who have recently immigrated are seen as less deserving of hospital treatment than patients who were born domestically.

2. **Blatant racism**: If welfare chauvinism is motivated by racist concerns about ethnic identity, acute COVID-19 patients with a typical Muslim name are seen as less deserving of hospital treatment than patients with a typical Nordic name. 
3. **Interaction**: If concerns about reciprocity and racism reinforce each other in a joint effect, acute COVID-19 patients with a Muslim name who have recently immigrated are seen as least deserving of hospital treatment.

- .backgrnote[Further hypotheses on age, classism. etc.]
]

---
class: clear
# Pre-registered Experimental design .font70[ [osf.io/wu6jk](https://osf.io/wu6jk) ]

.push-left[
 > The outbreak of Coronavirus has placed an immense pressure on healthcare systems, and in several countries, we are witnessing a lack of hospital beds, materials, and per-sonnel. A lot is being done in Danish society to avoid a similar scenario. Yet, Denmark is one of the countries in Europe with the lowest number of hospital beds per citizen. This fact is considered a bottleneck if the number of COVID-19 patients in need of hospitalization continues to increase.
]

---
class: clear
# Pre-registered Experimental design .font70[ [osf.io/wu6jk](https://osf.io/wu6jk) ]

.push-left[
> In the following you are asked to take a stand on the case of **[name]** who has lived in Denmark **[length of residence]**. **[Name]** has been tested positive for COVID-19 (Corona virus) and later developed severe symptoms such as fever, fatigue, dry coughs, breath-ing difficulties, and chest pains. He is **[age]**. The doctor who examined **[name]**, as-sessed that he needs treatment. However, given the increased pressure the healthcare system is experiencing, **[name]** might be admitted a hospital bed at the expense of someone else.

> Based on the above scenario, to what degree do you feel this person should be prioritized a hospital bed?”

> (1) Very low degree ... (8) Very high degree
]

.push-right[
- Names (Racism):
  1. Popular Muslim names in DK: Mustafa, Ibrahim, & Ahmad.
  2. Most frequent Danish names cohorts 1937 & 1961: Jørgen, Hans, & Erik.
  3. Most Frequent US-inspired (i.e., working class) names cohorts 1937 & 1961: Sonny, Freddy & Benny.

- Length of residence (Reciprocity):
  1. Born in DK
  1. Moved to DK 1 year ago.

- Age (Need):
  1. 59
  2. 83

- `\(\rightarrow\)` (3 X 2 X 2) = 12 full factorial design.
  + power analysis ( `\(\text{Power} = 0.8; \text{f}^2 = 0.01\)` ): `\(n = 966\)`; we pre-registered `\(n = 1,200\)`.
]

---
# Fieldwork .font70[YouGov online panel 17-30 April]

.push-left[
<img src="https://upload.wikimedia.org/wikipedia/commons/c/cc/Covid-19_cases_and_deaths_in_Denmark.png" width="100%" style="display: block; margin: auto;" />
.center[.backgrnote[*Source*: [Wikipedia](https://en.wikipedia.org/wiki/COVID-19_pandemic_in_Denmark)]]
]

.push-right[
<img src="media/time_trend.jpeg" width="100%" style="display: block; margin: auto;" />
]

---
# Results

<img src="media/mainplot1.jpeg" width="85%" style="display: block; margin: auto;" />
.center[.backgrnote[Marginal effects and associated 90 and 95% (two-tailed) confidence intervals based on post-stratification-weighted OLS regression with robust standard errors.]]

---
# Results

<img src="media/mainplot2.jpeg" width="85%" style="display: block; margin: auto;" />
.center[.backgrnote[Marginal effects and associated 90 and 95% (two-tailed) confidence intervals based on post-stratification-weighted OLS regression with robust standard errors.]]

---
# Results

<img src="media/mainplot3.jpeg" width="85%" style="display: block; margin: auto;" />
.center[.backgrnote[Marginal effects and associated 90 and 95% (two-tailed) confidence intervals based on post-stratification-weighted OLS regression with robust standard errors.]]

---
# Need/Age

.left-column[
- Contra hypothesis & theory of deservingness: 
  + `\(\rightarrow\)` Danish respondents prioritize younger patients!

- Need/Age doesn't moderate main findings.
]

.right-column[
<img src="media/Age.png" width="100%" style="display: block; margin: auto;" />
.center[.backgrnote[Results of OLS regression with robust standard errors in parentheses; two-tailed p-values are indicated by + p < 0.10, \* p < 0.05, \*\* p < 0.01, \*\*\* p < 0.001.
]]]

---
# Classism

.left-column[
- No classist healthcare chauvinism in DK.

- Classism doesn't confound anti-Muslim racism.
]

.right-column[
<img src="media/Classism.png" width="100%" style="display: block; margin: auto;" />
.center[.backgrnote[Results of OLS regression with robust standard errors in parentheses; two-tailed p-values are indicated by + p < 0.10, \* p < 0.05, \*\* p < 0.01, \*\*\* p < 0.001.
]]]

---
# Conclusion

- Contra prior survey experiments: <br> .backgrnote[(Ford, 2016; Hjorth, 2016a; Kootstra, 2016a; Reeskens and van der Meer, 2019)] 
  + No blatant anti-Muslim racism in DK, i.e. healthcare chauvinism *proper*.
  + `\(\rightarrow\)` Were prior comparisons invalid?

- Anti-Muslim Racism catalyzes reciprocity-driven welfare chauvinism.
  + Deservingness dimensions act in concert! <br> .backgrnote[(see also: Ford, 2016; Kootstra, 2016a)]

- Apparently, age is not only a dimension of need, but potentially also of having had ones share of a good life.

- No work has yet disentangled "good citizen" from "ethnic background" deservingness dimension.
  + General problem, maybe also for work in taste vs. statistical discrimination.

<br>
<br>
.font150[.center[.alert[Thank you for your attention!]]]

---
# References

.font80[
Alesina, A, E. Glaeser, and B. Sacerdote (2001). "Why Doesn't the United States Have a European-Style
Welfare State?" In: _Brookings Papers on Economic Activity_ 2001.2, pp. 187-254.

Andersen, J. G. and T. Bjørklund (1990a). "Structural Changes and New Cleavages: The Progress Parties
in Denmark and Norway". In: _Acta Sociologica_ 33.3, pp. 195-217.

Denmark, S. (2019). "Indvandrere i Danmark 2019". In:
_https://www.dst.dk/da/Statistik/Publikationer/VisPub?cid=29446_.

Helliwell, J. F, R. Layard, and J. D. Sachs (2019). "World Happiness Report 2019". In:
_https://s3.amazonaws.com/happiness-report/2019/WHR19.pdf_.

ILO (2019). "Trade Unions in the Balance". In: _https://www.ilo.org/wcmsp5/groups/public/-ed\_
dialogue/-actrav/documents/publication/wcms\_722482.pdf_.

Jørgensen, M. B. and T. L. Thomsen (2016a). "Deservingness in the Danish Context: Welfare Chauvinism
in Times of Crisis:". In: _Critical Social Policy_.

Marx, K. and F. Engels (1975). _Selected Correspondence_. Moscow: Progress Publishers.

Matthiessen, P. C. (2009). _Immigration to Denmark: An Overview of the Research Carried Out from 1999
to 2006 by the Rockwool Foundation Research Unit_. Odense: University Press of Southern Denmark.
]

---
# References

.font80[
Andersen, L. H, C. Dustmann, and R. L. ø (2019). "Lowering Welfare Benefits: Intended and Unintended
Consequences for Migrants and Their Families". In: _Rockwool Foundation Study Paper No. 138_.

Feather, N. T. (1999). _Values, Achievement, and Justice Studies in the Psychology of Deservingness_.

Kootstra, A. (2016a). "Deserving and Undeserving Welfare Claimants in Britain and the Netherlands:
Examining the Role of Ethnicity and Migration Status Using a Vignette Experiment". In: _European
Sociological Review_ 32.3, pp. 325-338.

OECD (2018). _International Migration Outlook 2018_.

van Oorschot, W. (2000). "Who Should Get What, and Why? On Deservingness Criteria and the
Conditionality of Solidarity among the Public". In: _Policy & Politics_ 28.1, pp. 33-48.

van Oorschot, W. (2006). "Making the Difference in Social Europe: Deservingness Perceptions among
Citizens of European Welfare States". In: _Journal of European Social Policy_ 16.1, pp. 23-42.

van Oorschot, W. (2008). "Solidarity towards Immigrants in European Welfare States". In:
_International Journal of Social Welfare_ 17.1, pp. 3-14.

van Oorschot, W. and W. Uunk (2007). "Welfare Spending and the Public's Concern for Immigrants:
Multilevel Evidence for Eighteen European Countries". In: _Comparative Politics_ 40.1, pp. 63-82.
]

---
# References

.font80[
Ford, R. (2016). "Who Should We Help? An Experimental Test of Discrimination in the British Welfare
State". In: _Political Studies_ 64.3, pp. 630-650.

Hjorth, F. (2016a). "Who Benefits? Welfare Chauvinism and National Stereotypes". In: _European Union
Politics_ 17.1, pp. 3-24.

Jørgensen, F. J. (2020). _How to Develop Policies That Foster Refugee Integration and Are Supported by
Voters - Forskning - Aarhus Universitet_. Aarhus: Politicas ph.d.-serie, Forlaget Politica.

Reeskens, T. and T. van der Meer (2019). "The Inevitable Deservingness Gap: A Study into the
Insurmountable Immigrant Penalty in Perceived Welfare Deservingness". In: _Journal of European Social
Policy_ 29.2, pp. 166-181.
]