Tackling social inequalities in health in the Nordic countries: targeting a residuum or the whole population?

Abstract

The Nordic countries are often pictured as similar inasmuch as they are egalitarian welfare states with a universal approach to welfare policies. Here, the policies of four Nordic countries towards social inequalities in health are analysed by focusing on how they suggest the inequalities should be tackled. Two types of approach can be identified: universal policies, which target the whole population, benefits and services being offered to every resident, and residual policies, which target only a section of the population with specific characteristics. These residual policies rely on professional discretion in the decisions about who should be targeted and, consequently, benefit from the interventions. In disease prevention a similar distinction is made between population-based, or mass strategies, and high-risk strategies. In mass strategies the interventions target the whole population. In high-risk interventions people are screened to identify those most at risk of death and disease, and the interventions are then targeted at those identified. Furthermore, interventions can be characterised as addressing behaviour or living conditions. As is shown, the four countries' policies differ when it comes to who is targeted and what is targeted.