1. The role of civil society in health and social services:
the Swedish case
• Magnus Jegermalm, PhD, Associate Professor
Ersta Sköndal UC, Sweden
• Cecilia Henning, PhD, Associate Professor
Department of Behavioural Science and Social Work
School of Health Sciences, Jönköping University, Sweden
• International Federation on Ageing Conference in Prague
28 May- I June 2011, Theme: Ageing Connects

2. Aim of this presentation
• Discuss the Swedish case by analysing the possible role for
civil society in health and social services with focus on
patterns of change over the two last decades regarding scope
and character.
• As an empirical illustration for this discussion we will use
results from a national survey in Sweden repeated four times
1992-2009 by the Department of Civil Society Studies, Ersta
Sköndal UC

3. We describe and analyze the role for civil society by
using four ‘engagement profiles’ that we have
identified
1. Those volunteering in organizations,
2. Those involved in informal helpgiving outside
organizational settings,
3. Those involved both in volunteering and in informal
helpgiving,
4. and those not involved in either of these activities.

4. Contextual factors
• Sweden is characterized as a country with high levels of
taxation and a social policy system with ambitions of having
universal welfare schemes
• Sweden has one of the oldest populations in the world.
Around the turn of the new millennium, 17 percent of the
population in Sweden was aged 65 and over.
• In the year 2000, Sweden was the first country in the world to
have reached the 5 percent level for people aged 80 or over

5. Contextual factors
• Home help has been considered a cornerstone of the Swedish
public care system for older persons
• The 1980s and 1990s saw a fall in the proportion of older
people (65+) receiving home help from about 16 percent to
less than 10 percent
• Housing issues are closely connected to the organization of
eldercare. “Aging in place” has been the dominant policy in
Sweden

6. Contextual factors
• Since the late 1990s informal caregiving has been ‘re-
discovered’ by the state
• Since 2009 the municipalities are legally obliged to offer
support for an informal caregiver who provides care for
someone with chronic illness, an elderly person or a person
with functional disabilities

7. Voluntary work in Sweden
• Voluntary work in Sweden in 1992, 1998, 2005 and 2009. Percentage of
the adult population (16-74 years) involved
Year 1992 1998 2005 2009
Percentage of 48 52 48 48
population

8. Informal caregiving in Sweden
Informal caregiving in Sweden as a whole 1992, 1998, 2005 and 2009 (%)
1992 1998 2005 2009
Percentage of 28 30 52 45
population

9. Unpaid engagement and non-engagement among
different groups in
1992, 1998, 2005 and 2009 (%)
1992 1998 2005 2009
1. Engaged in volunteering only 33 36 21 24
2. Engaged in informal helping only 12 13 23 20
3. Engaged in both volunteering and 17 16 30 24
informal caregiving
4. Engaged neither in volunteering nor 38 35 26 32
informal caregiving

10. Some preliminary conclusions
• Repeated surveys over a span of 17 years
indicate that Sweden has a strong stock of social
capital at the national level,
• From the studies of unpaid activities in Sweden,
we see that there may be more of a ”crowding
in” effect on social care instead of informal
helpgivers and volunteers ”crowding out” the
government programs

11. Our most important empirical finding: the fact that a large group
of Swedish citizens engage in both voluntary and informal efforts
• The double involvement, leading to an increase of
both volunteering and informal caregiving, is an
example of a cumulative citizenship
• Here we find a civic main-force creating as well
bonding as bridging social capital.

12. Some preliminary conclusions
• One explanation for the parallel existence might be that the
public welfare system and civic involvement in the form of
unpaid help are involved in different forms helping tasks,
especially concerning older people
• After cutbacks and changed priorities concerning home help
the public system have focused more on helping people with
‘heavier’ tasks involving personal care

13. Some preliminary conclusions
• This development have most likely led to that informal
caregivers and volunteers commonly carries out ‘lighter’ tasks
for someone who is a relative but might also be a neighbour
or a friend
• Many of these contacts could probably be described as weak
ties or thin ties
• The linkage between weak ties and ‘light tasks’ is mostly an
invisible part of the helping patterns, and we need more
knowledge about the significance of these patterns

14. Some preliminary conclusions
• We argue that it is important to challenge the widespread
view of unpaid help work as being instrumentally related to
the country’s welfare system and to changes in the welfare
state
• Sweden gives an example of a country where there does not
seem to be any simple contradiction between having a vital
civil society and a welfare state including a substantial public
sector.

15. Who is responsible?
State
Civil Society Market
(Including voluntary organizations
and informal help/caregiving outside organizational
frameworks)