Care in Europe: what makes for generosity?

How well children, dependent adults and the elderly are cared for isn’t about national stereotypes—but it does reflect welfare regimes.

Across Europe there are country differences in how families care for children, dependent adults and the elderly. While some of these differences could be cultural, stemming from what people consider ‘right’ or appropriate in each country, we also show in a recent report that welfare services play a role in determining patterns of care.

Childcare

When it comes to formal childcare services, where care is provided by a paid worker in a formal setting, ‘social-democratic’ Scandinavian countries, such as Denmark, Finland and Sweden, lead the way. ‘Corporatist’ continental-European states show lower coverage, with Austria, Belgium and France reporting less access to formal care than their Scandinavian counterparts; ‘southern’ welfare states, such as Italy and Spain, show the lowest formal childcare use. ‘Liberal’ states such as Ireland and the UK sit closer to southern states, rather than corporatist comparators.

These differences in access affect country differences in wider childcare options, such as family help and childminding services. Family help with childcare (where family members, other than the parent, step in to help) is particularly prominent in Ireland, England and France but virtually non-existent in Scandinavian countries. Does this suggest that Scandinavian grandparents are uninterested in looking after their grandkids, when compared to British grandparents? We would argue not.

Instead, parents in countries with little access to formal childcare must create a patchwork of care using other forms—whether exclusively parental care, where a parent (typically the mother) provides most, or non-parental family care, where a relative provides care while the parents are away, or some mix of several options. Often the gaps which arise from these patchworked solutions cannot be closed completely, leading to country differences in unmet needs for formal childcare. We estimate that unmet childcare needs are most common in the UK, Spain and Ireland and least prevalent in Denmark, Belgium and Sweden.

Such gaps have distinct country properties: they cannot be explained by differences in household compositions, lone parenthood, disability status or social class between countries. Even when we take account of these characteristics, of the countries considered the Nordics have the least amount of unmet childcare need, while the UK, Ireland and Spain have the greatest deficit. Unmet need for formal childcare is further associated with material deprivation and mother’s non-employment, though the causal path is likely to operate in both directions.

Wherever households cannot secure formal childcare or adequate access to it, they have a higher chance of experiencing social exclusion and deprivation. Interestingly, households with no need for formal childcare, where children receive traditional forms of care, are also more likely to experience material deprivation than households with adequate formal childcare. The fact that these households report no need for formal childcare could be the consequence of adaptive attitudes when access to formal childcare is difficult. (This effect is far smaller, however, than that of inadequate care.)

Gøsta Esping-Andersen’s classical welfare-regime typology fits our discussion of childcare and social exclusion well. There is still variance within welfare-regime clusters—differences  remain among the social-democratic countries, for instance—but, in general, social-democratic states have little unmet need for formal childcare, while liberal and southern states have more. That under-supply of services is associated with a range of negative outcomes, such as deprivation and non-employment.

Home care

Corporatist and social-democratic states are also more likely to provide home care than most liberal and southern states. Yet of the 11 countries considered in our study, the majority of those who require help at home, due to an illness or disability, do not receive a formal service for this need. This is even true of Austria (41 per cent) and France (49 per cent), which have some of the highest rates of formal home-care access. Unsurprisingly, Ireland (24 per cent) and the UK (18 per cent) have low home-care coverage, while in Italy (12 per cent) and Spain (12 per cent) formal care is minimal.

Most home care is provided informally by family members. As with childcare, countries fit the welfare-regime typology very well, with social-democratic and corporatist countries showing little unmet need and liberal and southern countries manifesting higher incidence. Once again, these country differences cannot be explained by differences in the prevalence of disability, in social class or lone parenthood across countries, when we control for them, pointing to institutional divergences in access to home care.

Unmet need for home care is also closely tied to material deprivation, even after controlling for a range of predictors, but is not associated with non-employment. This suggests households are having to balance care obligations with employment—and caring full-time has become less of an option.

Political will

So how do countries differ in terms of caring for the most vulnerable? In short, social-democratic and corporatist states provide more resources to families with young children or those where respondents need daily help in the home because of old age or infirmity. Southern and liberal states leave families to their own devices.

Southern states may claim to lack the resources to increase provision. But there is little reason other than lack of political will as to why wealthier states such as Ireland and the UK cannot match their Scandinavian, or at least their continental-European, partners.