Social Differences in Health as a Challenge to the Danish Welfare State

  • Camilla Hoffmann Merrild
Part of the Approaches to Social Inequality and Difference book series (ATSIAD)


In Denmark, as in most other parts of the world, socially deprived people most often lead shorter and more illness-ridden lives than people living in more affluent social situations. In the context of an egalitarian welfare state where ideals of equality, solidarity, and universality dominate, this may seem somewhat paradoxical. The central argument in this chapter is that differences in morbidity and mortality across the population in a very definite way reveal fundamental structures of inequality in the Danish egalitarian welfare state. These differences are most often overlooked or ignored, given the egalitarian ideology of imagined sameness. This implies that ideologies of egalitarianism in the Nordic welfare states may sometimes blind us to the consequences that existing social hierarchies have for the lives of people from lower social classes.



I would like to extend my profound thanks to Rikke Sand Andersen for taking the time to read through this chapter and for offering insightful and critical constructive comments. I would also like to thank the members of CAP anthropology at The Research Unit for General Practice for their valuable comments and input.


  1. Andersen, Rikke S., Marie L. Tørring, and Peter Vedsted. 2014. Global health care-seeking discourses facing local clinical realities: Exploring the case of cancer. Medical Anthropology Quarterly 29 (2): 37–55. doi: 10.1111/maq.12148.Google Scholar
  2. Ayo, Nike. 2012. Understanding health promotion in a neoliberal climate and the making of health conscious citizens. Critical Public Health 22 (1): 99–105. doi: 10.1080/09581596.2010.520692.CrossRefGoogle Scholar
  3. Baadsgaard, Mikkel, and Henrik Brønnum-Hansen. 2012. Social ulighed i levetiden. København: Arbejdernes Erhvervsråd. Accessed 10 Jan 2016.
  4. Bourdieu, Pierre. 1987. What makes a social class? On the theoretical and practical existence of groups. Berkeley Journal of Sociology 32: 1–17.Google Scholar
  5. Briggs, Charles L. 2003. Why nation-states and journalists can’t teach people to be healthy: Power and pragmatic miscalculation in public discourses on health. Medical Anthropology Quarterly 17 (3): 287–321. doi: 10.1525/maq.2003.17.3.287.CrossRefGoogle Scholar
  6. Bruun, Maja H. 2011. Egalitarianism and community in Danish housing cooperatives: Proper forms of sharing and being together. Social Analysis 55 (2): 62–83. doi: 10.3167/sa.2011.550204.Google Scholar
  7. Bruun, Maja H., G. Skrædderdal Jakobsen, and S. Krøijer. 2011. Introduction: The concern for sociality – Practicing equality and hierarchy in Denmark. Social Analysis 55 (2): 1–19. doi: 10.3167/sa.2011.550201.CrossRefGoogle Scholar
  8. Bruun, Maja H., S. Krøijer, and M. Rytter. 2015. Indledende perspektiver: Forandringsstaten og selvstændighedssamfundet. Tidsskriftet Antropologi 72: 11–37.Google Scholar
  9. Christiansen, Niels F., and Pirjo Markkola. 2006. Introduction. In The Nordic model of welfare: A historical reappraisal, ed. Niels F. Christiansen, Klaus Petersen, and Nils Edling, 9–30. Copenhagen: Museum Tusculanum Press.Google Scholar
  10. Cummins, Steven, Sarah Curtis, Ana V. Diez-Roux, and Sally Macintyre. 2007. Understanding and representing “place” in health research: A relational approach. Social Science & Medicine 65 (9): 1825–1838. doi: 10.1016/j.socscimed.2007.05.036.CrossRefGoogle Scholar
  11. Cummins, Steven, Ellen Flint, and Stephen A. Matthews. 2014. New neighborhood grocery store increased awareness of food access but did not alter dietary habits or obesity. Health Affairs 33 (2): 283–291. doi: 10.1377/hlthaff.2013.0512.CrossRefGoogle Scholar
  12. Dalton, Susanne O., Joachim Schüz, Gerda Engholm, Christoffer Johansen, Susanne K. Kjær, Marianne Steding-Jessen, Hans H. Storm, and Jørgen H. Olsen. 2008. Social inequality in incidence of and survival from cancer in a population-based study in Denmark, 1994–2003: Summary of findings. European Journal of Cancer 44 (14): 2074–2085. doi: 10.1016/j.ejca.2008.06.018.CrossRefGoogle Scholar
  13. Diderichsen, Finn, Ingelise Andersen, and Celie Manuel. 2011. Ulighed i sundhed. Årsager og indsatser. København: Sundhedsstyrelsen.Google Scholar
  14. Faber, Stine T. 2008. På jagt efter klasse. Phd thesis, Institute of Sociology, Social Work and Organization, Aalborg University.Google Scholar
  15. Farmer, Paul. 1999. Infections and inequalities. The modern plagues. Berkeley: University of California Press.Google Scholar
  16. Fassin, Didier. 2003. The embodiment of inequality. AIDS as a social condition and the historical experience in South Africa. EMBO Reports 4 Spec No (June), S4–S9.Google Scholar
  17. Good, Byron J. 1994. Medicine, rationality and experience: An anthropological perspective. Cambridge: Cambridge University Press.Google Scholar
  18. Gullestad, Marianne. 1984. Kitchen-table society: A case study of the family life and friendships of young working-class mothers in urban Norway. Oslo: Universitetsforlaget.Google Scholar
  19. ———. 1992. The art of social relations: Essays on culture, social action and everyday life in modern Norway. Oxford: Oxford University Press.Google Scholar
  20. ———. 2001. Likhetens grenser. In Likhetens paradokser. Antropologiske undersøkelser i det moderne Norge, ed. Marianne Lien, Hilde Lidén, and Halvard Vike, 32–67. Oslo: Univeritetsforlaget.Google Scholar
  21. Højrup, Thomas. 1983. Det glemte folk – livsformer og centraldirigering. København: Museum Tusculanum.Google Scholar
  22. Jöhncke, Steffen. 2011. Integrating Denmark: The wellfare state as a national(ist) accomplishment. In The question of integration. Immigration, exclusion and the Danish wellfare state, ed. Karen F. Olwig and Karsten Pæregaard. Cambridge: Cambridge Scholars.Google Scholar
  23. Kapferer, Bruce. 2015. When is a joke not a joke? The paradox of egalitarianism. In The event of Charlie Hebdo: Imaginaries of freedom and control, ed. Alessandro Zagato, 93–114. New York: Berghahn Books.Google Scholar
  24. Kjærsgård, Andreas P. 2015. Scandinavian egalitarianism. Understanding attitudes towards the level of wage inequality in Scandinavia. PhD dissertation, Aalborg University.Google Scholar
  25. Krasnik, Allan. 1996. The concept of equity in health services research. Scandinavian Journal of Social Medicine 24 (1): 2–7.CrossRefGoogle Scholar
  26. Langer, Susanne, and Susanne Højlund. 2011. An anthropology of welfare. Journeying towards the good life. Anthropology in Action 18 (3): 1–9.CrossRefGoogle Scholar
  27. Larsen, Finn B., Karina Friis, Mathias Lasgaard, Marie H. Pedersen, Jes B. Sørensen, Louise M.A. Jakobsen, and Julie Christiansen. 2014. Hvordan har du det? 2013—Sundhedsprofil for region og kommuner—Bind I. Hvordan har du det? 2013—Sundhedsprofil for Region Og Kommuner—Bind 1. Aarhus: Folkesundhed og Kvalitetsudvikling.Google Scholar
  28. Lavrsen, Lasse. 2011. En sygdom der kender sin klasse. Information, 29 Oktober.Google Scholar
  29. Linnet, Jeppe T. 2011. Money can’t buy me “hygge”. Danish middle-class consumption, egalitarianism, and the sanctity of inner space. Social Analysis 55 (2): 21–44. doi: 10.3167/sa.2011.550202.CrossRefGoogle Scholar
  30. Lupton, Deborah. 1995. The imperative of health: Public health and the regulated body. London: Sage.Google Scholar
  31. Macintyre, Sally, Anne Ellaway, and Steven Cummins. 2002. Place effects on health: How can we conseptualise, operationalise and measure them? Social Science and Medicine 55 (1): 125–139. doi: 10.1016/S0277-9536(01)00214-3.CrossRefGoogle Scholar
  32. Madsen, Marie H., Betina Højgaard, and Jens Albæk. 2009. Health literacy—Begrebet, konsekvenser og mulige interventioner. København: Sundhedsstyrelsen.Google Scholar
  33. Marmot, Michael G., Geoffrey Rose, Martin Shipley, and Patricia J. Hamilton. 1978. Employment grade and coronary heart disease in British civil servants. Journal of Epidemiology and Community Health 32 (4): 244–249.CrossRefGoogle Scholar
  34. Marmot, Michael G., George Davey Smith, Stephen A. Stansfeld, Chandra Patel, Fiona North, Jenny Head, Ian R. White, Eric Brunner, and Amanda Feeney. 1991. Health inequalities among British civil servants: The whitehall II study. Lancet 337 (8754): 1387–1393.CrossRefGoogle Scholar
  35. Marmot, Michael G., Sharon Friel, Ruth Bell, Tanja A.J. Houweling, and Sebastian Taylor. 2008. Closing the gap in a generation: Health equity through action on the social determinants of health. Lancet 372 (9650): 1661–1669. doi: 10.1016/S0140-6736(08)61690-6.CrossRefGoogle Scholar
  36. Merrild, Camilla H., Rikke S. Andersen, Mette B. Risør, and Peter Vedsted. 2016. Resisting “reason”. A comparative anthropological study of social differences and resistance towards health promotion and illness prevention in Denmark. Medical Anthropology Quarterly, E-pub ahead of print. doi: 10.1111/maq.12295.
  37. Merrild, Camilla H., Peter Vedsted, and Rikke S. Andersen. 2017. Noisy lives, noisy bodies: Exploring the sensorial embodiment of class. Anthropology in Action 24 (1): 13–19.CrossRefGoogle Scholar
  38. Nørgaard, Marie, Peter Korsgaard, and Caroline Clante. 2015. Din uddannelse afgør, om du overlever en kræftsygdom Ekstrabladet, 12 July.Google Scholar
  39. Nowatzki, Nadine R. 2012. Wealth inequality and health: A political economy perspective. International Journal of Health Services: Planning, Administration, Evaluation 42 (3): 403–424. doi: 10.2190/HS.42.3.c.CrossRefGoogle Scholar
  40. Nutbeam, Don. 2000. Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International 15 (3): 259–267. doi: 10.1093/heapro/15.3.259.CrossRefGoogle Scholar
  41. Offersen, Sarah M.H., Peter Vedsted, and Rikke S. Andersen. 2017. “The good citizen”: Balancing moral possibilities in everyday life between sensation, symptom and healthcare seeking. Anthropology in Action 24 (1): 6–12.CrossRefGoogle Scholar
  42. Olsen, Lars, Niels Ploug, Lars Andersen, and Jonas S. Juul. 2012. Det danske klassesamfund. København: Gyldendal.Google Scholar
  43. Olsen, Lars, Niels Ploug, Lars Andersen, Sune E. Sabiers, and Jørgen G. Andersen. 2014. Klassekamp fra oven. København: Gyldendal.Google Scholar
  44. Ortner, Sherry B. 2003. New Jersey dreaming: Capital, culture, and the class of ‘58. Durham: Duke University.CrossRefGoogle Scholar
  45. Pausewang, Elin A. 2001. Syk og frisk, yter og nyter—Likhetsdilemmaer i et helsefremmende fellesskab. In Likhetens paradokser. Antropologiske undersøkelser i det moderne Norge, ed. Marianne Lien, Hilde Lidén, and Halvard Vike, 170–194. Oslo: Univeritetsforlaget.Google Scholar
  46. Pedersen, Ove K. 2011. Konkurrencestaten. København: Hans Reitzels Forlag.Google Scholar
  47. Pickett, Kate E., and Richard G. Wilkinson. 2014. Income inequality and health: A causal review. Social Science & Medicine 128 (December): 316–326. doi: 10.1016/j.socscimed.2014.12.031.Google Scholar
  48. Popay, Jenny, Sharon Bennett, Carol Thomas, Gareth Williams, Anthony Gatrell, and Lisa Bostock. 2003. Beyond “beer, fags, egg and chips”? Exploring lay understandings of social inequalities in health. Sociology of Health & Illness 25 (1): 1–23. doi: 10.1111/1467-9566.t01-1-00322.CrossRefGoogle Scholar
  49. Reay, Diane. 1998. Rethinking social class: Qualitative perspectives on class and gender. Sociology 32 (2): 259–275. doi: 10.1177/0038038598032002003.CrossRefGoogle Scholar
  50. Rose, Nikolas. 2007. The politics of Life itself. Biomedicine, power, and subjectivity in the twenty-first century. Princeton: Princeton University Press.Google Scholar
  51. Sabiers, Sune E., and Helene B. Larsen. 2014. De sociale klasser i Danmark. København: Arbejdernes Erhvervsråd. Accessed 10 Jan 2016.
  52. Sandemose, Aksel. 1992 [1972]. En flygtning krydser sit spor. Aalborg: Schønberg.Google Scholar
  53. Sontag, Susan. 1978. Ilness as metaphor. New York: Farrar, Straus and Giroux.Google Scholar
  54. Tørring, Marie L. 2014. Hvorfor akut kræft? Et bud på en epidemisk forståelse af tid og kræft-tendenser i Danmark. Tidsskrift for foskning i sygdom og samfund 20: 13–45.Google Scholar
  55. Townsend, Peter, Margaret Whitehead, and Nicholas Davidson. 1992. Inequalities in health: The black report & the Health divide, new 3rd ed. London: Penguin Books.Google Scholar
  56. Trägårdh, Lars. 2010. Rethinking the Nordic welfare state through a neo-Hegelian theory of state and civil society. Journal of Political Ideologies 15 (3): 227–239. doi: 10.1080/13569317.2010.513853.CrossRefGoogle Scholar
  57. Vike, Halvard. 2001. Likhetens Kjønn. In Likhetens paradokser. Antropologiske undersøkelser i det moderne Norge, ed. Marianne Lien, Hilde Lidén, and Halvard Vike, 145–169. Oslo: Univeritetsforlaget.Google Scholar

Copyright information

© The Author(s) 2018

Authors and Affiliations

  • Camilla Hoffmann Merrild
    • 1
  1. 1.The Research Unit for General Practice, Department of Public HealthAarhus UniversityÅrhusDenmark

Personalised recommendations