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Voluntary care associations

There is a revival of the citizens’ initiative in care in The Netherlands. These are initiatives that usually have their ‘place’ in the social atmosphere in which ‘voluntary associations are dominant’ (Dekker, 2014). The characteristics of these free associations or citizen initiatives are:

  • Participation is voluntary;
  • Participation can be ended at any time;
  • Apart from paying contribution, there are no legal obligations;
  • Participants produce their own services;
  • Participants are not subject to the disciplines of the market or the state;
  • Principle values are: a better world, be good, friendship and care.

Reviving the citizens’ initiative

Several explanations count for the resurgence of this type of association. The first is that civil society continues to grow. For years, the Netherlands has been at the top of the global rankings when it comes to volunteering and membership of voluntary associations. From 1980 to 2006 the Dutch population increased by 16%. In the same period the number of participants of voluntary associations, with more than 50,000 members, increased by 40%. In ​​care and welfare with almost 70%. For these associations this means an increase of participants from 3 to 5 million. Examples are the Diabetes Association, De Zonnebloem, the Dutch Patients’ Association, and the Salvation Army.

Hurenkamp and Tonkens in 2011 researched voluntary associations with less than 20 participants in Smilde, a small village in the province Drenthe. There were 70 of them. At that time, in Smilde lived 4,500 people. Extrapolation to the total Dutch population yields, according to their estimation, the astronomical number of an estimated 200,000 to 300,000 initiatives of this size. Another example is the number of Dutch small-scale voluntary citizens initiatives that directly provide structural support to one or more developing countries. This is estimated at 6,400 to 15,000.

There are organizations that do not appear in these statistics. Although some of them already exist for over a hundred years. For instance independent regional care-associations, recovery care associations and care cooperatives. The care cooperatives have grown from a handful to 500 in the last ten years. They are voluntary associations whose main objective is that people can stay at home for as long as possible in good health and under their own guidance.

Civil society constantly renews itself

The second reason, for the resurgence of voluntary care associations, is that civil society is constantly renewing itself. In recent years, in The Netherlands, all kinds of initiatives emerged: in the field of public green areas, energy cooperatives, ‘bread funds’, and cultural facilities. It is precisely in this new wave that the emergence of care cooperatives must be situated.

Three contemporary changes in the welfare state explain the growth and continuous innovation of civil society.

The revival of the ideals of the civil society

Citizens’ initiative is again highly regarded, by citizens, but also by politicians. At the same time, we know that civil society revivals are always connected with shortcomings of the welfare state experienced by citizens. These shortages are of a financial, social, cultural or moral nature.

The emergence of individualism

The second major change in the welfare state that underpins the revival of the citizens’ initiative dates from the seventies of the Twentieth Century. This concerns the increased importance of the individual (Hustinx, 2009). In other words, we have come to find ourselves more important. That is the result of a shift in socio-cultural values. Autonomy, self-actualization and quality of life have become more important than tradition, collective identity and solidarity. This shift is to a large extent the product of the welfare state. Through better education and good social services people could shift their concerns from material to non-material.

The shift from state to community

The shift from the state to the community is the third change that is assumed to have an impact on the revival of civil society. An example of this shift is the Law for societal development (Wmo). Everyone must join in, is the motto of this law. This endorses the political-administrative plea for a greater responsibility for one’s own destiny and that of others. On the other hand, it also means increasing public interference with the daily life of citizens. Those who want to appeal to the state for assistance must tolerate a civil servant at the kitchen table.

Hybrid motivation

Why do people participate in this kind of associations? For a number of them the political administrative ideal of greater responsibility is in line with their socio-cultural ideal of more autonomy. Self-actualization is also cited as an important motive. Many initiatives focus on supporting people to live independently in their own homes and surroundings, for as long as possible and in good health. This shows that the quality of life is also an important motive. Not all old ideals of civil society are lost: helping each other in someone’s own direct social circle is still seen as an important motive.

However, the striking feature of participants’ motivation is that it’s hybrid. They combine an openly confessed, well-understood self-interest with strong social feelings for their fellow human beings. A feeling they convert into action in times of need. But they expect something back. When time comes, when they themselves are less well off, they also expect support. Reciprocity is an important incentive for active participation in voluntary care associations.

The resurgence of the voluntary care associations is best explained by the coincidence of these hybrid motives and the welfare state changes.


Dekker, P. (2014). Leren uit het buitenland: Burgerparticipatie. College voor DIVOSA/VU-cyclus. Amsterdam: Vrije Universiteit. [Lessons from abroad: citizens participation. Lecture at the DIVOSA/VU-cycle 2014. Amsterdam: VU Amsterdam.]

Hurenkamp, M. & Tonkens, E. (2011). De onbeholpen samenleving. Burgerschap aan het begin van de 21e eeuw. Amsterdam: Amsterdam University Press.

Hustinx, L. (2009). De individualisering van het vrijwillig engagement, in Buys, G., Dekker, P. & Hooghe, M. (red.) Civil society. Tussen oud en nieuw (pp. 211-224). Amsterdam: Aksant.

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Sense of Care

Study into the viability of a theoretical concept

The following weeks I will publish the results of a study I conducted the last seven years. This study explores the viability of a theoretical concept: the sense of care. I have designed this concept to be better able to explain care behavior. The existence of such a concept is inspired by the ‘social awareness’ concept (De Swaan, 2004 [1989]), which explains for the attachment of humans to the welfare state, and the sense of work (Van Oosterhout & Breij, 2014), which I consider to be a ‘heuristic instrument’ that people administer at moments they have to make important work-related decisions.

These publications will also appear on my Dutch website

TvO, 2018.04.13

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Older employees feel abandoned by ‘their’ employers

Older employees across Europe feel let down. In the European Union, but more specifically in The Netherlands, employers associate the aging of society foremost with higher labour costs (+75% of the employers), stagnating or decreasing productivity and poor profitability. And yet, for these employers aging is mainly a national problem and not a challenge to their own organization.

Higher birth rates

European employers do hardly take care of their older employees and as far as they do something, they employ so-called ‘care-measures’: less hours and more days off. Actually these types of measures are only administered in The Netherlands. Most employers in Europe seldomly ask older employees to continue to work after they have reached their pension-age. These employers don’t worry about the necessity to prolong the working life of older employees. They assume to have enough alternatives if they have a shortage of employees. They can turn parttime into fulltime work, open the countries borders and raise the birth rate (for these measures there is less enthousiasm in The Netherlands). Employers in the European Union prefer younger employees. Although older workers outperform the younger ones if it comes to ‘soft’ and less quantifiable characteristics of work (loyalty, reliability, management), only the ‘hard’ productive employee values count (physical health, technological skills, creativity). This image of employee values is identical for most employers in European countries.

Flexibility has vanished

Since older employees are hardly of any value to employers, it’s no surprise they feel let down. To a certain degree and some surprise Dutch employers appear to be the exception. Employers, as well as employees, prefer a more gradual and flexible end of the career. For instance, by combining work and pension. Due to the repeal of different senior-, parttime, early retirement and pre-pension settlements, the possibilites for a flexible retirement process in most European countries have been reduced drastically. The immediate effect of these steps is the increase of the average retirement age. In The Netherlands, against the wishes of employees and employers, flexibility at the end of the working life has come to an end.

Older employees are tired

Anyway, for The Netherlands must be concluded that older employees are tolerated. At the same time, there appears to be an incomprehensible discrepancy between the demand of employers and employees for a flexible pension and at the same time the social regime that goes with it, such as the rigid state pension age. In research we conducted, older employees often told they were tired of their work. This never implied there actual labor activities. They are tired of bureaucracy, the eternal whining of organization changes which in the end always fail and the lack of genuine concern for the fact that at the end of their career they have to give up their career and craftmanship. Most older employees feel abandoned by ‘their’ employers.

Sources (only in Dutch):

Breij, B. & Oosterhout, T. van (2016). Met pensioen. Wat houdt mij tegen? Leiden: ILC Nederland (voorheen ILC Zorg voor Later).

Dalen, H. van, Henkens, K., Conen, W., & Schippers, J. (2012). Dilemma’s rond langer doorwerken. Europese werkgevers aan het woord. Den Haag: NIDI.

Oosterhout, T. van & Breij, B. (2013). Een langer arbeidsleven? Drijfveren voor al of niet doorwerken. Leiden: ILC Nederland (voorheen ILC Zog voor Later).

Oosterhout, T. van & Breij, B. (2014a). Een langer arbeidsleven? Dat maken we zelf wel uit! In Bronner, A.E., Dekker, P., Leeuw, E. de, Paas, L.J., Ruyter, K. de, Smidts, A. & Wieringa, J.E. (red.), Ontwikkelingen in het marktonderzoek: Jaarboek MarktOnderzoekAssociatie, dl. 39 (pp. 189-199). Haarlem: SpaarenHout. [For those interested an English translation is available.]

Oosterhout, T. van & Breij, B. (2014b). Perspectieven op een langer arbeidsleven. Leiden: ILC Nederland (voorheen ILC Zorg voor Later).

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Doubt is our product. A destructive ideology

Early this year the Rockefeller Family Fund “announced that it would divest its holdings in fossil fuel companies. We mean to do this gradually, but in a public statement we singled out ExxonMobil for immediate divestment because of its “morally reprehensible conduct.”” (1) For decades ExxonMobil casted doubt on climate change. Despite their early and vast knowledge of the problems of CO2 depletion.

Doubt: a handsome strategy

ExxonMobil must be praised for its vast investments in scientific research into climate change, from 1977 until 1988. What changed its mind? In 1988 for the first time the public and political community became aware of the effects of global warming due to the rise of CO2 levels. From then on, paradoxically, ExxonMobil started to cast doubts on the scientific evidence supporting the climate change claims. A strategy that paid of handsomely: “…the U.S. Senate in 1997, only three months before the Kyoto Protocol was finalized, resolved to block its adoption by a vote of 97 to zero.” (2) This strategy was far from revolutionary.

Tobacco, acid rain, ozone depletion

From 1953 and onward it was well known in the scientific community that smoking caused cancer. For forty years the tobacco industry was able to postpone any legal action by paying scientists to deny the overwhelming evidence. Companies that feared their trade was in danger (the coal industry, cfk-producers) directed their pr- and pa-strategies in the same direction: to cast doubt on the scientific evidence. In every case it paid of. Albeit in some cases governmental ruling was able to curtail these practices. And from 1990 the tobacco industry was plagued by one lawsuit after another.

It’s the ideology stupid

In 2004 two colleagues and I conducted a survey among regular milk farmers to find out whether they would be susceptible to conversion to biological farming. In fact they could do this practically from one day to the other and they would gain a substantial raise of their turnover, estimated at an average of 20% to 40%. None of the farmers even considered changing their business. There was only one reason: they associated biological farming with a liberal anti-business attitude. The strategy of casting doubt on climate change, was orchestrated by four scientists with vast track records in the academic community: Fred Seitz (the inventor of the ‘Tobacco Strategy’ of casting doubt), Robert Jastrow and Bill Nierenberg. In 1984 they founded the George C. Marshall Institute, which was later joined by Fred Singer. They where paid vast sums of money by ExxonMobil and other companies to cast doubt on the scientific evidence which supported climate change. But far more interesting are the ideological motives of these men: “They were all fervent anti-Communists and ardent free-market purists. … they saw environmentalists as the next great threat to capitalism, since, by pointing out the damage industry sometimes does to the environment and human health, defenders of the environment are implicitly criticizing the workings of free markets and bolstering the case for regulation.” (3)


(1) and (3): Kaiser, D. & Wasserman, L. (2016) The Rockefeller Family Fund vs. Exxon, in The New York Review of Books, the December 8, Issue.
(2) Proctor, R. (2010). Manufactured Ignorance, in Amercian Scientist, September/October issue.

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Romantic wonder: genetic manipulation

Freeman Dyson was a physics professor at Princeton. A prestigious university in the USA. Dyson is professor emeritus, which gives him all the time in the world to read and write. In the summer of 2009 he reviews Richard Holmes’ The Age of Wonder: How the Romantic Generation Discovered the Beauty and Terror of Science, in The New York Review of Books (Volume LVI, Number 13).

Single culture of poetry and science

The Age of Wonder is the sixty-year period between 1770 and 1830. Richard Holmes demonstrates that English scientists and poets in this Romantic period belonged to one and the same culture: “Many of the poets were intensely interested in science, and many of the scientists in poetry. The scientists and the poets belonged to a single culture and were in many cases personal friends.”

Against Enlightenment, rationalism and science?

A couple of things stand out in Dyson’s review. For instance, he missed the chance to discuss Holmes’ outstanding book in the broader European perspective of the Romantic era. He could have wondered why a historian as Schenk (1) and a publicist as Safranski (2) see the Romantic period as a reaction against the Enlightenment, rationalism and science. And he could have noticed that science and the arts in the USA during that period were at such an undeveloped stage that the Romantic era hardly made any impression (3).

Goethe was an exemplary Romantic scientist

Second, Dyson could have pointed out that Goethe, whom he briefly mentions, as a German Romantic novelist and poet, was also an exemplary scientist. Goethe was not only thoroughly interested in science, he also contributed substantially: “On June 1791 (Goethe) writes to Jacobi about his study of the optics and the science of the colors: ‘For the time being, I am more and more attached to these sciences, and I feel strongly in future I will occupy myself solely with science.’ But he didn’t travel all the way into that direction. He wouldn’t part from the arts and literature, next to physics for him they were the second bastion against the agitated spirit of the times.” (4).

To enrich the ecology of our planet

Although Dyson concludes, that the scientific discoveries in the Romantic era were “… as unexpected and intoxicating as the poems”, Holmes’ The Age of Wonder is about scientists and science, not about poetry. At the end of his review Dyson, dramatically changes his subject. He suggests that the first half of the 21st century can be compared to The Age of Wonder. Biology is the dominant science and the dominant art form should not be poetry but “… the design of genomes to create new varieties of animals and plants.” If his dream comes true “a new generation of artists … might create an abundance of new flowers and fruit and trees and birds to enrich the ecology of our planet. … to make the planet beautiful as well as fertile, hospitable to hummingbirds as well as to humans.” (1).

Genetic manipulation as a Romantic dream?

It’s unclear whether Dyson hopes his romantic dream will come true. Nevertheless, this dream raises some interesting questions. Is the planet not beautiful and fertile as such? Are there not enough varieties of flowers, fruit, trees, and birds? Is the ecology of our planet not rich enough? And if so, how come? If Dyson’s dream will come true, will poetry ever be able to express the beauty of this new planet? Will genetic manipulation enrich our cultural, artistic lives? How unexpected and exciting will this be?

Genetic manipulation is a democratic insult

If humans are considered political animals “what may appear to be direct action on biological or geological forces is virtually always mediated by politics.” (5) The framing of the Anthropocene, whether it replaced the Holocene 8.000 years ago or not, clearly establishes human beings as the dominant agents of the new epoch. And this is where Freeman Dyson completely misses the point. Given “… the grossly unequal responsibility for anthropogenic carbon emission among different groups of human agents, as well as the grossly differentiated vulnerability to its worst impacts, both on a domestic scale and internationally” (6), it’s obvious that his dream totally goes of the road, due to a total lack of respect for democratic traditions.


(1) Schenk, H.G. (1966). De geest van de romantiek. Bilthoven: Amboboeken. [Only in Dutch]
(2) Safranski, R. (2009). Romantiek. Een Duitse affaire. Amsterdam: Atlas. [Romanticism: A German Affair]
(3) Hughes, R. (1997). Amerika’s visioenen. Het epos van de Amerikaanse kunst. Amsterdam: Uitgeverij Balans. [American Visions. The Epic History of Art in America]
(4) Safranski (2009).
(5) Lane, M. (2016). Political Theory on Climate Change, in Annual Review of Political Sciences, 19, 107-123: 118.
(6) Lane, M. (2016). Political Theory on Climate Change, in Annual Review of Political Sciences, 19, 107-123: 118.

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Socio-cultural rift of 1970 still dominates our lives

The socio-cultural history of the current generations starts in 1970 (1). In that year a ‘hard’ breach in societal trends can be marked. A run up to this trend can already be noticed from the fifties, and onward. The dissemination of popular culture through radio, soon followed by television, the general introduction and use of the car, the growing wealth, the disappearance of political, social, and religious restraints, the expansion of leisure time, the rising educational levels, all powerfully contributed to the breach in the socio-cultural trend of 1970 (2).

The replacement of the standard life cycle

Some call this breach a “separation of the spirits” (3): “… newer generations felt themselves more attracted to popular in stead of traditional culture. The appeal of popular culture was not just a youthful folly, but a preference that stuck during the course of life of the generations whom grew up with the entertainment industry.” Another striking feature of the change in the socio-cultural trend is the diversity of the modern lifestyle: “In previous days one central activity was part of a life’s phase, such as paid labor or domestic activities, from 1970 and onward in every phase of life all kind of different activities are combined or alternated. The standard life cycle is replaced by a mounting diversity of life cycles.” (3). We burden ourselves with this demanding diversity of modern life. It’s all about “individual choices made voluntarily” (4). Such as, both partners work, relational and family duties, a high mortgage, big consumptive spending, and a varied leisure repertoire (3).

Hedonism as a general attitude

The socio-cultural breach of 1970 has improperly been claimed by the ‘baby-boomer’ generation. If hedonism is taken to be the most characteristic attitude of today’s socio-cultural life, in 1970 almost unnoticed all generations veered to this attitude, young and old, the political left as well as the political right. Freedom of choice, and to enjoy life, here and now, did become and still are dominant life principles in society. People are supposed to be happy, with their partner, with their children, at work, and in social life, to be physically healthy, and stay “forever young” (4). Material wealth contributes hugely to the happiness people experience.

A new socio-cultural rift is rising?

The socio-cultural rift of 1970 was accompanied by some noteworthy other developments, which emphasize the puzzle as to which societal changes caused this breach. The first puzzle is the paradoxical relation between the perception of health and longevity. Today, we live longer as ever, but we also have never been so nervous about our health. Perhaps peoples’ anxiety was stirred by the fact that from 1970 the dynamism of medical progress came to a standstill (5): “… doctors are increasingly discontented and the public is increasingly neurotic about its health.” The second paradox is the lack of macro-economic growth, despite the rise of the computer and internet (6). A technological revolution, made possible by Intel’s invention of the first ‘cheap’ microprocessor in 1971 (7)! Now, forty-five years later, the question still looms what caused the socio-cultural rift of 1970. And whether we should expect the financial and economic crisis to launch a new era, and how we will be able to identify the socio-cultural rift, which will announce it.


1. Liefbroer, A.C. & P.A. Dykstra (2000). Levenslopen in verandering. Een studie naar ontwikkelingen in de levenslopen van Nederlanders geboren tussen 1900 en 1970. Den Haag: Wetenschappelijke Raad voor het Regeringsbeleid (WRR). [Only in Dutch]
2. According to Liefbroer and Dykstra 1970 is a ‘turning point’ because of “(…) the relatively quick change in the process of the formation of families.” People married later, got children later, and fewer children, more people even stayed without any children, and a growing number of people lived together without even getting married.
3. Broek, A. van den, F. Huysmans & J. de Haan (2005). Cultuurminnaars en cultuurmijders. Trends in de belangstelling voor kunsten en cultureel erfgoed. Het culturele draagvlak 6. Den Haag: SCP. [Only in Dutch]
4. Danesi, M. (2003). Forever Young. The ‘Teen-Aging’ of Modern Culture. Toronto: University of Toronto Press.
5. Le Fanu, J. (2006). The Rise and Fall of Modern Medicine. London: Abacus.
6. Roberts, K.H. & Grabowski, M. (1996). Organizations, Technology and Structuring, in Clegg, S.R., Hardy, C. & Nord, W.R. (eds.), The Sage Handbook of Organization Studies (pp. 409-423), London: Sage.
7. Ridder, W.J. de (2006). Omgaan met doorbraakinnovaties. Een nieuwe democratische revolutie op komst. Den Haag: SMO. [Only in Dutch].

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Decentralization: The rise of the local welfare state

The decentralization trend in the social domain has materialized in many European countries (1). Although decentralization in general is met with some sympathy, it is also much debated (2). If decentralization is discussed, rather often implicitly is assumed that duties and responsibilities, e.g. if it comes to social and health care provisions, are best served at the local level (3). In the following brief survey, this assumption is explored by examining the UK Governments localism policies. Does the local welfare state emerge from these policies?

Decentralization: fuzzy, political concept

Clarke and Cochrane (4) listed four significant localism concepts. The first is that localism is a positive disposition towards decentralization of political power. Such a disposition is the classical liberal presumption that decentralization to the local level better serves local needs, is more efficient, less bureaucratic and more democratic. The second positive assumption is the communitarian interpretation. Local community and civil society are “some kind of mediating institutional layer through which responsible action, right living, and good welfare outcomes may be achieved …”. Other concepts of localism are the actual decentralization of political power and the assertion of locality by citizens, businesses, politicians and other interest groups. Localism can also be seen as a policy strategy to use “locality as a space of engagement”. This space produces a variety of ends, such as: “regulation of the capitalist economy; efficient organisation of welfare provision; and government of the population.” From these varied concepts, Clarke and Cochrane conclude that localism is a “fuzzy, political concept with many uses and meanings”.

Decentralization as a strategic policy instrument

The localism policies of the British government can best be categorized as a mix of classical liberalism and communitarianism. This is not obvious at first sight. Analyzing the localism ideology of the UK government, different political aspirations unfold (4). UK localism is supposed to free local government “from central and regional control.” On the one hand this presupposes the abolishment or reduction of all kinds of central, regional and local institutions, on the other it allows local authorities more freedom e.g. “to choose their own structure of governance” and to raise their own money “by charging and trading.” The second aspiration is to make local authorities “more directly accountable to local people.” Localism should also enable the delegation of local governmental powers to a “variety of actors presumed to be local.” In short, for the UK government the political and institutional organization of accountability and provision are central to their concept of localization. This concept is best explained by the use of locality as ‘a space of engagement’: the efficient organization of welfare provision on the local level. But this doesn’t explain for the mix of classical liberalism and communitarianism in the UK’s localism ideology. This assumption needs further exploration. This will be done by examining two decentralization instruments: the Localism Act 2011, and more specifically the Social Care Act 2012.

Localism Act 2011: deconstruction of the welfare state

The most important policy instrument of decentralization in the UK is the Localism Act 2011. This act is a legal framework aimed at institutional change (4): “… the regional government machinery of the 1997-2010 Labour government is dismantled, to be replaced by more diffuse institutional structures such as Local Enterprise Partnerships and City Deals, and localism replaces regionalism as a discourse of spatial governance …” New is also that the Localism Act prescribes the cooperation of all concerned institutions on a local level (section 110; 5). Moreover, the decentralization process is accompanied by appeals to citizens to take more responsibility for their own health and welfare, their neighborhoods and their respective lesser well of co-citizens (6). It’s this mix of de-individualization through institutional change, and individualization through participation and responsibility, which is characteristic for the neoliberal communitarian approach (7). To dismantle bureaucracies and replace them with diffuse institutional structures, and the simultaneous call to citizens to take more responsibility for them selves, their loved ones, and their neighbors, exemplifies this specific localism ideology. A close review of the Health and Social Care Act 2012, confirms this assumption.

Health and Social Care Act 2012: de-privatization

Health and Wellbeing Boards (HWB’s) are another example of decentralization in the UK. They are a product of the Health and Social Care Act 2012. As of April 1, 2013 this act “… transfers responsibilities for public health in England, at the local delivery level, from primary care trusts to local authorities … 152 health and well-being boards are being established in every part of England as the primary multi-organisational governance arrangement to implement delivery, facilitate public reporting and assure the continuing public accountability of public health services in the future.” (8). Here it seems as if the pendulum of decentralization swings back as responsibility is taken away from the private non-profit sector and given to local authorities. Albeit the fact that these local authorities have to share their responsibility with a HWB. So it’s obvious that for the local authorities in the UK there is not much free choice left to structure their own governance in the social and healthcare domain.

A radically different model of care is required

Moreover, in Humphries’ view the decentralization reforms of the Health and Social Care Act 2012 “… fail to address … long-term pressures and trends …” (9). These pressures and trends refer to societies developments, which require a radically different model of care “… whereby growing numbers of people with chronic health conditions, frailty in old age and dementia receive long-term care that is much more personalised and coordinated across services and professional disciplines, and delivered closer to home, with a greater emphasis on self-care and the use of technology.” (9). These arguments plead a strong case for the decentralization of political responsibilities to local authorities in the social and healthcare domains. But not for the appeal to citizens to take more responsibility for their own health and welfare, their neighborhoods and their respective lesser well of co-citizens. People with chronic health conditions, or who are in old age, or suffer from dementia and receive long-term care, are not prone to the communitarian call to action. Moreover, these people need professional care, and should not be dependent on medieval charity practices. To make things worse, the decentralization process in the UK comes with another catch. It lacks funding.

Decentralization by cutting local public funding

The Dutch social scientists Verhoeven and Tonkens (10) express optimism about the “substantial investments” of the Big Society agenda. But their optimism about the funding of the decentralization trend in the UK is not shared by many of their British colleagues. Although the UK government devolved central, regional and local powers to a widespread variety of local actors, the claim that power is being put back in the hands of local communities is questionable. This becomes especially clear “when local government funding is added to the mix” (4). Clarke and Cochrane parade an endless number of recent national cuts of local public spending. To name but a few: a 26% cut in revenue funding from 2010 to 2015, a 45% cut in capital funding to local government and a 60% cut in capital funding for schools, a cut in social housing of 50%, a cut of 34% in flood defense and coastal erosion, a budget cut of 8% on local roads, etc. (4). Besides, the pressures on local social care, welfare and health provisions will continue to rise taking in account that the NHS funding will have “a productivity gap of as much as £20 billion by 2016. Local government grants will reduce by 28 per cent over the same period. (9). This leaves local public authories emptie-handed. Unless they are willing to commit political suicide by raising local taxes on their constituencies.

Place matters, but not without proper social investments

Clarke and Cochrane (4) point out several major social and political trends that hamper the success of HWB’s, and the decentralization policies more in general. The most important is the lack of a proper analysis of the problems that are faced by modern bureaucracies: “The problem today is less one of general principle (e.g. equity of service provision across space) and more one of control over certain particularly sensitive policy areas e.g. taxation, economic development, and access to education and housing.” Local welfare is also much more than the neoliberal promise of the breakup of bureaucracy, or the responsibilization of local communities and the introduction of market principles. Local welfare “frames a new policy paradigm, expressing the belief that ‘place matters’ when it comes to welfare provisions … Typical of these service-oriented policies is that they require strong institutional and professional presence in the daily living environment of people: place matters.” (1). Without a proper problem orientation, without any structural room to maneuver, and without proper funding, the decentralized welfare state might very well never emerge.


  1. Trommel, 2013.
  2. Antrobus, 2012; Ayres & Pearce, 2013; Clarke and Cochrane, 2013; Grover, 2012; Jacobs & Manzi, 2013; Jones & Stewart, 2012; Layard, 2012; Mitchell, 2012; Schmuecker, 2011; Verhoeven & Tonkens, 2013; Wiggan, 2012.
  3. Bovaird, 2012; Clark, 2011; 2012; Murphy, 2013.
  4. Clarke & Cochrane, 2013.
  5. Ross & Chang, 2012; 2013.
  6. Newman & Tonkens, 2011; Bannink, Bosselaar & Trommel, 2013.
  7. Schinkel & Van Houdt, 2010.
  8. Murphy, 2013; see also: Colin-Thomé & Fisher, 2013; Durose, Richardson, Dickinson, & Williams, 2013; Mumford, 2013; Parker & Gallagher, 2007.
  9. Humphries, 2013.
  10. Verhoeven & Tonkens, 2013.


  • Antrobus, D. (2012). Localism, globalism, and the spaces in between, in Journal of Public Policies and Territory, 1 (1), pp. 4-9.
  • Ayres, S., & Pearce, G. (2013). A Whitehall perspective on decentralisation in England’s emerging territories, in Local Economy, 28 (7-8), pp. 801-816. DOI: 10.1177/0269094213500631.
  • Bannink, D., Bosselaar, H. & Trommel, W. (eds.) (2013). Crafting Local Welfare Landscapes. Den Haag (The Hague): Eleven International Publishing.
  • Bovaird, T. (2012). The future of local authorities: revolutionary, revolving in the grave or just going round in circles? In, Oyarce, C.M. & Boardman, F. (2012). Public service reform in the UK: revolutionary or evolutionary? pp. 21-30. London: CIPFA / The Chartered Institute of Public Finance & Accountancy.
  • Clark, G. (2011). A plain English guide to the Localism Act. London: Department for Communities and Local Government.
  • Clark, G. (2012). Decentralisation. An assessment of progress. London: Department for Communities and Local Government.
  • Clarke, N. & Cochrane, A. (2013). Geographies and politics of localism: The localism of the United Kingdom’s coalition government, in Political Geography, 34, pp. 10-23.
  • Colin-Thomé, D. &Fisher, B. (2013). Health and Wellbeing Boards for a new public health, in London Journal of Primary Care, (5), pp. 56-61.
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Make way for the district nurse

The driving force behind the return of the district nurse on the social and health agenda in The Netherlands is the Regional Care Association West-Brabant (RKWB). This is a voluntary care association with just over 100.000 members. To put this in perspective, some 300.000 people live in the region that is serviced by RKWB.

district nurse

Reintroduction of the district nurse

RKWB was established in 1909 and is deeply rooted in the local and regional communities. After a long period of a relatively marginal existence, on December 12, 2007, the General Members Council of RKWB decided to follow the proposal of the elected executive board to drastically change it’s policies. From then on the association started to interfere in local and regional care and cure provisions. During the next council meeting, in December 2008, the members ordered the board to start a campaign for the reintroduction of the district nurse. A care provision which was abandoned in the eigthies of the last century. The campaign has been overwhelmingly successful. The main result was the proposal in the coalition agreement of the Dutch government ‘Rutte II’: “From 2015 and beyond we will invest in extra district nurses with an amount that will subsequently rise to 250 million euro in 2017.”

Closely evaluated experiments

Next to the campaign, the path to this success was paved with exceptionally fruitful and closely evaluated experiments. These proved the district nurse to be a much needed and professional addition to the local care and cure network. With quick and short interventions the nurse is able to get back on track again the lives of patients, relatives and informal caretakers. An analysis of the client files of the district nurse revealed that the nurse is confronted with severe personal and social problems, which she or he is able to solve with substantial results for the personal lives of the patients and their direct social environment. Moreover, the district nurse saves costs in the next professional levels of care and cure.

Mobilizing and motivating members

The reintroduction of the district nurse is a remarkable national success. The more since it was achieved by a regionally oriented voluntary care association. This success was mainly due to the chairman, Henk van Tilburg, and the treasurer, Frans Fakkers, of the RKWB. Relentlessly they pursued their goal by mobilizing the members of the association and motivating them to campaign for the district nurse in their neighbourhoods and social networks. Themselves, they lobbied in the heart of the national political establishment. The campaign and their personal actions are a perfect example of the revival of voluntary care associations in the Dutch arena of health care.

The revival of voluntary care associations

For over one hundred years voluntary dedication and small financial contributions of the members grounded the care that has been given by local voluntary associations in many regions in The Netherlands. Until the eighties, of the past century, home care and maternity and infant care were their most important care provisions. From then on the national government considered these voluntary associations incapable of running the vast and complex professional care programmes these associations had established. The subtle local interplay of volunteers, the district nurse, employed by the voluntary care associations, the family doctor (general practitioner), the local council, religious people, and the church came to an end. Most local voluntary care associations merged with professional home nursing organizations. But not in West-Brabant. In 2007, the year of the introduction of the new Social Support Act (Wmo) in The Netherlands, the members of the RKWB decided to change course and direct their own policies. From then on a serious revival of the voluntary care association in The Netherlands can be observed.


This article has been based on literature, which is only published in Dutch. Fortunately we were able to procure the kind assistance of social psychologist, sociologist and publicist Bert Breij, who for many years has been, and still is, one of the most important consultants of the board of RKWB.
Those who are interested in recent changes in Dutch local care policies should read: Veer, J. van der (2013). Local Welfare Landscapes. The Case of Social Care in The Netherlands, in: Bannink, D., Bosselaar, H. & Trommel, W. (eds.) Crafting Loacal Welfare Landscapes. The Hague: Eleven international publishing.

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Public opinion polls: ‘truth amongst the majority’

In July 1974 the European Commission published what became a series of public opinion polls which lasts until this day. In 1974 inflation was the main concern of the citizens in the European Union, a mere nine member states. In 2016 inflation is still at the top of the list of the personal problems EU-citizens say they face. The European Union in 2016 counted for 28 member states.

public opinion polls

Public opinion polls as a source of beliefs

The “initial results” of the first public opinion poll of the Commission of the European Communities were published in July 1974: the Euro-barometer No 1. The Commission decided to carry out this poll “in order to follow the trends in European public opinion with regards to Community activities, particularly the areas of most interest to the public.” (1) It’s an interesting question whether the idea for this public opinion poll was inspired by the first political scientist, the Frenchman De Tocqueville, who saw public opinion as the main source of the beliefs of the people who live in democratic nations. He reasoned that people in democratic nations do not trust each other, because they see each other as equals. At the same time, this equality produced an overwhelming trust in public opinion, because De Tocqueville thought people in democratic nations see themselves as enlightened, and thus they think truth can be found amongst the majority. (2)

Four public opinion schools

The reasoning of De Tocqueville can be compared with the populist view (3): “… when conducted correctly, opinion polls can more or less effectively express the will of the people and facilitate democratic policymaking.” Lipari (3) mentions three other types of schools of public opinion polling: the critical, constructionist, and ritual schools. The critical school states “… that public opinion polls contribute to the management of popular attitudes by elites …”. The constructionist school conceptualizes public opinion as “the social construction of reality” and “… centers on language and symbolic processes as the unit of analysis …”. The fourth perspective is the ritual approach. This approach examines “…polling as a cultural form, not to focus on its failures, but to examine its successes.”

The Euro-barometer

Back to the Euro-barometer No 1. Without a minimum of introduction, on page 4, the report opens with the announcement that the “most important problem at the present time” (April-May, 1974) is inflation. People were asked what in their opinion was “the most important problem being dealt with by their Government at the present time”: “In nearly every country the first spontaneous reply was wages and prices: purchasing power, taxation, family budget and standard of living.” The second problem was the economic and energy crisis and the third was the protection of nature. In 2016 the inflation problem ended eight (7%) on a list of thirteen topics. Immigration (48%) and terrorism (39%) headed the list. With terrorism being the only issue substantially going up with 14 percentage points. In 2016 the first question was slightly different as in 1974 (4): “What do you think are the two most important issues facing the EU at the moment?”

Euro-barometer 2016: public opinion polls

Source: Standard Euro-barometer 85. Spring 2016. First Results. Public opinion in the European Union. Page 4.

Back to square one

The Standard Euro-barometer 2016 reports public opinions on three levels: the EU, by country and on a personal level. Comparing these levels, they appear to differ substantially. From this comparison there are at least two notable conclusions to be drawn. The first is that at the national levels people’s concerns differ in a specific way. People in the ‘rich’ EU-states are primarily concerned with immigration and people in the ‘less rich’ EU-states address unemployment as the biggest problem. The second interesting conclusion is that at the personal level inflation is at the top of the list, as it was in 1974. Is it justified to conclude that in 1974 people were more occupied with their personal problems? Or can these differences be attributed to the more sophisticated way of polling in 2016?

The sacred ritual of opinion polls

According to Lipari (3) the polling ritual can be seen as sacred in the “… way in which social and political authority is produced and maintained.” The Euro-barometer surely falls into this category. The Euro-barometer was introduced “… to follow the trends in European public opinion with regards to Community activities …” (1). In 2016 the majority of the questions indeed refer to the public opinion regarding the European Union. But it’s highly unlikely that these polls successfully produce and maintain the EU as an authority outside the political cloud of the mandarins (5) in Brussels. For them though this idea of an independent authority is probably sufficiently confirmed with the Euro-barometer as such: “Around a third of Europeans trust the European Union (33%). … Meanwhile, trust in the national political institutions has remained stable, but at a lower level than trust in the EU: 28% of Europeans tend to trust their national parliament (unchanged) and 27% their national government (unchanged).”

Do beliefs shift over time?

Some general issues can be raised concerning the Euro-barometer. For instance, do Europeans consider the EU to deal adequately with the problems they’ve put forward. Another interesting issue is how Europeans establish the consequences of specific problems on their personal lives. And, what is the context in which Europeans perceive their concerns? In 1973 oil prices rose with 200% after the Arab members of the OPEC (Organization of Oil Producing and Exporting Countries) restricted the flow of oil to states that supported Israel. This triggered a worldwide economic crisis with inflation as one of its most severe conditions. On a more fundamental level it would be appropriate to establish whether beliefs of Europeans have shifted over the years. Did inflation, unemployment, immigration, and terrorism, meant the same in 1974 as it does in 2016?

Public opinion polls facilitate democratic policymaking

Public opinion polls, such as the Euro-barometer, have little significance. They only register what comes out of the heads of people at a specific moment without much circumstantial evidence to corroborate the given opinions. To say the least, it’s very risky to state that public opinion polls are “the social construction of reality”. The lack of context and the lack of insight, in the ‘construction’ of these so-called opinions (causation), makes it hazardous to refer to these opinions as reality. If this reasoning is correct, at the risk of making the elites look like fools, it’s obvious that public opinion polls cannot contribute to the “management of popular attitudes” by the same elites. Besides, if we believe the Dutch ritual expert Frits Staal and we see rituals as meaningless (6), trying to manage the public opinion doesn’t make much sense. What remains is the use of public opinion polls to facilitate democratic policymaking. Now there’s an opportunity! But at the EU-level this opportunity can only materialize if the European institutions democratize and the quality of their polls enhances.


(1) Commission of the European Communities (1974). Euro-barometer No 1. Brussels: EC.
(2) Tocqueville, A. de (2011 [1835-1840]). Over de democratie in Amerika [De la démocratie en Amérique I [1835] en II [1840], Oeuvres II; On the democracy in America]. Rotterdam: Lemniscaat.
(3) Lipari, L. (1999). Polling as ritual, in Journal of Communication, winter issue, 83-102.
(4) European Commission (2016). Standard Euro-barometer 85. Spring 2016. First Results. Public opinion in the European Union. Brussels: EC.
(5) Eppink, D.J. (2007). Life of a European mandarin. Inside the Commission. Tielt: Lannoo.
(6) Staal, F. (1979). The Meaninglessness of Ritual, in Numen, 26, 1, 2-22.

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Social healthcare: fad or factual

In 1976 McKeown, at that time a professor of social healthcare at the University of Birmingham in England, launched an all out attack on the idea that the improvement of people’s health during the past century resulted from the progress of medical science. Even without any direct proof he stated that better food and improved hygiene and housing were responsible for the decrease in TBC’s death toll. His reasoning was plausible due to the fact that the decrease started way ahead of the introduction of proper medication.

social healthcare



McKeown’s so called social healthcare theory is based on the history of tuberculosis. In 1838, in England and Wales, every year four thousand people, on every one million, died of tuberculosis. In 1882, the year in which Robert Koch discovered the tuberculosis bacillus, the death toll decreased to two thousand people, on every million. From then on, every year in succession the TBC toll decreased to only three hundred and fifty at the end of WO II in 1945. In that year streptomycin and PAS entered the markets as medication for the cure of TBC. In 1960 the number of TBC deaths were almost zero.

Eating habits

McKeown was convinced that more prevention could help battle more illnesses. He identified two types of illnesses. The first were caused by poverty (such as tuberculosis and other infectious diseases), the second were caused by abundance (for instance in the case of cancer, brain haemorrhage and hart conditions). Tobacco, alcohol and food, from one day to the next – and without any proper scientific prove – were blamed to cause various deceases. All those things Western people by their wealth had come to enjoy so much. Especially food was the culprit: 70% of all known cancers were addressed to our Western eating habits.

Forceful separation

But McKeown’s social healthcare theory was wrong. At least, if it comes to TBC. TBC did not disappear because of improved living conditions. It disappeared because the patients were forcefully placed in sanatoria. Because they were separated from other, healthy people they no longer could contaminate them. A fact that already had been established in 1908 in the book “The Prevention of Tuberculosis”. McKeown probably on purpose ‘overlooked’ this fact.

Abundant and varied food supply

The Dutch professor of technical history, Harry Lintsen, claims that from 1870 onward, “suddenly and almost from one year to the other, life expectancy started to rise as a consequence of a revolution in the food supply and the increase of welfare. (…) Without exception, and despite age, and sex, income, power or possessions.” Due to better economic circumstances, people were able to eat more and vary their nutrition. This resulted in improved physical conditions, which protected people against decease and ailments. Chronologically the improvement of life’s expectancy can be attributed as follows (the percentages represent the contribution) (1):
– 1870-1900: the revolutionary change in the food supply (75%);
– 1900-1940: improvement of hygiene (10%);
– 1945-1970: medical progress (15%). “The combination of clinical science, fortuitous drug discovery and innovative technology (…) impelled medicine forward.”(2)

The resurrection of social healthcare?

It’s a comforting thought that as long as we are able to provide for an abundant and varied supply of foods, our health and our life expectancy probably will stay in tact. The growing bulk of the bodies of the modern human, do however indicate that the quality of the food supply carries more and different risks for our health. Even less reassuring is the complete stand still which has taken all the dynamism out of medical progress during the last forty years: “doctors are increasingly discontented and the public is increasingly neurotic about its health.”(2) Social healthcare, which attributes unhealthy living to social conditions, may have done some harm in the past or perhaps is misunderstood, might well be resurrected to cope with the mishaps of modern living conditions.

(1) Lintsen, H. e.a. (2005). Made in Holland. Een techniekgeschiedenis van Nederland [1800-2000]. Zutphen: Walburg Pers, p. 25-29. Only in Dutch.
(2) Le Fanu, J. (2006). The Rise and Fall of Modern Medicine. London: Abacus.