Narratives, Indicators and Concepts in Changing European Welfare Societies
NICE Welfare takes up the challenges that relate to the development of inclusive and innovative welfare societies, as they are described in Research2020 and Horizon2020. The project combines fields of research within the social sciences, statistics and medicine that are emphasized as central in both research plans. But NICE Welfare decisively improves the possibility to deliver relevant insights by including and combining research fields from history, culture, philosophy and health, which today are considered crucial to acquire a more thorough understanding of the welfare system and to develop sustainable ideas for societal renewal.
In this way NICE offers an interdisciplinary framework engaging leading experts in order to develop new questions and new approaches to address major social problems of the 21st Century. NICE is an investment in establishing a generator for new methodological approaches, innovating existing approaches and formulating cutting edge research projects.
Over the past 20-25 years, European welfare societies have been under pressure from demographic changes, globalization, debt crisis, immigration and the shift from an industrial towards a knowledge society – a society facing the challenge of becoming more inclusive and innovative. The self-reflexivity of societal institutions and citizens has changed so that traditional concepts and indicators for the life quality of citizens and societies must be altered, especially in areas such as family, health and ageing.
The grand challenge for European welfare societies is to analyze these problems, identify the goals and formulate the solutions to how future welfare models can be designed. To do so new knowledge is needed which will provide a firm ground for understanding which interventions are needed in order to achieve more effective and sustainable European welfare systems both adapted to a global reality of increasing competition and cultural diversity, and to the populations’ demands and expectations for new welfare.
This is no easy task. Central elements involved in the process are narratives, concepts and indicators.
Narratives about the good life, the inclusive and innovative welfare society set the overall frame for social and political activity in Europe. The Nordic welfare model is for example in this way often portrayed as being more successful in achieving the good life for all. Concepts are the concrete manner of speaking about the problems, policies and outcomes. The Nordic welfare model is, for example, characterized by welfare states, universal, generous cash benefits and high quality services in a wide range of situations. Indicators are the way we measure and evaluate the cost and benefits of welfare societies. Traditionally focus has been on so-called objective indicators and the Nordic welfare model has been characterized by (gender) equality, high social spending, income security and low levels of poverty.
However recent discussions on indicators have pinpointed the need for developing better and more subjective indicators and critical sociology has underlined the possible conflicts between different values. Conceptual history and narrative theory have renewed the study of concepts and narratives seen in relation to social context and political conflicts, and health sciences have pointed out the need to include social categories (class, gender, age e.a.) and subjective experiences in health policies.
The grand societal process of change and the current reformulation of narratives, concepts and indicators call attention to a series of serious problems in the relationship between authorities, welfare providers, politicians and citizens. NICE identifies and addresses the most central of these problems through the main thesis that we in recent years have seen the acceleration of:
1) mismatches between narratives, concepts and indicators, and their links to experiences of the social, political and mental realities. These mismatches originate both with authorities, welfare providers and citizens and they lead to:
2) misrepresentations of many of the problems, policies and outcomes that large groups of citizens and welfare providers face or engage in.
3) As a consequence many of the perceptions, recommendations and pieces of information that form the basis for policies can be misleading.
Mismatches, misrepresentations and misleading basis for policy decisions are an unfortunate point of departure from which to handle the grand societal challenges of the future on a rational basis. Consequently, there is a need to generate new knowledge, new conceptions and to find new ways of exchanging this between public institutions, politicians and citizens. This is the challenge the NICE project will contribute to solving.
The German conceptual historian, Reinhart Koselleck, has shown how a horizon of expectation necessarily takes shape on the basis of our experiences. This is a basic assumption for analyses of grand societal challenges.
NICE therefore examines our experiences in relation to these changes. We will locate, characterize and in some instances remedy mismatching, misrepresenting and misleading indicators, narratives and concepts (for examples see research plan). An investigation of this nature must necessarily be interdisciplinary. The premise for interdisciplinarity is mastery of a core discipline and we define interdisciplinarity as scholarship that combines, creates a dialogue and paves the way for a focused exchange between disciplines (see also research plan). What one discipline (or tradition) considers banal fact will, when moved to another discipline, alter the research agenda; and complex societal problems call for analyses from more than one perspective. The project participants have good opportunities to achieve such a constructive and critical methodological approach because they represent cutting edge research within their separate disciplines, and have well-documented experience with and willingness to develop their research across the disciplines and to challenge all kinds of disciplinary blind spots (see CVs for individual profiles, enclosure B).
To include all societal changes in one project would not be manageable. Instead we focus on three major events in most human lives: family, health and ageing. The project’s interdisciplinary investigation takes a life course perspective by which it captures representative cases from the European welfare societies and renders concrete the nature of the problem and its prevalence of the life course.
NICE explores its main thesis by engaging with three themes that encompass the three major life events:
1. Life Course and Wellbeing
The good life that the welfare state finds its legitimacy in securing and furthering is being redefined. A leading happiness scholar has found evidence that the size of a welfare state is not an indicator of the population’s level of happiness.  Others have found correlations between different types of European welfare states and levels of happiness and argued that the more a welfare state de-commodifies individual citizens through critical phases of the life course, the higher will be the individuals’ subjective wellbeing and happiness. The Scandinavian welfare states therefore typically outrank other types of welfare states on this issue. If it wants its citizens to flourish the welfare state of the future may alter focus from the size of economic transfers towards the kinds of services offered and the ways in which they are offered. 
Increasingly, individual citizens demand to be asked and are being asked about their subjective understanding of what wellbeing and the good life is to them. The individual citizen both expects the welfare state to meet his or her individual demands for welfare, and becomes more uncertain about the capability of the state. The life course to be anticipated by most citizens will form more individualized curves than is expected today, and their wellbeing will depend on new solutions and offers when it comes to critical life events. Regarding issues of family, health and ageing, we find important examples of a growing gap and mismatch between the welfare state narratives, concepts and indicators and the social and mental reality such as it manifests itself in the various empirical investigations represented by this interdisciplinary thematic group.
2. Democracy and citizenship
The development of civil, political and social rights can be seen as culminating with the emergence of the welfare state in the 20th century. Social citizenship, however, has different content across localities and over time. The Nordic welfare model has a reputation of providing universal, generous cash benefit and public health and social services, both with a highly egalitarian profile, resulting in a high degree of equality in outcomes across gender, income, age and ethnicity. However, in reality, the access and generosity of cash benefits vary between socio-economic groups and so does the quality and quantity of benefits in kind. Ageing populations, multi-cultural societies and changing gender patterns in education and labour markets accentuate these differences and the mismatch between old conceptions and systems and the increased complexity and diversity. On top of that both the universalism and the public provision of the model are under fundamental transformation. Targeting of benefits and changing the mix of public-private provision are key elements of welfare reforms. This has implications for both citizens as consumers and clients, the professionals delivering health and social services and the purpose and type of welfare benefits. In health, for example, patients are increasingly involved in deciding on the provision of their health services and in preventing certain illnesses from occurring in the first place.
3. State and Society
A crucial question is: who is responsible for the welfare of the individual? Is it the state, civil society, the market, the family or the individual who is responsible for the good life? Different types of welfare states have chosen different balances between the production, the distribution and the guarantee of security and welfare. The specific welfare-mix settled upon is the result of political choices and institutional legacies. To understand citizens’ expectations of the welfare state (and vice versa), we have to investigate the historical processes which have shaped the welfare society and its foundational institutions that carry its values, concepts and narratives. The past 10-15 years have seen an intense public and political discussion about the long-term sustainability of the “old” welfare model compared to a number of major social changes. This has led to some reforms and the expectation of more to come. Reforms which have often dealt with limiting the responsibility of the state at the expense of the market, the individual and civil society. While we know a lot about the political processes behind these reforms, we know very little about the welfare narratives and the concepts that have carried them. Yet it is evident that there is a mismatch between what citizens expect of the state and what the politicians and administrators of the state expect of the citizens. There is a new distribution of roles where clients have become users (and consumers), public authorities have become welfare producers and market agents have taken over many of the state’s roles.
Theory and method
In terms of theory and method, the project draws on a plurality of approaches covered by the participants: history (history of ideas and ‘new political history’), social sciences (microsimulation, experimental surveys, statistics and QCA and the role of ideas in politics), literary analyses (narrative theory, neo-historicism, metaphorics, discourse and rhetoric), philosophy (ethics, political philosophy, value theory), and empirical positivism (user analyses and research into ageing and the good life, type 2 diabetes and osteoporosis) and focusing on the interplay between society and health.
The project will practice a continuous exchange of advanced theoretical and methodological discussion of the empirical fields and emphasize comparative analyses of European data with special attention to the blind spots of the participating disciplines. ”Narrative”, “Indicator” and “Concept” are overarching terms and nodal points within the different empirical fields of the participating part projects. The project will therefore focus on carrying through a continuous theoretical and methodological development process with exactly these nodal points and with examples of their relevant uses. The most important theoretical approaches drawn upon will be conceptual history, new political history, narrative theory and theory of metaphor, value theory, indicator-theory and statistics.
The approach through conceptual history serves to illuminate which analytical tools and comparative approaches can assist in finding and characterizing mismatching, misrepresenting and misleading uses of welfare concepts. The new political history serves to cast light on what linguistic, rhetorical and cultural approaches and what types of transnational reflection will prove to be central to the comparative analyses of the political debate on welfare. Narrative theory and analysis of metaphor serve to illuminate the narratological concepts concerning narrator, focalization, fictionality and metaphorics that are relevant to the analysis of the discourses and the framing of issues of the welfare state within institutions and in the public debate. This is relevant to the examination of the cultural and institutional welfare narratives about gender, family, citizen and life course transformation insofar as they are challenged in social praxis, in civil society and in contemporary art and literature. Indicator theory, statistical theory and survey theory serve to illuminate which welfare indicators are being discussed and which are becoming increasingly central to the analysis of welfare state relevant circumstances, and how indicators influence empirical analyses. Philosophical analyses of the concept of welfare and welfare phenomena can contribute to nuance the discussion of indicators and measurability. The conceptual historical, the literary and the philosophical analyses can nuance and enhance one another in significant ways in the context of both health and social science that will also benefit from the interdisciplinary approach.
The empirical focus is European and will include analyses of a variety of material such as: public and political documents, surveys, statistical material, legal documents, information material, patient guide lines, campaign material, public debate in various media, scientific texts, artistic texts, films and products in various genres and media. The project will also generate its own empirical data through surveys and experiments.
State of the art
The project defines renewing research tasks, requiring input from several disciplines. Key participants in the project from history, culture and the social sciences are experienced in working with this type of innovation, for instance through the Nordic Centre of Excellence Nordwel. Key participants in the projects from health sciences are experienced in research on patient education. Research approaches covered by the participants will include studies of conceptual history and on the role of ideas in shaping politics and societal beliefs. The project continues these efforts, and the participants respond to the fact that research on the grand societal challenges within social science, history and health is increasingly interested in ideas, concepts, languages and values, including narratological and metaphor-theoretical approaches.  The importance and utility of patient education, patient empowerment and participatory medicine are currently investigated within an array of diseases and conditions such as diabetes, osteoporosis, multiple sclerosis and hypertension. The full potential of “participatory medicine”, however, is far from elucidated. New approaches to typologies, measurement and indicators are being discussed,  while studies in art, literature and philosophy increasingly find that artistic forms of experience are in demand in the analysis of the nature of change, as is seen e.g. within the growing fields of narrative medicine and narrative gerontology. At the same time some of cultural studies’ most influential work from different traditions includes the philosopher Martha Nussbaum on the narrative moral imagination and capability approach (with Amartya Sen) and Bruce Robbins on the literary history of the welfare state.
NICE utilizes these and other research ideas in its continuous development of new research questions and interdisciplinary cooperation.
 Cf. Bauman, Zygmunt (1991): Modernity and Ambivalence. New York: Cornell University Press. Murtagh, B. et al. (2007): ‘Participatory Citizenship through Cultural Dialogue’, i: Neill, W. et al. (2007): Migration and Cultural Inclusion in the European City. Hampshire: Palgrave Macmillan: 88-101.
 Koselleck, Reinhart (1985): "'Spaces of Experience' and 'Horizon of Expectation': Two Historical Categories," On the Semantics of Historical Time ,Cambridge, MA: MIT Press; 1st ed. Frankfurt, 1979.
 Camic, Charles and Joas, Hans (2004): The Dialogical Turn. New Roles for Sociology in the Postdisciplinary Age. Lanham: Rowman & Littlefield Publishers.
 Veenhoven, Ruut (2000):“Wellbeing in the welfare state: level not higher, distribution not more equitable”, Journal of Comparative Policy Analysis, vol. 2, 2000: 91-125.
 For state of the art see Jordan, Bill (2008): Welfare and Well-Being: Social Value in Public Policy, Policy Press: University of Bristol, and Thin, Neil (2012): Social Happiness: Theory into Policy and Practice , Policy Press: University of Bristol.
 Halpern, David (2010): The Hidden Wealth of Nations, Polity Press: Cambridge, Ervasti, Heikki et al (ed.) (2008): Nordic Social Attitudes in a European Perspective, Northamton: Edward Elgar
 Marshall, T. H. (1964): Class, citizenship and social development. Garden City: New York.
 Esping-Andersen, Gøsta (1990): The Three Worlds of Welfare Capitalism, Polity Press: Princeton.
 Giddens, Anthony (1998): The Third Way: The Renewal of Social Democracy; Polity Press/Blackwell: Oxford
 Béland, Daniel & Robert Cox, Robert Henry (2011): Ideas and Politics in Social Science Research. Oxford: Oxford University Press;
Steinmetz, Wilibald (2007): “40 Jahre Begriffsgescichte – the State of the Art” in Kämper & Eichinger (eds.), Sprache – Kognition
Kultur, Berlin: Walter de Gruyter: 174-197.
 Charon R. R. (2001-10-17). JAMA: The Journal of the American Medical Association 286 (15, 2): 1897-1902; Frevert, Ute & Haupt, Hans G. (eds.) (2005): Neue Politikgeschichte, Frankfurt am Main: Campus Verlag
cf. Nielsen D, Ryg J, Nielsen W, Knold B, Nissen N, Brixen K. (2010): “Patient education in groups increases knowledge of osteoporosis and adherence to treatment: a two-year randomized controlled trial.” Patient Educ Couns. 2010 Nov;81(2):155-60. doi: 10.1016/j.pec.2010.03.010. Epub 2010 Apr 18. PubMed PMID: 20400258, Lejbkowicz I, Caspi O, Miller A. (2012): “Participatory medicine and patient empowerment towards personalized healthcare in multiple sclerosis”. Expert Rev Neurother. 2012 Mar;12(3):343-52. doi: 10.1586/ern.11.161. Review. PubMed PMID: 22364333, and Harding E, Pettinari CJ, Brown D., Hayward M, Taylor C. (2011): “Service user involvement in clinical guideline development and implementation: learning from mental health service users in the UK”. Int Rev Psychiatry. 2011 Aug;23(4):352-7.
 E.g. Forgeard, Marie et. al. (2011): “Doing the right thing: Measuring wellbeing for public policy”, International Journal of Wellbeing 1(1), 79-106; Adcock, Robert and Collier, David (2001), “Measurement validity: A shared standard for qualitative and quantitative research”, American Political Science Review (2001), pp. 529 546.Collier, David et al: (2012): “ Putting Typologies to Work: Concept-Formation, Measurement, and Analytic Rigor" Political Research Quarterly 65, No. 1 (March 20102): 217-32.
 Kenyon, Gary et al (2011), Storying Later Life: Issues, investigations and interventions in Narrative Gerontology. New York: Oxford University Press.
 Nussbaum, Martha (2011): Creating Capabilities: The Human Development Approach, Harvard: Harvard University Press, Robbins, Bruce (2007): Upward Mobility and the Common Good: Toward a Literary History of the Welfare State, Princeton: Princeton University Press.