DISSONANCE : RESTRUCTURING THE WELFARE STATE
During the second half of the 20th century, most European countries had developed an extensive policy of support for citizens who experienced a variety of problems from illness to unemployment; this is called the Welfare State. By the 1990s these policies had come under pressure from various quarters including free market economic theory, its application in the United States under President Ronald Reagan, and in the United Kingdom under Prime Minister Margaret Thatcher. More generally, a need was felt to respond to economic competitive pressures from the Far East, the need to meet a number of complex economic convergence targets to qualify for membership of the common European currency, the political desire to reduce taxes to stimulate demand, and the consequent need to reduce the size and expenditure of government.
The timing and strength of these developments varied within the four countries in our sample and even changed during the two years of our project. So in one country during the phase one meeting the experts were quite confident that there was no question of the Welfare State being dismantled; they felt confident that current budget discussions were going well, and that necessary funding would be available. This position changed significantly by the phase two meeting nine months later.
There are other related pressures on the financial resources available to carry out the work of prevention and amelioration of HIV/Aids. Some of this overlaps with other Dissonances (see for instance Increased Life Expectancy and Under-represented Need Groups). Then there is the pressure on Central and Local Government from competing, allegedly more urgent, health priorities and from the popular perception that HIV/Aids is no longer an epidemic spreading rapidly through certain sections of the community and is therefore more or less under control. Given the pressures on the Welfare State, the conflicting claims on diminishing resources have to be countenanced and solutions sought.
Dissonance Reduction
The following three suggestions emerged from the discussions:
- Although the countries in our sample had little experience with fund raising, this way of making up for loss of Welfare State income will have to be explored and in some cases was already seen to have been successful. Income from contributions of pharmaceutical companies is one obvious source, but has to be handled carefully to avoid ethical problems. Other venues can be explored with the help of people (or professionals) with fund raising experience.
- An expansion of voluntary work, for instance through innovations based on the successful Buddy System was contemplated (see Dissonance: Innovation vs. Tradition).
- A third approach is through rationalization of activities, increased collaboration between organizations or even mergers (see Dissonance: Integration vs. Specialization). In at least one country, the government already formally encourages such developments.
Perhaps the most important insight was the agreement that anticipating the consequences of changes of the Welfare State had strategic advantages over accepting changes under pressure. There is still time to be proactive.
