Based on a thematic content analysis of 63 key policy documents from the five Nordic countries, we discuss national strategies about introducing welfare technology to care for older persons. We argue that the Nordic care regime is a central research context in two senses: 1) the tradition of strong states and extensive social rights, and 2) the transformation of welfare states through marketisation and digitalisation, which also underpin welfare technology policies. We contribute to care policy research by contrasting the Nordic strategies and definitions and by identifying friction emerging within and across them. Our analysis shows that, while the overall image of WT policy is rather similar between the Nordic countries, the Danish, Finnish and Norwegian policy documents show signs of the earliest implementation. While the rest of the countries have implemented pilot-based, regional approaches, Denmark has seen a more centrally driven development. Our analysis also identifies friction in the welfare technology policies, portrayed as overly optimistic expectations; contested national rollouts; and financial resources designated for pilots and acquisition but not for maintenance costs. We argue that the notion of friction may support inter-stakeholder communication by providing cues to and making sense of the complexity of welfare technology innovation.
The overall image of WT policy is rather similar in all five Nordic countries.
National-level rollouts of WTs in Denmark stand in contrast with the more regional policy implementation in the other Nordic countries.
National and cross-country frictions have emerged when introducing WT, including excessive optimism, contested national rollouts, financial support for acquisition of WT but not of its maintenance costs.
The analytic notion of frictions may support inter-stakeholder communication by providing cues to and making sense of the complexity of WT innovation – especially in a rush for AI-enhanced technologisation.
In Denmark, Finland, Iceland, Norway, and Sweden (alphabetical order), as in many other parts of the world, the population is ageing. The demographic change will reach its peak in the coming decades and bring about many challenges, including an increased pressure on social and healthcare services. The scenario projected through policy papers and public reports across the Nordic countries is of a coming crisis in health and social care delivery, caused partly by increased demands for services, but also by a lack of personnel. Different measures have been launched to meet these challenges. Older people are, for example, expected to live longer at home and take more responsibility for their own health and illness and thus reduce the need for services.
As part of this shift in healthcare service delivery, technology plays an increasingly significant role. The concept of ‘welfare technology’ (WT) was introduced in the Nordic countries at the beginning of 2010s, encompassing a range of different digital and technical service solutions with a primary target-group being old persons in need of care services. A common feature of WT is that they enable care at a distance, i.e. services such as medicine handling, control of a person’s whereabouts, safety or follow-up of chronic illness from a remote location (
The purpose of this article is to compare the Nordic countries’ WT policies by clarifying (a)
In Nordic care policy, WT is often envisioned to lead to a new and better form of retrenchment, promising care quality, empowerment of care receivers, and a good working environment for informal and formal care for older people. As a political answer to increasing care needs, WT has become a “new mantra for reforming the Nordic public health and social care” (
While the aforementioned literature has illuminated and compared aspects of Nordic WT policies, comprehensive research on WT definitions covering all five Nordic countries’ policies from their early phases is lacking, as well as a deeper analysis focusing on what friction Nordic WT policies implicate. Through an integrated and comparative analysis of Nordic WT policy documents, our article aims to fill this gap. We argue that highlighting friction can both support inter-stakeholder communication and function as an important analytical contribution about the hitherto inertia of WT adoption of the Nordic countries.
In the following, we will first give a background for the socio-political development that has accommodated the turn to WT in care for older people: the Nordic welfare state and its transforming care regime and care ideals. After that, we will discuss our analytical approach to WT policies. Our analysis first outlines definitions of WT and national strategies for introducing WTs across the Nordic countries. Second, we discuss friction regarding Nordic WT policy about WT definitions, hype and optimistic expectations, centralised versus decentralised approaches, the role of maintenance costs and care workers’ voice.
Policies rallying for digitalised health and care services are common in European countries (
Recent WT policies in the Nordic countries may not be fully understood without understanding the changes in the Nordic welfare state, both through the idea of a Nordic care regime and through the transformation of its ideals. The most central characteristic of the Nordic care regime has been the principle of universality: equal inclusion based on legislated rights, public (tax-based) funding, public provision and comprehensive and needs-based usage of care services. Equal access to efficient care services has been a universal social right, and “a public good among other tax-financed services” (
Although sharing the ideal of universality, the Nordic countries are also subject to differences, which has raised the question of whether there exists a unified Nordic care regime. For example, in Finland, there is today a mixed system of public, private, third sector and individual care providers with exceptionally high client fees (
The shifts in the Nordic care regime in the 21st century are related to the growing significance of WTs in care policy. Digitalisation and care regime reforms have worked in tandem, as vast digitalisation processes started in the 1990s (
Therefore, the Nordic care regime is central as background for examining and comparing WT policy in two senses. On the one hand, the tradition of strong states and extensive social rights is to the point of WT policy. On the other hand, the transformations of welfare states, such as marketisation and digitalisation, affect and push forward WT policies.
Several studies have focused on the in-practice implementation and use of WTs, especially from ethical perspectives. WT is expected to realise many different and sometimes conflicting values and ideals (
From the service user perspective, WT policy may enforce the principles of welfare states by securing access to public services in loosely populated rural areas, and thus equal services in line with the universality principle (
The
This paper is also the outcome of a Nordic network funded by NOS-HS called “Reassembling Care for Older People (RECOPE)”. The network consists of early career and senior researchers from all Nordic countries. To gain diverse insight into each country’s WT practices, RECOPE hosted three workshops under the topics of automatisation of care (Copenhagen, May 2023), care relations (Reykjavik, September 2023), and the home as site of care (Jyväskylä, May 2024). Notes from discussions at the workshops provided
In our analysis, we first focused on how WTs are defined in the national policies and how WT policies have proceeded and progressed in each country during the 2010s and 2020s. Additionally, we concentrated on friction with regard to WT policies with a comparative angle between countries. Anthropologist Anna Tsing defines friction as a dynamic force:
Rubbing two sticks together produces heat and light; one stick alone is just a stick. As a metaphor, friction reminds us that heterogeneous and unequal encounters can lead to new arrangements of culture and power (
Scholars in Science and Technology Studies (STS), further emphasise friction as “places where dominant images lose their smoothness and become multiple” (
Despite its 15-year history, the concept of WT is ambiguous and loosely defined, as exemplified by The
[welfare technology is] all technology which in one way or another improves the lives of those who need it. The [welfare] technology is used to maintain or increase security, activity, participation or independence for people with a disability or the elderly [sic].
However, there are important similarities, path dependencies and differences among the Nordic countries’ definitions, governance and ways of adopting WT.
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Next, we will identify some similarities and differences among the Nordic countries’ WT strategies and plans, whose development we have sketched throughout the last 10-15 years. In the following, we will focus on the friction about definitions, hype, and ambiguity of rollouts. We will also focus on the role of maintenance costs and how the care providers’ perspective has been included in the policy.
The definitions of WT are broad in the Nordic countries, of which Denmark’s and Norway’s policies are good examples. WT simultaneously refers to both services and products in the social and health care sector. The overall goals of WT introduction are widely shared in the Nordic countries. The goals are improving care services, while also decreasing their demand, freeing up labor, mitigating the workload of care providers, providing security and independence and even active citizenship (
Defining WT resembles the ageing-and-innovation discourse identified by
Another friction related to definitions is the ways in which WTs cover both older people and people with disabilities. This produces some conflicts in the national policies. In Denmark and Norway, WT is not exclusively for older people; however, it is in relation to this group the WT agenda has found a foothold (
Broad definitions of technology also tend to produce high expectations, which is evidenced by the centrality of hype in WT policies. A recent analysis concerning Finland shows that policy documents on ageing and care present WT as overly positive (
The presence of high expectations in Nordic WT policies has to do with the fact that hype is important for policymakers, technology start-ups and entrepreneurs in gaining public attention and attracting investments. A good example of hype is the government led diffusion of feeding robots in Denmark. These robots passed quantitative and qualitative trials carried out at Danish Technological Institute. Correspondingly they were recommended by the authorities to be purchased by all Danish municipalities (
Hype puts the focus on saved expenses, improvement of services and increasing health benefits, but not on the contradictions that WTs can raise and certainly not on the care values that they downplay. Despite the hype, there are, as mentioned, difficulties in the utilisation of WTs in municipalities and other regional governing bodies. In general, there is a strong focus on WT implementation in all the Nordic countries. In Finland, Norway, Iceland and Sweden, the implementation and funding has been delegated to regional or municipal bodies, while Denmark has adopted national rollouts of selected WTs although it is important to notice that it is Local Government Denmark, i.e. the municipalities’ own interest organization, that drives this process to improve and streamline their own services. Two major national initiatives have driven this Danish strategy: the local government Denmark’s mandate for the dissemination of four robust technologies across all municipalities, and the nationwide, cross-sector rollout of COPD telemonitoring on a common platform. However, this approach appears to have been overly optimistic about achieving consensus among central government agencies, municipalities, and hospitals. It seems to have overestimated the capabilities of the technology while underestimating the potential controversies and differing values and accountability systems among institutions and professionals.
While the central Danish institutions and municipalities believe that WT can help the labour shortage and provide financial savings; an increasing number of municipalities are troubled by the fact that financing and resources hamper adopting and developing relevant WT services. This is documented by the 2023 edition of the annual survey of the municipalities’ use of WT (
In contrast with the Danish national rollout strategy, various obstacles have hindered moving from restricted pilot projects to full-scale, continuous operations in other Nordic countries. For example, in Sweden, government stimulus funds are limited to covering the initial purchase of WTs, excluding long-term costs such as maintenance, operating expenses, and ongoing training. As a result, a large proportion of WTs in Swedish municipalities remains stuck in the pilot phase, slowing broader implementation (
The estimates of replacing care workers with WT are argued to be too optimistic (
In Sweden, WT policies lack an employee perspective. The Swedish Municipal Workers Union highlighted this in 2018, and the National Board of Health and Welfare acknowledged it in 2019. In 2020, they further specified that WTs may be divided into two distinct areas: technologies for safety and independence for the individual, and technologies providing support to staff and caregivers. Yet, the Swedish governmental report published in 2020 did not include an employee perspective in its definition of WT. This is different among the Nordic countries. In Denmark, aims of working environment improvement for the care providers have been probated from the beginning as part of what is sometimes argued to be the quadrable win connected to WT; that is quality of care, efficiency, working environment for care providers and developing a new industry and business around WT (
In this paper, we have analysed definitions, strategies, and frictions concerning WT policy in the Nordic countries. Our comparative analysis makes two key contributions.
Our first contribution is the systematic comparison of WT definitions and strategies as portrayed in each of the five Nordic countries’ policy documents in a way that both confirms and extends past research on Nordic WT policy. For example, we reassert
Therefore, we present an extensive outlook on Nordic WT policy in the first decades of the 21st century. Our analysis suggests that WT is imagined as a solution to three problems concerning the care of older people in the Nordic countries. First, as a solution to secure the activity, participation and independence of older people who need or are at risk of needing healthcare services. This can be categorised as a citizen challenge. WT policy aims to secure older citizens’ rights to be active, independent and to participate in their own care as well as in social activities. However, individual empowerment through WT implementation also plays into shifting care responsibilities from professionals situated in the formal care sector to older persons themselves, as well as their next of kin and other informal actors. Second, WT is imagined as a solution to an efficiency challenge. WT is imagined to enhance care services for older people by optimising resource utilisation, improving quality and efficiency, and promoting sustainable management of human resources through better work conditions (
However, there are also significant differences in approaches between countries, which are partly related to differences in post-expansive welfare state trajectories. For instance, Denmark’s ideas of simultaneous rollouts differ substantially from the more scattered and regional approaches in the other four countries. Therefore, we call for future research concerning both the quantitative and qualitative comparative research settings aimed at investigating the impacts of such differences for care work and for older persons’ everyday experiences.
Our second contribution is that thinking about WT policy and implementation in terms of friction can support inter-stakeholder communication by providing cues to make sense of the complexity of WT innovation. We share the view that WT is best approached as an umbrella concept (
Concerning friction, the challenges of developing, upscaling, and sustaining emerging WTs pose a significant threat to the vision of digital transformation of welfare service delivery in caring for older people in the Nordic countries. Over-optimism regarding what WTs can achieve, and under-estimation of the complexity of WT implementation and diffusion are common themes across all the Nordic countries and strategies. This has crucial implications because it creates unrealistic expectations, not least in cases where significant amount of money is spent on technologies that may not end up in broad use in the long run. The policy document data, as well as the stakeholder workshop discussions, revealed rather fragmented policy developments characterised by unresolved discussions and implications for practice. The friction manifest in top-down directed WT policy also runs a risk of neglecting care professionals’ profound everyday insight on aspects of good care, thereby also neglecting older people’s needs (
There are no conflicts of interests.
This research is part of the network and project “Reassembling Care for Older People (RECOPE) funded by NOS-HS, 2022, Exploratory workshops grant no. 133106.