Introduction

Chapter 2 reviewed a number of theoretical perspectives that provided critical lenses through which to frame the book's themes, including the impact of global and national developments on health and social care. This and the following chapters use theoretical perspectives to examine the key global challenges that face health and social care provision for older people. Globalisation and neoliberalism have significantly shaped and moulded welfare state systems in the Global North on a national level, including health and social care services. This is the case for all the various archetypal welfare state systems: the neoliberal/Anglo-Saxon model, the social-democratic/Scandinavian model, and the corporatist/continental European model (Esping-Andersen, 1990). The United Kingdom, Germany and Sweden are used to demonstrate how three archetypal welfare state systems have been affected by neoliberalisation, and the resulting privatisation of health and social care services. The shift in responsibility for health and social care from the state to the individual has re-established the very class inequalities which the welfare state was originally constructed to eradicate. This regressive reassertion of class inequalities impacts health and social policy, and exacerbates the precariousness of the most vulnerable. This is especially true for older women with low levels of capital. Neoliberalisation and privatisation have made health and social care systems vulnerable to any pressures exerted on them, for instance, austerity measures or a pandemic.

Globalisation and neoliberalism

Globalisation is a frequently used, yet complex and contested term (Hyde and Higgs, 2017). In this book, globalisation has not replaced national-level analysis; instead, globalisation and the nation-state are theorised as interacting and shaping each other (Hyde and Higgs, 2017). It is argued that the reason globalisation has grown in power and ubiquity is due to the lack of any viable social-democratic political alternatives to capitalism (Beck, 1999). Thus, the rise of globalisation has been argued to be inextricably linked to the collapse of the Soviet Union and the rise of neoliberal free-market politics (Beck, 1999).

Although the changes associated with globalisation are generally accepted, there are questions over whether these are ‘new’ or if similar characteristics can be seen at other points in history, for example during colonialism (Bisley, 2007).