Structure of the welfare system

Structure of the welfare system
The Danish welfare system has a high degree of local autonomy and the administration is widely decentralized to the 275 municipalities. Current legislation clearly indicates that responsibility for support provision lies with municipalities who are entrusted with the duty of ensuring that there exist appropriate mechanisms for the provision of assistance, care and general support as well as facilities for the rehabilitation of people with physical or mental disabilities or special social problems. Through municipal reforms and social reforms in the period from 1960 to 1980 the responsibility for social welfare was transferred to the municipal level. The guiding principle is that responsibility should lie as close to the people as possible. Therefore, local and regional authorities administer important sections of social policy, while the State – primarily the Ministry of Social Affairs - is responsible for legislation, financing and controlling. The Ministry of Social Affairs serves as secretariat for the Minister for Social Affairs. It is the highest authority in the social sector. The Ministry formulates legislative proposals and executive orders, circulars and guidelines. It also maintains financial control and is responsible for the overall planning and analyses. Although the system is decentralized, the overall political responsibility rests with the Minister of Social Affairs. The Ministry is responsible for areas as: care of the elderly, children and young people, family policy, retraining and preventive social measures, physically and mentally disabled, particularly vulnerable groups and transfer incomes (social pensions, sickness and maternity benefits, occupational injuries benefits and supplementary payments). The main principles of social policy are regulated by four acts: The Act on Active Social Policy; The Social Services Act; The Social Pensions Act, and the Act on Rule of Law and Administration in the Social Field. The Ministry of Labour has responsibility for, among other things, work environment, benefits to insured unemployed people, retraining programs and labour exchange. Health is under the Ministry of Interior. Social policy is, broadly speaking, developed in a dialogue between the public, the Government, the Parliament and organized interest groups, for instance the National Association of Local Authorities and the National Association of County Councils, and the two parts on the labour market, but also user groups. All bills are read and commented upon by those whom they concern. In this way they can raise objections or suggest amendments.
Distribution of costs
Local authorities administer most of the social service. Expenditures on cash benefit, rehabilitation and anticipatory pension are divided equally between the State and the municipalities, while old-age pensions and family allowance are paid by the State. Municipalities and counties levy their own taxes, but around one-third of local revenues are derived by refunds to earmarked purposes from the State. Additionally the municipalities receive central government grants, and poorer municipalities receive equalization schemes from richer municipalities. Consumer payments play a growing role. 59 per cent of social and health services are carried out by the local governments, 20 per cent by the regional governments and 13 per cent by unemployment insurance funds. Only eight per cent are carried out by the state. But the distribution of costs is different from that. Around 46 per cent of net social costs are paid by the State, 36 per cent by the local governments, 7 per cent by employers, 5 per cent from unemployment insurance and 6 per cent from income from interest. Compared to Norway, and in particular Sweden, the public tax-financed contribution to covering the social costs is
The social conditions
Compared to international standard there is a high degree of social equality in Denmark, thanks to public redistribution through the tax system and the social system, the benefit of which is growing with want. It means the equality is higher for available incomes after tax. Inequality is reduced by 56 per cent when comparing earned income with disposable income. The last 20 years, the tendency has been towards equality. The rate of poverty, defined as 50 per cent of average national income, is 6 per cent of the population, compared to 17 per cent in EU. The highest 20 per cent income is three times richer than the lowest 20 per cent, while the average in EU is 5,5. Poverty in the traditional sense of absolute terms does almost not exist in Denmark. Through taxation and transfer payments a reasonable distribution of wealth is ensured. There is no official poverty definition in Denmark and no official figures of the number of poor. Most poor people are students, and they quickly move to better social positions. Only about 20 percent of those in the lowest income decile are still there after five years. Inequality today is not so much a question of heritage of positions as it is a question of social integration and of timing. People living in poor conditions are also found among long-term unemployed, pensioners, single parents, and recipient of social assistance, but also wage earners and tradesmen. However, their situation might be improved by social service Not least social transfers and in particular cash benefit contribute to equalizing the conditions for the poorest groups. The transfers’ share in total income is about 16 per cent in Denmark, compared to an average of 9 per cent in EU. Before social transfers around 30 per cent of the population live below the poverty line (according to EU-definition as 60 per cent of the median equivalized income). After social transfers it is 11 per cent. 3 per cent of the population live below the poverty line more than three It has been calculated that the tax system and social transfer has the effect that the poorest fourth of households net receives DKK 74.000 (8,888 $) in average per household annually from the state while the most wealthy fourth of households net pays DKK 256.000 (30,720 $) in average per household annually. The social minimum income in Denmark was in 2001 7.711 DKK monthly for a single person over 25 years (about 925 $). To persons under 25 years living independently the amount is DKK 4.969 (about 600 $).
Households and families
The average household consists of 2.1 people. Relatively, there are many single parents and
households without children. Since the 1960s the number of one-person households have increased to 36 per cent and even higher in the big cities, reflecting that more young people live on their own moving away from the family home. Also a growing number of older people is living alone in their own homes due to a strategy of staying in one’s own home as long as possible. The number of divorces is high, about 2.5 per 1000 inhabitants. Around one third of couples has divorced before 25 years of marriage and the likelihood of divorce is greater considering the marriages contracted in the 1980s. There might be a change in that pattern with the new generations. Family is still the dominant household form, and most children grow up with two parents. However, marriage as a legal construction between two persons of opposite sex has lost much of its meaning. Cohabitation and homosexual partnerships have come under many of the same rules as apply to married couples in the traditional sense. Spouses are reciprocally obliged to support each other and their children until 18 years old. Children are not obliged to support their parents. If one of the spouses has enough to support both of them, the other will not be eligible for social assistance from the municipality. However, this obligation only obtains as long as the cohabitation lasts and they are staying together – in case of a split-up not until a divorce has been granted. This has made it possible for a woman without self-support to abandon a marriage she no longer wants. Thus State and municipality play an important role as a third part in making it easier for people to neutralize the dependency on the stronger partner in a marriage. The very family structure has changed dramatically. Today almost all families consist of two breadwinners. The housewife has vanished. In mid-60s two-third of all mothers of infants were housewives. Today they count for five per cent at most. This change in the family structure is one of the most radical social revolutions, which has deeply effected the social policy in general. The average life expectancy for men is 74 years. For women 79 years. In Denmark life expectancy has stagnated and is among the lowest in Europe. People in the other Scandinavian countries live 3 years more. There is no single explanation for the stagnation in life expectancy, but often is pointed to lifestyle with regard to smoking, drinking and diet. The most frequent causes of death in Denmark are cancer and vascular diseases. The health service is primarily publicly financed through taxes (85 per cent), and all people, regardless of social status, age or capacity for work, have free and equal access to the public health service, covered by health insurance. The basic principles are that those patients in greatest need are treated first. Need is determined on basis of medical assessment. Public health insurance covers expenses for the general practitioner, specialist, dentist, physiotherapist and medicine, in whole or in part. The public health insurance is tax financed. The cornerstone in the Danish health system is the general practitioner. There is one general practitioner for every 1.600 inhabitants. Every person aged 16 is free to choose a general practitioner, and often the general practitioner serves as a “family doctor” with good knowledge of his patients. Consultations are free of charge. On average the Dane visits the doctor 6 times a year. If a special treatment is needed, the general practitioner will refer to hospitals or special clinics. In emergency The counties run most hospitals. The patients have free choice of hospital. Medical treatment is provided free of charge. Much treatment is today handled on outpatient clinics.
Children
Parents bear the responsibility for their children’s provision until the age of 18, which is full age in
Denmark, and children’s living conditions are a parental responsibility. This responsibility is supplemented by a public family policy, creating a supportive social framework for families with children. Because of the development of the family institution in Denmark, in particular the high employment rate among women on the labour market, some former family tasks have been taken over by public institutions, not least in publicly financed day-care institutions. The institutions not only meet the needs of care but also serve as educational enriching environments for children. Such institutions must be available in all municipalities to fulfill the demands of the parents. Most local authorities guarantee child-care for children up to five years old. No children must be excluded from day-care facilities on account of their parents being unemployed. All children are admitted on equal terms. Local authorities run two-thirds of the day-care centers. The rest are self-governing institutions run by private associations with contract to the authorities. Around fifty per cent of all children up to 10 years are enrolled in day-care institutions: Day nurseries (0 – 2 year), kindergarten (3 – 6 year) and after-school centers for 6 – 10 years old school children. Parents pay for at most one-third of operating costs. Free places in day-care facilities in full or in part are given to children from financially weak families. Children with disabilities are integrated into regular day care, often with extra staff to support them. The parents are involved in the centers and co-operate with the staff. All centers must have a parent’s board laying down the principles governing the work of the institution. The parents also influence the For the group of youth between 10 and 14 years old the municipalities must establish recreation centers with social and cultural activities, and youth clubs for youngsters between 14 and 18 years old. In certain situations of neglect and abuse in the home, the social authorities of the municipalities are obliged to take action. They may act with counseling of the parents or provide practical and educational support; a personal counselor may be appointed to the parents. If a child is unable to remain at home because of neglect of duty by the parents the local authorities may decide to remove the child, with or without the parents accept. This can occur if there is an obvious risk for the child’s health and development, if the child is not cared for, are exposed to violence, abuse drugs, show criminal tendencies or have severe social problems. The child may be placed in foster care or in a residential institution under professional supervision. Decision to remove a child without consent from the parents is to be taken by a special committee appointed by the local authority (one of the members is a judge). The parents are provided with legal aid in that case, and the decision can be Local authorities must also offer free and anonymous counseling where families may seek advice and counseling before their problems get out of hand. Local authorities may offer practical or educational- psychological help to families in their home, and a contact person may be appointed for a child or a family. At no cost to the consumer the Danish society provides preventive health measures. During pregnancy, a doctor or a midwife gives women check-ups. During a child’s first year a health visitor will advice the family concerning the baby’s health and development. Before schooling the child is offered 8 medical check-ups and vaccination against contagious diseases. School physician and school nurse give health instruction, and local authorities must also provide dental treatment to children and young people. A woman has the right of maternity leave from four weeks before expected date of delivery to 14 weeks after the child is born. A father has the right of two weeks’ paternity leave in the same period. The parents have an additional right of 10 weeks’ leave alternately. The father is entitled to leave with benefits two weeks in continuation of the 24 weeks leave period. During the leave periods the parents are given an allowance corresponding to the unemployment benefit rate. Parents are entitled to go on leave for up to one year to take care of children under 9 years of age. Parents with and without jobs alike are covered by the scheme. Around 93 per cents of parents on Children born out of wedlock have the same rights in relation to their fathers as children born in wedlock. The father is obligated to pay maintenance for the children. The mother is guaranteed the payment by advanced payment from the local authorities if the father neglect his obligation. Then the authorities will collect the money from the father. All families with children under 18 are paid family allowances that are not dependent on income. Lone mothers are entitled to special child benefits from the municipality.
Old people
20 per cent of the population are over 60 years old, which is more than the average for The European Union. Correspondingly, the number of young people is declining. Today there are four breadwinners for each supported. In 25 years there will be only 2-2,5 breadwinners for each supported. Changes in labour market structures have made it more difficult for children to take care of their elderly parents. It doesn’t necessarily mean the elderly are left alone or feel lonely. Society cares for them if needed, and many elderly people live an active life in senior clubs or high schools. The majority of elderly people lives in their own homes, in some cases with support from home helpers, health visitors and given practical aid from the municipality, for instance meals-on-wheels The aim of housing policy for elderly is that they should stay as long as possible in their own home. After death of a partner the surviving spouse has the right to retain the estate undivided, if the only heirs are common children. If not, accept from the children of the deceased spouse must be obtained. In practice this means that in most cases the widow will be able to keep the house of the marriage. For weak elderly there are more housing options: pensioners’ flats, service flats, sheltered homes, senior citizens’ centre and independent housing for senior citizens, which are adapted to the needs of the elderly. Approximately 27.000 dwellings are purpose-fitted for elderly and disabled people. Each dwelling is covered by a 24-hour emergency help call-out and adapted to the need of the elderly and disabled. Help may be granted with terminal care of a family member in the home. The help includes compensation for lost earnings and help to cover own expenses for medicine and nursing requisites. A general condition is that a doctor has determined that hospital treatment is futile and that the prognosis is a short life expectancy. Local authorities are obliged to provide personal and practical assistance to older people and others in need of assistance, for instance to house cleaning, shopping or laundering. About 50 per cent of those over 80 get such assistance, which is free of charge – in average six hours per week. The purpose of these efforts is to allow older people with a permanent need for assistance to stay in their own homes if that is what they want. User payment is required for temporary personal and practical help. Everyone over 75 years old is offered two annual preventive home visits from the local authority to make sure that any needs for everyday assistance is discovered in time. Conventional nursing homes are no longer built. Local authorities, non-profit housing societies, self- governing institutions and pension funds run dwellings for old people. The aim of elderly policy in Denmark is to enable the elderly to live a life as close to the norm as possible along such values as self-determination, freedom of choice and respect for the individual. The municipalities have set up senior councils and a complaint board giving the elderly a voice in their own affairs. Danish citizens are entitled to old age pension from the 67th. Year (in 2004 from 65th. year). The old- age pension is a national pension for everyone, introduced in 1956. To get the full rate, one must have lived 40 years in Denmark between the ages of 15 and 67. It is not based on insurance principles, or depending on any attachment to the labour market. The old-age pension is tax financed and amounts to about DKK 100.000 yearly (about 12,315 $). The pension is sufficient to cover a modest living only. It is around 60 per cent compared to average wage. The pension is regulated once a year, in line with wage increase on the labour market. For wage earners the pension is supplemented with a Labour Market Supplementary Pension Scheme, to which wage earners contribute. The amount of the contribution depends on the number of weekly working hours. Two- thirds of the scheme are financed by the employer and one-third by the employee. The pension is calculated on the basis of paid contributions. Personal allowance may be payable to pensioners whose financial situation is particularly difficult, for example expenses for medication, dietetic food, medical or dental treatment, and pedicure. Also pensioners have advantages under other legislation, such as housing benefit, payment for radio/TV license fee and transport by public means of transport. As part of collective bargaining on the labour market, labour market pension schemes have become more common in recent years. Both employer and employee contribute to the scheme. In years, for most people on the labour market the pension structure will change totally to labour market pensions. Persons older than 60 are entitled to voluntary early retirement pay to leave the labour force. To get early retirement pay the person must be entitled to unemployment benefit and be a member of an unemployment fund for at least 20 years. The amount of money depends on previous wages, but cannot exceed the maximum unemployment benefit. A reform in 1999 urges to postpone retirement to a later date and for gradual withdrawal from the labour market. Any 60-65 year old who wants to reduce his working hours is entitled to a partial pension.
Housing
To a wide extent, in Denmark the housing market is subject to legal regulation. The market can be divided into three markets: the ownership market, the rental market and the social housing market. 59 per cent of the populations live in single-family houses; 39 per cent live in flats. 54 per cent of householders own their home, either a single-family, detached house (72 per cent) or a flat. Since the 1960es rented flats have been converted to owner flats. The social housing sector accounts for 43 per cent and the privately rented dwellings for 40 per cent of the total rental property. The average floorage per household is 109 square meters. There are 2.1 persons per household, that is 52 square meters per person. About 90 per cent of the population are living in dwellings with more than one room per occupant. 85 per cent of the population live in towns. About 37 per cent of all households are one-person households. About 17 per cent of the households consist of four or more persons. On average, households in Denmark spend 29 per cent of their yearly consumption on basic things related to the accommodation such as rent, fuel, light and heating. Pursuant to legislation, individual dwellings must be constructed in such a way as to provide satisfactory health conditions, wastewater removal, drinking water supply, ventilation, heat and electricity, and in addition to living rooms, they must contain a kitchen, bathroom and lavatory. Over half of all dwellings were built after 1950 and one-third after 1970. Only 8 per cent of the dwellings are without basic amenities such as shower, toilet or heating compared to 20 per cent in 1980. Most of these dwellings are located in Copenhagen. An intermediate form of housing between rental- and ownership- based housing is co-operative housing. Since 1980, private landlords have been obliged to offer the tenants to purchase their flats on a co-operative basis before selling off the property. As a result a considerably number of tenants collectively bought the housing estates in which they lived. In Copenhagen, nearly 90 per cent of the municipally owned dwellings were transformed into co-operative dwellings in the period from 1994 to 1998. Membership of a co-operative housing association does not involve the outright buying of a dwelling but a share of the association’s total assets. By buying a share, the member acquires the right to the use of a flat. The social housing sector has obligations to meet housing needs of lower-income groups. The sector originates from philanthropic initiatives in the beginning of last century and has since been responsible for solving a range of social welfare problems on the housing market. The dwellings are built by non- profit housing associations and must be approved of by the local authority in which they are situated. The social housing sector receives subsidy from government. There are about 700 non-profit housing associations in Denmark. The social housing sector accounts for about 19 per cent of the total housing stock. There is no income limit for eligibility for social housing, but households with children are given priority for larger dwellings, and the local authorities have the right to use one in four vacant flats to solve urgent welfare cases. Compared with the rest of the housing market, tenants in the social housing sector have a weaker connection to the labour market, a lower rate of income development and they have considerably lower fortunes and are far more dependent on public income subsidies. In 1997, 16 per cent of all families in the social housing sector were immigrants and refugees from less- developed countries. There is state-subsidy to the production of dwellings and there are individual housing benefits. The direct public expenses to housing are nearly 2.5 per cent of total public expenditures or nearly 15 billion DKK. For low income households in rented accommodations there are rent subsidy schemes to reduce the rent to ensure a certain proportion between rent and income. The subsidy is means-tested. For receiving rent subsidy the rent must exceed 16 per cent of the household’s income for incomes up to 131.300 DKK per year (about 15,800 $). For households with an income exceeding 131.300 DKK, the percentage used on rent must be more than 27 per cent. For each child in the household below the age of 23 an additional income of 23.900 DKK (2,870 $) is allowed. Those who qualify for rent subsidy are given 75 per cent of the difference between the calculated limit for own payment and the actual rent paid. The subsidy cannot exceed 15 per cent of the total rent. Pensioners might qualify for rent allowance if the amount of rent exceeds 10 per cent of the income up to 135.300 DKK (about 16,240 $) and 20 per cent of income above. Rent allowance to house-owners is given as a loan with the value of the house as security. When the house is sold the municipality gets some of the profit. This arrangement ensures that elderly people can stay longer in their own dwelling, before they move to an House-owner expenditures deriving from mortgage payments are tax-deductible. Public expenses to deducible interests on loan equal about 60 per cent of the total public expenditures on housing. To reduce the public costs the tax-allowances for mortgage payments has been reduced since mid-1980s. However, there are still differences between the costs of living in the ownership sector and the social housing sector. In general, the first couple of years it is more expensive in the ownership market but by the end of a five-year period, the annual net expenses are almost identical for the two types of dwellings. Over a 30-year period the annual expenses of having a dwelling in the social housing sector is 41 per cent higher than the annual expenses of having an ownership dwelling. Since World War 2, the housing policy has had three foci: a period of construction of dwellings (1947 – 1970), a period of focus on good dwellings to ensure the quality of life of lower income groups, and urban renewal (1973 – 1993). In the 1990s, urban policy and solving social problems in deprived neighborhoods were emphasized. Urban renewal policy has had social objectives, trying to make it possible for sitting residents to stay in the dwellings by special individual housing benefits given to tenants in renovated dwellings. These benefits are reduced gradually over five years.
Employment
The population of Denmark is 5.3 million people. In 1998, 44 per cent of the whole population were on the labour market. 27 per cent was children or students. 20 per cent were pensioners, and 9 per cent were unemployed. The employment rate is almost 80 per cent of the population between 16 and 66 year. The employment rate of women is one of the highest in the world: 76 per cent although it is still lower than among Danish men (82 per cent). Most women work full-time, and the gap between male and female part-time employment is narrowing. The age of withdrawal from the labour market is also high, although declining these years. Around 50 per cent of men between 60 and 64 are still employed, compared to one third in EU. 43 per cent of all married women between the ages of 55 and 64 are economically active compared to 23 per cent in EU. These activity rates affect the level of social welfare in Denmark. On the other hand, that both parents are on the labour market cause demands on the social service system, for instance for childcare facilities and services for the elderly. A high standard and great extension of public social service is a prerequisite for the high activity rate on the labour market and for economic growth and productivity. The amount of occupied and self-supported Danes has been steady over the last 50 years. About 72- 73 per cent of people in their occupational years (18 – 66 years) support themselves, while a steady 27-28 per cent are out of labour market. But the trend in maintenance since 1945 for not self-supported has changed dramatically, from family maintenance to public maintenance. In 1960 only a few were supported by society according to law, while more than 20 per cent received their maintenance from the family. Today they count for only a few per cent, while 25 per cent receive assistance from society. In that way, there are not more non-occupied people outside the labour market than previous, but the maintenance system has been radically changed, from based on family The right to work is established in the Danish Constitution. The society is obliged to do the utmost to ensure employment for every citizen, so he/she is able to support him/herself.
The labour market model
The social partner organizations on the labour market were established in the late 19th. century, and they have helped to build a welfare society with one of the world’s most peaceful labour markets. Collective bargaining takes place every second year on central as well as decentralized level. The bargaining covers almost all labour market since 90 per cent of the occupied labour force are a member of a trade union. The organizations on both sides of the table have a strong hand, and collective agreements constitute the most important source of law in labour market matters. The State interferes as little as possible in the regulation of working conditions. Only if the bargaining breaks down and – following a strike – the situation becomes critically for the country will the Government intervene and dictate a solution by law making. To help the parties find a solution, a Public Conciliation Service is established. In case of disputes between the parties on the interpretation of the agreements the disputes can be submitted to the Industrial Court, which decides the interpretation? The judges of the Industrial Court are legally qualified judges and representatives of the social The social partners not only play a central role in connection with the determination of wages and working conditions. They are also involved in connection with legislation and the administration of the legislation. Generally, there is good experience with tripartite co-operation between the Government and the labour market organizations on for instance employment policy, labour market policy and education policy. The central co-operation is reflected in implementation policies on the regional or Everybody is entitled to 5 weeks of vacation.
Anti discrimination
The Act to Prohibit Discriminatory Treatment on the Labour Market prohibits employers directly or
indirectly exercising discrimination on grounds of race, colour of skin, religion, political conviction, sexual orientation, social or ethnic origin in connection with appointment, dismissal, transfer, promotion, wages and working conditions and access to vocational guidance or training.

Denmark is also working to create equal opportunities for the handicapped by giving them the same
opportunities as other citizens. A Central Council for the Handicapped has been established to advise the Government and the Parliament on conditions for people with handicap and to observe and assess the conditions in society for people with disabilities, also in the preventive area. There is also a centre for equal treatment of the handicapped, which collects and disseminates information and experience about people with handicap and who guides public and private authorities and business enterprises to realize the principle of equal treatment of disabled and not-disabled in all sectors of society. Yearly, the council submits a report to the Minister of Social Affairs and to the Parliament. A Council for Ethnic Equality has been set up to secure rights of persons of non-Danish origin. The council advises the Government, authorities, organizations and institutions on questions concerning ethnic equality. The council can, on its own initiative or upon request, make statements regarding ethnic discrimination, and it can recommend a change of practice to specific problems. A Council for Ethnic Minorities advises the Minister for the Interior on questions of importance for refugees and immigrants. According to law (Act on Equal Treatment of Women and Men) men and women are to be treated equally on the labour market, i.e. paid the same wage for the same work, have same opportunities for promotion, access to further training or education, and there must not be occupational and employment barriers for women. Now, most women can provide for themselves and legislation facilitates this. Pregnancy and childbirth or maternity leaves do not constitute valid reasons for dismissal or discriminatory treatment. A woman may be awarded compensation from the employer, who fails to comply with the rules. The perspective of equality must be developed and incorporated into all aspects of work and administration. Yet, there is still not total equality on the labour market. Women receive only 80 per cent of the wage paid to men due to differences in education, work experience and occupational level, although the differences between men and women have been reduced since 1988 for full-time employed; women are in majority in the group of unemployed and are more severely hit by long-term unemployment than men. An Equal Status Council was in 1978 established in the Prime Minister’s Office. The task of the Council is to promote equality between men and women in society, on the labour market, in education and in family life. The Council also encourages the social partners to increase efforts to achieve equality between men and women on the labour market and encourages women to take greater part in public life, for instance to ensure a balanced representation in councils, boards and commission. The public employment service has been working with equality for many years. Equality consultants are working to promote equal opportunities in the regional labour market. The labour market is still gender segregated, and it has been calculated, that more than half of the labour force should change work if the male and female labour force were to be equally distributed on the labour market. However, the number of female managers continues to increase and today nearly one-third of all young managers are women, compared to less than 20 per cent of managers over the age of 40 Also a Council on Children has been established to look after the children’s interests.
Income-replacing social transfer payments
There is in Denmark a both comprehensive and in some ways intricate system of income
compensating scheme of benefits for people, who are hit by social events, for instance unemployment or sickness. Which scheme of benefit to use depends on the actual event and its art. If the criteria change the scheme of benefit may also changes. In 1999, a total of 2.2 million Danes received one or more income-replacing benefits, corresponding to 52 per cent of the total adult population from 18 years old. The average number of all-year receivers of social transfer benefits is 1.6 million people. More women than men received benefits, in particular due to the fact that women’s life expectancy is higher than men’s – but in all age groups the majority is women. The benefits are divided into temporary and permanent benefits. Temporary benefits are for instance unemployment benefit, sickness benefit, maternity leave benefit, and cash benefit. Permanent benefits are old-age pension, anticipatory pension and early retirement pension. About 1.2 million received permanent benefits, corresponding to 28 per cent of the adult population, of which old-age pensioners accounted for 736.000 people. 275.000 received anticipatory pension and 188.000 early retirement pension. The number of persons receiving temporary benefits is about 1 million – or 42 per cent of the population between 18 and 66 years old. In man-years it corresponds to 430.000 persons. 316.000 received unemployment benefit, 257.000 received sickness benefit, 126.000 cash benefit, 111.000 activation benefit, 97.000 childbirth benefits, 73.000 leave benefit and 33.000 rehabilitation benefit. 320.000 persons under 60 years received income-replacing benefits more than half a year. To be eligible to unemployment benefit a person must be member of an unemployment fund and have worked 26 weeks within the past three years. Unemployment benefit totals 90 per cent of previous wage with the maximum of DKK 2,937 weekly (about 352 $). The coverage after taxes is 70 per cent compared to a workers average wage. There are 38 state-recognized unemployment insurance funds. The State contributes to financing the funds. Cash benefit from the local governments is the lowest social safety net, the amount depending on family size and total financial capacity. To get cash benefit the non-insured must enroll in an activation program, for instance educational activities or retraining program.
Active social policy
Since beginning of the 90s, the objective of Danish social policy has been to integrate a greater
number of people on the ordinary labour market through the so-called active labour market policy and active social policy and to activate and employ more vulnerable groups in different kinds of subsidized jobs on the labour market. The main strategy is a more inclusive and flexible labour market with room for more people, so that people with poor qualifications or reduced capacity for work get a chance to use their skills and participate in working life. The activation approach is about contributing to increasing the labour supply, to improving self-support and preventing marginalization. Persons who become sick or undergo crises should not be excluded from the labour market. The reason behind this policy is the fact, that the demographic development will entail a fall in the labour force in the coming years, and it will therefore be necessary to increase the participation rates of the individual age groups and weaker groups to avoid bottleneck problems and growth in wages and prices. The employment rate is already very high in Denmark. Also senior policy has been strengthened to keep elderly people longer on the labour market. Instead of passive benefits there is now a strong focus on alternative labour market schemes and active empowerment of the unemployed to improve their qualifications and to meet the new challenges on the labour market. Focus now is on motivation, job training, and rehabilitation, upgrading of qualifications, education and job offers. All unemployed must accept activation and educational re-qualification programs, for the vulnerable groups perhaps in the form of specially organized activities or jobs on special terms. Because the target group of the activation approach is complex, the activities are characterized by an individual approach to possible solutions. The activities are based on the individual’s situation and services adapted to the individual. Earlier unemployment was regarded as a social event in periods of low growth against which you could insure yourself in an unemployment insurance fund. If you lost your job you were entitled to unemployment benefit, while, at the same time, you were job seeking and at disposal of the labour market. However, unemployment is no longer just a matter of economic growth, to be managed by stimulating demand. Growth in itself does not always produce more jobs. Unemployment also depends on technology, education and cultural and social conditions and qualifications. In the eighties and nineties, more duties were imposed on the unemployed to keep their job ability. The period of unemployment benefit is reduced from seven years to now four years, but after one year of unemployment, unemployed persons between 25 and 6o years must have an action plan drawn up and accept an offer of activation. For people under 25 years without formal qualifications the term is 6 months’ unemployment before the action plan is drawn up. There are more forms of activation, taking individual needs and wishes, as well as labour market demands, into consideration. Job training takes place at a private or public employer. The employer is paid a wage grant of 50 per cent. Wage and work conditions must correspond to agreements on the ordinary labour market. Individual job training is for unemployed with difficulties to obtain a job. People activated in Individual job training must only do work that is not covered by agreement on the labour market. They are not paid a wage but a grant, not higher than the unemployment benefit, and working hours are individually arranged. If the insured unemployed person do not find a job within four year, he will be moved to the social system where he is entitled to cash benefit to a reduced amount of money.
Sickness and maternity leave
Sickness and maternity benefits are given to ensure persons with labour market affiliation –employees
and self-employed – a reasonable financial allowance during sickness and maternity. The right to sickness benefits ceases when the claimant is fit to work again or when the claimant has received benefits for more than 52 weeks during the previous 18 months. Under special circumstances, the period may be extended.
Cash benefit and activation
In general, people having suffered a change of circumstances because of for example illness, unemployment and separation and who cannot provide for themselves and who are not supported by their spouse are guaranteed a financial safety net in the form of cash benefits. In addition, offers of activation and rehabilitation ensure that the cash benefit claimants are supported in their efforts to enter or re-enter the labour market. In recent years, a strategy has been pursued according to which all services have been reviewed in terms of employability to increase the participation of the cash benefit claimants in social and working life. Since 1998, it has thus been a right and obligation of all cash benefit claimants to participate in activation schemes. The purpose of providing financial support is to enable recipients to become self-supporting. Therefore, recipients are required to apply their best efforts to improve and develop their working capacity by accepting offers of employment or activation. Depending on their needs and qualifications, recipients shall be given the opportunity to influence and participate in the planning of the assistance. When a person files a claim for assistance, the local authority shall immediately asses any need on the claimant’s part for advice about the way in which he/she may be able to deal with any present or future financial problems, preferably unassisted. The advice may consist in information about the way in which the claimant may improve his/her employment or training prospects. Where a person needs financial support in case of unemployment, the local authority may normally presume that the need can be satisfied by means of cash benefits and activation. The local authority shall determine not later than eight weeks from the first payment of periodical benefits, whether cash benefits and activation is sufficient to enable the claimant to provide for him/herself. If this is not the case, the authority shall seek to make other suitable offers available, such as rehabilitation or sheltered employment with wage subsidies. In connection with activation the local authority may prepare a written plan to promote a comprehensive strategy. According to the person’s own wishes and qualifications, the plan is to specify employment or training target and to plan the appropriate activities to ensure that the target is achieved. If employment or training target is not realistic for the time being, the aim of the plan may be to stabilize and improve the person’s general status. The local authority shall every three months follow-up to ensure continued compliance with the requirements for granting assistance and ascertain whether there is a basis for granting other types of assistance. Assistance will terminate if the claimant refuses a job offer or an activation offer without good cause. Activation activities cover: A) Short-term guidance and introduction programs providing guidance on employment and training opportunities and providing access to testing certain employment wishes. B) Work based training with wage subsidies with private or public sector employers; the working conditions shall correspond to the working conditions according to collective agreement. The municipality shall fix the working hours in consultation with the employer. C) Individual work based training with private and public sector employers; the same conditions apply to this training. D) Individually tailored training activities. E) Individually tailored activating guidance and trainee periods, work experience courses improving work readiness and other initiatives featuring a combination of work and training. F) Voluntary and unpaid activities according to the person’s own wishes and deemed by the local authority to be of importance for the community or to the individual’s training or employment situation. G) Adult or continuing education/training according to the individual’s own wishes. H) Job rotation schemes under which unemployed persons replace employed persons. The cash benefit claimants are divided into two groups: a group whose only problem is unemployment, and a group with additional problems. For claimants with additional problems, for instance abusive behavior or mental illness, the activation programs may prioritize acquiring personal and social competencies, for instance punctuality and stability. Where the aim of ordinary activation is to bring people back into ordinary employment the aim of social activation could also be to increase the general welfare of the claimant. Activation may be combined with treatment for alcoholism or drug abuse. Cash benefit is the last possibility for financial support if all other options are precluded. The monthly support for uninsured unemployed is 80 per cent of unemployment benefit for insured unemployed. The amount is DKK 10,245 (about 1,230 $) for persons aged 25 with dependent children; DKK 7,711 (about 925 $) for other persons over 25; DKK 4,969 (600 $) for persons under 25 living on his own; and DKK 2,398 (290 $) for persons under 25 residing with their parents. A person under 25 who has a child or children will be paid a monthly supplement. The benefits are taxable as most benefits are in Denmark. The cash benefit is paid monthly as a fixed amount of money. Special benefits may be given to persons, whose housing costs are high. Also the municipality may pay health care expenses, medicine, and dental treatment if the claimant is financially incapable of paying such expenses. Also financial support can be granted to furniture and costs in connection to changing the address.
The inclusive labour market
It is a precondition for a stable and solidary welfare society that its citizens feel that they can live in accordance with human dignity with the highest possible degree of self-support. Employment and participation in the social community of a workplace is very important for a cohesive society and solidarity between various social groups. That is why weak groups are given more options for gaining a foothold on the labour market. The inclusive labour market is the vision that persons with poor qualifications or reduced capacity for work, for instance physically or mentally disabled and socially vulnerable groups, get a chance to use their skills and participate in working life by help of wage subsidy schemes. Another reason is the need for an increased supply of labour due to reduction in the demographic development. Flexible working arrangements and sheltered employment mean jobs at ordinary work places with a wage subsidy to persons with permanently reduced working capacity. Such arrangements with wage subsidy can only be provided if it is impossible to gain employment without wage subsidy by any other means, for example by rehabilitation or assistance in the form of special equipment or personal aids. The objective of flexible working arrangements is to restrict access to anticipatory pension while sheltered employment with wage subsidy is offered to persons who receive anticipatory pension. In order to give the local authorities a bigger incentive to find employment rather than awarding social pension, the reimbursement from the State to the local authorities has been reduced. This is part of a political plan to reduce the number of persons on transfer incomes and an increase in employment. The local authority shall ensure that persons with permanently restricted working capacity are given the opportunity of finding employment in flexible working arrangements or sheltered employment. When the authorities have offered a job subject to flexible working arrangements, the wage and working hours shall be specified which take place in consultation with the labour unions. The employer shall pay wages to the person employed subject to flexible working arrangements. The local authority shall grant the employer a wage subsidy. The amount of subsidy shall be 1/3, _ or 2/3 of the wages depending on the extent of the loss of working capacity. And it shall not exceed the fraction of the minimum wages or the normal wage for similar work. In case of unemployment through no fault of their own, persons employed subject to flexible working arrangements are eligible for an allowance by the municipality for a period of 12 months. The allowance amounts to 82 per cent of the maximum of unemployment benefit. Also the local authority shall offer sheltered employment with wage subsidy to a person receiving The inclusive labour market is a broad concept, expressing the expectation that workplaces should be open and adapted to persons who are not capable of complying with prevailing performance To further the inclusive labour market, social chapters have been introduced in almost al collective agreements. They establish a framework for employing and retaining persons with reduced capacity for work in the labour market. Another instrument is social clauses. A social clause is a tender document requirement to the effect that the winner of the contract must undertake a specified social commitment, for instance to employ a number of staff on special conditions or employ staff who have been unemployed for a specified period of time. Only public tenders may include social clauses. The minister of social affairs has launched a campaign under the motto Our Common Concern – an initiative to promote the business sector’s social commitment together with the labour market organizations. The idea is to make a social image as popular among Danish firms as the green image is today.
Rehabilitation
Rehabilitation is job-oriented activities and financial assistance, which may contribute to enabling a
person with limited capacity for work to stay in or enter the labour market, thereby improving their prospects of providing for themselves and their families. Rehabilitation may consist of testing of capacity for work, activities that further work experiences or readiness, formally qualifying training, or education. Assistance in setting up a business is also a possibility. Activities attended by the rehabilitee before clarification of the employment targets are known as pre-rehabilitation. These are activities aimed at preparing the rehabilitee for employment or clarifying his/her situation. Municipalities can provide assistance to education, vocational training or re-schooling if it is estimated to be the condition for self-support. The local authority shall make the plan in co-operation with the rehabilitee so as to adapt the offer to the person’s qualification and needs and having regard to the person’s own future employment wishes. The financial assistance is provided as rehabilitation benefit and can be given for 5 years. It is implied that the receiver follows a laid down plan. About 43 per cent don’t receive public assistance 6 years after they received rehabilitation benefit. Before awarding anticipatory pensions, a person must be tested in a rehabilitation or activation program. The counties are running 60 rehabilitation centers providing tests for work ability, work clarification, education and training. Social workers, psychologists, medical specialists, therapist, teachers and work instructors are included in the staff.
Anticipatory pension
Anticipatory pension can be awarded to persons between 18 and 67 years old, when all arrangements of activation, education and treatment have been tried. Only if the work capacity is reduced by at least one half can a person be awarded anticipatory pension. In 1999, 271.895 people received anticipatory benefit, corresponding to 7,8 per cent of all people between 18 and 67 years. The major causes are mental illness and disorders in organs of locomotion. A new reform of the anticipatory system will come into operation in 2003. The reform means a shift from a criterion of reduced or lost working capacity to a criterion of remaining capacity for work which focus upon the individual’s potential for work rather than focusing on the lacking capacity. Anticipatory pensions will only be awarded if it turns out to be impossible to help the individual to remain on or return to the labour market on ordinary terms or in subsidized jobs. Occupational accidents
Everyone employed to do work in Denmark is ensured against the consequences of occupational
accidents and harmful influences through their employer’s compulsory industrial injury insurance. Private employers have to take out a compulsory insurance in special, state-recognized insurance companies. Central and local governments may be self-insured. The following benefits may be awarded to persons having sustained an occupational injury: payment of costs occurred on treatment, rehabilitation and technical aids; compensation for loss of working capacity; compensation for permanent injury; compensation for loss of supporter; transitional allowance on death.
Social appeal
In cases of conflict with the authorities the client has access to complain. Legal protection of the citizen is ensured by a right of appealing the decision to higher authorities: The Regional Boards of Social Appeal, The National Directorate of Social Security and Assistance, the Social Appeals Board and finally the Ombudsman. The Social Appeals Board is the highest appeals court in the social sector. The Board hears specific cases and lays down practice for interpreting social legislation. It is independent but responsible to the Ministry of Social Affairs. The fundamental principles for administration of social cases are laid down in The Act on Legal Protection and Administration in social Matters. The overall rules state that the local council and the county council shall deal with matters of assistance as soon as possible with a view to determining whether assistance is warranted and is so the nature of such assistance. The authorities shall stipulate a time limit within which a decision shall be made. If the said time limit cannot be complied with, the claimant shall be given written notice of when a decision may be expected. The citizen shall be given the opportunity to attend the proceedings in which he/she is involved in such a way as to facilitate such attendance by the citizen. The local council and the county council shall consider applications and enquiries for assistance, having regard to all possibilities available to render assistance under the social legislation, including counseling and guidance. In addition the councils shall have regard to the possibility that assistance may be available from another authority or subject to other statutory provisions. If a citizen requires long-term assistance the municipality and the county shall at an early stage seek to structure the assistance subject to an overall assessment of the claimant’s specific situation and long term needs. The municipal authority shall conduct such an assessment within 8 weeks from the first application for continuous financial provision. The claimant shall be given written notice of the On the other hand, persons claiming or receiving assistance shall procure any information necessary to determine whether or if so which assistance they are entitled to receive. And a person receiving assistance shall inform the authorities of any change in his/her conditions likely to affect the assistance. Every citizen can appeal to the Ombudsman. The Ombudsman can also examine cases on his own initiative. The Ombudsman can examine a case, when all other opportunities for appeals have been exhausted. The Ombudsman can submit criticisms and recommendations.
Vulnerable groups
The general objective of the policy concerning vulnerable or socially marginalized groups, such as
homeless people, drug and alcohol addicts, and mentally ill people, is to support the individual’s possibilities of taking advantage of the general service and activities of society and to improve the individual’s possibility of managing on their own to ease their everyday existence. Help is based on the individual’s own resources and responsibility, and it is designed according to their needs and qualification in co-operation with the individual person. Legal guarantees are provided to involve the individual in planning of their own process. In institutions, residents and user councils are set up, and user organizations are supported financially by the government. In a number of fields, support has been granted to projects that develop and reinforce co-operation between vulnerable groups, relatives and voluntary organizations, thereby helping them to help themselves. However, if is often necessary with targeted initiatives to improve the conditions for these groups and to provide services that may minimize the damages. In some cases they are not capable to exploit the ordinary service without help. Such help is often carried out in co-operation with non-governmental organizations and others doing voluntary social work with the aim of preventing the aggravation of problems and to strengthen individual opportunities of personal development. The basic objective of the measures is to put in place a cohesive and holistic policy allowing the individual to lead a more The group with heavy social and personal problems must be provided access to activity and day shelters offering a variety of services including after-treatment and employment programs. Through user participation and user organization qualifying activities can be developed which, in addition to a higher quality of life, may contribute to people becoming self-supporting. It has been estimated that 50.000 people are socially marginalized. It is less than one per cent of the total population. They are very often hit by a mix of various problems such as debt, substance abuse, mental illness, alcoholism, crime and homelessness. Drug misusers are estimated at about 14.000, homeless people at about 4,500 and mentally ill people requiring special social initiatives at about 30,000.
Homelessness
On a yearly basis around 18,000 enrolments of about 4,500 people are made in homeless institutions, of these 80 per cent men. However, the term homeless is often defined quite broadly to include a larger group than roofless people. People, who has an apartment but who have difficulties to manage for themselves and who on and off are institutionalized are often counted among homeless. In this broad sense of the word, almost equivalent to socially excluded, there might be around 10.000 homeless. According to law, everybody in Denmark has the right to accommodation, not only families but also singles. This right is to be ensured by the local governments, which have a statutory responsibility, against payment, to help people in urgent need of housing. To carry out the responsibility, the municipality has the right to assign dwellings to people in acute need to one-fourth of non-profit dwellings within the municipality. When these facilities are unavailable, the obligation can be fulfilled by visitation to a temporal residence. The regional councils have to make provisions for the necessary number of places at institutions intended for temporal residence for persons who do not possess, or cannot stay in, their own dwelling, and who because of special social difficulties need to be offered a place to dwell or who need activating support which cannot be provided through other legislation. There are 83 varied institutions in Denmark for this target group. The number of beds is around 2.300. Some of the institutions are directed toward a narrow group of people such as battered women, whereas others have a broader focus. Most rooms at the institutions are single rooms with a bed, a closet and a desk. The institutions have become smaller during the last 20 years, from 57 beds in average pr. institution in 1977 to 28 in 1997. The number of staff pr. day-user is 0,6. A new legislation in 1998 replaced the concept of institution with types of dwellings, thus separating housing arrangements from related support measures. Prior to the new legislation, the clients were in some ways declared incapable to managing some of his own affairs, for instance their maintenance as they were subjected to guardianship, supplied with food, clothing and pocket money. Now, the needs of the individual shall be evaluated and individual measures directed towards these needs shall then be provided, for instance housing, activation, rehabilitation, sheltered employment. According to the principle of individuality the homeless person has the same rights and duties as any other person. Instead of just a shelter the local administration must provide a range of possibilities in accordance with the needs of the homeless. Such places can be shared dwellings, core and cluster housing, staircase communities or traditional institutions. Supportive measures shall be provided independent of the type of dwelling in which people live. For people who are not able to live in their own dwelling can be provided a form of supported accommodation which is between an institution and a home, for instance in shared dwellings or in special sections of other housing arrangements. For people with special social problems, who after staying in temporary housing are not capable of living in their own ordinary flats, it is possible to carry into effect more flexible housing arrangements of permanency taking into account the need of permanent support. These arrangements are in-between an institution and an ordinary flat: shared housing in the same stairs with separate private rooms and shared kitchen and living room for 4-8 Some of the homeless are so deviant in their attitudes that they have proved impossible to integrate into the ordinary housing system, also in in-between institutions. A now initiative has been launched with Unusual Housing to Unusual Characters. Instead of adapting the homeless to the dwelling the dwelling is adapted to the homeless. They are ensured a room and some privacy. At the same time they are looked after. Such dwellings might be on boats, in huts or a cottage in a garden or a sort of In general, homelessness in Denmark is a social problem more than a housing policy problem, although a lack of small and cheap dwellings might lead to homelessness for people in low-income groups. For the worst off, those living in shelters for homeless, the mortality rate is significantly higher than for all people of same age. For women in shelters the mortality rate is 25 times as high, and for men it is 14 times as high. For battered women there are crises centers where they can stay over-night, in some centers with children. Most of the centers have agreements with public authorities. A substantial part of the people sheltered at these institutions have a foreign background. Recently an organization of homeless people has been set up in all counties, and nation wide tentatively. Homeless people are also invited to participate in national conferences on te most vulnerable groups arranged by the Ministry of Social Affairs. The reason is that homeless people should have a say in affairs concerning their situation. The activities are publicly supported. Homeless issue a street paper and broadcast radio and TV programs. Alcoholics
On alcohol, Denmark is known for a “liberal” attitude. It means, alcohol is easy to get. You can by it in retail shops. Licences are required only for bars selling alcohol. There are only few restrictions, for instance on age, and a self-disciplinary code restricts advertising of alcohol. Advertising must not target young people or encourage excessive drinking or idealize alcohol. Taxation is considered as a means to limit alcohol consumption. Beer and “snaps” are natural ingredients on the lunch table for many Danes, not least in weekends and holidays. The average consumption of alcohol in Denmark is 12 liter pure alcohol per inhabitant over 14 years. The consumption has been quite stable since mid-70s but there has been a shift between beer, wine and spirits. Since 1970, wine consumption (38 per cent of total consumption) has tripled at the expense of spirits (12 per cent) and beer (50 per cent). The consumption of alcohol is not bigger compared to many South-European countries. However, The Health Commission estimates that between 200.000 and 260.000 people drink too much. It is estimated that about 75 per cent of the heavy drinkers are men. The largest group is between 25 and 44. More than half of the misusers is single and unemployed. The responsibility for treatment of alcoholism in Denmark rests with the counties. County-based treatment occurs within the framework of the Hospital Law. Also voluntary and private organizations provide treatment and care service at outpatient clinics. Treatment often includes antabuse treatment, and therapy. In most cases, detoxification is carried out at hospitals. There are inpatient treatment centers. A stay at one of these centers lasts in general from five to 12 weeks. The centers are often run by Christian agencies. The service is funded through agreements with the counties. Some private companies fund outpatient or inpatient treatment stays for their employees. Company-funded treatment on recommendation of a physician is tax deductible. It is not allowed to sell alcohol to persons under 15 years of age. It is the lowest age limit in Europe. Denmark has the highest consumption in Europe of alcohol among teens. Over half of all 15-16 years olds has consumed alcohol more than 40 occasions, and 41 per cent declare they have been drunk at least 20 times. 76 per cent of the Danish teens have drunk a glass of beer before they turn 13 years old. The number of deaths because of alcoholism per 100.000 inhabitants is 30 – a triple since mid-60s. The temperance movement has never had the same influence in Denmark as in other countries, for instance Sweden. In general, prohibition and restrictions is said to be against the Danish attitude. Instead youngsters in school are told about the risk of alcohol and other kinds of intoxication as elements in preventive measures. Yearly campaigns are carried out to reduce health-damaging consumption among men and women as well. More companies adopt a stricter alcohol policy on the workplace, and a number of companies train employees to support colleagues with alcohol problems. Drug abusers
Treating older drug misusers, methadone is used systematically and in general in connection with other programs. In Denmark, methadone was introduced in the 1960s by private medical practitioners. After a period of almost unrestricted prescription, the authorities in the 90s mapped out tighter guidelines for using methadone. There must have been a long-term opiate abuse, and the drug addict must be motivated to stop illegal abuse (side abuse), and alternative treatment must be deemed of having no possibility of success. The responsibility for social treatment and methadone treatment is under the regional authorities. The distribution of methadone is controlled in clinics, where the actual intake of methadone is watched over. To control side abuse, a urine test is frequently carried out as well as needle-mark control. The reason for using methadone is to increase social stability of the drug addict and reduce crime. The police estimates that between half and three quarters of the burglaries in private dwellings are committed by drug addicts to cover costs of drugs. About 7,500 drug addicts are being treated, most of them outpatient. About 70 per cent are heroine addicts. There are about 40 residential institutions for drug misusers, and over the country there are day-shelters.
HIV/AIDS
The number of AIDS diagnosed was 2,254 in the period between 1980 and 1990. The number of diagnosed peaked in 1993 and had hereafter fallen steadily. Up to the end of 1999, 2,791 persons were reported HIV infected. Also HIV patients have fallen steadily. Compared to a number of other European countries relatively few drug addicts in Denmark are HIV-positive or have AIDS. In 1997 it was estimated that the prevalence of HIV and AIDS among Danish drug addicts is 4 per cent. Relatively few drug addicts share needles, and in areas with many drug addicts there are needle exchange programs in order to contain spreading of HIV virus. The Danish policy on HIV and AIDS is based on information and avoiding HIV by promoting safe sex with condoms among people not living together in stable relations. In case of infection anonymity can be preserved. It is a punishable offence to infect another person deliberately or by showing reckless behavior.
Mentally ill
There are about 40.000 – 50.000 mentally ill patients in Denmark. The overall service offered to mentally ill includes a large number of different treatment ranging from medical treatment to various forms of conversational or environmental therapy. To these can be added various social offers such as employment, drop-in centers, nursing homes and other sheltered residential facilities provided primarily by county and municipal social authorities. Recent years have seen a fundamental change in the organization of treatment and care of mentally ill persons. From emphasis on hospitalization and large-scale institutions, focus today is on district psychiatric centers providing treatment, care and social support. The reason behind this de- institutionalization has been that the conditions for mentally ill should resemble the conditions for other people. The psychiatric patients should be helped to live a life as close as possible to normal life, preferably in their own homes. The number of beds on the psychiatric hospitals has been cut to about one-third while steps have been taken to set up and expand a series of district psychiatric and sociopsychiatric offers. Sociopsychiatry aims at providing better living conditions for the mentally ill, not least to break the isolation of the mentally ill and link him/her to activities in the district. District psychiatry is an offer of outpatient help to mentally ill people in a delimited district with a population base of 60.000 – 90.000 people. The centers cover different types of service. Some offer treatment approximate to those provided at the hospitals. In others greater emphasis is attached to work on the social conditions. The offers may include medical treatment, psychotherapy, and activation. The centers are also in charge of instructing and supervising caseworkers, home-nurses and other staff attached to the local social welfare office. Patients can either approach the district psychiatric centers themselves or be referred by a general practitioner or psychiatric ward. Different kinds of housing options are available to mentally ill if they cannot fend for themselves in independent housing. To enhance the value of the offers, a support-contact person scheme has been introduced. Support-contacts persons serve the purpose of building and keeping contacts for and to people with mental illness. To the greatest extent possible they must also interact with relatives and
For mentally ill there are sheltered employment at institutions.
Disabled
The aim of the policy for disabled people is equal treatment of and equal status for disabled people and a life as close to the norm as possible and with influence on their own life. 40 per cent of all disabled persons in the age group 18 to 60 years are employed on ordinary terms. Since 1994 all regional employment services have been employing disability consultants who have the special task of finding employment for disabled persons. Disabled are guaranteed a pension, and necessary service and facilities are provided for housing by the local government. They are eligible for assistance of adaptation of their homes, for instance adaptation of kitchen, bath and toilet and access to the home. If they cannot stay in their own homes they might live in small institutions or shared housing with assistance. They can also be assisted in Job opportunities for disabled people are utilized, perhaps with adaptation of the workplace and by supplementary pay schemes. Local authorities are responsible for rehabilitation and employment of the disabled. In general, the aim of the disability policy is to create a society allowing people with reduced functional capacity to function on equal terms with other citizens, and where that is impossible to provide individually adapted compensating measures. The policy is based on three principles: 1) equal treatment and equal status for disabled people, 2) the sector responsibility principle, implying that the person responsible for the sector is also responsible for the area’s being accessible to disabled people, and 3) the compensation principle implying that, to the widest extent possible, people with reduced functional capacity should be compensated for the consequence thereof. Among the schemes available for disabled people can be mentioned: Advisory and counseling services; coverage for necessary additional expenses; personal help and care; aids and consumer durables, when such devices may considerably relieve the reduced functional capacity and/or enable the disabled person to ply a trade; support towards the purchase of a car to persons whose functional capacity considerably impairs the person’s ability to gain or maintain employment or complete training and education or when a car may substantially facilitate his or her daily life; adaptations to the home when this is necessary to make the home better suited for the person concerned; accompanying persons to make it easier to participate in leisure activities and interpersonal relations (disabled are entitled to monthly 15 hours of escort to friends, cafes, cinemas etc.); free transportation to and from treatment and activities and interpersonal relations. For persons who need extensive help, a monthly grant is given to cover up to 24 hours assistance day and night, in rare cases more than 24 hours. The disabled can personally decide whom they want for helpers. Locally, co-ordination committees are set up to promote measures on the labour market to enhance employment opportunities for the most vulnerable groups. The committees consist of representative of employee organizations, employers, general practitioners, the Public Employment Service, local authorities and the Council of Organizations of Disabled People. The committees advice the local authorities on social efforts aimed at the labour market and bring about a common understanding of what is needed to further employment of vulnerable groups. Since 1980 the National Handicap Council has followed and evaluated the conditions in society for disabled people. The Council can forward proposals in areas affecting the living conditions of disabled persons. All administrative authorities may consult the Council, which has become practice. The politicians have refused a special legislation for disabled people. Instead all public authorities and private enterprises are recommended by a Parliament resolution to comply with the principle of equal treatment of disabled and non-disabled citizens. An Equal Opportunities Centre was established in 1993 to collect information and expertise regarding the conditions for disabled people and to be aware of cases of discrimination against disabled people. Each year the Centre publishes a report, which forms the basis of a statement delivered to the Danish Parliament by the Minister for Social Affairs.
Urban regeneration
A new kind of social work surfaced in the 1990s. Social work has traditionally been oriented towards individuals and families. Urban regeneration work takes place in the district where people live. Not the individual but the district is the “client”. The objective is to improve life in the district. In Denmark the Government sat up an Urban Committee with the aim of starting development in deprived residential areas to give the district a social lift without displacing the original inhabitants. The organizational model rests on three main principles: Multidimensionality, partnership, and participation. The solutions should be found within a multifaceted, coherent, and total strategy; there should be created binding co-operation between relevant actors in the district, and emphasis was placed on partnership and responsibility between public and private organizations – and the inhabitants in the district should participate in the planning, decision making and implementation of the activities, also to the advantage of socially marginalized groups. The local decision-making process should be more open, and it should be easier for local inhabitants to take part in the process. This was a quite new model for urban development and co-operation between public authorities and residents, between bureaucrats and fiery souls. The model is based on maximum participation from local residents. The model has had its teething pains but it has also proven a viable model. In most of the urban regeneration projects, the residents have played a major role in formulation of plans for their area, for instance for traffic, physical renewal, job creation, culture, environmental improvement, housing, leisure activities, integration etc. However, the projects do not mean a formal political decentralization of decision making. The local government is responsible for the activities but consensus-steering and lasting consensus has been aimed at as the basis for further development. If conflicts occur they have to be negotiated and settled before moving on. The project presupposes agreement and partnerships among the residents. By no doubt, the projects will influence the municipal administration. When a broad consensus is reached among local residents the legitimacy of the process cannot easily be questioned by the bureaucrats. Also routines of the administration are challenged by officials taken part in partnerships with the citizens.
Adult education
For some years lifelong learning has been a very important policy field of action. The information and knowledge-based society and the increasing use of technology make heavy demands on the individual’s capability to acquire new knowledge, not only as a one-time acquiring, but as an ongoing process during the entire life. Participation in adult education is generally expected to be essential to maintaining competencies and qualifications and to retain an affiliation with the labour market. 30 per cent of the Danes between 20 and 60 years have received no professional training. 15 per cent have higher education on university level. 48 per cent are skilled workers or have completed other kinds of intermediate training. Adult education is a common tool to improve the qualifications of the work force. All sorts of schools, public as well as private, offer a wide range of general education courses as well as vocational oriented, continuing training for skilled and unskilled workers and for persons with higher educational qualifications. Every year almost every second Dane takes part in one or another form of adult education. About 25 per cent of the labour force participate yearly in training activities. Lifelong learning for all is a core issue on the political agenda for the coming years, from the level of unskilled workers to persons with university degrees. One of the new instruments is called preparatory adult education, which aims at improving the basic skills of adults, defined as reading, spelling, written presentation and arithmetic and basic mathematics. The teaching is organized in such a way that it can take place at the workplaces of the participants rather than in training institutions. This education is offered to all persons over 18 years.
Adult vocational training
Targeted vocational training for adults is an important feature of the labour market policy. The vocational training system offers training to persons who are already in employment as well as to unemployed persons. The objective is to give, maintain and improve vocational skills in accordance with needs on the labour market, to solve restructuring problems on the labour market and to contribute to a general lift in the qualifications on the labour market. Often general education is combined with vocational training elements. The qualifications are formally recognized on the labour The organization of the training activities is based on co-operation between partners on the labour market and the Ministry of Labour. There are 24 Labour Market Vocational Centers with a number of units all over the country. The centers offer training in more than 50 occupations. Each centre is run by a board, which is responsible for the activities. Each occupation has a committee for continued training responsible for the content of the training programs. On national level, there is a Vocational Training Council, which advises the Minister of Labour on training programs. In general, the courses take one to three weeks, and not more than six weeks. Some specially organized programs intended for unemployed persons have a duration of op to 18 months. Folk High Schools
A folk high school is a school for adults, emphasizing general existential learning for life education. There are around 100 folk high schools in Denmark, and every year some 2 per cent of the Danish population attend a course at a folk high school. Folk high schools are boarding schools. During the course students and staff live together. Most schools run 4-8 months courses during the winter for younger people (around 18 -. 25 years old) and 1-2 week’s courses during the summer for people of all age, including pensioners. Some schools are large and can accommodate hundreds of students while others have rooms for around 30. The schools are self-governing institutions with a board. The first folk high school was inaugurated in 1844, when 18 farm labourers gathered at a farmhouse to prepare themselves for the coming democracy. In the years to follow several schools were established, and they got a tremendous impact on the Danish society and its development. The founder was N.F.S. Grundtvig (1783-1872), a clergyman, hymn writer, historian and politician. He was himself a bookish man, but he reacted against “dead learning”. During the 1830s Grundtvig published a serious of papers sketching out plans for a higher civil service schools where administrators should sit side by side with young farmers, tradesmen, workmen, fishermen and house maids, so they learned the needs and wants of the ordinary people they were to serve in the new democracy. It never really went that way, but the ideas inspired peasant farmers, and the high schools helped them to gain authority and self-confidence to take full advantage of the democratic rights granted them under the Constitution of 1849. Since then all walks of life have gained resources from the folk high school, including the labour movement. The folk high schools are microcosmic societies, and many a young man and woman have been prepared for social life and popular involvement at the high schools. A folk high school put emphasizes on the vital potential already inside the students and tries to help it grow and develop. Rather than reading textbooks the students discuss. The teacher’s job is to bring a subject to life for the students through “the living word”, speaking as much to the heart as to the brain. The subjects are literature, history, psychology, ecology, education, music, drama, sport, dance, art, photography, civic, nature, international politics, etc., all provided as general broadening education. Folk high schools are forbidden to examine the students and to provide vocational education. There are no prescribed syllabuses. The schools rely entirely on the commitment of the students and the ability of the teachers to motivate them. The basic task is to educate students for life shedding lights on basic life questions facing the students, both as individuals and as members of society and to open up for dialogues. The most important book at a folk high school might be the Songbook with a total of 600 songs covering a wide range of aspects of life. Folk high schools are supported by the State. The idea of the folk high school is also used in day high schools that offer general education with the aim of strengthening the students’ personal development and improve their chances in the education
Production schools
Production schools offer training based on practical work and production to young people under 25 who have not completed a course of academically or vocationally youth training and who do not have the qualifications to start on such a course. The objectives of the training are to strengthen the personal development and to provide young people with qualifications enabling them to complete There are about 110 production schools in Denmark. This school form emerged from an experiment combining education and production, which was carried out at the end of the 1970s, mainly for unemployed young people with a low level of education. The schools are established on a municipal initiative. The basis for the learning processes at the schools is a number of workshops with practical work of traditional crafts such as wood, metal, construction and agriculture, but recently new lines such as music, drama, and multimedia. In addition, the schools offer teaching in general subjects. However, there are relatively few overall guidelines, and the individual school is characterized by a number of individual factors. The stay must not exceed one year. A typical stay is about six months, but there are big variations. Youth education
Around 20 per cent of every youth class do not get an education that provides them with work qualifications. Early actions are taken for young unemployed under the age of 25 years lacking such qualifications. After a six-month period of unemployment they now have the right and obligation to receive an education offer lasting one and a half-year. The aim of education is that 95 per cent of a birth group should complete a qualifying education. New initiatives have recently been launched to promote and realize that aim. It is the intention to create an education system that takes individual competencies and strengths into account and to start with the The Vocational Basic Education is primarily for youths about 16 – 18 years old, who because of learning difficulties or social reasons need to become personally qualified before completing an ordinary education or to get a job on the labour market. The aims of Vocational Basic Education are to qualify for employment or to prepare and motivate for further education. The courses are mostly practically oriented. The Vocational Basic Education takes 2 years, and the activities change between courses at vocational schools (one-third) and trainee service (two-third). The courses last 30 weeks. The trainee service takes place at ordinary workplaces, for instance car repair workshops, catering firms, or building and construction firms. The Free Youth Education was introduced in Denmark in 1995 as an attempt to reach young people tired of schooling and academic learning. The Free Youth Education breaks with stiff structures in the traditional educational system, and the student is, in co-operation with a professional counselor, made responsible for the planning of his/her own individual education. The Free Youth Education takes not less than two years and must consists of at least three education modules chosen by the student. Such modules can be for instance a folk high school course, a practice and project period, a stay abroad, but almost all opportunities are open. The Free Youth Education does not finish with a final examination or diploma, but the student and the counselor together write a declaration about the specific educational course, which serves as a certificate for entering ordinary education. Voluntary social work
There are more than 300 national voluntary social and health associations and organizations in Denmark, and more than 3.500 local branches and local organizations. It means one social or health organization per 1.500 inhabitants. Counting all voluntary organizations including sport and culture means one voluntary organization or association per 150 inhabitants. The voluntary social world is wide and multiple, from small local organizations to big, well established and professional organizations with more than 100 staff members. Add to that self-governing institutions, which carry out work according to an agreement with the municipality, for instance for children, youngsters and elderly people. About one fourth on all day care institutions for children are run as self governing institutions, as well as institutions and centers for elderly people, crisis centre, warm rooms and treatment institutions for alcoholics and drug addicts. These self-governing institutions are often branches of national associations. It is a characteristic of Danish voluntary work that it is membership-based. About 75 per cent of all voluntary organizations are membership organizations. It mans they are run according to statutes, they have a management or leadership, and they have members who pay a fee to the organization. However, organizations working with socially excluded people are not membership-based. Often they are church-based or self-governing institutions. The majority of these organizations are founded in the first half of the 20th. century. About 7 per cent of the population in Denmark do unpaid voluntary social work, and 31 per cent do unpaid work. A great majority of the population believes that voluntary social work contributes to increasing the responsibility people feel in relation to one another. Voluntary work is necessary for a better society. Voluntary activities are flexible and reach further and wider than public initiatives. In average, people who have committed themselves to do voluntary social work, work 4 hours a week. 16 per cent work more than 20 hours a month. The rate of people doing voluntary work is higher among people, who have a professional job. Among functionaries and public servants about 38 per cent do voluntary work, while the percentage among unemployed is 15. There is an almost equal distribution of men and women. Most active are men and women aged between 30 and 59. Voluntary social activities can be divided into three main activities: • Activities for people: counseling, advice, hot lines, self-help groups and visit groups for elderly people. In recent years more hot lines have emerged, for instance the Cancer Line, the Heart Line and the Mind Line. Self-help groups are based on people’s wish to change their life situation. It is estimated that there are about 1.800 self-help groups in Denmark • Information and campaigns, which defend the interest of certain groups, for instance sick or handicapped people and want to increase understanding of special problems of a specific group in the population. Often these organizations have political influence. Voluntary social work is a platform where all groups in society may be heard and may defend their own • Institutional activities for certain target groups: children, youngsters, elderly people, addicts, assaulted women etc. These institutions operate in a field with a fluid borderline between public and voluntary activities. Often the activities are financed by the public according to a contract. The institutions function as a kind of entrepreneurs for the public, and the staff is paid normal salaries. The staff is hired and professional. Children, young people and families are the target groups of most organizations (65 per cent), not least physically and mentally disabled people. Almost one third work for elderly people and about one fifth work for exposed groups in society. However, organizations catering for the needs of exposed groups are the largest and the most resource consuming of all the organizations. Local centers for contact between people who want to do social work and organizations that need voluntary staff have expanded the last ten years. There are about 50 such centers. Most of them arrange between three and nineteen jobs each month, some of them as much as 30-50 jobs monthly. Pursuant to the law, local governments must co-operate with voluntary social organizations and pay. It is a statutory obligation. Frame and scope of the co-operation is decided in the municipality according to overall guidelines from the government. The national government compensates for some of the costs of the municipalities. The voluntary social activities, reimbursed by the government, should expand the total activities in the municipality. A voluntary social organization cannot demand financial support from the local government. It is the local government’s decision which activities should be supported, but the priorities and criteria must be discussed with the voluntary organizations i co-operation fora. These priorities and criteria often constitute a voluntary policy. In the co-operation fora the local politicians and heads of the voluntary organizations discuss and exchange experiences to the benefit of the voluntary work. Every year the municipality must issue a report on voluntary social work. Before publishing, the report is read by the voluntary organizations, and they comment the report and give feedback. Also the national government supports voluntary social work by funding activities, in fact most of the funding comes from the national government. There are national programs for activities for sick people, socially excluded people, alcoholics, mentally handicapped, refugees, disabled people, children, and youngsters. The money is given to specific projects, in general not for more than one year. A proportion of the revenue of gambling and lottery are set aside for associations working in the Voluntary social work is not a substitution for public social work, and the responsibility for social conditions and the social service still rests with the politicians. Neither is the government, national or local, master of the voluntary organizations, imposing tasks on the voluntary organizations. They are not under command. The voluntary organizations are aware of the risk, that they become instruments of the State or municipality, for instance in a situation of cutting down public expenditures on home care to elderly people in their home. Such an attempt will not be met with approval from the voluntaries’ ranks. The voluntary sector should not be a cheap way out providing discount service. The relation between the voluntary organizations and public authorities is a relation of co-operation and conflict, and the voluntary organizations have the right to choose themselves the tasks, they want to carry out. It is not the job of the public authorities to interfere with the organizations. The organizations should be allowed freedom within general rules to fulfill another important task: to be a critical body to the ruling policy. Because the voluntary organizations often work directly with people, they become aware of new social problems, and they notice where and when the public service does not function well, and they draw attention to the needs of particular groups in society. They hold politicians to their promises, and they generate debate. New visions often come from voluntary social work, and the voluntary sector is a major contributor to change and innovation in relation to social work. They have the ability and the will to experiment and tread new paths in the area of social services. The voluntary sector very much plays a role of its own. In the beginning of last century the strategy of the voluntary organizations was to pass the problems to the State for solutions. The more the State took over the better. The voluntary organizations all found the building up of the welfare state more relevant. That is why the voluntary sector later became looked upon as unimportant and out of fashion. The State ought to take care of everything. This view has changed totally. Now the welfare state needs new models of thinking and acting and To promote the development of voluntary social work the Danish committee on Volunteer Effort was set up in 1983 by the Minister of Social Affairs. The committee consists of 29 members from voluntary organizations and from the local authorities and the Ministry of Social Affairs. The Committee is forum of debate concerning the role of voluntary work and the future of welfare state. It frequently organizes seminars and conferences. The aim of the Committee is to bolster the possibility for individuals, groups of citizens and private associations and organizations to participate in the solution of tasks in the social field, to collect information, to offer advice and guidance and make proposals to be used by national and local authorities and voluntary organizations as well. The Committee also offers guidance to the Ministry of Social Affairs concerning the voluntary social work in Denmark. In 1992, a Volunteer Centre was established. The Centre is an independent institution under the

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Wissenschaft Neue Leitlinie zur Behandlung des Hörsturzes Bedeutung für Patienten und behandelnde Kassenärzte von Prof. Dr. Gerhard Hesse Die Leitlinie zur Behandlung des Hörsturzes ist gerade aktualisiert worden. Prof. Dr. GerhardHesse, Chefarzt der Tinnitus Klinik Dr. Hesse am Krankenhaus Bad Arolsen, ist Mitglied derLeitlinienkommission „Hörsturz“ und erläutert im folgende

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