Seeking the Ideal of Universalism within Norway's Social Reality

Abstract

How much inequality in policy instruments can a universalist welfare state tolerate in its pursuit of equity? This article reviews the nuances of universalism as a concept through examination of its meaning and application in Norwegian health policy, with a contextual focus on migrant maternal health in Norway. The Nordic welfare model is generous and dedicated to achieving equality through the universal provision of social services; however, there are increasing gray areas that challenge the system, invoking the conundrum of equality versus equity. Universalism is a central principle in Norwegian health policy, however changes in the socio-political environment have meant the concept as originally conceived requires a more nuanced articulation. Population changes in particular, such as a growing and diverse migrant settlement, present challenges for how to achieve the equality desired by universalist measures, while maintaining the equity demanded by diversity. This article uses an example of a Norwegian program that delivers maternal health services to migrant women to question the concept of universalism as a theoretical and practical construct, as historically and currently applied in Norwegian health policy. This example illustrates how healthcare as an organization functions in the country, and the role of its key players in adapting policy instruments to meet the Norwegian welfare state’s universal policy aims. The scholarly contribution of this article lies in promoting a critical reflection on the evolving definition of universalism, and in contributing to a discussion on the need to retheorize the concept in Norwegian health policy to attain equity.