Who decides what’s good for you? How state philosophy shapes sex education.

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A few days ago I sat down with academic researchers tasked with evaluating the VIP project - a Swedish adaptation of the Australian sex education programme SLRR. A conversation that was meant to be about sexual health ended up focused on the nature of the state and this made me reflect on how philosophies of the state shape the welfare that it provides. 

The SLRR (sexual lives and respectful relationships) programme was a multi-week sex ed programme designed in Australia by people with intellectual disabilities for people with intellectual disabilities. It’s built on the principle of ‘nothing about us without us’ recognising that adults with intellectual disabilities are experts in their own lives. Swedish and Norwegian states adopted and adapted this programme and disseminated it across both countries, the Swedish model decentralised across municipalities and the Norwegian model centralised and adopted by NGOs. The Swedish evaluators of VIP reported that whilst it had many positive outcomes, particularly in relation to violence prevention and promotion of social wellbeing, it had all but lost the codesign element that was central to the original SLRR framework. What remained was more akin to a conventional curriculum delivered to people, rather than created with them. I was curious whether they could rationalise this process within the Swedish context, considering many Australian adaptations (such as EmpowerEd in Gippsland) had successfully retained codesign. Together we pondered whether the programme was shaped by the society it landed in, and whether Sweden, for all its extraordinary achievements in social welfare, has a particular relationship between state and citizen that could produce exactly this kind of outcome. 

In 1990, Danish sociologist Gøsta Esping-Andersen published The Three Worlds of Welfare Capitalism, which remains one of the most influential works in social policy. His key insight was that welfare states don't just differ in how much they spend on social welfare, they differ fundamentally in how they spend it, and in the configurations of state and market that shape broader power relationships and outcomes. He identified three broad types

• The social democratic model which aims at universal coverage and high decommodification, meaning your ability to live a decent life doesn't depend entirely on your market value as a worker (Scandinavia)

• The liberal model which is more residual and targets welfare at those who can't manage without it, leaving more to the market. (US/UK)

• The conservative-corporatist model which ties benefits to employment status and tends to preserve existing social hierarchies (Germany/France)

Michel Foucault’s concept of governmentality describes the way states don't just govern societies through force or law, but through the shaping of how people think about themselves and their needs - ‘the conduct of conduct’ (the control of behaviour). The welfare state, as a technology of governmentality, can liberate people from poverty and precarity but can also define them as dependent, in need of management, or incapable of knowing what's best for them. Neoliberal governmentality emphasises the active willingness of subjects in their own subjectification through the establishment of a culture of enterprise, responsible autonomy, and pervasive problematising of the welfare state. In other words: even our relationship to welfare is shaped by who designed the system we're in. If you grow up in a society where the state is the benign planner of your life, you may not develop the cultural habits of self-advocacy. If you grow up in a society where welfare is a floor rather than a ceiling, you may develop those habits but also fall through the cracks.

Sweden's welfare state is arguably one of the most ambitious ever built, marked by the use of big, centralised institutions and large-scale transfers, commonly provided on a universal basis with a view to reducing inequality, alleviating poverty, and insuring against social risks. This system is ideologically rooted in the 1928 leader of the Social Democratic Party Per Albin Hasson’s concept of Folkhemmet meaning ‘the people’s home’. He declared that Sweden should become like a good home marked by equality and mutual understanding. Whilst comforting in theory, this concept was closely associated with the view of the state as an organism that combines conservative and social democratic values including a strong sense of paternalism. 

Sweden's welfare engineering had its highlights in the planning era of the 1960s and 1970s, when large-scale social planning became embedded in how services were conceived and delivered. The result is that welfare professionals in Sweden, the social workers, educators and health practitioners, tend to be trained within a system that sees them as guardians of state resources and state-defined outcomes, rather than advocates for the individuals they serve. The general method is therefore: the state provides; the professional delivers; the citizen receives, the logic of which doesn't naturally produce co-design but encourages instruction. 

The question is therefore, would such a benign state discourage critical thinking about welfare design and provision, because when everything is being taken care of there's less impetus to question the terms on which care is offered? When there is a significant welfare state, flat hierarchies, and a high level of trust in the state to provide income, housing, healthcare and social protection, then is it possible that there is also a quieting effect, whereby it is harder to take a critical stance towards the hand that feeds? Does this result in a rigid distinction of professional and participant where the former knows best? 

I was curious to see whether this thought stands up in the Australian setting. Australia’s own welfare state has historically provided a floor not a ceiling, leaving people to manage their own lives. This residual approach came in with the Fraser Coalition in the late 1970s where neoliberal economists argued that the welfare state restrains the development of market economy and the freedom of individuals. As moral arguments around vulnerability did not pull at the heartstrings of the neoliberal politicians, disabled people were strategically positioned not as dependents needing more welfare, but as citizens with purchasing power who are being unfairly excluded from the marketplace. The current system of the National Disability Insurance Scheme (NDIS) founded in 2013 builds on this consumer model emphasising personalisation through choice and control as key to its design. This framing has its problems as it can reduce people to their market identities, not to mention can create a difficult commercial landscape to navigate for those with cognitive disabilities. However, it has also produced a strong tradition of positioning disabled people as agents who make choices, rather than passive subjects of state care.

Having considered bringing the SLRR approach to the UK as part of my project, I was compelled to reflect on how my state might intervene in the execution of such an attempt. The British welfare state emerged from post-war Beveridge reforms, creating the NHS and a system of social security, without the philosophical or theoretical coherence of the Scandinavian model. As such Britain retained a strong legacy of voluntary sector provision, civic activism, and (unsurprisingly) a culture of institutional scepticism.

This has produced a different orientation within social care provision, as the dominant professional ethic and identity is one of advocacy, with social workers (at least in theory) trained to see themselves as fighting for the client, navigating and critiquing the complex, bureaucratic systems that so often fail them. Even the language of ‘service-user’, as clunky and corporate as it is, captures a positioning of the person receiving support as an active subject not a passive recipient. As the welfare state never fully replaced civil society, there has always been more space for critical voices, and people diverting to professions less governed by state intervention. 

This system, as with all aforementioned, has weaknesses and the UK poorly veils its paternalism in ways that undermine the value of self-determination. A social worker can genuinely believe they are advocating for someone while still deciding what that advocacy should look like, what outcomes to aim for, and whose version of the good life to pursue. There are also fewer limits on the transformation towards a marketisation of welfare where a person becomes a consumer rather than a citizen with rights. Universal credit claimants, for example, experience the system as coercive rather than supportive, sanctions for missing appointments, pressure to take unsuitable work, and work coaches who have their own targets and incentives that don't necessarily align with the individual claimant's situation or goals. The balance between care and control remains contested.

Ultimately, the welfare state that most generously provides for people is not necessarily the one that most respects their autonomy and Sweden's extraordinary generosity coexists with a culture of professional guardianship. However the marketisation of welfare that positions people as consumers gives people theoretical choice in a system focused on profit, creating new forms of vulnerability even as it claims to dissolve old ones. The UK's advocacy model captures the idea that professionals should fight for individuals, not on behalf of the state but it's an incomplete solution when paternalism wears many disguises.

I’m leaving Stockholm with more questions that I arrived with, contemplating how adults with cognitive disabilities can be expected to navigate this complex political architecture to be empowered to identify and make the changes that they themselves want. How can any of us challenge paternalism when it comes in so many shapes and sizes? How can we be agents of change when the powers that be want us to be agents of the state? I hope that Malmo has more answers…

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Who decides what's good for you? How governments shape sex education

A few days ago I met with researchers who were looking at a sex education programme called VIP — a Swedish version of an Australian programme called SLRR. We started talking about sex ed, but ended up talking about something bigger: how governments shape the support they give people, and whether that support actually respects people's choices.

The original programme

SLRR (Sexual Lives and Respectful Relationships) was created in Australia by people with intellectual disabilities, for people with intellectual disabilities. The whole point was: "nothing about us without us." People with intellectual disabilities are experts in their own lives, so they should help design the programme.

Sweden and Norway both adopted this programme. But the Swedish researchers I spoke to found that, along the way, Sweden had quietly dropped the co-design part. Instead of being built with disabled people, it had become a standard course delivered to them. I wondered why — especially when some Australian versions had kept the co-design element successfully.

We started to think that the programme had been shaped by the country it landed in.

Different countries, different approaches to welfare

A sociologist called Gøsta Esping-Andersen wrote an influential book in 1990 identifying three broad types of welfare state:

• Scandinavian countries (like Sweden): The state provides a lot for everyone, aiming to make sure nobody falls behind.
• USA and UK: The state provides a safety net for people who really can't cope, but mostly leaves people to look after themselves.
• Germany and France: Benefits are tied to your job and tend to keep existing social structures in place.

A thinker called Michel Foucault pointed out that governments don't just support people — they also shape how people think about themselves and what they need. A welfare system can free people from poverty, but it can also send the message: you need to be managed, you don't know what's best for yourself.

Sweden: generous but paternalistic?

Sweden has one of the most generous welfare states in the world. This goes back to a 1928 idea called Folkhemmet — "the people's home" — the idea that Sweden should be like a good family home, equal and caring. It sounds lovely, but it also comes with a strong sense that the state knows best.

Swedish welfare professionals — social workers, teachers, health workers — tend to be trained to deliver what the state has decided people need, rather than to fight for what the individual in front of them actually wants. The system works like this: the state provides, the professional delivers, the citizen receives. That doesn't naturally lead to co-design.

I started to wonder: when the state takes such good care of everything, does it become harder to question how that care is delivered? When your housing, healthcare and income are all sorted, is it harder to criticise the hand that feeds you?

Australia: more choice, but also more risk

Australia's welfare system has always been more of a safety net than a full service. From the late 1970s, the argument was that the welfare state holds people back — that disabled people should be seen not as dependents, but as citizens with purchasing power who deserve access to the market like everyone else.

The current disability support system (the NDIS, set up in 2013) is built on this idea — giving people choice and control over their own support. This is good in some ways: it positions disabled people as people who make decisions, not passive recipients of care. But it also has problems — it can reduce people to their financial identity, and navigating a commercial marketplace is genuinely hard for people with cognitive disabilities.

The UK: somewhere in the middle

The British welfare state was built after World War Two, but without a strong guiding philosophy behind it. This left a lot of room for charities, community groups, and campaigners to fill the gaps.

As a result, UK social work has developed more of an advocacy culture — the idea that a social worker's job is to fight for the person in front of them, not just deliver what the system has decided they should have. Even the clunky phrase "service user" at least positions someone as an active participant, not just a recipient.

But the UK hides its paternalism well. A social worker can genuinely believe they're advocating for someone, while still deciding what that advocacy looks like and what a "good outcome" means. And the drift towards marketisation means people are increasingly treated as consumers rather than citizens with rights. Universal Credit, for example, often feels coercive rather than supportive — full of sanctions and pressure that don't match what individuals actually need.

So what does this all mean?

The most generous welfare state isn't necessarily the one that most respects people's independence. Sweden gives an enormous amount, but alongside a culture where professionals are trained to know best. Marketised welfare gives people theoretical choice in a system that's really focused on profit. The UK's advocacy approach has the right idea, but paternalism finds ways to creep back in regardless.

I'm leaving Stockholm with more questions than I arrived with. How can adults with cognitive disabilities be expected to navigate all of this complicated political landscape just to have a say in their own lives? How do any of us challenge paternalism when it comes in so many different disguises? How do we become agents of change when systems tend to want us to be agents of the state?

I hope Malmö has some answers.