Open Access Research article

Living on social assistance with chronic illness: Buffering and undermining features to well-being

Anneli Marttila1*, Eva Johansson2, Margaret Whitehead3 and Bo Burström1

Author Affiliations

1 Division of Social Medicine, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

2 Division of Global Health/IHCAR, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden and Nordic School of Public Health, Gothenburg, Sweden

3 Division of Public Health, School of Population, Community and Behavioural Sciences, University of Liverpool, UK

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BMC Public Health 2010, 10:754  doi:10.1186/1471-2458-10-754

Published: 6 December 2010



In Sweden, the social security and sickness insurance systems are comprehensive and aim to provide people whose illness prevents them from earning their own living, with either sickness benefits or disability pension. Some, however, are not entitled to these benefits or receive social insurance benefits at a level too low for subsistence, and are referred to social assistance. The purpose of this study was to explore in depth how social assistance recipients with chronic illness perceive and respond to the experience of living on social assistance.


Seventeen in-depth interviews were carried out with chronically ill people who had received social assistance for several years. Grounded theory informed the design of the study.


The study showed that different strategies (living one day at a time, taking steps forwards and backwards and making attempts to find ways out of the situation) were employed by social assistance recipients to maintain or improve their well-being. Contextual features like the prevailing welfare system, public services and the local neighbourhood could buffer or undermine these strategies and their overall well-being. These features together influenced how interviewees perceived their situation, the possible ways out of the situation and the consequences for their well-being.


From this study it is evident that the way in which individuals on social assistance interact with services and how they are treated by professionals plays an important role in their well-being, in combination with what kind of help and support is available for recipients through the welfare system. In this respect, persons living on social assistance with chronic illness are particularly vulnerable. This study suggests that more effort should be made to find long term solutions concerning income support, rehabilitation and other services provided to this group.