Hesitant Madams in a Global City: Japanese Expat Wives and their Global Householding in Hong Kong

Care work, once a sanctioned labor of love, is increasingly commodified in transnational contexts. The picture of migrant women shouldering the housework and child care of local professonal women may seem like a mutually beneficial arrangement—matching the “needs” of the haves and have-nots—, but the global care chain ultimately works to maintain the traditional gendered division of labor as well as global inequality. To this trend of globalization of care work, Japan has been an exception; however, how much longer it will be so is now in a question, as the government paves the way for importing domestic labor from abroad. This article focuses on Japanese expat wives in Hong Kong in order to locate Japanese women vis-à-vis the global care chain. The narrative analysis on how they decide whether to hire a domestic worker in their home away from home highlights the sociopolitical nature of their supposedly private choices. Some drew on cultural ideal of wifehood and motherhood to rationalize their choice while others referred to racialized or even overtly racist and classist images of foreign domestic workers. A few women spoke against the system itself, showing awareness of its inherent social injustice. All such narratives are never purely personal; their decisions and the rationalization behind them sustain the prevailing discourses of gender, race, ethnicity, culture, and class, which, in turn, envelop their attempts at global householding.     

Making Sense of After‐School Care Dilemmas in Mothers' Stories of After‐School Care in Finland and Sweden

The study focuses on dilemmas in storied experiences of everyday after‐school care arrangements among Swedish and Finnish mothers. Finland and Sweden, which share a history of strong labour market attachment among women, arrange institutional after‐school care in similar ways. The data consist of interviews with three Swedish and six Finnish mothers. A positioning analysis of four stories shows how decisions related to children's after‐school hours were allocated among different actors. Two reoccurring dilemmas, Competent‐dependent child stories and Unburdened‐deficient mother stories, emerged from the data analysis as related to prevailing moral discourses on childhood and motherhood.     

Maternity waiting homes in times of crisis: Can current models meet women’s needs?

BackgroundMaternity waiting homes (MWHs) located close to birthing facilities are a conditional recommendation by the World Health Organisation, based on very low-quality evidence that they contribute to improvements in maternal or perinatal health outcomes. In addition, several studies suggest that more vulnerable women are less likely to use them. Yet significant investments continue to be made in building and running MWHs within conflict-affected and under-resourced health systems.AimsWe critically examine the literature to shed light on the challenges and opportunities provided by MWHs during health emergencies and in conflict situations.Findings and discussionMWHs are difficult to utilise during crises because they require women to be away from home, are often designed as dormitories, can lack security and be over-crowded. Some MWHs have been adapted during situations of political conflict to incorporate birthing and broader reproductive health care, thereby improving the availability of care away from over-burdened health facilities. How MWHs are adapted during times of crisis may provide insights into what systems of care are more appropriate in meeting women’s needs more broadly.ConclusionThe current global pandemic is an important time to reflect on whether MWHs are meeting the needs of a diverse range of women, in times of stability and during emergencies, and engage in genuine dialogue with women about the kinds of maternity care they want. We need to co-create those systems now so that they are more resilient during the inevitable crises we will face in the future.     

Community care for adults with severe mental disorders in rural China: A case study

In China, family care is the dominant form of care for people with mental disorders. Since 2004, the government has been developing a community‐care model that places more responsibility on community organisations and the local governments at the provincial, municipal and county levels for the provision of formal care. As a large number of people with severe mental disorders live in rural China, this case study was conducted in a rural county in order to examine the development of community care. It was found that, although family care remains dominant, families’ need for formal care is increasing. Community services have improved, but their development is constrained by several contextual and micro factors. In this study, it is argued that the community‐care model introduces a process of reconfiguration of the relative responsibility for care among the family, social organisations and the government, but progress depends on further administrative and fiscal reforms.     

Health-care Work in Globalization: News Reports on Care Worker Migration to Japan

Health-care worker migration has emerged as a social issue in Japan, contrary to it has in Indonesia. This article shows how national contexts affected by globalization have shaped social understandings and policies towards health-care worker migration in the two societies over time. Analyses of news coverage in the Japanese and Indonesian national media reveal a gap of social responses toward this change. The Japanese are more likely to respond negatively to health-care worker migration; yet they intend to face cross-cultural challenges, although slowly, making revisions to related policies. In contrast, in Indonesia, from where health-care workers migrate to Japan and many other countries, this tends to be understood positively, overall, as providing economic benefits and permitting Indonesian professionals to contribute to the worker shortage in Japan. I interpret these results based on the literature on health-care worker migration, emerging global norms and local changes, and comparative research on employment and care work. This study contributes to the sociological understanding of worker migration and health-care issues.     

Psychometric properties of the Transitions from Foster Care Key Leader Survey

This study summarizes the development and piloting of the Transitions from Foster Care Key Leader Survey (TFC-KLS), an instrument designed to measure change in systems serving young people transitioning from foster care to adulthood. The Jim Casey Youth Opportunity Initiative’s logic model was used as a basis for instrument development. The instrument was piloted with 119 key leaders in six communities. Seven of eight latent scales performed well in psychometric testing. The relationships among the 24 measures of system change were explored. A CFA testing overall model fit was satisfactory following slight modifications. Finally, a test of inter-rater reliability between two raters did not find reliable reporting of service availability in a supplemental portion of the survey. The findings were generally positive and supported the validity and utility of the instrument for measuring system change, following some adaptations. Implications for the field are discussed.     

The embeddedness of organizational performance: Multiple Membership Multiple Classification Models for the analysis of multilevel networks

We present a Multiple Membership Multiple Classification (MMMC) model for analysing variation in the performance of organizational sub-units embedded in a multilevel network. The model postulates that the performance of organizational sub-units varies across network levels defined in terms of: (i) direct relations between organizational sub-units; (ii) relations between organizations containing the sub-units, and (iii) cross-level relations between sub-units and organizations. We demonstrate the empirical merits of the model in an analysis of inter-hospital patient mobility within a regional community of health care organizations. In the empirical case study we develop, organizational sub-units are departments of emergency medicine (EDs) located within hospitals (organizations). Networks within and across levels are delineated in terms of patient transfer relations between EDs (lower-level, emergency transfers), hospitals (higher-level, elective transfers), and between EDs and hospitals (cross-level, non-emergency transfers). Our main analytical objective is to examine the association of these interdependent and partially nested levels of action with variation in waiting time among EDs – one of the most commonly adopted and accepted measures of ED performance. We find evidence that variation in ED waiting time is associated with various components of the multilevel network in which the EDs are embedded. Before allowing for various characteristics of EDs and the hospitals in which they are located, we find, for the null models, that most of the network variation is at the hospital level. After adding these characteristics to the model, we find that hospital capacity and ED uncertainty are significantly associated with ED waiting time. We also find that the overall variation in ED waiting time is reduced to less than a half of its estimated value from the null models, and that a greater share of the residual network variation for these models is at the ED level and cross level, rather than the hospital level. This suggests that the covariates explain some of the network variation, and shift the relative share of residual variation away from hospital networks. We discuss further extensions to the model for more general analyses of multilevel network dependencies in variables of interest for the lower level nodes of these social structures.     

公共卫生支出、健康结果与卫生投入政策——基于189个国家和地区的面板门槛分析（1995—2011年）

利用189个国家和地区1995—2011年的数据实证检验公共卫生支出规模对一个国家的健康结果（婴儿死亡率和出生时的平均期望寿命）的影响，结果表明，公共卫生支出占GDP的比重对婴儿死亡率和出生时的平均期望寿命的影响具有门槛效应，门槛值分别位于1.9%和6.62%。分段回归结果显示，公共卫生支出占GDP的比重低于1.9%时，公共卫生投入对出生时的平均期望寿命没有显著影响，对婴儿死亡率的影响较弱；超过1.9%后，公共卫生投入的规模效应开始体现，对健康结果指标的影响均显著增强；超过6.62%后，公共卫生投入对婴儿死亡率的影响不再显著，对出生时平均期望寿命的弹性系数不再变化，单位边际贡献不再增加。中国当前政府卫生投入规模仍然较低，需要继续增大公共资金投入、降低个人卫生支出比重。     

政府支出对医疗服务健康公平影响的比较和启示

医疗服务公平和人民的健康是各国卫生系统向其国家居民提供医疗服务所应实现的两个重要目标。但以英美日为例的发达国家根据世界卫生统计年鉴中的医疗服务公平性排名确有明显差距，因此，高收入和高政府医疗卫生支出与医疗卫生服务公平和健康公平性并没有必然关系。本文通过比较分析美日英国的政府间医疗卫生支出责任划分的结构发现高政府医疗卫生支出比例是提高医疗服务筹资公平性的前提，中央承担社会医疗保险责任是实现医疗服务筹资公平性的保证，政府特别是中央政府出资的长期护理有助于提高国民健康水平，地方政府的参与更有助于提高一国医疗系统机构数量特别是医院的数量。