Gender and health among older people: What is the role of social policies?

The study investigated how social policies moderate the association between gender and health among older people across European countries. The study is the first to take a comprehensive view on the role of social policies in connection with gender inequality in health among older Europeans. The association between gender and poor self‐rated health and limiting long‐standing illness was investigated in a multilevel framework. Cross‐level interaction effects showed that more generous minimum pensions, higher spending on eldercare and a higher degree of eldercare formalisation are associated with relatively better health among women, while more generous standard pensions are associated with relatively better health among men. The conclusion is that policies directed towards older people are not gender neutral; rather they are likely to affect men and women differently. By shaping the distribution of resources as well as of unpaid work, social policies can contribute to either strengthening or weakening the link between gender and health.     

Playing the Game of Outcomes‐based Performance Management. Is Gamesmanship Inevitable? Evidence from Theory and Practice

This article presents the case for the need for a re‐think in the prevailing orthodoxy of measurement approaches in the governance and management of public services. The article explores the simplification of complex reality that outcomes‐based performance management (OBPM) requires in order to function, and the consequences of such simplification. It examines the evidence for and against the effectiveness of OBPM, and argues that both sets of evidence can be brought into a single explanatory story by understanding the theory of OBPM. The simplification required to measure and attribute ‘outcomes’ turns the organization and delivery of social interventions into a game, the rules of which promote gamesmanship, distorting the behaviour of organizations, managers and practitioners who undertake it.     

Understanding the Relationship between Income and Health: How Much Can be Gleaned from Cross‐sectional Data?

The aim of this paper is to develop a better understanding of the relationship between income and health using a cross-sectional survey of the general British population. It is divided into two parts. First, it examines a number of methodological inconsistencies in the existing literature and assesses their consequences for the inferences that can be drawn about the income–health association. These issues include: the measurement of income and its functional form; health selection; and the role of confounders. Second, it explores the relative strength of the income–health association in contrast to that of other socioeconomic measures. The relationship between income and health is complex. However, having taken into account a range of methodological problems, income is still significantly associated with health. The association appears to be non-linear and is attenuated but not removed by controlling for health selection effects. The inclusion of a wide range of confounders into models of income and health reduces the association between them, but does not make it insignificant. In comparison to other socioeconomic measures, income appears to be a better discriminator of health status than education or occupation. However, tenure and car ownership seem to be at least as good if not better than current income.     

Do peer effects mediate the association between family socio‐economic status and educational achievement?

Differences in levels of academic achievement according to socio‐economic status (SES), and parental education in particular, have been a persistent feature of Australian education systems. Young people with highly educated parents are more likely than their peers with low‐educated parents to attain high levels of achievement at school. Students with low levels of achievement are less likely than their high achieving peers to complete Year 12 and are more likely to experience negative post‐school outcomes. The SES of the neighbourhood, and in particular, the school attended, has also been found to have an effect on levels of both academic achievement and attainment. For this paper, we conduct analyses of National Assessment Program – Literacy and Numeracy test scores for four cohorts of secondary school students attending government schools in the Australian Capital Territory to examine the associations between parental education, school attended and levels of educational achievement. Our findings show that students with university‐educated parents achieve at much higher levels than their peers with low‐educated parents and that attending a school with a higher proportion of students from educationally disadvantaged families has a negative effect on educational achievement.     

Being counted? Examining the prevalence of looked‐after disabled children and young people across the UK

Since the 1970s, there has been growing academic interest in children and young people living in state care and, more recently, in the lives of disabled children. However, there has been little attention on the lives of disabled children who are looked after by the state. This paper compares and critiques what is known about the numbers of disabled children who are looked after in England, Northern Ireland, Scotland and Wales. We discuss the conceptual and methodological limitations of systematically collecting data on disabled children in state care across the UK. We argue that to ensure that the rights of disabled children in state care are identified, acknowledged and upheld, ‘being counted’ is a fundamental first step.     

Reaching universal coverage by means of social health insurance in Lesotho? Results and implications from a financial feasibility assessment

This article discusses the process, results and implications of a financial feasibility assessment of social health insurance (SHI), as one part of Lesotho's exploration of how to move towards achieving universal health care coverage. Quantitative data from government and other sources, and qualitative data from discussions with stakeholders, were entered into SimIns, a health insurance simulation software, through which SHI revenue and expenditure for 11 years was projected. In principle, the assessment reveals that through a mix of tax financing and SHI contributions, all citizens of Lesotho could be covered with a defined benefit package of health services under the defined policy assumptions. Such a financing scheme would provide financial risk protection and enhance equity in access and health financing.     

Capitalizing the Crisis? Explanatory Factors for the Design of Short‐time Work across Organisation for Economic Co‐operation and Development Countries

This article looks at the financial and economic crisis 2008–10 in 18 Organisation for Economic Co‐operation and Development states and seeks to investigate explanatory paths for the subsidization of further education within short‐time work programmes. Several hypotheses are put to the test: first, a classical partisan difference argument; second, a varieties of capitalism approach proposing a successful joint rallying of employers and employees for subsidization in coordinated market economies; and, lastly, the merged hypothesis that right‐wing parties in a coordinated economic context might subsidize feeling the pressure to overcompensate an ‘issue ownership’ of left parties in the field of employee‐friendly policies. We identify four explanatory paths: coordinated economies in the sample subsidized when they were economically closed or highly indebted. The results also support our combined hypothesis, that New Zealand – a left‐governed liberal market economy – and right‐governed coordinated market economies of the non‐Scandinavian type subsidized.     

Can Quasi‐market and Multi‐level Governance Co‐exist? Insights from the Case of Lombardy's Employment Services System

This article explores the functioning of Lombardy's networked employment services system, inspired by quasi‐market and horizontal subsidiarity principles, and specifically addresses a gap in the quasi‐market literature, where little attention is devoted to the role played by institutions at lower levels of government. A qualitative study of the Lombardy system, with a focus on the municipality of Milan, is relied upon in order to explore the extent to which the principles of quasi‐market and multi‐level governance pursued by the regional government are allowed to co‐exist in practice. Here, sub‐regional levels of government are directly involved in services provision, but enjoy a more privileged condition relative to the private providers, thereby jeopardizing the implementation of an effective quasi‐market. The article contributes to existing theories by suggesting that horizontal subsidiarity and marketization cannot neglect multi‐level governance in those sectors where public bodies at various levels of government are directly involved in implementation.     

Does job satisfaction mediate the relationship between work–family conflict and psychological strain? A study of Australian social workers

The present study investigated the mediating effects of job satisfaction on the relationship between work–family conflict and psychological strain among Australian social workers. Data for the study were collected by an online survey of the membership of the Australian Association of Social Workers, yielding 439 usable responses. The results provide evidence that job satisfaction mediates the relationship between work-to-family conflict, family-to-work conflict and psychological strain. These findings contribute significantly to the social work literature on work–family interface and confirm the importance of developing and targeting not only strategies that aim to reduce work–family conflict, but also those that aim to increase job satisfaction among social workers.     

Better together? Learning lessons for group decision‐making practice from a study of secure accommodation in Scotland

This paper draws on the findings of a research study that examined the factors that influence local decision‐making in cases where a child or young person is being considered by residential workers, social workers and senior managers for placement in a secure unit. After outlining the research problem and case study approach taken, the paper focuses on explicating the findings of the study that relate to the impact of group membership, goals, roles and norms on group performance in such cases. The paper illustrates how attending to these four areas, and the way in which power relations impact on them, may help those developing and managing groups to improve decision‐making practice.     

Gaps in social protection for health care and long‐term care in Europe: Are the elderly faced with financial ruin?

While public expenditure on health care and long‐term care (LTC) has been monitored for many years in European countries, far less attention has been paid to the financial consequences for older people of private out‐of‐pocket (OOP) expenditure necessary to access such care. Employing representative cross‐sectional data on the elderly populations of 11 European countries in 2004 from the Survey of Health, Ageing and Retirement in Europe (SHARE), we find that OOP payments for health care and LTC are very common among the elderly across European countries and such expenditures impact significantly on disposable income: up to 95 per cent of the elderly make OOP payments for health care and 5 per cent for LTC, resulting in income reductions of between 5 and 10 per cent, respectively. Failure to prevent financial ruin, as a consequence of excessive OOP payments, is evident in 0.7 per cent of elderly households utilizing health care and 0.5 per cent of elderly households utilizing LTC. Those particularly concerned are the poor, women and the very old.     

Migrant Care Work Going Dutch? The Emergence of a Live‐in Migrant Care Market and the Restructuring of the Dutch Long‐term Care System

In recent years, a live‐in migrant care (LIMC) market has emerged in European countries with specific care, migration, and employment regime features. In countries with relatively low levels of formal long‐term care (LTC) provision, people in need of care and their families have started purchasing LTC directly from individual – mostly migrant – workers who live‐in with the person in need of care. Previous research has shown that this arrangement is facilitated by the availability of cash‐for‐care benefits that can be freely used by the beneficiaries, and/or by low levels of regulation of employment and migration. The Netherlands traditionally features strong, universal and generous LTC policies. However, recently, the phenomenon of LIMC has also appeared there. Based on exploratory qualitative research, this article examines the features of Dutch LIMC and the factors that foster or hinder its development. Our findings show that the ongoing restructuring of the Dutch LTC system – particularly the emphasis on informal care and decreasing accessibility of institutional care – are important factors pushing an LIMC market. At the same time, various institutional factors limit its growth, particularly the high levels of regulation of the Dutch care, migration and employment regimes. Further cutbacks in the care sector might push more families to this market in the near future, and change the character of the Dutch LTC sector. The Dutch case is relevant for other countries with longstanding traditions of generous LTC services which currently undergo retrenchment, and sheds light on routes to institutional change.     

When Is It Okay to Exclude a Member of the Ingroup? Children's and Adolescents’ Social Reasoning

Social exclusion of those who challenge group norms was investigated by asking children and adolescents, adolescents, age 9–13 years (N = 381), to evaluate exclusion of group members who deviated from group norms. Testing predictions from social reasoning developmental theories of group‐based exclusion, children and adolescents evaluated exclusion based on group norms involving allocation of resources and group traditions about dress code. Exclusion of deviant members was viewed as increasingly wrong with age, but also varied by the type of norm the deviant challenged. Participants who reported disliking a deviant member who wanted to distribute money unequally also found it acceptable to exclude them. Those who disliked deviants who went against norms about dress codes did not think exclusion was warranted. These findings are discussed in the context of children's social‐cognitive development regarding peer rejection as well as the role played by moral judgment and group dynamics.     

Do depressive symptoms in justice‐involved girls reduce the effects of a cognitive‐behavioral program on their disruptive and delinquent behaviors?

The present study evaluated the effects of a cognitive‐behavioral program on disruptive and delinquent behaviors among a sample of adolescent girls placed in a residential center in Quebec (Canada). This study also investigated the moderating impact of depressive symptoms on program effectiveness. The study used a quasi‐experimental design to allow comparisons between 104 girls in the treatment group and 78 girls in the comparison group over 18 months. Findings showed that the program contributed significantly, albeit modestly, to a decline in some forms of disruptive/delinquent behaviors. Results also indicated that girls with a higher level of depressive symptoms at admission also reported higher involvement in a myriad of disruptive/delinquent behaviors and that for some types of problem behaviors, this higher involvement persisted over time. In general, however, the seriousness of the depressive symptoms that the girls reported at admission did not interfere with the effectiveness of the cognitive‐behavioral program.     

What about the fathers? The presence and absence of the father in social work practice in England,Ireland, Norway,and Sweden—A comparative study

Within Northern Europe, gendered roles and responsibilities within the family have been challenged through an emergence of different family forms, increasing cultural diversity, and progressive developments in welfare policies. To varying degrees, welfare policies in different countries support a dual‐earner model and encourage men to be more active as fathers by reinforcing statutory rights and responsibilities. In child welfare practice, there has traditionally been a strong emphasis on the mother as primary carer for the child; the father has been less visible. This paper explores, in four national welfare contexts, how child welfare social workers include fathers in practice decisions. Data were collected using focus group interviews with social workers from England, Ireland, Norway, and Sweden. Similarities and differences emerge in relation to services and the focus of social work assessments. However, overall, the research suggests that despite gains in policy and legislation that promote gender equality, fathers remain largely absent in child welfare practice decisions about the parenting of their children. From the research, we raise questions for social work practice and the development of welfare policies.     

Risk assessment and domestic violence – how do child welfare workers in three countries assess and substantiate the risk level of a 5‐year‐old girl?

This paper examine how a sample of 301 child welfare workers in Norway, England and California, USA assess risk in cases of domestic violence. Decisions in child welfare cases are made under a high degree of uncertainty, and by using the vignette method, we explore whether child welfare systems and risk assessment approaches result in different assessment of risk level and substantiations. We find both cross‐country differences and similarities: Norwegian workers consider the risk level to be significantly higher than their peers in England and USA. However, workers' justifications for and identification of decisive factors in the case are strikingly similar across countries. These similarities are observed for both high‐risk and low‐risk assessors, and they may exist due to widespread knowledge about domestic violence and its negative consequences. We argue that the international differences in risk level assessments are due to system differences in the countries studied.     

Eight years after – a follow‐up study of mothers and children at psychosocial risk who received early treatment: does early intervention leave its mark?

One‐hundred forty‐five mothers at psychosocial risk who, with their babies, had been given treatment at a parent–baby clinic during a 2‐year period starting in 1999, treatment designed to strengthen the mother–child relationship, were followed up 8 years later. Both the mothers who had agreed to take part in the treatment programme (n= 73) and those who had declined (n= 72) were searched for in the records of the Social Welfare office to determine if the treated mothers had been focused on to a lesser degree in the following 8 years than those who had declined treatment, a hypothesis that was initially put forward. The behaviour of the children whose mothers had undergone treatment (n= 46) was studied. The initial hypothesis had to be rejected; support and intervention from the social authorities had been equally common in both groups. However, the children of treated mothers had fewer externalizing behaviour than children of untreated mothers at psychosocial risk.     

How effective do families of non–English‐speaking background (NESB) and child protection caseworkers in Australia see the use of interpreters? A qualitative study to help inform good practice principles

Little empirical research has been conducted in Australia on what constitutes as effective practice with interpreters in child protection matters. This study aimed to address this gap. Qualitative interviews were conducted with 29 non–English‐speaking background (NESB) client families and 17 child protection caseworkers (as part of a larger study). Four examples of good practice (e.g. accurate translation) and 14 examples of ineffective practice emerged. The examples of poor practice were consequently grouped as issues with: (i) interpreters (e.g. inaccurate translation); (ii) caseworkers (e.g. insufficient time); (iii) NESB families (e.g. refusing to use an interpreter); and (iv) resources (e.g. insufficient face‐to‐face interpreters). As expected, the results largely replicate the (scant) national and international literature, indicating that features of good practice, and barriers to them, are similar across multicultural countries. This paper does however argue that training for interpreters dealing in such sensitive matters and training for caseworkers on working effectively with interpreters seem to be at the heart of good practice. This study is significant because it draws on the richness of data that qualitative methods offer to identify the full range of relevant variables and provide empirical support for principles of good practice.