Urban Housing as an Issue of Redistribution through Planning? The Case of Dhaka City

The rapid growth of population, the mushrooming of poor settlements and unplanned urbanization have crucial implications for the efficiency and equity of urban services. The resultant infringements of critical human rights throw into focus the importance of housing as a social policy issue. Urban services are strained in Dhaka city. Urban management has been disrupted as a result of spatial encroachment and environmental degradation. In addition to land scarcity, land speculation and endemic corruption, the high price of land is also a product of the system of land registration. The dearth of valuable urban land, together with delays in urban planning and its implementation, have made the acquisition of land for housing prohibitively expensive for middle and low‐income households. Consequently, the quality of the housing environment is deteriorating. The problem of housing finance is intrinsically linked to its affordability, being currently the prerogative only of the affluent. This article delineates the inherent lack of integrated urban planning, the lacunae within institutions responsible for urban management – and, contextually, the nature of housing as a social policy issue, where reinforced, coordinated planning and administration could ensure distributive benefits even to the poor.     

Gender and Health Inequalities: What Are They and What Can We Do About Them?

The subject of gender and health inequalities is contested territory in health policy, research and practice. Yet there is a dominant approach which I describe as a form of technocratic rationality. Its application imposes significant limitations because it represents the problem of gender and health in terms of measurable sex differences in relation to health service access and health outcomes. In doing so, it fails to address and explain the social dynamics that generate the problem. I propose an alternative approach that originates in Australian women's health policies of the 1980s. These emphasised the inequalities between men's and women's participation in mainstream health policy, planning, management and delivery of services, and women's concomitant marginalisation. Recent sociological study offers support for this perspective suggesting that the endogenous organisational dynamics (or logics) within public health institutions provide a better way of understanding what the problem of gender inequalities in health is, and how we might fix it.     

Addressing older women's homelessness: service and housing models

There is limited understanding of the nature and extent of older women's homelessness in Australia and how it can be alleviated. The aim of this project is to ascertain the combination of program and housing models that is likely to be most effective in addressing older women's homelessness. The data comprise interviews and correspondence with 14 Australian and international stakeholders. The findings draw on insight from housing, gerontology and gender studies, and highlight the need to match welfare and housing programs with the diverse life experiences and current needs of older women. Alongside flagship models of practice in housing provision are assumptions within housing and homelessness sectors of what older women need. There is a lack of understanding that most older women in housing crisis have limited knowledge of the welfare sector, and with provision of mainstream housing (and community aged care if needed) will live independently. Traditional homelessness programs and specialised supportive housing, associated with both seniors and homelessness sectors, are appropriate for women who have lived with ongoing disruption and substantive health concerns. Addressing older women's homelessness in Australia requires a range of services and housing responses, with increased attention given to a discourse of housing – affordable, secure housing – rather than continued discourse of homelessness.     

Ageing and Family Dependency

The ‘graying’ of Australia's population has generated much debate within government, demographic, health and social service circles in recent times. Current and projected shifts in population structure towards greater numbers of ‘dependent’ populations raise a number of complex issues in regard to resource allocation in both income support and service provision. Service issues revolve around questions of whether public or private provision will resolve the care issues for dependent elderly people. It is argued that contrary to popular opinion, family care is well entrenched within the framework of social care, and that the solution of community care, posited in relation to the rising levels of chronic illness and dependency within the elderly population, is actually an attempt to place more responsibility of care on to the family. It is further suggested that family care is, in fact, care by women who themselves are in a state of dependency. Citing evidence from a study conducted by the authors, the paper argues that family care imposes heavy burdens upon women and families and suggests that social policy should, firstly, actively bolster family care through the provision of supportive and supplementary services; and secondly, broaden its intent by exploring other options of care for elderly people. The latter response is important because without it, family care will only help to reinforce and sustain the dependent status of women.     

The social and economic impacts of immigration detention facilities: a South Australian case study

The negative attitudes fostered by political rhetoric against asylum seekers create significant problems when asylum seekers are housed within communities. Much of the community's opposition focuses on the perceived economic and social impacts of large numbers of asylum seekers. However, we currently lack research on the local economic and social impacts of asylum seekers. As a contribution to this evidence base our paper outlines a South Australian case study of the impact of a low security immigration detention facility on the local economy, health services and social cohesion. Our impact assessment found that community concerns were not borne out. There were increases in employment and local expenditure, no reduction in health care services or access, and tensions between residents subsided, as did initially strong reactions against the asylum seekers themselves. The minimal impacts were due to the government and community interventions such as seeking local contracts and providing onsite health services. This case study is used to provide some guidelines for other communities to effectively target the fears that matter most to the community – either through disseminating information that reduces fears and myths, or through planning and interventions that minimise negative impacts and enhance positive benefits. In this way, the arrival of asylum seekers can potentially become one that benefits all community members.     

Why Ugandan rural households are opting to pay community health insurance rather than use the free healthcare services

Twikirize JM, O'Brien C. Why Ugandan rural households are opting to pay community health insurance rather than use the free healthcare services Uganda reintroduced free healthcare in 2001, but today, nine years later, less than 30 per cent of the population are using these services. This study investigated why rural households were under‐utilising the government's free health services and turning to community health insurance instead. A survey carried out on 260 randomly selected households was triangulated with qualitative data gained from 3 focus groups and 12 in‐depth interviews. The findings showed that 21 per cent of the households always accessed the government's free health services, while 79 per cent used private health services. The reasons given were poor quality services, including frequent drug stock‐outs, unmotivated and insufficiently trained health personnel, and overcrowding. Factors influencing enrolment in community health insurance included easier access to healthcare, financial protection against the cost of care, better quality care and benefits related to mutual assistance. This has both practical and policy implications, which are discussed in this article.     

A Brave New World of Personalized Care? Historical Perspectives on Social Care and Older People in England

Social care policy for older people in England continues to generate extensive discussion around the need to break with the past and to deliver a personalized response to need. This article explores the extent to which this represents a complete break with the past by looking at four key reports from the past, namely the Rucker Report (1946 ) on the break up of the Poor Law, the Seebohm Report (1968 ) on the personal social services, the Griffiths Report (1988 ) on community care and The Royal Commission on Long Term Care ( Sutherland Report, 1999 ). Each is interrogated in terms of how social care is defined, how services are to be delivered, how quality is understood and the assumptions made about who will be able to access services. This analysis is used to draw out key continuities in policy assumptions such as the primacy of family and the ongoing debate about ‘What is social care?’ and how it can be distinguished from health care. The article also argues that the voluntary sector has always been seen as a ‘key player’ in social care. Finally, the analysis of the four reports is used to trace the ever changing role of local authorities in the planning, purchase and provision of social care services for older people.     

Choices, Policy Logics and Problems in the Design of Long–term Care Systems

Establishing a public, comprehensive, independent, mainly community–based long–term care system, separate from medical care and social services, can lead to the provision of more effective and consumer–oriented services, and also to a more appropriate mix of public/private financing. Of the two main approaches to financing long–term care (LTC), a tax–based model is more flexible in providing benefits according to the individual's need, since income levels and the family's ability to provide care will be taken into consideration, while a social insurance model is more rigid because the individual's rights are more explicitly defined. The latter system is likely to provide more opportunities for choice, including decisions about the mix of health and social services. Policy–makers must decide which approach to take after weighing the positive and negative aspects of each, and the existing organizational infrastructure. Decisions must also be made on the practical issues of coverage, fairness, form of benefits, service delivery patterns, relationship with medical and social services, and controlling costs. With increasing pressure to contain public sector expenditures and improve efficiency, the focus of care will gradually shift from medical care to LTC, and within LTC, from institutions to housing. How to make this process proactive and planned, instead of ad hoc and reactive, is the challenge for public policy.     

Health Care Fraud and Industry Structure in the United States

The cost of health care fraud and abuse is enormous. Not only is it costing us a lot of money but one wonders how many more people could afford and receive medical insurance if fraud and abuse were significantly lower. This paper will show that the problem is embedded in the way America does health business. The problem needs to be better addressed by both the criminal justice community and the health care industry. Most importantly, those making the health care industry policy decisions need to make a paradigm shift. The system is out of balance because of past policies and decisions that have given excessive power and liberty to the medical services community and insurance providers. Using O’Toole's Compass Card of the four major ideas that have influenced political decision‐making as a guide, this paper recommends that current decision‐making needs to strengthen the equality and community poles and restrict the liberty and efficiency poles so that more balance might exist within the American health care system. Talcott Parsons saw the dangers of commercializing health care over half a century ago. The health care scene of today shows that he was correct in his appraisal.     

Human Motivation and Professional Practice: of Knights, Knaves and Social Workers

Efforts to improve the efficiency and responsiveness of public services by harnessing the self‐interest of professionals in state agencies have been widely debated in the recent literature on welfare state reform. In the context of social services, one way in which British policy‐makers have sought to effect such changes has been through the “new community care” of the 1990 NHS and Community Care Act. Key to this is the concept of care management, in which the identification of needs and the provision of services are separated, purportedly with a view to improving advocacy, choice and quality for service users. This paper uses data from a wide‐ranging qualitative study of access to social care for older people to examine the success of the policy in these terms, with specific reference to its attempts to harness the rational self‐interest of professionals. While care management removes one potential conflict of interests by separating commissioning and provision, the responsibility of social care professionals to comply with organizational priorities conflicts with their role of advocacy for their clients, a tension rendered all the more problematic by the perceived inadequacy of funding. Moreover, the bureaucracy of the care management process itself further negates the approach's supposedly client‐centred ethos.     

Social Policy in Greece: Rhetoric versus Reform

This paper reviews the major social policy developments in Greece during the 1980s and 1990s, focusing on social security, health and employment policies. It argues that the concept of social policy and the practice of politics have been distorted in this country. Social policy reflects the legacy of a heavily politicized and centralized policy‐making system, an impoverished administrative infrastructure and poorly developed social services. Its emergence is characterized by the pursuit of late and ineffective policies. It lacks continuity, planning and coordination, being oriented towards short‐term political expediency. It is largely insurance‐based, reproducing huge inequalities and institutional arrangements which are behind the times. It provides mainly cash benefits, low‐quality but rather expensive health services and marginal social welfare protection. Moreover, the lack of a minimum income safety net confirms the country's weak culture of universalism and social citizenship. By implication, complex policy and interlocking interest linkages have tarnished the “system” with a reputation for strong resistance to progressive change. At the same time, sources of change such as globalization, demographic developments, new household and family/gender patterns, unstable economic growth, fiscal imperatives, programme maturation, as well as persisting unemployment, changing labour markets and rising health care costs, have produced mounting pressures for welfare reform.     

Puerto Rican Elders' Knowledge and Use of Community-Based Long-Term Care Services

We conducted 3 focus groups with 28 Spanish-speaking Puerto Rican elders to explore their knowledge and use of community-based long-term care services, including an exploration of whether their residential setting influences access to services. Analysis revealed themes relating to participants' difficulties and frustrations with formal services. A major theme was a reliance on formal services, given a lack of reliable familial help. Elders living in Latino senior housing reported the greatest access to services, with availability of Spanish-speaking housing staff and informal support from neighbors serving as critical components of their social networks. Practice and policy recommendations are provided.     

Lessons Unlearned—Planning Disaster and Community Anomie

This article critically reviews the Hong Kong Government's ‘new town’ policy. It argues that the case of Tin Shui Wai illustrates the ‘planning disasters’ where casualties are resulted from poor government planning; a lesson that should have been learned from its predecessor, Tuen Mun, in the early 1980s. The analysis shows how rigid bureaucratic administration led to inadequate community facilities and services; the physical remoteness and the homogeneity of the populations stalled economic development; and large numbers of new immigrants, ethnic minorities, and people of low socioeconomic status concentrated in a virtually deserted community that was characterized by various social problems. The article concludes with the recommendation to make community development efforts to nurture social capital in anomic communities.     

昆明市空巢老人健康与照顾需求的评估

“空巢”是中国科技与社会发展、独生子女政策落实的必然。日益增长的“空巢老人”为国家福利、代际和谐和社区照顾带来了严峻挑战。本文从社会保障的视角,采用健康自测量表（SRHMS）,从生理、心理和社会健康的维度,对昆明市10所养老机构和18个社区的289位空巢老人和212名非空巢老人进行了比较分析,发现空巢老人社会健康与心理支持令人担忧。文章就构建“空巢老人”长期照顾网络作了讨论和建议。     

Public Satisfaction with the Health System and Popular Support for State Involvement in an East Asian Welfare Regime: Health Policy Legitimacy of Hong Kong

The legitimacy of social policies has gained increasing attention in the past decade, against the backdrop of fiscal austerity and retrenchment in many nations. Policy legitimacy encompasses public preferences for the underlying principles of policies and the actual outcomes as perceived by citizens. Scholarly knowledge concerning the legitimacy of health policy – a major element of modern social policy architecture – is, unfortunately, limited. This article seeks to extend the scholarly debates on health policy legitimacy from the West to Hong Kong, a member of the East Asian welfare state cluster. A bi‐dimensional definition of health policy legitimacy – encompassing both public satisfaction with the health system and the normative expectation as to the extent of state involvement in health care – is adopted. Based on analysis of data collected from a telephone survey of adult Hong Kong citizens between late 2014 and early 2015, the findings of this study demonstrate a fairly high level of satisfaction with the territory's health system, but popular support for government responsibility presents a clear residual characteristic. The study also tests the self‐interest thesis and the ideology thesis – major theoretical frameworks for explaining social policy legitimacy – in the Hong Kong context. Egalitarian ideology and trust in government are closely related to both public satisfaction with the system and popular support for governmental provision of care. However, the self‐interest thesis receives partial support. The findings are interpreted in the context of Hong Kong's health system arrangements, while implications for the territory's ongoing health policy reform are discussed.     

A Study of a Total Social Services Care Population and its Inter-Agency Shared Care Populations

There are very few large population studies and little informationabout the characteristics of social services populations andthe inter-agency populations that social services departmentsshare with other agencies. This study fills this gap. It examinesa total social services adult care population, excluding residentialcare homes (N = 19,461) in the context of its general co-terminoushealth authority population (N = 646,239). Approximately two-thirds(61 per cent) of the social services population were women,compared to the health authority population of 51 per cent.Sixty-two per cent were over sixty-five years compared to 23per cent of the health authority. Age groupings and genderedpatterns of service use are then identified for different caregroups. The study then examines care populations shared betweensocial services and other agencies, identifying the amount ofshared care and the characteristics of specific shared caresubgroups. Forty-two per cent of the social services populationwere shared with the community health trust and 19 per centwith the mental health trust. The proportion of the social servicespopulation in contact with Criminal Justice and accident andemergency was nearly twice that in the overall health authoritypopulation. The limitations of these data are examined and thepotential of this method to inform inter-agency planning andshared care is discussed.     

Creating elder-friendly communities: preparations for an aging society

Because many communities where older people live were not designed for their needs, older residents may require support to remain in the least restrictive environment. "Age-prepared communities" utilize community planning and advocacy to foster aging in place. "Elder-friendly communities" are places that actively involve, value, and support older adults, both active and frail, with infrastructure and services that effectively accommodate their changing needs. This paper presents an analysis of the literature and results of a Delphi study identifying the most important characteristics of an elder-friendly community: accessible and affordable transportation, housing, health care, safety, and community involvement opportunities. We also highlight innovative programs and identify how social workers can be instrumental in developing elder-friendly communities.     

Care of Older Adults in Iceland: Policy Objectives and Reality

ABSTRACT

We examine the implementation of the Icelandic government's policy on formal care of older adults in Iceland. The policy as expressed in legislation and other policy documents is to ensure access of older adults to the appropriate level of health and social care services. How does the actual level of formal care compare with the policy objectives? Does there exist an implementation deficit, and if so, why? We address the question by analyzing Icelandic and international statistical databases. The findings reveal a gap between the aims of the current policy and its delivery. As elsewhere in the Nordic region, the policy allows for the emphasis to be on home-care services in which the individual's needs are assessed comprehensively. Administrative problems and insufficient resources to better understand and explain the problem are identified. Current steps to address the problem include the necessity of a comprehensive evaluation of the level and quality of elder-care services in Iceland, which would help compensate for the shortcomings of the existing public statistical databases. In future research, it is necessary to analyze how services can be coordinated while increasing responsiveness to the voices of older adults and their relatives on the care of older people.     

A Functional Classification of Services for Older People

A deductively derived classification scheme is proposed which categorizes the health and social services of a community according to the levels of competence (behavioral functioningj and the levels of independence of the older people they address. Five levels of individual behavioral functioning ranging from simple to complex are specified: life-maintenance and health; perception-cognition: self-maintenance; effectance: and sociol role performance. Three levels of independence (of living arrangements) are specified ranging from the independent to the dependent subgroups of older people: the comparatively well elderly; elderly who require alternatives to prevent premature institutionalization; and elderly whose needs may confer institutional care or its equivalents. The services of a sample community are classified within this two dimensional scheme. The applications of the classification scheme to both community planning and individual treatment plan formulation are discussed.     

Policy Changes in Community Mental Health: Interventions and Strategies Used in Sweden over 20 Years

The deinstitutionalization of mental health care has changed the responsibilities of involved authorities and has led to a continuous need for new treatment forms and interventions. This article describes this development in Europe, and in particular how these new conditions have been handled in Sweden over the past 20 years at the level of governmental policy‐making. Three major policy documents from 1994, 2009 and 2012 were included in this study. To increase our understanding of the policies' contents, we have used theoretical concepts concerning governance, implementation and political risk management. Although our main interest was to find out how the government handles interventions for users of the mental health care system, we found that the policy work is progressing stepwise. The first document, from the deinstitutionalization era, did not discuss interventions clearly. Instead, it was mainly concerned with both practical and economical areas of responsibility. The second document, from the post‐deinstitutionalization era, was more focused on what services should be delivered to the users, while the most recently published document to a greater extent addressed the question of how the support is supposed to be designed. The trend in European community mental health policy has been to advocate services in open forms that are integrated into the society's other care systems. This is also the case in Sweden, and continuous work is being done by the government to find strategies to support the development, and to meet the needs at both political and local levels.