The Generational Equity Debate

This article discusses the generational equity debate in the United States-including its origins and the functions it serves. This debate has emerged in the context of concerns over the aging of the population, budgetary crises, growing health care costs, increased poverty among children, growing economic inequality, and declining faith in institutions. By potentially fragmenting support for Social Security and other social programs, the generational equity approach to framing public policy issues may serve the interests of those conservatives wishing to shrink and restructure the American approach to social welfare. However, the possibility exists that this debate could serve also as a forum to advance progressive ideas about universal access for persons of all ages to income and health benefits and employment opportunities.     

Ways of Thinking About the Long-Term Care of the Baby-Boom Cohorts

In examining various ways of thinking about the development of long-term care policy for the baby-boom cohorts, this article discusses the importance of basing long-term care policy discussions on a recognition of social and economic trends, as well as on the informal exchanges of care that occur over life and the diversity within the baby-boom cohorts. The implications of two ways of thinking about challenges posed by the aging of baby boomers-the generational equity/crisis perspective and the generational investment/gradual adjustment perspective-are also discussed. It is suggested that the generational equity perspective is consonant with proposals to expand private savings for long-term care contingencies and private long-term insurance and, secondarily, with proposals to expand means-testing for benefits. The second perspective is more consistent with proposals to create new universal services through a traditional social insurance approach, or through a block grant such as the one discussed in the context of the Clinton health care reform plan.     

Ways of thinking about the long-term care of the baby-boom cohorts

In examining various ways of thinking about the development of long-term care policy for the baby-boom cohorts, this article discusses the importance of basing long-term care policy discussions on a recognition of social and economic trends, as well as on the informal exchanges of care that occur over life and the diversity within the baby-boom cohorts. The implications of two ways of thinking about challenges posed by the aging of baby boomers--the generational equity/crisis perspective and the generational investment/gradual adjustment perspective are also discussed. It is suggested that the generational equity perspective is consonant with proposals to expand private savings for long-term care contingencies and private long-term insurance and, secondarily, with proposals to expand means-testing for benefits. The second perspective is more consistent with proposals to create new universal services through a traditional social insurance approach, or through a block grant such as the one discussed in the context of the Clinton health care reform plan.     

A dynamic social-ecological model of generational identity in the workplace

We approach generational identity in the workplace as a social identity simultaneously linked to biological and historical location. We outline a dynamic social-ecological model of generational identity in which various levels of influences shape the potential for and manifestation of generational identities in the workplace. We propose that individual generational identity in the workplace is influenced by the interaction of four levels of factors: the workgroup, where generational identity is triggered; the organization, which structures the context in which work-related generational identity takes shape; the extra-organizational environment, which sets the general parameters for generational interactions with occupational and stakeholder groups; and society, where generational phenomena are manifested as historical social movements and depicted as mass media narratives. We examine each of these levels of influence and offer propositions, guided by social identity, self-categorization theory, fault line theory, and generational theory, to elucidate what each level of influence contributes to a fulsome understanding of generation as a complex phenomenon. This approach to generational identity in the workplace highlights the influences that serve as pre-conditions for generational conflict in organizations.     

PUBLIC–PRIVATE PARTNERSHIPS FOR MATERNAL HEALTH IN AFRICA: CHALLENGES AND PROSPECTS

ABSTRACT

The concept of public and private partnerships raises growing interest and hope from international development agencies, governments, and communities as an alternative strategy in social welfare delivery. Conceptualized as a strategy to build and capitalize on the tangible and intangible assets and resources endogenous to social organizations and communities, individually and collectively, this article embraces an asset-based approach to analyze the potency of such a framework in enhancing maternal health care delivery in developing countries such as Senegal and Mali. These countries face growing retrenchment of the state from social service delivery and scarcity of human and financial resources, which call for innovative approaches and sustainable solutions in addressing pervasive deficits in health service delivery. Drawing from empirical field research conducted in Senegal and Mali, this article examines the trend toward public–private partnerships and its gender impacts and critically analyzes the challenges and opportunities it offers conceptually and practically to address and improve equity in health care delivery, particularly safe motherhood and maternal health care delivery in developing countries.     

Using Generational Intelligence to Examine Community Care Work between Younger and Older Adults

Exploring the factors that contribute to sustainable forms of an intergenerational relationship is becoming an important conceptual and practical challenge, not least because of the growing need for an aged care workforce that is both motivated and suitably trained. Generational intelligence is a means of examining interaction between younger and older people which has been applied to community care settings. Dimensions of generational intelligence include recognising and valuing generational differences, finding common ground, plus negotiating social and practical outcomes from the situation. A case study plus a series of qualitative interviews are used to examine the value of this approach both as a means of exploring the processes involved in generational exchange and in providing recommendations for work preparation and training. It is suggested that intergenerational relations have been a missing factor in the understanding of sustainable care and that in future, service delivery should not simply be analysed as comprising professional and lay perspectives but also as containing generationally distinctive perspectives that require negotiation.     

Four elephants in the room: A reflective analysis of the wailing rage displayed by Baltimore youth after Freddie Gray’s death

Eliminating health disparities is our ethical and generational responsibility to protect and promote the health of all Americans. However, we cannot effectively eliminate health disparities in the United States unless we acknowledge and confront the three social culprits that threaten the elimination of health disparities: poverty, racism, and inequities. When addressing communal health, a multigenerational intentionality approach is needed to combat determinants of health. Retrospectively, we used the 2015 wailing rage demonstrated by youth in Baltimore City after the death of Freddie Gray Jr. to introduce our Multigenerational Intentionality to Communal Health conceptual framework. The conceptual framework directs any determinants of health process (i.e. planning, policy, programming, practice, etc.), to decisively utilize the looking backward-thinking forward method to explore the intersectionality of how generational determinants of health (e.g. poverty, racism, disparities and inequities) threaten communal health.     

Generational equity and measurement bias: Who is really poor?

One core contention of the generational equity argument is that elderly people are financially well-off. To support this argument, generational equity proponents compare poverty rates of elderly people to those of children in the United States demonstrating that elderly people enjoy a privileged position in terms of financial well-being as compared to other age groups. I argue that the measurement of poverty upon which this argument is based is grounded in faulty logic and incorrect assumptions. Therefore, the basis of this generational equity argument is invalid. I conclude that using poverty rates creates the impression of a conflict between children and elderly people drawing attention away from the continuing problem of discrimination against women and minorities.     

The Presentation of Self: Dramaturgical Theory and Generations in Organizations

While interest in intergenerational phenomena has been growing in organizations, academic research in the field of organizational studies has questioned the existence of generational differences. However, despite this questioning, generational stereotypes are known and enacted in the workplace. Using a dramaturgical approach as suggested by Goffman (1959), the purpose of this theory article is to advocate a simple model of generational stereotype reinforcement in organizations in which individuals enact (or do not enact) prototypical generational traits and behaviors when doing so allows them to appear in a positive light to a particular generational group.     

Changing Behaviours,Improving Outcomes? Governing Healthy Lifestyles Through Social Marketing

Recent public health policy and practice in the UK and beyond has promoted behavioural and lifestyle change as key methods for health improvement and the reduction of inequalities. These methods contrast with more upstream and structural interventions intended to address environmental and material determinants of health. A current exemplar of this approach is the use of social marketing. These changes represent a shift from the social to the individual as the target of public health interventions and raise a number of critical questions for health social scientists concerned not only with health improvement but also equity and social justice. Further, they can be identified as part of broader social and economic shifts that posit the individual as responsible for the management of their own bodies and selves in late modern societies characterised by ‘government at a distance’ and the repeal of welfare. This paper offers a review of shifting paradigms of public health and considers the implications of newer modes of health governance such as social marketing and their role as a modern form of health governance.     

‘The Girl About Town’: discussions of modernity and female youth in Drum magazine, 1951–1970

This article examines the trope of the ‘modern miss’ in Drum magazine 1951–1970 as a locus for debate over South African urban modernity. At the centre of Drum’s African urbanity was a debate between a progressive, positively ‘modern’ existence and an attendant fear of moral and social ‘breakdown’ in the apartheid city. The trope of the ‘modern miss’ drew upon both discourses. Drum’s fascination with the ‘modern miss’ reached a peak in the years 1957–1963, during which time she appeared prominently in the magazine as a symbolic pioneer of changing gender and generational relationships. However, this portrayal continued to coexist alongside the image of young women as the victims of moral degeneration. The ‘modern miss’ was increasingly differentiated from adult women within Drum’s pages, which distanced her from the new space won by political activists. By examining constructions of young womanhood, this article points to the gendering of ‘youth’ at the intersection of commercial print culture and shifting social relations in mid‐twentieth‐century South Africa. It is also suggested that understanding the social configurations of Drum’s modernity illuminates the gendered and generational responses of formal political movements as they conducted their own concurrent debates.     

Use of concurrent mixed methods combining concept mapping and focus groups to adapt a health equity tool in Canada

The aim of this project was to identify and prioritize a set of conditions to be considered for incorporating a health equity tool into public health practice. Concept mapping and focus groups were implemented as complementary methods to investigate the conditions of use of a health equity tool by public health organizations in Quebec. Using a hybrid integrated research design is a richer way to address the complexity of questions emerging from intervention and planning settings. This approach provides a deeper, operational, and contextualized understanding of research results involving different professional and organizational cultures, and thereby supports the decision-making process. Concept mapping served to identify and prioritize in a limited timeframe the conditions to be considered for incorporation into a health equity tool into public health practices. Focus groups then provided a more refined understanding of the barriers, issues, and facilitating factors surrounding the tools adoption, helped distinguish among participants’ perspectives based on functional roles and organizational contexts, and clarified some apparently contradictory results from the concept map. The combined use of these two techniques brought the strengths of each approach to bear, thereby overcoming some of the respective limitations of concept mapping and focus groups. This design is appropriate for investigating targets with multiple levels of complexity.     

The Hidden Costs of Informal Elder Care

Demographic, socio-economic, and political trends throughout the developed world have contrived to make elder care an issue of utmost policy importance. They also have led to sharp reductions in health and social program expenditures. Policymakers are looking to communities to help meet growing care needs because community care is believed to be better and cheaper than institutional care. However, these beliefs become untenable when costs beyond public sector costs are considered. In fact, informal care carries a number of hidden costs that seldom are considered in health and social policy discussions. This article introduces a taxonomy of the costs of informal elder care, which can be categorized as out-of-pocket expenditures, foregone employment opportunities, unpaid labor, and emotional, physical and social well-being costs. Then, an illustration is provided regarding how the taxonomy can be applied to understanding the incidence, magnitude, and distribution of these costs among stakeholder groups. This taxonomy can help inform ongoing debate about health and social policy reform.     

Aging in a critical world: The search for generational intelligence

Critical gerontology attempts a radical approach to adult ageing drawing on both the personal experience of older adults and their relationship to social and structural inequality. In this paper the author uses personal historical experience to chart a critical approach to intergenerational relationships and draw out lessons and new directions for a revitalised critical approach to adult ageing. The concept of generational intelligence is introduced, as a joint project with another author, and as a bridge toward future intergenerational solidarities.     

Social Protection and Health: Experiences in Uganda

There is an interesting and continuing debate on the nature and role of social protection in poverty reduction. Within the health sector, discussion has focussed on the drawbacks associated with fee exemption schemes and community‐based health insurance, with much less attention paid to the policy option of abolishing user fees. This paper reviews empirical evidence on the impact of the Government of Uganda's decision in 2001 to abolish user fees for health services. The paper finds that this policy intervention has had a significant positive impact on health‐seeking behaviour in Uganda and concludes that this policy measure can make an important contribution towards a more ‘promotional’ policy approach to social protection.     

Forum: social network for the surveillance and prevention of workplace accidents

In 2008, academic researchers and public service officials created a university extension studies platform based on online and on-site meetings denominated "Work-Related Accidents Forum: Analysis, Prevention, and Other Relevant Aspects. Its aim was to help public agents and social partners to propagate a systemic approach that would be helpful in the surveillance and prevention of work-related accidents. This article describes and analyses such a platform. Online access is free and structured to: support dissemination of updated concepts; support on-site meetings and capacity to build educational activities; and keep a permanent space for debate among the registered participants. The desired result is the propagation of a social-technical-systemic view of work-related accidents that replaces the current traditional view that emphasizes human error and results in blaming the victims. The Forum uses an educational approach known as permanent health education, which is based on the experience and needs of workers and encourages debate among participants. The forum adopts a problematizing pedagogy that starts from the requirements and experiences of the social actors and stimulates support and discussions among them in line with an ongoing health educational approach. The current challenge is to turn the platform into a social networking website in order to broaden its links with society.     

Changing Fatherhood: An Exploratory Qualitative Study with African and African Caribbean Men in England

This paper presents findings from a qualitative study undertaken with 46 African and African Caribbean men exploring their experiences of fatherhood. Data analysis was informed by Connell’s theoretical work on changing gender relations. Findings indicate that fathers’ lives were mediated by masculinities, racism, gender, migration and generational changes in parenting. Fathers advocated a style of parenting centred on good communication with children. The implications of findings for theory, future research and health and social care policy regarding both children’s well‐being and the inclusion of fathers by health and social care practitioners are discussed.     

Questioning the professionalization of recovery: a collaborative exploration of a recovery process

While the recovery concept strongly resonates in clinical mental health care today, it first arose in service user-led contexts. A major risk of this professionalization shift is that recovery primarily becomes defined by treatment providers. This study aims to keep the debate on recovery alive through a collaborative exploration of Pete’s recovery process by means of a bricolage approach. This resulted in an idiographic portrait of Pete’s experiences of recovery and treatment, clustered around four themes: life rebuilding, identity, continuity of care and the role of drugs. His experiences illustrate a number of contradictions in the operationalization of the recovery ethos in today’s mental health care; whilst recovery appears as a hopeful vision of empowerment, it also risks being reduced to a tokenistic model that fails to address the social realities of people in recovery and in which the assumption that mental illness is chronic is still latently present.     

Quality of life: Efficiency,equity and freedom in the United States and Scandinavia

The article discusses three basic elements of quality of life and seeks to illuminate these from two cultural perspectives. The elements are 1) social equity (including issues like virtues, justice, fairness, equal moral value, human rights, resource ethics etc. and 2) efficiency (including issues like economic efficiency, productivity, material well being, etc.) 3) freedom (including liberty, pursuit of happiness, individual choice, exit and voice options, etc.). Concerns for social equity, efficiency and freedom are at the heart of the political debate in many countries. In this article, we will look at some of the ways in which the Scandinavian cultures and the American culture view these basic elements of quality of life. It is argued that social equity drives efficiency and freedom of choice.