KINSHIP,RECIPROCITY AND VULNERABILITY: SOCIAL RELATIONS IN THE INFORMAL ECONOMY

This paper examines the notion that informal interhousehold transfers of goods and services in the communal economy are based upon reciprocity. Patterns of interhousehold transfer of goods and services are described, and the significance of kinship (or familial obligations) in shaping patterns of informal exchange are discussed. Data from a 1990 survey of household and residential organisation in Brisbane are used. Differences in income, labour force participation and the density and character of householders' social networks are considered as factors shaping contemporary interhousehold economic activity. Implications for our understanding of people's economic vulnerability are drawn from the observations.     

Comparison on predictors of mental health service use among Asian older adults

Studies have mostly examined mental health service use of older Asian immigrant combining all Asian Americans into one group whereas immigration backgrounds and socioeconomic status of each Asian minority group are different. Therefore, this study aimed to identify predictors of mental health service use within specific ethnic groups among older Asian adults focusing on Chinese, Japanese, Korean, Filipino, and Vietnamese in California. The Behavioral Model for Vulnerable Populations (BMVP) is used to guide the secondary data analysis of a sample of 3,453 older Asian immigrants from the California Health Interview Survey (CHIS). Logistic and linear regression analyses are performed to examine predictors of mental health service use and the frequency of mental health service use, respectively. As results, mental health‐seeking patterns differ by ethnicity within the older Asian immigrant sample, not being married (Korean), higher levels of acculturation (Filipino), lower levels of neighborhood cohesion (Korean and Vietnamese), higher levels of perceived safety (Korean) and lower levels of perceived safety (Vietnamese), higher levels of mental distress (Korean and Filipino), and having perceived need (all) were related to more visits for mental health services. The study findings highlight the necessity of cultural competency services and programs for each Asian ethnicity.     

Informal workers and Kenya’s National Hospital Insurance Fund: Identifying barriers to voluntary participation

This article investigates the barriers to informal workers’ voluntary participation in Kenya’s national health insurance scheme – the National Hospital Insurance Fund. Based on primary data from both qualitative and quantitative methods, we find that the key determinants of enrolment include social factors, such as marital status, which create demand for insurance, and the role of informal workers’ associations that promote the voluntary uptake of health insurance and prevent default through contribution support. Participation barriers and reasons for inactiveness stem from the nature of informal work characterized by irregular earnings, which combine with apprehension about having to pay penalty charges for the late payment of premiums, inadequate levels of knowledge about health insurance schemes, institutional constraints such as complex registration procedures, as well as premium costs and poor-quality services, all of which discourage enrolment or the reactivation of lapsed membership. There is thus a need for health insurance schemes, such as Kenya’s National Hospital Insurance Fund, to educate informal workers on insurance services and protocols and to improve services to encourage uptake and reduce default behaviour.     

Health Care in Asia and the Pacific: Increasing the focus on social health insurance

This paper focuses on health insurance reform within the broader frameworks of both social security and health services system development. In most countries in Asia and the Pacific, it is indeed the reform of the health services system, through policy changes in health care financing, that has led to an increased focus on health insurance. The underlying issue in this reform is the shift in responsibility that has taken place in most countries in the region over recent years. In the past, governments were responsible for financing health care for their populations. This shifted to defining, legislating and implementing an appropriate health care financing mechanism, presenting several challenges: to reach universal health insurance coverage through new initiatives for new populations, mainly the informal sector accounting for the majority of the population in almost all these countries; to apply provider payment systems that enable control over costs and the volume of utilization; and to strengthen primary health care as a foundation for rational utilization and more resources for prevention, including prevention of chronic diseases among the ageing population. This approach will require an active partnership between health insurance schemes and government that should reflect the new division of responsibilities to guarantee access to high-quality health care for all.     

‘Problematising’ Australian policy representations in responses to the physical health of people with mental health disorders

Australia, like other jurisdictions, is recognising the poorer physical health of people with mental health disorders. This paper explores policy responses to this issue through discourse analysis of 22 Australian Federal and State government policy documents published in 2006–2011. The paper utilises Bacchi's ‘what's the problem represented to be?‘ approach to explore policy solutions in relation to the representation of the issue, enabling identification of issues which are not problematised and policy solutions that have not been considered. The poor physical health of people with mental health disorders is attributed in policy to poor lifestyle habits and limited access to monitoring of physical health care. Three policy solutions are offered: collaborative care delivery involving greater use of fee‐for‐service primary care to manage physical health; the monitoring of physical health status by mental health teams; and the promotion of lifestyle change. These solutions fail to address ongoing issues with collaboration between specialist mental health and primary care services. Reliance upon fee‐for‐service primary mental health care may, in fact, reduce rather than increase access to services. The strategies are discussed in light of neoliberal ideals of governance and personhood which are underpinned by informed consumer choice and personal responsibility for health.     

Do we care? Adult mental health professionals' attitudes towards supporting service users' children

The impact of parental mental health is well known, but children's very existence may fail to be recognized by adult mental‐health services. This study aimed to explore attitudes of mental‐health professionals in one outer London borough regarding support needs of mental‐health service users' children to highlight potential barriers to identifying or meeting their support needs. All statutory mental‐health teams in the borough participated in a cross‐sectional survey. The response rate was 62.8% (n = 94) out of 150. The sample consisted of a diverse range of professionals from both inpatient and community settings. The main finding was that practitioners were overwhelmingly in favour of supporting children. However, attitudes and practices were significantly associated with profession, setting and whether the respondent was a care coordinator. Demographic characteristics or experience was not associated with attitudes. Perceived barriers to supporting children are highlighted. In particular, the mental‐health professionals in our sample considered supporting children important but did not necessarily consider it their role to do so. Training is required to raise awareness about this issue.     

Social Support and Government Policy on Services for the Elderly

Government policy on services for the elderly is to increase the provision of care in the community. This paper examines this policy in relation to informal help received from relatives and friends.
Drawing on the results of a pilot study of 92 people over the age of 75, registered in a group general practice, data are presented on the balance between informal and formal help over a group of activities of daily livhg. The main informal helpers are described with the range of activities for which people in the study were receiving assistance.
Community services are, at present, limited in the help they can provide for people in their own homes. If policies of community care are to be successful, then they must take into account the strengths and weaknesses of informal support. Using the data presented, suggestions are made a bout improvements in services including task specific services not currently provided and the definition of groups at risk of their social support breaking down.     

HEALTH NEEDS OF MIGRANT VIETNAMESE WOMEN IN SOUTH‐WEST BRISBANE: AN EXPLORATORY STUDY

This study was conducted in the southwest area of Brisbane, Australia, and is designed to explore and assess the health needs of Vietnamese migrant women. The needs of this group are becoming increasingly urgent due to ageing of the original immigrant refugee community and decreased capacity for support from their children and families. The study used a qualitative research strategy involving focus groups and in‐depth interviews with Vietnamese women between 18–65 years and interviews with Vietnamese health care providers. It shows that the women have had to deal with culture shock, low self‐esteem, lack of friends and relatives, unrecognized professional skills and most importantly in health terms, low socioeconomic status. Significant barriers to access health services and to improved health and well‐being were also identified, such as language difficulties, transportation, time, and knowledge about health education. Recognition of specific requirements of sub‐populations as well as broader socio‐economic and cultural determinants of health should be a guide to more effective planning and implementation of health promotion strategies. The changing needs, over time, of these sub‐populations should also be recognized.     

Experiences of rural male caregivers of older adults with their informal support networks

More male caregivers are assuming primary caregiving roles for older adults with chronic health conditions. One of the main sources of support for many caregivers is the assistance that is provided by members of their informal support network. Little is known about the relationship between male caregivers and their informal support networks. This qualitative study examines the experience of male caregivers with their informal support networks, specifically looking at two phenomena: (1) Perceptions of the male caregivers about the willingness of their informal support networks to provide caregiving assistance and (2) Willingness of the male caregivers to ask their informal support networks for assistance. Twenty male caregivers were recruited across a rural Midwestern state. Each male caregiver engaged in two interviews that lasted between 60 and 120 minutes. Seven themes emerged from the data about the male caregivers experience with their informal support networks. Results from this study have implications for geriatric health professionals who work with male caregivers to obtain the necessary amount of caregiving assistance.     

The Privatization of Welfare

The different forms of privatization all imply some diminution of the state's role in the provision, financing or regulation of welfare. Privatisation does not simply mean the sale of public assets and greater reliance on private enterprise and competitive markets; it also means the transfer of welfare responsibilities from the state to the voluntary and informal sectors. This is partly an ideological issue, concerning the state's relationship with individual citizens and social groups, and partly a matter of practicalities. Welfare pluralism implies a less dominant role for the state in the provision (as opposed to the financing and regulation) of welfare services: its major themes are decentralization and participation. Some doubt is cast on the capacity and the desirability of the informal and voluntary sectors substituting for the state in social service provision. The family is undergoing substantial changes which may reduce its capacity to provide care and, at the same time, the number of dependents is increasing. The voluntary sector is beset with problems of uneven and incomplete coverage, equity, fragmentation and accountability. The chief consequence of welfare pluralism has been the rapid development of the commercial sector.     

Contextualising the ‘Crisis in Aged Care’ in Australia : A Demographic Perspective

Australia's ‘old‐old’ population is growing even faster than the total aged population and despite improved incomes, living conditions, health risk behaviours and health care this will result in a concomitant increase in the numbers of older people with disabilities. This paper examines ABS 2003 survey data on the incidence of disability among older Australians and their need for, and utilisation of, formal and informal care. It uses this as a basis for projecting the incidence of disability among older Australians and the need for informal and formal care up to 2031. These indicate there is a major challenge since the aged care workforce has grown only slowly in Australia and is concentrated in the older working ages presaging a loss of workers through retirement. There needs to be a significant effort put into attracting workers to both the skilled and unskilled parts of the aged care industry.     

Violence Across the Lifespan: Interconnections Among Forms of Abuse as Described by Marginalized Canadian Elders and their Care-givers

Elder abuse is recognized as a major problem, with profoundeffects on the health and quality of life of older persons.In our aging population, elder abuse represents an escalatingclinical issue for social workers and health care professionalswho provide care to older people. A major gap in our examinationof elder abuse is the potential contribution and applicationof knowledge developed within research derived from other formsof family violence. This paper explores the interconnectionsamong various forms of violence across the lifespan, and theexperiences voiced by marginalized elders and their care providers.We interviewed seventy-seven rarely consulted older adults andforty-three formal and informal care-givers of older adultsin focus groups in Ontario and Alberta, Canada. Study findingsrevealed four major themes that describe interconnections amongtypes of abuse: (i) intergenerational cycles of abuse; (ii)violence across the lifespan; (iii) exposure to multiple subtypesof elder abuse; and (iv) ongoing spouse abuse that shifted intoelder abuse. The results from this study indicate that victimsoften ‘suffer in silence’ and cultural factors,ageism and gender are ubiquitous to elder abuse. Recommendationsto reduce elder abuse include education, formal and informalsupports and services.     

The extent and limits of solidarity in Dutch health care

Solidarity and equal access are twin principles in the Dutch health care system: solidarity between the rich and poor and among people with high and low risks formally guarantees equal access to health care services. However, in the past few years government policies, guided by the ideology of market reform and free choice, have resulted in patterns of inequality that favour privately insured over sickness fund insured. In the meantime, the level of public support for the principles of solidarity and equal access is dropping. A significantly larger portion of the Dutch people now believes that it would be too costly to grant everyone the right to all medical treatments possible. An important reason for the decline of solidarity and equal accessibility is the scarcity of resources. The scarcity of resources and the waiting lists resulting from it will reduce the extent of the benefits package and the access to the care services of the health system. The better-off will have the resources to receive care services that are not part of the basic package. Moreover, the scarcity of resources will affect the readiness in society to provide informal care. Opposed to the compulsory macro solidarity of the health insurance system, informal care is based on a voluntary kind of solidarity in which personal choice plays an important role. Waiting lists and diminishing professional support weaken this readiness, as such support is a necessary condition for informal carers to keep caring for their relatives and friends. Because the informal care system is a necessary supplement to the formal system of care, the lack of help offered by the latter will in the end endanger the solidarity not only in informal care, but in the institutional care system as well.     

Social Context in Mental Health Service Use Among Young Adults

Examining the sources of health communication that young adults with mental health challenges receive regarding service use is critical to curbing the societal concern of unmet mental health needs of this population. Semistructured interviews were conducted with 59 young adults, all of whom were diagnosed with a mood disorder and used public mental health services and additional public systems of care during childhood. Thematic analysis was utilized. Of the 59 participants, 45 nominated at least one supportive adult, with a total of 97 relationships analyzed. Results indicate that the majority of messages came from informal supports (e.g., family) who spoke positively about mental health services. Fewer messages came from formal supports (e.g., professionals). Messages included statements surrounding beliefs toward services, social norms (approval and disapproval), self-efficacy, and image considerations around using services. These findings can suggest ways that mental health service engagement interventions can leverage communication from informal supports. Future research can explore what messages young adults find most influential in persuading them to use mental health care consistently and the relationship between messages and health behavior.     

Long-Term Care Policy for Functionally Dependent Older People in the Republic of Korea

In the Republic of Korea, the construction of a long-term care system for frail older persons has become an issue of great concern in the twenty-first century, as the population is ageing rapidly. Functionally dependent older people aged 65 and over (excluding those who have difficulty performing so-called instrumental activities of daily living) are estimated to make up 15 per cent of the total population, but only about 1 per cent of older people can afford to use formal services. In response to the increasing burden of supporting frail older persons, a long-term care model is being prepared with the establishment in March 2003 of the Planning Committee for Developing a Public Long-Term Care Security System for the Elderly. This paper analyses the sociodemographic background to the introduction of a long-term care system, as well as the content and problems of the current system, and suggests the fundamental policy areas to be improved on the basis of these results. Policy issues are as follows: expansion of infrastructures for providing long-term care services, transforming small and medium-sized acute hospitals into long-term care hospitals, continuum of health and long-term care services, construction of a system to support informal caregivers, and development of a funding system for long-term care service costs.     

Promoting Personalization in Social Care Services for Older People

This article presents findings on 4 themes associated with the personalization of social care for older people: integration of health and social care services; initiatives that prevent the need for more costly interventions; services to maintain people at home; and systems that promote choice, control, and flexibility. The quantitative study utilized data from a national postal survey conducted in England. Findings suggest variable progress regarding the range and style of support available to older people. These are discussed in the context of service integration, community-based services, and consumer-directed care. Implications for service development and future research are highlighted.     

Stepping through the door – exploring low‐threshold services in Norwegian family centres

Public policies encourage the service system to work in new ways to promote health and increase social equality. This paper presents four categories that show the character of the low‐threshold services in Norwegian family centres from the professionals' and parents' perspectives, focusing on accessibility and participation: easy access, low level of bureaucracy, collaborative competences and inclusive arena. This paper is based on an inductive study in three municipalities that have chosen to establish family centres as interdisciplinary co‐located services that aim to offer low‐threshold services for children and their families. Data were generated through a fieldwork, and participatory observation and interviews were the main source of data. The methodological framework for the analysis was grounded theory, in which the data generation and analysis interchanged throughout the study, and theoretical sampling set the focus for the fieldwork. Exploring the actor's perspective highlighted both strengths and challenges with the low‐threshold services in the family centres. The four elements presented emphasize that the value of these low‐threshold services are not found in one single hallmark; rather, the value depends on an interaction between different elements that must be addressed when establishing, evaluating and developing low‐threshold services in family centres.     

Promoting personalization in social care services for older people

This article presents findings on 4 themes associated with the personalization of social care for older people: integration of health and social care services; initiatives that prevent the need for more costly interventions; services to maintain people at home; and systems that promote choice, control, and flexibility. The quantitative study utilized data from a national postal survey conducted in England. Findings suggest variable progress regarding the range and style of support available to older people. These are discussed in the context of service integration, community-based services, and consumer-directed care. Implications for service development and future research are highlighted.     

Use of Professional and Informal Support by Black Men with Mental Disorders

This study utilized data from the National Survey of American Life to investigate the use of professional services and informal support among African American and Caribbean black men with a lifetime mood, anxiety, or substance use disorder. Thirty-three percent used both professional services and informal support, 14% relied on professional services only, 24% used informal support only, and 29% did not seek help. African American men were more likely than to rely on informal support alone. Having co-occurring mental and substance disorders, experiencing an episode in the past 12 months, and having more people in the informal network increased the likelihood of using professional services and informal supports. Marital status, age, and socioeconomic status were also significantly related to help-seeking. The results suggests potential unmet need. However, the reliance on informal support also suggests a strong protective role that informal networks play in the lives of black men.     

Different Effects of Acculturative Stress and Family Life Stress on Depressive Symptoms among Married Vietnamese Immigrant Women in South Korea

Married Vietnamese immigrant women often face multiple stressors related to sociocultural adaptation and new family lives in South Korea. The purpose of this paper is to identify the different influences of acculturative and family life stress on depressive symptoms among Vietnamese immigrant wives. Data were collected through a questionnaire survey of 301 married Vietnamese immigrant women residing in South Korea. The study utilized linear regression analysis to test the relationships between the variables. The findings show that both acculturative and family life stress are positively related to depressive symptoms. Family life stress influences depressive symptoms to a greater extent than acculturative stress. The study emphasizes the significance of family‐related stress on mental health among married Vietnamese immigrant women in Korea and provides some implications for research, clinical practice, and policy.