Public Policy and Inequalities of Choice and Autonomy

Choice by service users has been promoted in social policy across many developed welfare states, often on the grounds that it will incentivize providers to enhance quality and efficiency. But this instrumental motivation for the promotion of choice overlooks the possibility that choice, understood in the deeper sense of autonomy, has intrinsic value, as suggested by egalitarian and capability‐based theories of social justice. This article argues that the narrow motivation of choice policies leads to a focus on services rather than outcomes for individuals and fails to address deep‐seated inequalities in the opportunities people have for real autonomy. We test this concept using newly collected data for the UK. Our empirical findings indicate that disabled people are more likely to experience constrained autonomy in all respects, while being from a low socio‐economic group and/or lacking educational qualifications is a risk factor across several components. We conclude that improving the ‘choice’ agenda for policy requires: (1) adopting a more sophisticated concept of ‘choice’ such as the conceptualization of ‘choice as autonomy’ outlined here; (2) developing a better understanding of existing inequalities in autonomy, such as we begin to explore in our empirical results; and (3) tackling these inequalities through, for example, the removal of obstacles to active decision‐making by providing effective support and advocacy, especially for disabled people, and addressing the major structural barriers – poverty, ill health and geographical inequality – which place significant restrictions on the autonomy of those who are already disadvantaged.     

Autonomy,Choice and Control for Older Users of Home Care Services: Current Developments in Swedish Eldercare

In Sweden, a policy shift towards more individualized eldercare, with an emphasis on consumer choice, has taken place. The aim of this study was to analyze the processes and practices of individualized eldercare, focusing on preconditions for older peoples’ choice and control. Data consist of qualitative interviews with users of home care services (n – 12) and staff (n – 12) and participant observations (n – 7) of meetings between staff and older people. The choice and control available to older users emerged as decisions about ‘what’ care and services, ‘who’ should provide the care and services, and ‘how’ the care and services should be performed. Three approaches to enable older people choice and control over their home care services were revealed: test and revise, services elaborated in close collaboration between users, care managers and home care staff; choices in the moment, users could choose services at each occasion; and quality improvement through competition, competing providers develop attractive services. The findings could guide policy makers in combining the strengths of these approaches to enable older people in need of support to become co-producers in designing, managing, as well as consuming, care and services. Future quantitative research is needed to achieve generalizable knowledge about the strengths and weaknesses of different ways to organize eldercare services.     

Are Quasi‐markets in Education what the British Public Wants?

In the context of inconclusive evidence on the extrinsic successes of quasi‐markets, policy defences of school choice and competition in education have often discussed the intrinsic, empowering value of choice for consumers, arguing that school choice for parents is ‘what people want’. Discourses often imply that choice is desired for its own sake rather than merely as a means by which families can escape what are deemed to be poor quality schools. Support for an idealistic, abstract notion of ‘choice’ is also taken to imply support for quasi‐markets overall and is not considered alongside possible competing values that people may hold at the same time as they value choice. Additionally, views of parents are often examined without considering possible differences in views between parents and non‐parents. Contributing to debates about how far a public desire exists for quasi‐markets in education, this article draws on data from newly designed questions fielded as part of the 2010 British Social Attitudes survey. The article finds that while choice ‘in the abstract’ is supported widely by both parents and non‐parents (albeit slightly more so by parents), a valuing of choice among the British public appears to be more instrumental than intrinsic – potentially problematic given evidence on the extrinsic benefits of quasi‐markets is mixed. Support for choice is tempered among parents and non‐parents by clear opposition to vouchers, school diversity, government spending on transport costs to facilitate choice and by strong support for the idea of sending children to the ‘nearest state school’.     

Representing personal and common futures: Insights and new connections between the theory of social representations and the pragmatic sociology of engagements

To understand social issues and practices such as those related to climate change and technological change that are clearly future-oriented – collectively experienced events that are “not yet” – and co-constructed by different actors, we need nuanced conceptualizations of how people think about, negotiate and co-create futures that allow us to understand not only what people (can) think and do about future-related issues but also how that happens, what for and with which implications. However, so far, one of the key theoretical approaches that has conceptualised how people make meaning in situations of change and uncertainty – the socio-psychological social representations theory (SRT) – has not often engaged with the future or with different forms of temporality. By contrast, the French pragmatic sociology of engagements and critique (PS) has engaged with these notions, conceptualising them in relation to materiality and a plurality of moral orientations – two dimensions often seen as key to how collective futures are made and imagined. To offer a more nuanced and systematic conceptualization of how people represent the future and with what consequences, this paper will present, compare and synthesise SRT and PS, as a first step towards an interdisciplinary research agenda on social change and representations of the future.     

Food Security: Rights, Livelihoods and the World Food Summit–Five Years Later

An international Summit was called for June 2002 aiming to reaffirm the commitments of the 1996 World Food Summit and intensify efforts to halve the number of hungry people in the world to 400 million by 2015. However, progress on achieving this target is open to question. This paper analyses recent policy debates in two areas: first, the right to food and freedom from hunger; and second, the measurement of food insecurity at global and national levels. It agrees that the "World Food Summit–five years later" (WFS–fyl) should reaffirm commitment to the right of all people to food and freedom from hunger and the commitment to raise the resources required to achieve this. A rights–based approach to food security implies that policies be defined and actions taken to reduce hunger by a range of local, non–governmental, governmental and international actors. However, reliable information on who the hungry are and where they are situated is required in order to track progress to WFS targets and identify and implement appropriate actions at the global, national or subnational levels. The inter–agency Food Insecurity and Vulnerability Information and Mapping Systems (FIVIMS) plays a key role in generating information on trends of the numbers of food–insecure in the world, but the robustness of its "undernourishment" measure has been debated. The paper concludes by outlining practical ways to improve food security analysis, indicating the potential contribution of rights–based and livelihoods approaches.     

Understanding Social Inclusion and Its Meaning for Australia

This paper considers the various meanings of ‘social inclusion’ from both sociological and policy viewpoints. It shows how the perspective has been translated into particular policies and approaches to governance. After drawing some lessons from the policy experiences of other countries, it weighs the appropriateness of a ‘social inclusion agenda’ for Australia, a country with a particular history of social exclusion – of prisoners, indigenous people, and immigrants from around the world – and a special emphasis on dignity, respect and equal treatment.     

Hunger Reduction in China: An Analysis of Contextual Factors

In recent times, China has significantly reduced hunger in its populace. The main objective of this paper was to analyze some of the contextual socioeconomic factors contributing to the reduction of hunger in China, using Qualitative Interpretative Meta‐Synthesis (QIMS). The results revealed that China has followed a broad‐based and multispectral approach to reduce hunger. Factors, such as poverty alleviation; social safety nets for disadvantaged villagers; agricultural development and land reforms; regional development and equity in development activities; infrastructural development; and political‐economic reform and sustainable growth were influential in reducing hunger in China. Poverty is attributed as one of the principal contributors and is interlinked with many other dimensions. The findings of this paper are a useful guide to the Chinese government, policy‐makers, international organizations, and development practitioners.     

Personal Assistance for Disabled People – The Norwegian Experience

This article presents data from a survey of all disabled people in Norway who receive personal assistance in the municipalities that have been granted subsidies from the state. It concentrates on the following issues: – Who are the users of personal assistance? What distinguishes them from other disabled people? – What dimensions has personal assistance as a service? How has it influenced the total service to the recipients and how is this composed? – How do the users value the service? To what extent does it seem to fulfil the aims of self-dependence and sovereignty for the users? The article concludes that personal assistance seems to be a suitable instrument to reach the goals of full participation and equality of status for disabled people in Norwegian society. The main challenges which personal assistance will meet in the future are the financing of the arrangement and how the principles of user-determination could be implemented and transferred to other services without losing its ideological base.     

Care of Empowerment? A Disability Rights Perspective

This paper challenges the notion of "care", arguing that people who need support in their daily lives have been constructed as "dependent people". Instead, the author argues, if we want to empower people we must learn from the Independent Living Movement, from the people who struggled against segregation and insisted that access to personal assistance over which they have control is a civil rights issue. The paper takes issue with Clare Ungerson's perspective on the new direct payments legislation. This legislation is an important stage in the achievements of a civil rights movement and social researchers have a moral responsibility to collaborate with this movement in any work which they develop on issues which are not of mere academic interest but which concern people's rights to choice and control in their lives.     

Understanding the Downshifting Phenomenon: A Case of South East Queensland,Australia

A quality of life survey of a sample of households across the Brisbane‐South East Queensland region has identified about 28 percent of people as ‘downshifters.‘ They are defined as people who voluntarily make a long‐term change in their lifestyle – other than planned retirement – which reduces income and adjusts their lifestyle conditions. A typology of downshifters is developed on the basis of their motives for downshifting and their socio‐economic and demographic characteristics using a Two Step Cluster Analysis. Results indicate that the social and economic circumstances and the reasons and methods of downshifting tend to vary substantially across the clusters.     

Resilience of Young People in Residential Care

Children and young people in residential care may have experienced or may experience various difficult, life-threatening events, such as neglect, abuse, or violence and maltreatment known as adversities. Despite this, some of them are able to function and even prosper and this has been attributed to the development of resilience. In this qualitative empirical study, we focus on the under-researched area of how young people in care reflect on and cope with such adversities. The exploratory research comprised of semi-structured interviews with young people in two different care settings – re-education centres and children’s homes. The results showed that the sample of 34 young people had experienced 73 adversities prior to leaving residential care and that half of them were not able to resolve some of these adversities. It was found that methods for dealing with adversity change during time spent in care and that a combination of various individual strategies, adaptation and accepting support are effective. The findings also indicate that the development of resilience may vary according to type of residential care setting specifically, whether these facilities allow the development of multiple individual strategies for dealing with adversities, or whether they provide social support. The article discusses implications for future research and practice in residential care.     

‘It's about changing services and building relationships’: evaluating the development of Children in Care Councils

The introduction of Children in Care Councils under the Care Matters reforms in England set a challenge for local authorities to find effective ways by which children in care could contribute their views to the planning and provision of services. This paper discusses a review of progress across London which combined a survey of boroughs with focus group discussions with young people, local authority staff and elected members. The research found that considerable progress had been made in that virtually all boroughs had some mechanism for representing children in care, and that staff and young people were proud of their achievements. However, major challenges remain – to embed a culture of participation in services, to ensure continuity, to reach all children including the many placed ‘out of borough’ and to defend what has been achieved in the face of severe cuts in public spending. The paper highlights a tension between empowering young people and meeting targets as corporate parents. The results support other research pointing to the need for a better understanding of the relationship between participation in governance and participation grounded in ordinary life.     

Towards New Indicators of Disadvantage: Deprivation and Social Exclusion in Australia

Concern over the reliability of conventional poverty studies has focused attention on the need to demonstrate that those identified as poor are actually experiencing hardship. This paper takes a step in this direction by examining poverty using a living standards approach derived from the literature on deprivation and social exclusion. Deprivation – defined as an enforced lack of socially perceived necessities – has emerged as a way of identifying who is missing out on what the community regards as the necessities (or essentials) of life. Social exclusion – which exists when individuals do not participate in key activities in society – has opened up new areas of inquiry relating to a lack of connectedness between individuals, the communities in which they live, and key economic and social processes. The findings indicate that many Australians face deprivation and exclusion in numerous aspects of their lives, and that those defined as poor in income terms are different from those who are deprived or excluded. The low overlap between the three indicators implies that they all have a role to play in documenting the extent of social disadvantage and helping to identify the factors that contribute to its various manifestations.     

Iranian consecration of Irish nationalist ‘martyrs’: the Islamic Republic of Iran and the 1981 republican prisoners’ hunger strike in Northern Ireland

This article focuses on the official and semi-official Iranian coverage and representation of the 1981 republican prisoners’ hunger strike in Northern Ireland and the related corporeal constructs of the hunger strikers as ‘martyred’ bodies. The particular characterization and utilization of Irish republican hunger strikers by media outlets, officials, and other propagandists of the Islamic Republic of Iran (IRI) was an instance of groups outside Northern Ireland appropriating Irish nationalist bodies for their own ends. IRI commentators re-articulated the starving bodies of Irish republican hunger strikers, re-infusing them with symbolic meanings in a cross-cultural and ideologically laden configuration in the service of IRI’s self-projection as the patron of worldwide struggles for justice and liberation against the twin forces of imperialism and domestic opponents. In the process, IRI added its own layers of agency and politically crafted somatic meaning to the hunger strike. Meanwhile, IRI’s extensive advocacy of the republican hunger strike in Northern Ireland was eagerly welcomed by the Provisional Irish Republican Army (PIRA), to which most hunger strikers belonged; with PIRA and its political wing, Provisional Sinn Féin, hoping to secure diplomatic recognition, and possibly material aid, from the Iranian government for bolstering PIRA’s domestic and international standing vis-à-vis the British government.     

Evidence for multiple strategies in choice under risk

This paper describes an experimental study that yields evidence for the coexistence of two decision strategies of choice under risk. Under the first strategy, choices are made based on aspiration levels – a heuristic that simplifies risky decisions. Under the second strategy, which can be used when aspiration levels are not determinative, choices are made based on preferences for positive skewness. Our model fitting confirms the efficacy of a two-pronged approach that can marshal either strategy depending on specific features of the risky prospects under consideration.     

Syncretism in rituals and performance in a culturally pluralistic society in the Philippines

Preserving indigenous culture and practices remains a great challenge for indigenous groups living in a pluralistic, westernized, modernized/post-modernized, and globalized society. With the different elements of social change interacting with the traditional knowledge, systems and practices, it is imperative to look at the risks and changes experienced by indigenous groups in relation to its culture. This paper narrates the presence of syncretism of traditional and contemporary practices in the rituals and music of the Ibaloi community and tries to present the possibility of harmonious interface between the modern quotidian and indigenous life in an attempt to pose minimal risks in the relationship. Rituals in the culturally pluralistic society in the Philippines – Loakan, Baguio City – are still executed and observed at present but the elements of which and other preparations are being lessened because of practicality and shift in beliefs. Nonetheless, these systems and practices still exist because of the meanings attached by the people and their socio-cultural function – as social structures and institutions of social coherence and solidarity – and their outlook about the changes and preservation of performances and rituals in the Ibaloi society.     

Care without coercion – mental health rights,personal recovery and trauma‐informed care

Australian mental health services continue to use involuntary measures in response to consumers' mental distress. Regardless of the intent behind these practices, the experience of being forced to receive treatment, be secluded or restrained is traumatic and can cause further distress and harm. Other parts of the health or social service system have shifted to approaches that emphasise agency, social context, prevention, and rights. Three frameworks currently used in mental health services – human rights, personal recovery, and trauma‐informed – are consistent with a shift away from the use of force. We applied these frameworks to the text of the National Standards for Mental Health Services 2010 to analyse the degree to which it reflects a shift. We also analysed the public text of speakers' notes from the Care Without Coercion Conference 2012 concerning lived experiences of force in mental health services. The analysis highlights force in many aspects of policy. The findings have implications for directions of change, including freedom from violence; support for decision making; access and choice about community and inpatient options; safety and risk management; and greater understanding of current policy frameworks through engagement with people with lived experience about the options and impact of support processes that exclude the use of force.     

Increasing Choice and Control for Older and Disabled People: A Critical Review of New Developments in England

This paper critically examines new policies currently being implemented in England aimed at increasing the choice and control that disabled and older people can exercise over the social care support and services they receive. The development of these policies, and their elaboration in three policy documents published during 2005, are summarized. The paper then discusses two issues underpinning these proposals: the role of quasi‐markets within publicly funded social care services; and the political and policy discourses of consumerism and choice within the welfare state. Despite powerful critiques of welfare consumerism, the paper argues that there are nevertheless very important reasons for taking choice seriously when considering how best to organize and deliver support and other services for disabled and older people. A policy discourse on consumerism, however, combined with the use of market mechanisms for implementing this, may be highly problematic as the means of creating opportunities for increased choice and, on its own, risks introducing new forms of disadvantage and social exclusion.     

Young people’s disillusionment with French education before 1968: sport,the school curriculum and social change

The quasi-revolutionary events of May 1968 have come to symbolize the generation gap between young people and their elders in France, and of contestation over social values, freedom and control. This article demonstrates that this discontent was apparent earlier in the decade, although politicians in charge of youth affairs either did not see it or chose not to publicize its existence. It focuses on debates relating to sport – and its incorporation into the teaching of physical education in lycées – because of its importance both within formal schooling and as an extra-curricular leisure activity. In 1966 François Missoffe, Minister of Youth Affairs and Sport, launched a huge inquiry into the problems facing young people, leading to the publication of an official report in 1967 which, perhaps surprisingly, had nothing to say about unrest among young people. This article aims to access the voices of young people in French lycées by mining the contents of over 2600 files of evidence that were collected during the course of the Missoffe inquiry. We argue that it is important to measure the gap between what the political and educational decision-makers presupposed about the sporting needs of young people and the views these same young people actually expressed. The article highlights examples of young people’s disillusionment with the teaching of sport and physical education, demonstrating that this not only conveyed signs of discontent with educational institutions as a whole but also a wider desire for social change that anticipated the views of angry lycéens (school pupils) in May 1968.