Help or hindrance? Social policy and the ‘social determinants of health’

In recent years, public health research has become increasingly focused on issues of social inequality and social disadvantage. This is because social issues, such as poor housing and unemployment, have been found to impact health significantly, and are now referred to as ‘the social determinants of health‘. As a result of this shift, public health is now principally concerned with what are historically considered to be social policy issues. This paper discusses the confluence of public health and social policy; it examines the opportunities and risks posed by this convergence for those working in social policy seeking to reduce poverty and inequality. We argue that, while much can be gained in the two fields by working more closely together, there remain fundamental differences in perspectives and approaches. In order to maximise benefits, these points of difference need to be thought through sooner rather than later.     

The Gender Dimension of Social Policy Reform in Turkey: Towards Equal Citizenship?

This article discusses the current social policy reform process in Turkey from a gender perspective. Until now, social security and labour regulations have provided women with special benefits and protections. Depending on the particular case, these gender‐specific policies can be interpreted differently – as positive discrimination, satisfying practical gender interests, or as a reinforcement of traditional gender norms and relations, stigmatizing women as a weaker, vulnerable group in need of special protection. Ongoing reform initiatives, however, neutralize most of these long‐lasting gendered policies, either by terminating rights formerly enjoyed only by women or by extending these rights to men as well. The article questions this changing nature of social policy as to whether it promises equal citizenship for women or increases their vulnerability, in the absence of former benefits and without sufficient policy measures for improved capability.     

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.     

Poverty and Hardship among the Aged in Urban China

China's record in reducing poverty over the last three decades has been impressive, yet few studies have examined the incidence of poverty among older people despite the rapid ageing of the population. This article uses a unique national data set to examine patterns of poverty, deprivation and exclusion among the urban aged population (60 years and over) in 2000. The results point to the importance of poverty as an issue for older people, particularly for women and those who live alone. A number of indicators of hardship are developed in four areas – economic insecurity, housing, health, and social isolation – and the incidence of these is examined, separately and in combination, by living arrangement and gender. Women are shown to experience greater levels of hardship and isolation than men, and to be more likely to experience multiple deprivation across two or more areas. Finally, the overlap between poverty and hardship is examined as a way of validating the poverty estimates and giving them greater credibility. The results indicate that there are strong overlaps, although these differ across the different dimensions of hardship. Access to pension income and concern over the cost of necessary visits to see a doctor emerge as strong predictors of poverty and point to areas where policy change is needed.     

Risk, Mental Disorder and Social Work Practice: A Gendered Landscape

Whilst the importance of gender for social work practice, riskand mental health has been recognized theoretically for sometime, few attempts have been made to explore this area empirically.This paper presents findings from a mixed-methods study of socialwork practice in relation to mental health service users perceivedto be ‘high-risk’. Findings suggest, first, thatthe concept ‘high-risk’ was gendered because theprimary focus in social work practice was on the risks posedby male service users to others. Second, female social workersin the present study were found to have more female serviceusers from their caseloads who had been defined as ‘high-risk’compared with their male counterparts. The paper goes on toexplore this apparent congruence between female social workersand female service users and highlights how the management ofrisk could be considered gendered because it reflects a worker’s(perceived) capacity in cultural terms to ‘decode’the nature of the risks that their clients face as genderedsubjects. The paper demonstrates how the intersections betweenrisk, mental disorder and social work practice can thereforebe understood as a gendered landscape. It concludes by highlightingthe implications of these findings for social work practiceand research.     

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.     

Neoliberalism,Inequality and Politics: The Changing Face of Australia

Since the early 1980s Australian public policy has undergone the most major transformation since Federation. This transformation has been underwritten by two key principles: liberalism – the view that citizens are autonomous individual actors whose interests are best served when they are free from coercive government interventions into individual action; and marketisation – the belief that free markets are arenas which best enable individual autonomy and produce efficient economic outcomes. These principles define ‘neoliberalism’ or ‘hard liberalism‘. After summarising the major policy changes identified with neoliberalism in Australia, the paper introduces a new research project that examines its impact on socioeconomic inequality, gender inequality and politics and culture. Inspection of relevant data indicates that there are important trends in inequality, public opinion and political behaviour that warrant this investigation.     

Compulsory income management: Combatting or compounding the underlying causes of homelessness?

Compulsory Income Management (CIM) is a form of conditional welfare that involves the mandatory quarantining of a portion of welfare recipients’ social security payments. Quarantined funds are accessible via a government-issued debit card, with restrictions surrounding where and on what funds can be spent. Official justifications of CIM have framed these policies as attempts to combat substance abuse and gambling problems, and to thus secure better outcomes for welfare recipients and their families. Central to this narrative has been the argument that welfare quarantining will ensure more money is spent on ‘essentials’, including accommodation. No existing studies, however, have specifically interrogated the impacts of CIM on housing security. This article responds to this gap in the literature by reviewing existing research concerning CIM's impacts and locating this research within broader debates regarding the causes of homelessness and the efficacy of individualised policy interventions. In doing so, it highlights CIM's potential to exacerbate housing insecurity not only through technical issues such as rental transfer failures, but also by contributing to underlying stressors such as economic disadvantage; relationship difficulties, poor health and addiction; and social stigma. The article concludes that – far from addressing the structural causes of homelessness – CIM has enflamed them.     

Gender, social capital and location: understanding the interactions

In recent years, governments in many post-industrial nations have re-discovered 'community'. Social capital and neighbourhood renewal are key concepts underpinning policies aimed at building the capacities of communities to respond to the problems facing them. Despite the apparent consensus amongst Anglo-American governments about the use of social capital, and related concepts, as a guide for policy formulation these ideas remain hotly contested amongst social policy commentators. Against a general backdrop of disquiet about the application of social capital initiatives to communities facing significant social and economic challenges, some commentators highlight the curious inattention to gender in debates about social capital. This is all the more troubling given the apparent reliance of social capital initiatives on the informal network-building activities often undertaken by women. In this article we present findings from an empirical study of social capital creation across four geographically diverse communities. We show that the relationship between gender and social capital is complex. We argue that the 'one-size-fits-all' approach to social capital formulation fails to recognise gendered patterns of social capital formulation, but so, too, do analyses of gender that neglect the complex interactions between gender and other factors, particularly location, age and income. We argue for approaches to policy formulation that recognise local differences, including differences between and amongst men and women in social capital creation.     

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

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

The Australian child support reforms: a critical evaluation

The Australian Child Support Scheme aims to ensure that children continue to be supported financially should their parents separate or never live together. Sweeping changes to the Australian Child Support Scheme were introduced between 2006 and 2008, featuring a dramatically different system for the calculation of child support and a more rigorous enforcement regime. The reforms were intended to respond to ongoing concerns about equity, and to changes in social expectations and practices in gender, work, and parenting. In this article we summarise key findings from a large cross‐sequential study of the child support reforms. Although the new formula initially led to lower child support payments, and an increase in the proportion of separated mothers experiencing income disadvantage, payments two years later had increased slightly. More broadly, the new scheme appears to have resulted in little change in separated parents' policy knowledge, parenting arrangements, perceptions of fairness, and child support compliance. Taken together, these findings suggest that Australia may not have made as much progress as it would have liked in this thorny area of social policy – especially in relation to compliance and perceptions of fairness.     

Predictors of Cambodian parents’ perceptions of corporal punishment

This cross‐sectional study was conducted to examine the predictors of parents’ positive perceptions of using corporal punishment on their children. We investigated whether there is a gender difference in the use of corporal punishment according to parents’ gender and socioeconomic variables and what factors predict Cambodian parents’ positive perceptions of the use of corporal punishment toward sons and daughters. Cambodian parents hold different views on raising boys versus girls. Younger parents with more children, limited education, low socioeconomic status, unemployed, living in rural areas, and parents who hold positive perceptions of spousal abuse of women were more likely to approve of the use of corporal punishment. Our results present implications for social work practice and policy, particularly in child welfare in Cambodia. Most importantly, in order to prevent the use of corporal punishment on children in the home, the government of Cambodia as well as domestic and international organizations need to make more active efforts to promote parenting education.     

Reinvigorating the social contract and strengthening social cohesion: Social protection responses to COVID-19

The COVID-19 pandemic has exposed the vulnerability of those who are inadequately covered by social protection in more and less developed countries alike, and has exacerbated the fragility of a social contract that was already under strain in many countries. A weak social contract in the context of an exceptional crisis poses a very real risk to social cohesion. Nevertheless, many States have reasserted themselves as the guarantor of rights by protecting public health and incomes. By sustaining these measures, economic recovery will be supported which will help minimize risks that may weaken social cohesion. However, this is a fast-moving, inherently unstable and protracted crisis. Social protection stands at a critical juncture. Decisive policy action will be required to strengthen social protection systems, including floors, as one of the cornerstones of a reinvigorated social contract.     

Poverty, Housing Niches, and Health in the United States

Drawing on psychological, health, and social science literature, a housing niche model is developed that focuses on (a) housing markets and other societal processes that constrain residential choice, (b) effects of residential environments on health and access to human and social capital, and (c) family dynamic effects on health and the intergenerational consequences of particular housing niches for future health and housing choices. The model requires the examination of cumulative risks, mediating and moderating processes, and the use of multilevel statistical models. The health consequences of existing housing policies are explored and future directions for research and policy suggested .     

Subverting Social Policy on the Front Line: Agencies of Resistance in the Delivery of Services

An understanding of policy implementation issues in many of the core fields of social policy requires attention to the mode of service delivery that is characteristic of those fields: face‐to‐face interaction between frontline service staff and service users. A focus on implementation as interaction between these groups reveals the significance of ‘agency’ to the analysis of why and how certain social policy outcomes occur – and in particular why outcomes may sometimes be different from those anticipated by formal policy objectives. This article considers how the agency of workers and users shapes the processes of mediation, negotiation and adaptation that occur in different service delivery contexts, and identifies ways in which resistance to intended policy outcomes, and to the practices expected to deliver them, is formed and expressed. Drawing on a wide range of empirical research material, the article shows how agencies of resistance produce outcomes that are uncertain, fragile and contested, and whose effect can be the subversion of formal policy intentions.     

Changing Places: Men Replace Women in Mental Health Beds in Britain

Based on census materials collected in England and Wales from 1921 to 1991, this study focuses on gender differences in occupancy rates in hospitals and other mental health facilities in Britain. The results suggest that since 1991, or for the first time in the twentieth century, there are more males than females in residential mental health facilities in Britain. Furthermore, this pattern of association holds for all age groups except those aged 65 years and over. Second, there are currently two distinct subpopulations in mental health facilities—a male group which is predominantly of working age, and a female group, which is predominantly of retirement age. The existence of these two "care" populations will impact significantly on current and future resourcing of mental health services. The policy implications of the research findings are discussed within the context of the debates on the changing relationship between gender and mental health.     

Inclusionary policy and marginalised groups in Aoteaora/New Zealand process,impacts and politics

ABSTRACT

This paper presents the consolidated findings of a four-year research project that evaluated policy inclusion between the New Zealand government and communities of difference – specifically, ethnic/migrant/refugee groups, women/gender and Māori. Policy inclusion builds on foundational principles of deliberative democracy that dialogue and relationship not only improve policy but also foster democratic transitions towards pluralism and diversity. Although associated with the social democratic agenda of the Fifth Labour government, collaborative policymaking with marginalised groups continued in the subsequent National government. Drawing on interviews with policy communities, this paper analyses (a) the processes of inclusionary policymaking, (b) policy impacts and (c) implications for politics of difference. The findings suggest that, overall, the greatest efforts in inclusive policy have been at the level of design, primarily by maximising the presence of members and promoting visibility for communities of difference. These processes have had less impact on sustained, deep political transformations or opportunities for advancing diversity. The findings suggest that inclusionary policymaking had benefits for recognition politics, but against the backdrop of recent neo-conservatism, the prospects for pluralistic politics have been compromised, paving instead a politics of regulation.     

Room to move? Professional discretion at the frontline of welfare‐to‐work

Outcomes of social policies have always been mediated by the discretionary agency of front‐line staff, processes which nevertheless have received insufficient attention in policy evaluation and in the social policy literature more broadly. This article takes the case example of the policy reforms associated with the Australian government's welfare‐to‐work agenda. Drawing on two discreet research projects undertaken at different points in the policy trajectory, the practices of social workers in Centrelink – the Commonwealth government's primary service delivery agency involved in welfare‐to‐work – is examined. Centrelink social workers have been and remain one of the core groups of specialist staff since the Department's inception in the late 1940s, working to improve the well being of people in receipt of income security. Their experiences of the recent past and their expectations of the future of their professional practice as welfare reform becomes more entrenched are canvassed. In summary, the discretionary capacity of the Centrelink social workers to moderate or shape the impact of policy on income security recipients is steadily eroding as this group of professionals is increasingly captured by the emerging practices of workfare.     

Convergence of family policy across welfare regimes (1990 to 2010): Different connotations of family policy expansion

Using multiple indices of family policy efforts – work/family reconciliation, gender equality and income protection, this study offers a nuanced understanding of family policy expansion in 14 OECD countries across three welfare regimes from 1990 to 2010. Findings suggest an overall convergence of family policies, particularly in gender equality and work/family reconciliation. Convergence has occurred simultaneously with distinctive family policy changes across welfare regimes. Conservative welfare states have experienced the most profound family policy alterations, shifting from a traditional gender model to one that encourages women's employment, but have, nevertheless, maintained policy efforts that sustain the traditional gender role. Despite an increase in their family policy efforts, liberal welfare states have continued to maintain minimal state action regarding family policy. Changes in social democratic welfare states have been less substantial, as they seem to continue to pursue a dual‐earner model with high degree of gender equality and work/family reconciliation.