Planning Australia's Health and Welfare Services

The report of the Health-Welfare Task Force to the Royal Commission on Australian Government Administration brings together for the first time a great deal of useful information about health and welfare services in this country. However, restricted definitions of health and welfare compounded by strict adherence to a structuralist model of society leads to a predictable set of proposals for the planning, delivery and financing of services in a federal structure. It is to be hoped that the recommendations for greater research efforts and for increased community participation will be given enthusiastic support at all levels of welfare organization.     

Accountability and academic freedom: The battle concerning research on cold fusion at Texas A&M university

abstract

The Massachusetts Task Force on Human Subject Research has so far been the only serious attempt to investigate radiation experiments on humans. No other federal, state or private agency has looked at a specific experiment in detail. The President's Advisory Committee on Human Radiation Experiments (ACHRE) provided an overview of the entire nationwide research project, but without a thorough evaluation of any single experiment. The Massachusetts Task Force examined a group of experiments using institutionalized children at two state facilities, the Fernald and Wrentham schools, from 1943 to 1973. The experiments were performed under supervision by scientists at Harvard and MIT, and were funded by several federal agencies. The Task Force found that these experiments were conducted according to the ethical and protocol standard of their day. This did not prevent the Task Force from judging that the experiments violated human rights, and recommending apology and compensation to the victims.     

A grass roots approach to influencing child welfare policy

This paper provides a brief review of child welfare issues identified by a Canadian Task Force convened for the 1979 Year of the Child. Project experience with the use of Looking After Children is linked to the issues identified in 1979. A fairly extensive discussion of legal considerations is presented to provide a context for the challenge of influencing policy. Finally, the possibility of influencing policy from a grass roots approach that can transcend jurisdictional boundaries is presented as offering hope for change in a child‐centred direction.     

Federalism Policy,Economic Policy and Implementation of the Bailey Report

The Bailey Task Force (BTF) report is reviewed from the perspective of a would-be implementer. The BTF report is partially implementable if its writers were able to resolve three critical issues. First, they might emphasize how its four Program (Block) Grant proposals would influence the economy through opening up employment opportunities. Next, they should spell out how pilot developments of certain Program Grants could proceed with model legislation, and should indicate the contents of that legislation. Finally, they should be more specific about consultative mechanisms involving non-government agencies and local government.     

Anticipated Ethics and Regulatory Challenges in PCORnet: The National Patient-Centered Clinical Research Network

PCORnet, the National Patient-Centered Clinical Research Network, seeks to establish a robust national health data network for patient-centered comparative effectiveness research. This article reports the results of a PCORnet survey designed to identify the ethics and regulatory challenges anticipated in network implementation. A 12-item online survey was developed by leadership of the PCORnet Ethics and Regulatory Task Force; responses were collected from the 29 PCORnet networks. The most pressing ethics issues identified related to informed consent, patient engagement, privacy and confidentiality, and data sharing. High priority regulatory issues included IRB coordination, privacy and confidentiality, informed consent, and data sharing. Over 150 IRBs and five different approaches to managing multisite IRB review were identified within PCORnet. Further empirical and scholarly work, as well as practical and policy guidance, is essential if important initiatives that rely on comparative effectiveness research are to move forward.     

Task force on Medicaid in Missouri: a community collaboration in gerontological social work education

Master's level social work gerontology students formed a Task Force on Missouri Medicaid as the primary course project of the Social Policy and Aging class at George Warren Brown School of Social Work, Washington University in St. Louis. Led by students, the Task Force collaborated with community leaders to address issues with the escalating enrollment and cost of Missouri's Medicaid program, resulting in a widely disseminated policy brief. Students identified multiple professional skills gained through this assignment and community leaders determined the issue brief to be a significant contribution to Missouri's Medicaid policy debate.     

Management and the Health District

This article is by a member of a district health authority in the London Area, and is stimulated by Haywood's paper in our last issue. It examines the most recent developments in health service management in implementation of the Griffiths Report.     

Manpower Utilization before and after Differential Deployment of Manpower in Jerusalem Welfare Offices

Summary This article describes patterns of manpower utilization in Jerusalemmunicipal welfare offices before and after reorganization ofthe Welfare Department whereby the functions of eligibilitydetermination and provision of income maintenance grants wereseparated out from the tasks of family caseworkers and givento special non-professional administrative units.The time studycarried out after ‘separation’ showed a more rationaluse of professional staff time, where a worker's education wasbetter correlated with bis tasks and significantly more professionaltime was devoted to individual counselling and inter-agencybrokerage on behalf of welfare clients. Mention is made of theneed for experimentation with innovative uses of welfare officestaff based on changing conceptions of welfare systems     

Work,welfare, and wellbeing: The impacts of welfare conditionality on people with mental health impairments in the UK

The personal, economic, and social costs of mental ill health are increasingly acknowledged by many governments and international organisations. Simultaneously, in high-income nations, the reach of welfare conditionality has extended to encompass many people with mental health impairments as part of on-going welfare reforms. This is particularly the case in the UK where, especially since the introduction of Employment and Support Allowance in 2008, the rights and responsibilities of disabled people have been subject to contestation and redefinition. Following a review of the emergent international evidence on mental health and welfare conditionality, this paper explores two specific issues. First, the impacts of the application of welfare conditionality on benefit claimants with mental health impairments. Second, the effectiveness of welfare conditionality in supporting people with experience of mental ill health into paid work. In considering these questions, this paper presents original analysis of data generated in qualitative longitudinal interviews with 207 UK social security benefit recipients with experience of a range of mental health issues. The evidence suggests that welfare conditionality is largely ineffective in moving people with mental health impairments into, or closer to, paid work. Indeed, in many cases, it triggers negative health outcomes that make future employment less likely. It is concluded that the application of conditionality for people with mental health issues is inappropriate and should cease.     

Poverty, welfare problems and social exclusion

This article investigates whether, and to what degree, poverty is linked to other types of welfare problems and, in larger perspective, whether the situation can be understood in terms of social exclusion. Two different measures of poverty – income poverty and deprivation poverty – and 17 indicators of welfare problems were used in the analysis. It was shown that income poverty was rather weakly related to other types of welfare problems, i.e. the most commonly used measure of poverty seems to discriminate a section of the population that does not suffer from the kinds of problems we usually assume that poverty causes. Deprivation poverty, identifying those who most often had to forgo consumption of goods and services, did correlate strongly with other types of welfare problems. Hence, people living under poor conditions do suffer from welfare problems even though this section of the population is not always captured by income poverty measures. The final analysis showed that the types of welfare problems that were most likely to cluster were deprivation poverty, economic precariousness, unemployment, psychological strain and health problems. Whether these types of accumulated welfare problems, from a theoretical perspective, can be seen as indicators of social exclusion is more doubtful.     

Social Justice and the Reform of Social Security

There have been massive increases over the years in expenditure on the public services loosely grouped together as the “welfare state”, but widespread dissatisfaction persists. This article is a critique of the proposals for reform presented in the Report of the Commission on Social Justice, set up by the late John Smith. The report contains a sweeping condemnation of existing arrangements and puts forward a series of recommendations ranging from the health service to decentralization in government and from employment policy to benefits for the elderly. As was perhaps inevitable, some are more precisely presented than others. An important example of the more fully specified proposals is one to establish what would, in effect, be a means-tested “pension guarantee”but with “means”so defined as to exclude capital and with much improved “disregards”. Another is the endorsement of the proposals to extend social insurance to part-time workers—a proposal which raises some controversial issues. There is much in this report that deserves close attention, and it is, therefore, all the more unfortunate that its proposals are not presented in the form of a quantified plan for social policy. Even for the first five years or so of the fifteen the Commission has in mind, there is no attempt at quantification. The importance of economic growth is rightly stressed, but “faster growth”can become a panacea that obscures the need for choice, not only between private and public expenditure but also between the various components of public policy itself.     

Layoffs, Plant Closings, and Worker Displacement in America: Serious Problems that Need a National Solution

Pervasive economic changes in America during the past decade have generated severe structural adjustment problems for millions of long-service blue-collar workers. Public and private efforts to help these workers are inadequate and tardy in delivery. This article examines the severity of the displaced worker problem, reviews what is currently being done, and argues that America needs a new displaced worker adjustment program. In December 1986 the Secretary of Labor's Task Force proposed such a program, and most of it has since been passed by Congress and signed into law. If this legislation is fully implemented, it will fill a major gap in the nation's employment and training policy, and help America remain competitive in the world marketplace.     

Civil criticism and the welfare state

This article is a report on a Finnish survey on criticism of the welfare state. The research questions are: 1) How commonly do people see the negative sides of the welfare state? 2) What background variables correlate with critical attitudes? Data for the study were gathered in a representative Finnish mail survey (N=2, 949). The main results show that criticism against the welfare state is rather widespread in Finland. The most critical people are those who support the Rightist parties. However, different socio-economic groups express diverging forms of criticism. People with a lower position in stratification hierarchies are critical of the alleged bureaucracy of the welfare state. The middle classes are more critical about the redistributive effects of the welfare state. However, the widespread criticism cannot be interpreted as a sign of a legitimation crisis. People both support and criticize the welfare state at the same time.     

Lineages of the Iranian Welfare State: Dual Institutionalism and Social Policy in the Islamic Republic of Iran

This article examines the relationship between welfare and state governance in Iran since the 1979 Revolution. It argues that the contemporary set of social welfare organizations in Iran arose as a corollary to post‐revolutionary state formation, particularly during the 1980–8 war with Iraq. The Revolution itself resulted in a process of ‘dual institutionalization’ where new revolutionary organizations appeared in tandem with the inherited bureaucracies of the Pahlavi Monarchy, and both sets of institutions were directed by the new regime towards social welfare in areas relatively untouched by the ancien régime. These institutions were locked in place by the exigencies of the long war that followed, and most have continued to the present. This is followed by a discussion of the main developmental outcomes of the past three decades in Iran in literacy, health and poverty. The article concludes by discussing how the successes and shortcomings of the Islamic Republic's welfare system are consequential for understanding broader developments in Iran today.     

The Urban Geography of Welfare Reform: Spatial Patterns of Caseload Dynamics in Detroit

Objective . To assess how the characteristics of welfare recipients have varied geographically in the Detroit metropolitan area since the passage of welfare reform in 1996 and how spatial proximity to job opportunities is related to work rates among welfare recipients. Methods . Using administrative data on welfare receipt in the Detroit metropolitan area and data from two employer surveys in Detroit, I examine changes in the welfare caseload between 1992 and 2000 and estimate logit models of the probability that welfare recipients report work earnings in 1998. Results . Although the number of adult welfare recipients in the Detroit metropolitan area declined by over 75 percent between 1992 and 2000, nearly 25,000 households—most residing in the central city—continue to receive welfare. Rates of work among welfare recipients are positively related to the accessibility of employment opportunities. Conclusions . My results indicate that support services and programs in the coming years will have to fit a caseload that is changing both qualitatively and geographically. Further, consistent with the most current spatial mismatch research, my findings show that greater access to job opportunities leads to greater rates of reported work earnings among welfare recipients.     

The differential role of human capital and health in explaining welfare exit‐route and labour outcomes

The aim of this study was to determine the differential effects of human capital and health on welfare exit‐route, earnings and working hours among female welfare recipients in Israel. The study also examined whether higher human capital mediates the effect of health problems on the different outcomes. The data were obtained from a national panel survey of 2,700 single mothers who were receiving welfare when the Israeli welfare reform was implemented. The effect of health was found to be more consistent than the effect of human capital. Formal education had no effect on welfare exit‐route, while health did. The effect of health on working hours was more profound than the effect of human capital, while the reverse applied to earnings. Richer human capital did not mediate the effect of health problems. These findings suggest that the prediction power of human capital on labour and welfare decisions has weakened under welfare reform provision.     

Creating Spaces: Exploring the Role of Cultural Knowledge as a Source of Empowerment in Models of Social Welfare in Black Communities

Summary Research data continue to indicate that black communities aredisproportionately represented across social welfare statistics.The Macpherson Report (1999) considered the impact of institutionalracism and the various ways in which these contingencies affectthe life chances of black families and individuals. Black community-basedorganizations have responded to these challenges through culturallyconstructed interpretative frameworks in shaping and definingsocial welfare activities. Through a critical reading of culturalelements and products they have utilized cultural knowledgeas a source and means of empowerment. These are important sitesof empowerment that reject deficit approaches to embrace culturallyaffirming models located in cultural knowledge and lived experiences.In this way, black communities have engaged in an active processof revitalization, cultural renewal and regeneration. This articleexplores models of social welfare in black community-based organizationsand draws on a research study conducted by the author, whichexamines the role and saliency of cultural knowledge in shapingsocial welfare delivery. Research findings reveal the ways inwhich black agency is sometimes located in culturally constructedways to reflect on daily lives and experiences. Cultural knowledgeacted as a vehicle in framing action-orientated communal strategiesfor social and educational change.     

Trust and health in Eastern Europe: Conceptions of a new society

Little attention has been paid to why trends and levels of mortality and morbidity differ in Eastern Europe and few studies have addressed people's own perceptions of their new political system – perceptions which per se may be important for social development. The aim of the present study was to analyse the extent to which trust and economic circumstances affect self‐rated health in Poland, Estonia and Russia and how much health differences between the countries can be explained by these factors. A better economy and higher trust were related to better individual health, while economic factors seemed most important for inter‐country differences. It is probable that both institutional factors and individual perceptions contribute to people's well‐being, but in terms of social policy, an improved welfare system may be the most effective way forward.     

When 'Choice' and 'Choice' Are not the Same: Institutional Frameworks of Choice in the German Welfare System

The creation and strengthening of welfare markets in Germany means that citizens can increasingly choose among competing providers of welfare goods and services. However, the conditions under which citizens may exercise choice in various fields of social policy are quite different. A major reason for these differences can be found in the public institutions that frame citizens' choice in welfare markets. This article analyses welfare markets in German health care, long-term care, pensions and employment policies, paying special attention to the respective public institutional frameworks. It will be argued that differences between frameworks of choice can be categorized by means of four parameters representing different aspects of public involvement in welfare markets. Depending on the kind and the degree of public involvement, welfare markets may be compatible with 'traditional' notions of public responsibility for citizens' social security.