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.     

Experimenting with Welfare Reform: Emulating Success,Cutting Costs,or Racing to the Bottom?*

This article calls upon the social scientific research community to systematically assess policy devolution within American federalism through the lens of welfare reform. It asks specifically whether the benefits of policy devolution in this area—the opportunity to learn from policy experiments in similar states and the ability to tailor policies to individual state circumstances—outweigh the costs of devolution—possible racial biases across the states, incentives for cutting costs, and fears of a race to the bottom in benefits and eligibility criteria. A scientific research agenda for addressing these issues is developed. The contribution of De Jong et al. (2006) is assessed in terms of its advancement of this agenda. A path toward future contributions to this agenda is suggested.     

Affirmative Action: Psychological Contributions to Policy

Affirmative action is a controversial policy. Lauded by many, the attempt at social engineering has also been condemned by some as unnecessary and by others as counterproductive to the goal of social equality. As such, affirmative action is ideally situated to benefit from psychological research pertaining to the need for and the effectiveness of the policy. This article discusses both the potential benefits to American society of affirmative action and the potential costs of such a policy. Concluding that affirmative action is useful, we end with a look at ways to make affirmative action programs as effective as possible.     

Choices, Policy Logics and Problems in the Design of Long–term Care Systems

Establishing a public, comprehensive, independent, mainly community–based long–term care system, separate from medical care and social services, can lead to the provision of more effective and consumer–oriented services, and also to a more appropriate mix of public/private financing. Of the two main approaches to financing long–term care (LTC), a tax–based model is more flexible in providing benefits according to the individual's need, since income levels and the family's ability to provide care will be taken into consideration, while a social insurance model is more rigid because the individual's rights are more explicitly defined. The latter system is likely to provide more opportunities for choice, including decisions about the mix of health and social services. Policy–makers must decide which approach to take after weighing the positive and negative aspects of each, and the existing organizational infrastructure. Decisions must also be made on the practical issues of coverage, fairness, form of benefits, service delivery patterns, relationship with medical and social services, and controlling costs. With increasing pressure to contain public sector expenditures and improve efficiency, the focus of care will gradually shift from medical care to LTC, and within LTC, from institutions to housing. How to make this process proactive and planned, instead of ad hoc and reactive, is the challenge for public policy.     

Social Policy in Greece: Rhetoric versus Reform

This paper reviews the major social policy developments in Greece during the 1980s and 1990s, focusing on social security, health and employment policies. It argues that the concept of social policy and the practice of politics have been distorted in this country. Social policy reflects the legacy of a heavily politicized and centralized policy‐making system, an impoverished administrative infrastructure and poorly developed social services. Its emergence is characterized by the pursuit of late and ineffective policies. It lacks continuity, planning and coordination, being oriented towards short‐term political expediency. It is largely insurance‐based, reproducing huge inequalities and institutional arrangements which are behind the times. It provides mainly cash benefits, low‐quality but rather expensive health services and marginal social welfare protection. Moreover, the lack of a minimum income safety net confirms the country's weak culture of universalism and social citizenship. By implication, complex policy and interlocking interest linkages have tarnished the “system” with a reputation for strong resistance to progressive change. At the same time, sources of change such as globalization, demographic developments, new household and family/gender patterns, unstable economic growth, fiscal imperatives, programme maturation, as well as persisting unemployment, changing labour markets and rising health care costs, have produced mounting pressures for welfare reform.     

Social Policy from Olson to Ostrom: A Case Study of Dutch Disability Insurance

Social policy development and reform in corporatist welfare states often follows a pattern of subsequent collectivization and de‐collectivization. This has to do, the article argues, with the social problems these phases address. Early social policy development forms a response to Olson‐type collective action problems that organized actors (labour and employers' organizations) in the field experience: state‐obliged benefits solve free rider problems, while bipartite administration allows labour and employers' organizations to organize their constituencies. This solution to Olson‐type collective action problems, however, also constitutes an Ostrom‐type collective action problem. Such a system functions as a common pool resource. Individual benefit take‐up is experienced as free and the costs of benefit take‐up are collectivized in the common pool. The article illustrates this pattern with reference to Dutch disability insurance.     

The Reform of Health Policy in China – Left Behind in the Race to Industrialize?

A major programme of health reform was announced in 2009. China is growing fast, and is beginning to engage with the international social policy community to discuss and review the consequences of rapid industrialization. As a specific part of social policy, health policy shares some of the characteristics of a policy area driven by the consequences of industrialization, but it also has its own particular features. This article reviews the general relationship between state and citizens in the health field by way of an introduction before focussing more specifically on Chinese patterns of health inequalities, and the pressures for reform. The 2009 reform of health policy and its dynamics are then presented, and the article concludes that there has been a deterioration in Chinese health policy, which threatens to undermine the benefits of economic growth for Chinese people.     

Forced to work and liberated from work

The work-welfare nexus is essential in all social policy regimes. The question is in what situations individuals should be entitled to social welfare benefits and in which situations they should be obliged to work. Social welfare law and administrative practices define mechanisms that separate the deserving poor from people able to work. This article analyses the functions and character of these "separation mechanisms" in Sweden during three periods in history: a) in rural society in the late 19th century; b) in industrial society during the successful years of the Swedish model from World War II until the late 1970s; and c) the present, including the period of welfare retrenchment and reconsideration since the early 1980s. The conclusion is that Swedish social policy has always been strongly work-oriented, but the specific form and content of the work ethic has varied under the influence of different ideologies and handled in different social policy institutions. Under specific conditions the work line has been either generous or restrictive and it has been based on structural attempts to improve the opportunities to work as well as on attempts to strongly pressure the individual to work. The work line of today is seen as an interesting attempt to combine an effort to create good work through improved work conditions and an effort to reinforce elements of work enforcement in the social insurance system.     

Subsidizing wages or supplementing transfers? The politics and ambiguity of in-work benefits

In-work benefits (IWB) have become mainstream social policy programmes in modern welfare states. Aimed at employment promotion as well as poverty reduction, their introduction and expansion have been supported by both centre-right and centre-left governments. However, the article argues that policy positions towards IWB are essentially unstable. Political preferences can alter fast, with the same actors advocating IWB growth at one time and containment at another. In part, this is influenced not only by prevailing socio-economic conditions but also by the institutional shape of IWBs, their interaction with complementary policies, and their inherently ambiguous nature. Characterized by multiple aims, IWBs occasionally offer political opportunities but often create challenges and even confound policymaking. Thus, the understanding of the politics of IWB requires a careful consideration of the particular properties of concrete IWBs and the ways in which they relate to other policy arenas. The article discusses this with reference to relevant debates and reforms in Germany.     

Social Work Responses to New Labour' in Continental European Countries

Summary The re-emergence of a majority of centre-left governments incountries of the European Union was associated with the hopethat, after the neo-liberal attempts at its marginalizationand de-institutionalization, social work could regain a morevalued position in society. There are indeed indications thatthe growth of the profession continues and that social workis returning to a more explicit and official role in nationalsocial policies. However, this tends to be associated with anexpectation that social work would play its part in ‘activating’the recipients of welfare benefits in the context of the NewLeft project of shifting from social rights to social obligations.The practical and political effects of this new agenda are,however, modified greatly by the prevailing ‘welfare cultures’as well as the professional and academic discourses. This paperexplores the dilemmas and opportunities for the social professionsin Europe associated with the ‘pull’ to become incorporatedinto these new social policy agendas.     

Potentials,problems and possibilities for developing New Zealand’s built environment through high-value geospatial information

Gaining useful information about our built, social and natural environments is vital and possible. The value of data for cities is more informed, more effective management and development choices resulting in more benefits to a greater range of stakeholders. This article explores the state-of-play of data infrastructures in New Zealand to identify the challenges to gaining better value from geospatial information. Following engagement with built environment data custodians and information users, it analyses how digital information infrastructure can support the sharing and use of richer and more comprehensive information by weaving a supportive fabric across data. The analysis reveals that data infrastructures primarily need to facilitate agreement on data management, sharing and use; the sharing of costs and benefits across stakeholders; and emphasise place as a powerful driver to richer information. An overarching sociotechnical approach to digital information infrastructure weaves data platforms, policy and technology together.     

Extension of social insurance coverage to informal economy workers in China: An administrative and institutional perspective

This article reviews administrative issues in the context of decentralized social protection in China. In particular, what are the main obstacles to expanding social insurance coverage for workers in the informal economy? Over the last two decades, China has achieved remarkable progress toward universal social protection when this target was set as a national policy priority. However, the social insurance enrolment of informal economy workers still lags significantly behind. This article reviews the application of the International Labour Organization’s definition of informality in the Chinese context and overviews existing pension and health insurances in China. This article discusses the impact of China’s inter‐governmental fiscal relations and decentralized social protection in the multilevel government system. The article highlights that under a system of decentralized managed social insurance many informal economy workers choose to opt out of the system because of low benefits and high compliance costs. This result in deficits in social insurance coverage amongst informal economy workers.     

Policy-making for immigration and integration in Québec: degenerative politics or business as usual?

Policy Design Theory (PDT) predicts that the distribution of the costs and benefits of governmental intervention depends on the social construction and level of power of target groups. The case of Québec, Canada, which recently went through acrimonious policy debates on immigration and integration issues, does not correspond to this pattern. Degenerative politics – that is, the stigmatization of powerless groups and an unequal distribution of the costs and benefits of governmental intervention to the detriment of the most vulnerable – did not occur even if the conditions were seemingly in place to produce it. Using Québec as a ‘most likely’ case, I show that the policy-making sphere remained immune to the degenerative dynamics that took hold in the media and the legislature. More precisely, I argue that three interrelated factors explain the results: past policies and their unintended consequences, an implementation structure committed to the needs of immigrants, and the specific incentive structure facing political actors. The results question the transferability of PDT outside of the institutional setting of the USA, where it was first developed and applied.     

Universalism versus targeting: The vulnerability of social insurance and means-tested minimum income protection in 18 countries, 1990-2002

The stagnation and retrenchment of social policies in recent decades raise considerable interest and concern in writings on the welfare state. This study examines differences in the development of means‐tested benefits and social insurance provisions. Questions relating to the measurement of policy retrenchment and the vulnerability of social benefits are addressed. Two conflicting hypotheses are discerned: one stating that the development of means‐tested benefits resembles that of social insurance; and another more recent one claiming that the evolution of means‐tested benefits follows a unique pattern. The empirical analyses are based on institutional data on the level of social benefits. It is shown that social insurance stands a better chance of surviving periods of retrenchment and that the greater vulnerability of means‐tested benefits is related to the organization of social insurance provisions.     

The Universal Decline of Universality? Social Policy Change in Canada,Denmark, Sweden and the UK

The debate about the future of universal social programmes has been raging for years, both in social‐democratic and in liberal welfare states. The objective of this article is to contribute to the literature on universality by analyzing the evolution of universal social programmes in two social‐democratic and two liberal countries: Denmark, Sweden, Canada and the UK. This choice of countries provides the opportunity to investigate whether the principle and practice of universality has fared differently both within and between countries. The analysis focuses primarily on the national level while exploring three policy areas: pensions, healthcare and family policy, specifically child benefits and day care. The main conclusion of our comparative analysis is clear: among our two liberal and two social‐democratic countries, the institutional strength of universality varies greatly from one policy area and one country to another. Considering this, there is no such a thing as a universal decline of universality.     

THE ECONOMIC AND SOCIAL DIMENSIONS OF THE NEW ECONOMY

The concept of the ‘new economy’, though increasingly used by the media, policy makers and scholars, remains elusive. Two main definitions (the popular and specialised) may be identified; and the dimensions of the ensuing debate clarified in terms of three key questions: Is there is something qualitatively different about recent trends in the economy? What are the main economic consequences said to result from this new economy? What are the main social consequences? Of particular importance for social policy is that most models of the new economy suggest that it has led to an increase in inequality and social exclusion for those not positioned to take advantage of its supposed benefits. With most discussion focussed on a narrow use of the term — to do with communications technology — greater attention should be given to a broader definition which examines its consequences for the disadvantaged.     

The social cost of the Black Saturday bushfires

The Intergovernmental Panel on Climate Change have predicted with high confidence that the risk of bushfires will increase in the future. As this risk increases, so too does the need for appropriate policy responses. In developing these responses, costs need to be weighed against benefits. To fully appreciate the benefits of bushfire risk mitigation policies and strengthen the development of social policies around such events, it is necessary to include the psychological cost of experiencing these events. In this study, we employ the ‘life satisfaction approach’ to place a monetary estimate on the cost of Australia's Black Saturday bushfires (Australia's worst bushfires on record). Results reveal that the bushfires significantly reduce self‐reported levels of life satisfaction, with an implied willingness‐to‐pay of AUD 2,991 in terms of annual household income, or AUD 1,039 per capita, to reduce by one percent the extent to which an individual's immediate local area was affected by the Black Saturday bushfires. In doing so, we identify an apparent gap between current levels of expenditure on bushfire response and mitigation, and that amount which (with the inclusion of associated social benefits) would be welfare maximising.     

Social Exclusion, Inequality and Social Work

This paper sets out the environment of inequality in which social work and the poor have recently operated. It explores pragmatic and idealist arguments concerning whether or not the poor need social work. Finally, policy solutions developed in consultation with social service users and carers are suggested in relation to poverty and social exclusion. Social exclusion can be linked to relative poverty as exclusion from economic and social norms. However, there is a wider brief in our own government’s publications and those of Europe, of examining how people are excluded from actions and policies of agencies who are there to support them. This paper will retain the concepts of poverty as lack of material income, and inequality as the gap between the rich and the poor, while being aware of the policy implications for social service users and carers of the more comprehensive process of being shut out partially or fully from social, economic, political and cultural systems. The debates around social work, social exclusion and inequality that follow establish: that some of the poor do need social work; that the poverty of social service users is related to policies that have restructured welfare in Britain; that the reason for individuals approaching or being referred to social services are complex but are likely to include financial deprivation as a key contributory factor; that if the poor do need social work, advocacy is essential rather than social work being seen as concerned only with social control—taking children into care, mentally ill people into hospitals, and advising the DSS on the suitability of claimants for benefits. Finally, the discussion turns to new policy agendas on social exclusion instigated by the Labour government. What positive difference can such policies make for social service users, their carers and social workers?.     

The complex politics of catastrophe economics

The purpose of this essay is to explore the implications for public policy of the assumption that policy makers exhibit the same cognitive and perceptual problems as other citizens regarding catastrophic events. The key conclusion is that the same factors that cause citizens to behave inefficiently in preparing for and responding to disasters also will cause inefficiencies in policies concerning catastrophic events. Among the more important expected pathologies of disaster policies are: (1) a failure to balance benefits and costs at the margin for different types of disasters, due to cognitive pathologies such as availability and overconfidence; (2) a tendency for policy to underinvest in protection and overinvest in response; and (3) a skepticism for policies based on sound insurance principles for spreading costs and assessing claims.     

Using Remote Sensing to Evaluate Environmental Institutional Designs: A Habitat Conservation Planning Example

Objective. Satellite-based remote-sensing analysis is a beneficial, yet underused, tool for environmental policy, planning, and evaluation. We identify its benefits and costs to encourage social scientists to consider the use of remote sensing as a tool for planning and evaluating environmental institutions. Methods. We analyze two multispectral Landsat Thematic Mapper satellite images to evaluate a habitat conservation plan (HCP) implemented pursuant to the Endangered Species Act. Results. Image analysis provides useful broad spatial scale information on HCP performance that is not discernible to the naked eye or through other methodologies. Conclusions. Satellite image analysis should be considered as a tool for planning and evaluating environmental institutional designs—despite the financial costs and requisite technical training. These images provide ecological and land cover change information that may not be available elsewhere. We provide lessons learned to help make analysts cognizant of some important issues surrounding the use of satellite-based imagery for environmental institutional analysis.