This chapter addresses inequalities in the United Kingdom through the lens of health inequalities. Driven by inequalities in income and power, health inequalities…
This chapter addresses inequalities in the United Kingdom through the lens of health inequalities. Driven by inequalities in income and power, health inequalities represent a microcosm of wider debates on inequalities. They also play a role as the more politically unacceptable face of inequalities – where other types of inequality are more blatantly argued as collateral damage of advanced neoliberalism including ‘inevitable’ austerity measures, politicians are more squeamish about discussing health inequalities in these terms.
The chapter starts by depicting health inequalities in Scotland and summarises health policy analyses of the causes of, and solutions to, health inequalities. It then describes the concept of ‘proportionate’ universalism’ and sets this within the context of debates around universal versus targeted welfare provision in times of fiscal austerity.
It then turns to a small empirical case-study which investigates these tensions within the Scottish National Health Service. The study asks those operating at policy and practice levels: how is proportionate universalism understood; and, is it a threat or ballast to universal welfare provision?
Findings are discussed within the political context of welfare retrenchment, and in terms of meso- and micro-practices. We conclude that there are three levels at which proportionate universalism needs to be critiqued as a means of mitigating the impacts of inequalities in the social determinants of health. These are within the political arenas, at a policy and planning level and at the practice level where individual practitioners are enabled or not to practice in ways that might mitigate existing inequalities.
This chapter considers how far political devolution has enabled the government in Wales to develop a distinctive approach to student funding. It examines in particular…
This chapter considers how far political devolution has enabled the government in Wales to develop a distinctive approach to student funding. It examines in particular claims that policy choices in Wales on student funding reflect a commitment to ‘progressive universalism’, a term sometimes used by policy-makers in Wales and elsewhere to describe combining means-tested and non-means-tested benefits. The chapter also explores the growing use of income-contingent loans, arguing that such loans complicate debates about targeting and universalism.
There are clear links between health, housing and social care. The homeless live much shorter lives as do those people living in poorer quality accommodation and areas of deprivation. Life expectancy and the quality of life in later years are both drastically affected by Marmot's (2010) social gradient, with people from poorer backgrounds often doing worse. A decent home is fundamental to a healthy and a good life. The paper aims to discuss these issues.
The research approach reviewed existing articles, examples from the housing sector and analysis of a range of data from organisations including the NHS.
Good housing helps to support better health but it is not the only answer – joined up working between agencies and Marmot's proposal of proportionate universalism are significant factors in finding solutions to this long-standing issue.
Costs to the government, health services and local authorities and other agencies could be reduced by wider thinking around the link between housing, health and other support.
This paper focuses on the existing links between health, housing and social care.
The purpose of this paper is to outline the development of a resource designed to support practitioners, who are not sexual health specialists, but who work with young…
The purpose of this paper is to outline the development of a resource designed to support practitioners, who are not sexual health specialists, but who work with young people who may be at risk of teenage pregnancy or parenthood. Its aim was to enable practitioners to carry out an assessment using a screening tool, and to use educational interventions designed to reduce risk-taking behaviour or refer to a sexual health specialist. A research project to examine the perceptions of practitioners who had used the resource is reported.
The resource was based on a local needs assessment and developed by a multi-agency working group. The research utilised an online questionnaire and telephone interviews with practitioners.
Practitioners reported using the screening tool with young people with an average age of 13.1 years. They thought the educational interventions provided knowledge and helped with communication, self-awareness, reflection, confidence, attitudes and values clarification.
The project was based in one county in England. A sample of 17 per cent of the practitioners responded to the questionnaire, and they might be biased towards those who had engaged most, or most positively, with the resource. Three practitioners undertook interviews. The views and behaviours of young people are yet to be evaluated.
Within a climate of limited resources, the findings suggest that the project is providing an acceptable proportionate universalist, early sexual health intervention for young people.
Equity is an issue that pervades all aspects of primary care provision for children and as such is a recurring theme in the Models of Child Health Appraised project. All European Union member states agree to address inequalities in health outcomes and include policies to address the gradient of health across society and target particularly vulnerable population groups. The project sought to understand the contribution of primary care services to reducing inequity in health outcomes for children. We focused on some key features of inequity as they affect children, such as the importance of good health services in early childhood, and the effects of inequity on children, such as the higher health needs of underprivileged groups, but their generally lower access to health services. This indicates that health services have an important role in buffering the effects of social determinants of health by providing effective treatment that can improve the health and quality of life for children with chronic disorders. We identified common risk factors for inequity, such as gender, family situation, socio-economic status (SES), migrant or minority status and regional differences in healthcare provision, and attempted to measure inequity of service provision. We did this by analysing routine data of universal primary care procedures, such as vaccination, age at diagnosis of autism or emergency hospital admission for conditions that can be generally treated in primary care, against variables of inequity, such as indicators of SES, migrant/ethnicity or urban/rural residency. In addition, we focused on the experiences of child population groups particularly at risk of inequity of primary care provision: migrant children and children in the state care system.
The purpose of this paper is to offer a contribution to our understanding of the changing relations of the middle classes with the Italian welfare state. The paper argues…
The purpose of this paper is to offer a contribution to our understanding of the changing relations of the middle classes with the Italian welfare state. The paper argues that the new interplay between public and private welfare is based on a very simplified analysis of Italian society.
The paper aims to integrate a variety of different theoretical approaches. The paper makes extensive use of the EU-SILC database, as well as the recently updated historic series of consumer studies undertaken by the Italian National Institute of Statistics. The data used in the paper were also drawn from the biennial cross-sectional Survey on Household Income and Wealth carried out by the Bank of Italy.
The analysis suggests that the problems of Italian society include not only a high incidence of poverty, but also increasing financial constraints for households placed between the established middle class and people in conditions of persistent poverty. The current public-private mix in service delivery appears less and less capable of protecting this social stratum against the growing risk of instability across all life domains, let alone of creating opportunities and fostering social mobility.
The paper explores some ways in which current politics of welfare have been designed with the view of fundamentally changing the welfare regime. It highlights how the public and private welfare mix has been purposefully organized in order to introduce a new model of social protection that aims to overcome certain specific characteristics of Southern European welfare states. It examines the sustainability of this model compared to the real living conditions of the Italian middle classes.