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The purpose of this chapter is to benchmark Tunisia against other emerging economies in terms of the regulatory barriers affecting particular services sectors and to assess the economy-wide effects of further liberalizing these services trade restrictions, compared with reducing the dispersion in barriers to its merchandise trade. On the basis of a rather restricted sample of services sectors, partial regulatory reform would yield gains roughly equivalent to full unilateral reform of manufacturing tariffs, but roughly one-tenth the gains from full bilateral reform of border protection in agriculture with the European Union. The adjustment costs associated with these services trade reforms would be minimal. The chapter identifies the reasons why the gains from these services reforms are relatively small and argues that a wider set of reforms could provide win-win outcomes and even fewer adjustment costs. By contrast, the gains in agriculture and manufacturing tend to come at the expense of domestic output in the reforming sectors – the gains are greater, but so too are the adjustment costs.

The purpose of this study was to re-examine racial and gender differences in home and community-based services utilization. Using the 1999 National Long Term Care Survey, the Anderson-Newman (1995) health behavioral model, social supports and structural factors were used to examine predictors of service use among four in-home and two community-based services. The results showed that race did not have a significant main effect on service use, but gender had a significant main effect for housework, home delivered meals, and congregate meals. Using an interaction term, older white women reported higher usage of housework. Among the predictors, enabling factors had the strongest effect on the use of personal care/nursing, home delivered meals, transportation and senior centers’ services. The results also indicated the importance of social supports and structural factors, particularly service awareness, in predicting service use. Implications for policies and practice to improve community outreach, access and utilization of services by different racial groups of elders are discussed.

Although work has a fundamental role in the individual’s psychological well-being, the vast majority of mental health service users are not in employment. This is the result of various barriers that impede their work re-integration process despite their desire to work. Apart from the illness’ symptoms, these barriers are strongly associated with the negative effects of long-term unemployment, the negative stereotypes and attitudes towards mental health service users and the fear of losing disability benefits. There are several occupational intervention models aiming at vocational rehabilitation of mental health service users. Arguably, the Individual Placement and Support (IPS) model of supported employment has proved to be more effective compared to other models. This chapter presents an innovative career counselling approach that combines elements from the IPS model and from the newly emerged career theories that have been developed to address today’s world of work challenges. This model was developed by the Pan-Hellenic Association for Psychosocial Rehabilitation and Work Integration (PEPSAEE) in Greece during the recent major economic crisis. Further implications of the model’s implementation regarding vocational rehabilitation of mental health users as means for social inclusion are discussed.

We have used the Michigan computable general equilibrium (CGE) model of World Production and Trade to calculate the aggregate welfare and sectoral employment effects of the menu of U.S.–Japan trade policies. The menu of policies encompasses the various preferential U.S. and Japan bilateral and regional free trade agreements (FTAs) negotiated and in process, unilateral removal of existing trade barriers by the two countries, and global (multilateral) free trade. The U.S. preferential agreements include the FTAs approved by the U.S. Congress with Chile and Singapore in 2003, those signed with Central America, Australia, and Morocco and awaiting Congressional approval in 2004, and prospective FTAs with the Southern African Customs Union (SACU), Thailand, and the Free Trade Area of the Americas (FTAA). The Japanese preferential agreements include the bilateral FTA with Singapore signed in 2002 and prospective FTAs with Chile, Indonesia, Korea, Malaysia, Mexico, Philippines, and Thailand. The welfare impacts of the FTAs on the United States and Japan are shown to be rather small in absolute and relative terms. The sectoral employment effects are also generally small in the United States and Japan, but vary across the individual sectors depending on the patterns of the bilateral liberalization. The welfare effects on the FTA partner countries are mostly positive though generally small, but there are some indications of potentially disruptive employment shifts in some partner countries. There are indications of trade diversion and detrimental welfare effects on nonmember countries for some of the FTAs analyzed. Data limitations precluded analysis of the welfare effects of the different FTA rules of origin and other discriminatory arrangements.

In comparison with the welfare gains from the U.S. and Japan bilateral FTAs, the gains from both unilateral trade liberalization by the United States, Japan, and the FTA partners and global (multilateral) free trade are shown to be rather substantial and more uniformly positive for all countries in the global trading system. The U.S. and Japan FTAs are based on “hub” and “spoke” arrangements. We show that the spokes emanate out in different and often overlapping directions, suggesting that the complex of bilateral FTAs may create distortions of the global trading system.

Objective – The first wave of experiences of exemptions policies suggested that poverty-based exemptions, using individual targeting, were not effective, for practical and political economic reasons. In response, many countries have changed their approach in recent years – while maintaining user fees as a necessary source of revenue for facilities, they have been switching to categorical targeting, offering exemptions based on high-priority services or population groups. This chapter aims to examine the impact and conditions for effectiveness of this recent health finance modality.

Methodology/approach – The chapter is based on a literature review and on data from two complex evaluations of national fee exemption policies for delivery care in West Africa (Ghana and Senegal). A conceptual framework for analysing the impact of exemption policies is developed and used. Although the analysis focuses on exemption for deliveries, the framework and findings are likely to be generalisable to other service- or population-based exemptions.

Findings – The chapter presents background information on the nature of delivery exemptions, the drivers for their use, their scale and common modalities in low-income countries. It then looks at evidence of their impact, on utilisation, quality of care and equity and investigates their cost-effectiveness. The final section presents lessons on implementation and implications for policy-makers, including the acceptability and sustainability of exemptions and how they compare to other possible mechanisms.

Implications for policy – The chapter concludes that funded service- or group-based exemptions offer a simple, potentially effective route to mitigating inequity and inefficiency in the health systems of low-income countries. However, there are a number of key constraints. One is the fungibility of resources at health facility level. The second is the difficulty of sustaining a separate funding stream over the medium to long term. The third is the arbitrary basis for selecting high-priority services for exemption. The chapter therefore concludes that this financing mode is unstable and is likely to be transitional.

The homelessness of those 50–64, older homeless people, is a growing problem in the United States. This chapter seeks to understand the unique healthcare issues faced by this population. Data in the city of Chicago was collected and analyzed through a variety of qualitative and quantitative methods. Data included answers to survey questions by older homeless individuals, interviews with providers and older homeless individuals, focus groups with older homeless individuals, and agency data from homeless service organizations. Findings agree with previous research that shows a growth in the homeless population, the greater number and severity of health problems in the population, the significant number of barriers that the population encounters in obtaining health care, housing, and jobs, and the concern with preventative health that the older homeless have. After outlining these findings, this chapter offers policy and program recommendations for the larger health care and homeless service systems.

This chapter embarks on a cross-Asian comparison to glean valuable insights from various regions and religious contexts. By examining family planning practices and challenges in different parts of Asia, valuable lessons are uncovered that can inform policies, programs, and initiatives aimed at achieving family planning-related sustainable development goals (SDGs). The complexities and nuances of family planning across diverse cultural, social, and religious landscapes are delved into, shedding light on both common threads and unique challenges faced by marginalized communities. Through this comparative analysis, the aim is to contribute to a holistic understanding of family planning in Asia and provide actionable recommendations to enhance access, equity, and outcomes in pursuit of family planning-related SDGs.

Research on Asian Americans’ health behavior has often cited socioeconomic status, race, language, cultural beliefs, acculturation, etc. as barriers to seeking health care services. Less is known about Southeast Asians refugees’ help-seeking process. In this exploratory study, we examine the illness experiences of Southeast Asian refugees with a Type 2 diabetes diagnosis, and consider the factors that contribute to their understanding and management of diabetes.

We used Pescosolido’s network episode model to frame our understanding of the ways in which Southeast Asians maneuver through their social support networks, face barriers in accessing health care services, and manage their diabetes. We interviewed a convenience sample of 16 adults. All interviews were digitally recorded, transcribed, and coded. Analysis was guided by the grounded theory approach.

Our findings revealed that Southeast Asians’ definition, acceptance, and management of their diabetes was largely influenced by various factors including: trauma and PTSD from their refugee experience, challenges of acculturation, illness experience, mental health, and access and barriers to health care services. The network episode model provides a blueprint for understanding the social and cultural challenges that Southeast Asian refugees face with regards to their diabetes.

Research limitations include the small and convenience sample used for the study, which does not contribute to generalizability. However, our findings contribute to the limited but growing studies on Southeast Asian refugees in the United States, and emphasize the need for health care providers to consider the illness experience, health beliefs, and the social context of Southeast Asian refugees with diabetes. Although the adults in this study were not recent immigrants, their immigrant history and experiences influenced their understanding and management of their diabetes.

Few qualitative studies focus on the health of Southeast Asians in the United States (Hmong, Laotian, Cambodian, and Vietnamese). This study has potential value for clinicians, social workers, and community providers serving ethnic minority populations, specifically Southeast Asians. In this study, older immigrant adults faced generational challenges that impacted their chronic illness (Type 2 diabetes).

Drawn from a case study of a public library in a large urban area, this chapter offers insights into the lives of lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) youth experiencing homelessness and the potential intersection of public libraries and their lives. To gain insight, the author conducted one focus group with five youth, as well as 22 one-on-one interviews with public librarians, service providers who work with the youth, and the young people themselves. The chapter offers specific examples of the challenges the youth face on the streets, as well as concrete steps libraries can take to address these challenges. These findings and strategies will help public librarians and those who support public libraries to understand and take action to address the ongoing needs of a group that falls outside what libraries may consider typical service expectations.

Older women living in medically underserved areas (MUA) might have particular problems with access to health care. This is an in-depth report of the accessibility issues raised by six frail older women (age 82–93 years) during a longitudinal descriptive phenomenological study of the experience of home care. Three White women lived in the same rural MUA, and three Black women lived in the same urban MUA. The need for health service was understood subjectively and prospectively as the personal perception of a situation requiring relief or supply. Some women reported presenting needs for accessibility to providers, whereas others reported needs for their future accessibility to providers or services. Some intentions were likely linked to residence location, and residence in a rural MUA was relevant to the phenomenon of securing the help that I might need down the road. Feasibility was proposed as a new parameter of access. Research and practice implications were proposed.