Pensions and the Health of Older People in South Africa: Is there an Effect?

Abstract

This paper critically reviews evidence from low and middle income countries that pensions are associated with better health outcomes for older people. It draws on new, nationally representative survey data from South Africa to provide a systematic analysis of pension effects on health and quality of life. It reports significant associations with the frequency of health service utilisation, as well as with awareness and treatment of hypertension. There is, however, no association with actual control of hypertension, self-reported health or quality of life. The paper calls for a more balanced and integrated approach to social protection for older people.     

Meeting the Information Needs of Older People: A Challenge for Local Governance

The challenge of the ageing population is not just to provide more services but to employ new strategies. One of these is the need to rethink the provision of information to older people and their carers. This paper makes four points. First, that information and access to information have become more critical issues. Second, that older people may place a much higher value on information than other citizen groups but their access is poor for a range of reasons. Third, that the processes by which older people seek information may be empowering. Finally, effective partnerships with creative older people can be a catalyst to changing governance cultures which is a vital step in modernising local government. The paper draws upon examples from the author's experience of working alongside older people under the umbrella of the Better Life in Later Life project in Newcastle upon Tyne.     

People with disabilities working in the disability sector in Timor Leste: a study of ‘lived experience’ using PhotoVoice

Perspectives on disability originating from non-Western cultures are beginning to appear in disability literature, however discussions may become lost in rhetoric unless grounded in experiences of people with disabilities themselves. The purpose of this study was to investigate the lived experience of physical disability in Timor Leste with the assistance of a group of Timorese participants with disabilities who were employed in the disability sector. These participants recounted experiences of disability from their own lives together with their observations of people with disabilities living in remote parts of Timor Leste who often lived with stigma or deprivation. The participants thus described their own lived experiences against a backdrop of a non-Western culture. A picture emerged of a stigmatising culture where acceptance of disability is uncommon yet where significant attempts are being made to change attitudes to disability within the culture of Timor Leste.     

Standard of Living and Disability in Cambodia

Little is known about the extra costs faced by households with disabled members in low resource settings and the impact of these costs on living standards. In this paper we estimate the direct cost associated with disability for households in Cambodia. Using the Standard of Living approach, the direct cost associated with having a member with disabilities is estimated to be 19 per cent of monthly household consumption expenditure. Accounting for the direct cost of disability doubles the poverty rate amongst households with disabled members from 18 per cent to 37 per cent, and increases the poverty gap from 3 to 8 per cent. A comparison of the direct cost associated with disability and income support received from government and family sources reveals that only 7 per cent of the costs of disability are met. Our findings suggest that, in the absence of increased coverage of public income support, households with disabled members will continue to experience a lower standard of living compared to households without disability in Cambodia.     

Health care and the elderly.

Western values have long emphasized an interventionist approach to problems of health and health care. Yet, as medical technology becomes increasingly expensive and as the number of older people grows, proposed changes often are now governed more by considerations of cost than by quality of services. This tension between cost and quality also affects public willingness to invest in social components of health care despite their importance in enhancing quality of life. The tension emerges in sharpest contrast as scarce resources are allocated by gatekeepers in health maintenance organizations and in the arrangements for long-term care. With respect to financing, what seems to be needed is a creative mix of voluntary inputs from the community, private initiatives, and new programs of public entitlements. With respect to quality of care, what has often been overlooked is the recognition that gains in the quality of life require programs that encourage older people's continued involvement and participation in social life and in active and healthy life-styles. This article discusses the evolving balance between these two types of interventions: the medical and the social.     

Choice and vulnerability in aging societies: Understanding the impact of age on user capacity

One necessary condition for realizing the benefits of choice‐based models of public service provision is that the service users in a given sector are capable of exercising choice. However, along with population aging, critics may question the level of user capacity in the growing user group consisting of older citizens with healthcare needs. For the first time in an older‐aged sample (52 to 97 years, N ~ 10,000), this study examines the link between age and user capacity (public service efficacy). Our results from the hospital sector in Denmark reveal a negative age gradient, where those of advanced age and declining health report significantly lower public service efficacy. However, when examining this age gap, much is attributable to cohort differences in educational attainment. Thus, while current generations of older service users constitute a vulnerable group under choice‐based policies, this challenge is likely to diminish in the future.     

Why Does Citizens' Knowledge of New Policy Vary Between Municipalities? The Case of the Social Support Act

Providing information to citizens is an important first step in the implementation of new policy. In this study we explain differences in the knowledge of citizens between municipalities of a newly introduced law in the Netherlands, the Social Support Act, 10 months after it became into force. This law is especially important for older people that need support in their daily functioning and participation. We focused on two aspects of knowledge related to the act, i.e. having heard of the new act, and knowing how voice with regard to policy on support is organised in the place of residence. Given that socialist local governments focus more on social topics than liberal local governments, we expected citizens of municipalities with socialist councils to have more knowledge about the new Social Support Act. Contrary to our expectations, citizens from municipalities where a liberal party or a collaboration of liberal/socialist parties is the largest, have a better understanding of how voice is organised. On the other hand, citizens in municipalities with an alderman from a combination of liberal/socialist parties have a lower chance of having heard of the Social Support Act. We argue that in view of the Social Support Act, the ideology of a local government related to citizens' responsibilities (liberal view) may have more influence on citizens' knowledge than being a government that pays attention to social issues (socialist view). As far as individual differences between citizens are concerned, as expected, older people that are more educated but in poorer health status have more knowledge about the new act. A higher educational level and an excellent mental health status are related to more knowledge about voice. Educational level is the most powerful predictor for knowledge about the act.     

Participation and Earnings of Older People in Argentina: Nice Work if You Can Get It?

The article explores the potential contribution of better labour market participation among older people in Argentina to address old age poverty and vulnerability. The acute financial crisis in 2001 led to a steep rise in poverty and renewed concerns over the deterioration of old age support. Broadly, two main strategies took shape: to strengthen pension provision for poorer and vulnerable older people, and to improve their labour market participation. Using data from a dedicated survey of older people, the article tests the feasibility and effectiveness of the second strategy through a detailed analysis of the labour market participation and earnings of older people in Argentina.     

Formal and informal disability resources for Afghan reconstruction

After 23 years of turbulence the number of disabled Afghans is unknown and formal services are minimal. The great majority live with whatever resources they find in themselves and their families, the normal pattern throughout history. Informal help and some cultural resources of Afghan history and Muslim teaching are noted in this paper, together with some common negative views. UN agencies and NGOs have made efforts to promote an adapted Community Based Rehabilitation in Afghanistan from the 1980s to the present and to transfer rehabilitation knowledge and skills to families with disabled members. Some local resource centres and community disability organisations have developed and can be a useful basis for disability planning in the anticipated national reconstruction. Emphasis should be given to the participation of disabled people as beneficiaries and employees in all reconstruction programmes, which should proceed in consultation with families and disabled individuals.     

Social Protection Policy or a Political Largesse: Disability Fund Efficacy Assessment and Roadblocks to Sustainable Development Goals

ABSTRACT

Social protection policies have been tools for fighting social exclusion, inequality and reducing poverty incidence among vulnerable populations in developing countries. In this regard, the government of Ghana through the institution of the disability fund has demonstrated a commitment to advancing the cause of people with disabilities. In assessing policy efficacy, the realities on the ground, as well as policy challenges, 130 persons with disability (PWDs) and 10 Key Informants (KIs) were recruited from across five regions. In addition to conducting face-to-face interviews with PWDs, the study conducted a number of interviews with key informants (KIs). The study findings concluded amongst other things that, the policy is plagued with challenges such as limited information about the fund, fund access difficulty and disbursement delays. It was also revealed that; the policy is saddled with opacity and partisan politics. To ensure efficiency and expedite the achievement of Sustainable Development Goal (SDG) 1, the research proposed for policy restructuring. In addition to introducing financial literacy and management training for beneficiaries, the study proffers decoupling the fund management from political structures to help meet the objectives for which it was incepted.     

Sense of control: potentials for intervention.

A substantial amount of research has demonstrated that the sense of control is associated with numerous positive outcomes, including good health. Many aspects of the personal and social conditions of old age influence the control-health relationship. Environmental events associated with old age often place limits on the range of outcomes that are attainable by older people. Moreover, the association between control and indicators of health status may be altered by old age. Finally, old age may influence the relationship between control and various health maintenance behaviors. Aspects of the sense of control can be altered with small interventions that can enhance health specifically and the quality of aging in general. Given the relationship between control and health in old age, several possible factors may help explain or mediate this relationship including mechanisms of behavioral and cognitive change, and physiological adaptations. Despite the largely positive outcomes associated with increased sense of control, negative outcomes are also possible, especially when control is not desired or entails too much responsibility or other demands.     

‘I Know My Rights,but Am I Better Off?’: Institutions and Disability in Uganda

Uganda is internationally recognised for both its legal and constitutional provisions for people with disabilities, and the presence of disabled persons’ organisations that provide informal advocacy and support. Using a unique dataset of 579 Ugandans with physical disabilities, we develop a conceptual framework on social capital to investigate the factors correlated with knowledge of formal institutions that target disability. In examining whether this knowledge results in higher incomes we find that gender matters. A woman’s education and membership of external networks are correlates of knowledge; higher levels of this knowledge are associated with substantially higher levels of income.     

Diversity,Inclusion, and the Voice of Older People: Engagement and Decision-Making in Seniors’ Organizations

Seniors’ organizations play a vital role representing older people in policymaking. The impact of diversity among older people on organizations’ engagement and decision-making processes therefore has implications for democratic inclusion. Interviews were conducted with paid and voluntary managers of Australian seniors’ organizations, along with analysis of organizational documents. Findings identified issues of presence and participation and challenges inherent in inclusive deliberation, highlighting the importance of leadership. Leaders’ understandings about what drives and impedes participation, who and what is represented, and how inclusion should be practiced are vital. It is important to consider how organizations can be supported to facilitate inclusion as their constituencies grow.     

COMPETING TRADITIONS OF GOVERNANCE AND DILEMMAS OF ADMINISTRATIVE ACCOUNTABILITY: THE CASE OF DENMARK

This article offers a study of the changing role of the state in Denmark under the condition of the overall transformation from government to governance with particular emphasis on the corresponding transition from process accountability to performance accountability. It is argued that although new modes of governance have been introduced, and new interpretations of accountability have been proliferated, neither conventional modes of governance nor older interpretations of accountability disappear. Thus, what we see is a co-existence of competing traditions of governance and different and sometimes contradictory interpretations of administrative accountability, which create potential dilemmas and contradictions for the individual civil servant. Employing an interpretative approach to governance and public administration, the article analyses the constitution of competing traditions of governance and interpretations of accountability, and the way in which these competing traditions and interpretations lead to accountability dilemmas for the individual civil servant.     

Exploring Microfinance Clients with Disabilities: A Case Study of an Ecuadorian Microbank

Using a unique sample from an Ecuadorian microfinance institution that has focused on increasing its outreach to disabled clients, we present a comparative analysis of the characteristics of disabled versus non-disabled clients. The study shows that disabled clients are more often male, are less likely to be living with a partner, have fewer children, and are older compared to their non-disabled counterparts. Moreover, we observe differences in repayment statistics between clients with and without disabilities, as well as differences within the disability sample. Our findings illustrate the importance of adapting microloans to the special needs of persons with disabilities.     

Building up French blackness through an Afrocentric lens?

The French national historical narrative, epitomized by the anthem ‘liberty, equality, fraternity’, has long been a monochrome one. Despite a long black presence, Blackness was ignored. Black people were considered as outsiders. After the 2005 riots in the suburbs and the 2007 presidential election, they gained attention as a community significant to the constructing of a multicultural society. Black communities seize this time as an opportunity to remedy their political and social invisibility. One way chosen by some black people is to look back at history. Whether calling for an ‘African-centered’ or ‘black-centered’ perspective or knowledge, some now define their approach as Afrocentric. Though the ideas and concepts carried by Afrocentrism are not new in France, they now gain popularity among people of African descent as a means to challenge black people's outsider/insider status in French society.     

New directions in welfare: rights-based social policies in post-neoliberal Latin America

What happens to the politics of welfare in the Global South when neoliberal values are questioned? How is welfare re-imagined and re-enacted when governments seek to introduce progressive change? Latin America provides an illustration and a valuable entry point to debates about ‘interruptions’ of neoliberalism and the changing nature of social policy. Drawing on examples of disability policies in Ecuador and care provision in Uruguay, we argue that there is a ‘rights turn’ in welfare provision under the left that reflects a recognition that previous welfare models left too many people out, ethically and politically, as well as efforts to embed welfare more centrally in new patterns of respect for socio-economic and identity-based human rights. Given Latin America’s recent contestation of neoliberal development as well as its history of sometimes dramatic welfare shifts, the emergence of rights-based social provision is significant not just for the region but also in relation to global struggles for more equitable governance.     

THE ‘NEW PUBLIC GOVERNANCE’ AND EMPLOYABILITY SERVICES IN AN ERA OF CRISIS: CHALLENGES FOR THIRD SECTOR ORGANIZATIONS IN SCOTLAND

Third sector organizations (TSOs) have emerged as key players in the delivery of public services to assist jobless people to improve their employability and move from welfare to work. Drawing on in‐depth research with employability providers in Scotland, this article explores how TSOs have responded to the challenges of a rapidly changing public services environment. Specifically, we use the concept of the ‘New Public Governance’ to explore TSOs' relationships with UK, devolved and local government stakeholders. TSOs demonstrated a pragmatic approach to shaping their services to reflect the priorities of public funders, and identified some opportunities arising from the new emphasis on ‘localism’. However, the evidence suggests that opportunities for collaboration at times remained constrained by certain forms of ‘contractualism’ and top‐down performance management. Based on the evidence, lessons for future policy and practice are considered.     

Can Policy to Address Some Disability Rights Mitigate Weak Approaches to Others?

Governments prioritize some rights over others because of policy constraints. We ask whether differential disability policy priorities can readdress other unrealized rights when applied to services for people with disabilities in boarding houses in Australia. The housing is inappropriate to their support needs and breaches their immediate right to unsegregated housing. Findings about the government-funded support showed that their well-being improved, but the housing increased their support needs and reduced their eligibility for suitable housing, implying that support policies that prioritize progressive realization rights are not successful where immediate realization rights to housing remain unaddressed. These findings about the negative social outcomes from ignoring human rights hierarchies have implications for policy priorities.     

Beyond budgetary support: pro‐poor development agendas for Africa

The latest fashion in a sequence of global interventions by donors, designed to make a difference to the lives of poor people, is the use of budgetary support mechanisms. These have emerged afresh at the start of the twenty‐first century as the increasingly dominant mode of desired aid delivery for many donors in the African context. However, this paper argues that such an approach to ‘development’, particularly when combined with an understanding of poverty largely as an absolute concept that can be eliminated through economic growth, will have damaging effects on the lives of the poor and marginalised across the continent. The time is ripe for a new global agenda that seeks to place as much emphasis on equity as it does on economic growth.