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Joint Report Team

This paper combines two documents on employment flexibility and security prepared in the context of the research project ‘Social Quality and the Policy Domain of Employment,’ undertaken by the European Foundation on Social Quality. The first document relates to work time in Europe, its social distribution and its evolution – the crucial importance of work time for the approach of flexibility is not to be demonstrated, as it is one of the main factors, alongside other characteristics, such as skills and working conditions, that have been promoted under the general umbrella of ‘employment flexibility ’as a panacea for bringing the ‘Old Europe ’back in line with the successfully job-creating U.S. economy. At the same time, people at work themselves increasingly recognise work-time flexibility as a fundamental instrument of quality of life. To achieve such flexibility will require significant social investment, such as support from the Welfare State and a full regulation framework.

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Andrew Ward

The nature of health care, a multifaceted system of reimbursements, subsidies, levels of care, and trade-offs between economics, values and social goods, makes it both a problematic area of policy and critical to the well-being of society. In the United States, provision of health care is not a right as in some countries, but occurs as a function of a complex set of cross-subsidized mechanisms that, according to some analysts, exclude from coverage those who may be in the most need of it. Accordingly, this article examines some of the issues involved in making decisions on how to justly expand health insurance.

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The Penis-Care Information Gap

Preventing Improper Care of Intact Boys

Dan Bollinger

A penis-care information gap exists in North America where most physicians and parents do not know how to care for an intact boy’s penis, especially his foreskin. They lack basic knowledge and personal experience, which would allow them to advise or provide proper care for boys. Unless this gap is filled with reliable information, many boys are at risk for penile problems and perhaps even circumcision—something that the parents and the boy would like to avoid. The causes and problems resulting from this clear case of remediable medical ignorance are discussed, and solutions offered.

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Social orphans and the neblagopoluchnaia family

The cycle of child displacement in the Russian north

Elena Khlinovskaya Rockhill

Due to profound socioeconomic and political changes in post-Soviet Russia, the number of families viewed as neblagopoluchnye and 'unfit' for bringing up their children is increasing, and so is the number of children without parental care. To protect children from the harmful influence of their 'unfit' parents and to ensure a better future for them, state agents remove children from their families placing them in residential care institutions. Yet the nature of parenting in state care, the absence of inter-generational support and the lack of networks for family support and assistance render some of these young people ill equipped to deal successfully with the difficulties and uncertainties of post-Soviet social realities. Usually the state agents hold care-leavers responsible for their maladjustment and place the former residents' children in residential care institutions. This leads to the creation of whole 'dynasties' of institutionalised individuals. This article outlines some concepts and practices of child removal, demonstrating that both are still underpinned by Soviet values. Institutional experiences as narrated by former residents illustrate the genesis of difficulties in post-institutional adjustment.

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Place of Birth and Concepts of Wellbeing

An Analysis from Two Ethnographic Studies of Midwifery Units in England

Christine McCourt, Juliet Rayment, Susanna Rance and Jane Sandall

This article is based on analysis of a series of ethnographic case studies of midwifery units in England. Midwifery units1 are spaces that were developed to provide more home-like and less medically oriented care for birth that would support physiological processes of labour, women’s comfort and a positive experience of birth for women and their families. They are run by midwives, either on a hospital site alongside an obstetric unit (Alongside Midwifery Unit – AMU) or a freestanding unit away from an obstetric unit (Freestanding Midwifery Unit – FMU). Midwifery units have been designed and intended specifically as locations of wellbeing and although the meaning of the term is used very loosely in public discourse, this claim is supported by a large epidemiological study, which found that they provide safe care for babies while reducing use of medical interventions and with better health outcomes for the women. Our research indicated that midwifery units function as a protected space, one which uses domestic features as metaphors of home in order to promote a sense of wellbeing and to re-normalise concepts of birth, which had become inhabited by medical models and a preoccupation with risk. However, we argue that this protected space has a function for midwives as well as for birthing women. Midwifery units are intended to support midwives’ wellbeing following decades of professional struggles to maintain autonomy, midwife-led care and a professional identity founded on supporting normal, healthy birth. This development, which is focused on place of birth rather than other aspects of maternity care such as continuity, shows potential for restoring wellbeing on individual, professional and community levels, through improving rates of normal physiological birth and improving experiences of providing and receiving care. Nevertheless, this very focus also poses challenges for health service providers attempting to provide a ‘social model of care’ within an institutional context.

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The Possibilities of Failure

Personhood and Cognitive Disability in Urban Uganda

Tyler Zoanni

This article offers a person-centred analysis that closely attends to lives shaped by cognitive disability in Uganda. It reflects on the most widely used Ugandan term for disability, obulemu, which literally means ‘state of failure’. Ugandans with cognitive disabilities are often perceived as failed people (abalemu) insofar as they depart from dominant scripts for being human. Yet departures are also beginnings, and I attempt to think failure otherwise. Rather than understand these supposed failures in negative terms – as loss and diminishment of collective and personal possibilities – I focus on the possibilities of failure, tracing what arises around ‘failed people’ in terms of therapeutics, care and personhood. The article intervenes in a wider anthropological conversation about personhood. Rather than privileging cultural concepts of the person or the successful social realization of personhood, as much of that conversation does, the article takes inspiration from Meyer Fortes and makes ‘failures’ of personhood central.

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Piet P. J. Houben

International comparative research and discussions on the social quality of policies for frail older adults are in need of a common conceptual framework. Such a framework is also needed because, due to the many innovations and the increasing professional differentiation and specialisation in the area of housing and care, more and more specialised professionals and organisations are operating in this area. The resulting differentiation in providers demands extra efforts to meet the multiple needs of frail older adults with a balanced package of products and services. As a result of decentralisation and privatisation, the co-operation between disciplines and organisations needed to achieve this has to be realised on increasingly lower levels. To facilitate co-operation and fine-tuning on regional and local levels, it is useful to develop a common language. Innovation and specialisation lead to an increasing differentiation in the allocation of products and services, which – in combination with the new information technology –creates a growing demand for an adequate ‘Main Menu’ that will facilitate the decision-making processes concerning the allocation of funds on all relevant levels. From a social quality perspective, it is important to ask the question what could be legitimate core concepts in such a ‘Main Menu’.

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Aging Away

Immigrant Families, Elderly Care, Ethnography and Policy

Rita Henderson

This article considers how immigrant retention relates to family obligations, drawing a complex portrait of a common family dilemma involving the care of aging kin. The ethnographic life-history approach offers an important perspective on how health and well-being are not simply structured by formal access to institutions of care, but by the socio-cultural, economic and geographic flexibility of families to accommodate their needs. Analysis draws on the interdependant migration histories of a family of six adult sisters originating in Tanzania. In the case of this family, the dilemma surrounding the care of aging parents is not so much caused by migration's disruption of traditional filial obligations. Instead, it is the effect of social pressures stirred in both sending and receiving countries, which frame opportunities for eventual social integration, relocation or sometimes reluctant repatriation. A reflexive approach argues for the active presence of ethnographers in policy debates.

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Introduction to the Issue

Encountering Hospitality and Hostility

Mette Louise Berg and Elena Fiddian-Qasmiyeh

This introductory article to the inaugural issue of Migration and Society reflects on the complex and often contradictory nature of migration encounters by focusing on diverse dynamics of hospitality and hostility towards migrants around the world and in different historical contexts. Discourses, practices, and policies of hospitality and hostility towards migrants and refugees raise urgent moral, ethical, political, and social questions. Hospitality and hostility are interlinked, yet seemingly contradictory concepts and processes, as also acknowledged by earlier writers, including Derrida, who coined the term hostipitality. Drawing on Fiddian-Qasmiyeh’s work and on feminist scholars of care, we argue for the need to trace alternative modes of thought and action that transcend and resist the fatalistic invocations of hostipitality. This requires an unpacking of the categories of host and guest, taking us from universalizing claims and the taxonomy of host-guest relations to the messiness of everyday life and its potential for care, generosity, and recognition in encounters.

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When Frost Happens

A Case Study of an Organization Committed to Care

Philip Kao

This article draws from my time spent working as a caregiver in a 350-plus resident not-for-profit Continuing Care Retirement Community (CCRC) in the American Midwest. Caregivers working in CCRCs provide care and support to elderly residents who live out the rest of their lives in these transitional 'homes'. Yet even these organizations are transforming and changing the way care is being constructed and delivered. This paper examines how a long-term care facility (LTCF) is grappling with specific discourses about the nature of person-centred care, and its self-professed commitment to the journey of life. I show ethnographically how an organization centred on the business of care deals with the process of ageing, and that while the life course has been subject to forms of social and medical regimen, the ageing person is ontologically greater than his or her experiences in the nursing home, no matter how totalizing the institution.