Health inequalities researchers have long advocated for governments to adopt policy instruments that address structural determinants of health rather than targeting individual behaviours. The assumption behind this position is that such instruments might challenge a core neoliberal principle of individualism embedded in the prevailing health policy paradigm. We critique this assumption by highlighting the discursive construction of policy instruments, and their discursive effects. Using the UK’s Tackling Obesity policy as a case study, we demonstrate how instruments designed to target structural determinants of health (such as food advertisement regulation) can actively sustain – rather than challenge, the dominant policy paradigm. We call this phenomenon ‘upstream individualism’, exploring how it relates to tensions in the research-policy relationship, and its relevance beyond health policy. We argue that instruments can shape policy change and continuity, including at a paradigm level, and that ‘upstream individualism’ provides a useful basis for theorising these power dynamics. This article contributes to the constructivist public policy literature by noting how policy instruments meant to challenge the discursive construction of individualism within public health can ultimately reinforce it.
Background:
The advent of the COVID-19 pandemic in South Africa and across the globe posed special challenges and implications for low-income families with children. In this study we explored the experiences of primary caregivers of children receiving a South African social assistance programme, the Child Support Grant (CSG), during lockdown in Cape Town, South Africa, and sought to understand whether and to what extent the underlying logic of cash transfers such as the CSG speaks to the pitfalls of the social protection paradigm and the potential for moving closer to a transformative social policy approach.
Methods:
We conducted 26 telephonic qualitative interviews with primary caregivers of recipients of South Africa’s CSG that were part of a longitudinal cohort study assessing the impact of the CSG on child nutritional status and food security.
Results:
Even though primary caregivers of the CSG and their children and households were already living in precarity before the pandemic, COVID-19, and particularly the hard lockdown, worsened their social, economic and living conditions, especially as regards hunger and food insecurity.
Conclusion:
Low-income women bore the brunt of the pandemic in their roles as mothers, providers and homemakers. The pandemic has highlighted the inadequacies of the social protection paradigm that underlies the design of cash transfers such as the CSG, which has a narrowed focus on chronic poverty and vulnerability. It has also highlighted opportunities to shift to a transformative social policy framework that incorporates production, redistribution, social cohesion, adequacy and protection.
The Village Savings and Loan Association (VSLA) model is currently being employed in Uganda for deepening financial inclusion and poverty reduction. Despite its focus on women’s empowerment, concerns have arisen of an under-representation of women on VSLA leadership committees. Human rights-based, economic, and social justice arguments support active participation of women on VSLA leadership committees. The study sought to identify, explicate and characterise the barriers and facilitators to women in VSLA leadership. An exploratory study design using qualitative methods was selected to address the research objectives. Forty-nine focus group discussions were undertaken, featuring both VSLA members and non-members. VSLAs for inclusion in the study were randomly selected from within four regions of Uganda, stratified by: mature (>2 years old) versus new (<2 years old). The study exposed a diverse array of barriers and facilitators to women in VSLA leadership positions, revealing the influence of individual, material, institutional and social factors, in addition to social norms and gender characteristics, on women in VSLA leadership. The findings revealed that the design of interventions to achieve fair representation of women in leadership positions should be informed by an understanding of the different types, relative strengths, support for/against, and intersectionality of the factors impacting women in VSLA leadership.
This commentary discusses the ways in which the welfare system has responded to the financial and housing needs of Ukrainian citizens coming to the UK since the Russian invasion of Ukraine on 24 February 2022. The focus is on two key areas of policy: social security and housing. The article considers the revised eligibility criteria for welfare benefits and two policies which can provide accommodation: the Ukraine Family Scheme, which allows applicants to join family members in the UK, and the Ukrainian Sponsorship Scheme (known as ‘Homes for Ukraine’) which allows Ukrainian nationals to come to the UK if they have a sponsor who can provide accommodation for at least six months. It provides a comparison of the provision for Ukrainian refugees and the standard asylum system in the UK.
This article concludes that although the UK government quickly introduced emergency provisions for newly arrived Ukrainians which go beyond the scope of support for many other groups moving to the UK, significant areas of concern are evident, with risks that these will increase in future months and years. These concerns centre on discrepancies between the two policies which provide accommodation, risk of exploitation, homelessness caused by the breakdown in provision, and complexity in the welfare benefit system.
Why and how do policymakers initially sceptical of policy innovations from abroad eventually transfer them to their own countries? Focusing on Chile’s reforms to combat business cartels in 2009 and 2016, this article answers that question. Policy diffusion and transfer literatures maintain that coercion, competition, learning or emulation could account for foreign inspirations in policymaking. However, these literatures overplay the role of coercion and emulation in policy transfer to countries in the global south, and have difficulty distinguishing between different mechanisms in empirical studies. To address these limitations, I suggest analysing three intermediate causal steps in policy transfer: first, policymakers’ motivations in initiating policy reforms, second, their reflections on how the foreign-inspired model responds to the policy problem at hand, and third, their reflections on the fit between the foreign model and domestic conditions. Through process-tracing of two anti-cartel reforms in Chile, I find that policymakers introduced foreign-inspired policy measures to combat business cartels through a process of learning from other countries and international organisations, rather than coercion or emulation. Learning was evident in three ways. First, in the initiation of the reform, as policymakers responded to a clearly identified policy problem; second, in policymakers’ careful reflection on how the foreign-inspired model responded to these problems; and third, in the adjustments made to fit the foreign model to domestic conditions. The analysis demonstrates the utility of analysing intermediate causal steps in policy transfer, and of paying more attention to local actors and political processes.
The role of charity in the provision of public services is of substantial academic and practitioner interest, and charitable initiative within the English and Welsh National Health Service (NHS) has recently received considerable attention. This study provides rich insights into the role that NHS-linked charities present themselves as playing within the NHS. The dataset analysed is a novel construction of 3,250 detailed expenditure lines from 676 sets of charity accounts. Qualitative content analysis of itemised descriptions of expenditure allows us to explore how these charities portray their activities. We distinguish between expenditures that can be framed as supplementary to government funding (such as amenities and comforts) and items that suggest charitable effort is substituting for government support (such as funding for clinical equipment). We also consider the claims being made through these representations, and suggest that the distinctiveness of the charity and NHS spheres are currently under question. We argue that, through their representational practices, charities are both shaping and blurring the expected roles of government and charity. Acceptance of the benefits that charitable initiative does provide, in terms of innovation, pluralism and participation, must be tempered with the realisation that charitable funds are playing a role in service provision that is not guided by clear policy, and that this has the potential to widen existing inequalities within a key public service.
The study analyses the household food security situation in Libokemkem woreda of the Amhara region in Ethiopia using 285 randomly selected sample households. The Household Calorie Acquisition (HCA) is used to measure the diet quantity aspect of food insecurity, and 225 kg/year/AE is used as a food security threshold. The Household Diet Diversity Score (HHDDS) is used to measure the diet quality aspect of food insecurity, and consuming four food groups is used as a food security line. Approximately 83 per cent of the total households achieved minimum food security status in terms of diet quantity, and 64 per cent were food secure in terms of diet quality. Determinants of food security in terms of diet quantity and quality were analysed using Tobit and logit regression models, respectively. Sex, family size, farm size, number of oxen, expenditure on agricultural technology, agroecology zone and distance from market centre are statistically significant determinants of food security in terms of diet quantity. On the other hand, sex, education status, off-farming activities, livestock ownership and agroecology zone are statistically significant determinants of food security in terms of diet quality or diversity. The study suggested the urgency of human capital development, increasing the production and productivity of major cereal crops, and promoting labour-intensive rural employment opportunities to break the vicious circle of poverty and food insecurity. It also suggested the promotion of soil and water conservation, livestock rearing and the use of organic fertiliser in highland areas, while mechanised farming for major crops such as rice, onion, chickpea, tomato and garlic is recommended for midland areas.
This work adopts different approaches to analyse situations of poverty and extreme poverty in Spain during the last decade, considering different monetary thresholds, measures of severe material deprivation and the combination of both. The determining factors of these situations and the patterns that act as a link between extreme poverty and homelessness are also examined. The results of the study show that for the most restrictive thresholds of 10 per cent and 20 per cent of the median equivalised disposable income the smallest variations during the series are observed, confirming that situations of such deep poverty are not influenced by the cycle since they do not respond to economic stimuli. The determinants of extreme poverty suggest that public policies should be target towards high-risk groups, such as single person households, households with children, younger individuals, individuals with a low educational attainment, and of foreign nationality. Finally, an interesting result is that the profile of individuals in situations of consistent poverty have the greatest similarities to the group of people experiencing homelessness.
The benefit cap and the two-child limit were both introduced with the aim of promoting fairness. However, women are disproportionately affected by both of these polices. This article presents new empirical evidence that demonstrates the gendered impacts of the benefit cap and the two-child limit on mothers. It shows that the benefit cap and the two-child limit ignore the gendered reasons for women’s disproportionate subjection to the policies, devalue unpaid care, fail to recognise gendered barriers to paid work and ultimately, harm women in a wide range of ways, particularly by further entrenching them in poverty.
