Deanna L. Williamson

The Hidden Costs of Informal Elder Care

Demographic, socio-economic, and political trends throughout the developed world have contrived to make elder care an issue of utmost policy importance. They also have led to sharp reductions in health and social program expenditures. Policymakers are looking to communities to help meet growing care needs because community care is believed to be better and cheaper than institutional care. However, these beliefs become untenable when costs beyond public sector costs are considered. In fact, informal care carries a number of hidden costs that seldom are considered in health and social policy discussions. This article introduces a taxonomy of the costs of informal elder care, which can be categorized as out-of-pocket expenditures, foregone employment opportunities, unpaid labor, and emotional, physical and social well-being costs. Then, an illustration is provided regarding how the taxonomy can be applied to understanding the incidence, magnitude, and distribution of these costs among stakeholder groups. This taxonomy can help inform ongoing debate about health and social policy reform.

Is ''Treat your child normally'' helpful advice for parents of survivors of treatment of hypoplastic left heart syndrome?

BACKGROUND Developing technology affords children with complex congenitally malformed hearts a chance for survival. Parents gratefully pursue life-saving options on behalf of their children, despite the risks to the life of their child, and uncertainty about outcomes. Little is known about how mothers and fathers experience parenting a child whose new state as a survivor may include less than optimal developmental sequels. METHOD Our study involved multiple interactive interviews with 9 mothers and 7 fathers of infants and preschool children with hypoplastic left heart syndrome who had survived the Norwood surgical approach. Qualitative methodology included grounded theory methods of simultaneous collection and analysis of data, and we used open and selective coding of transcribed interviews. RESULTS Parents used normalization in the context of uncertainty regarding the ongoing survival of their child. Parents described their underweight children as being on their own growth curve, and viewed their developmental progress, however delayed, as reason for celebration, as they had been prepared for their child to die. CONCLUSION There is growing evidence that children with congenitally malformed hearts who require surgical intervention during the first year of life may experience developmental delay. The use of normalization by their parents may be effective in decreasing their worry regarding the uncertain future faced by their child, but may negatively affect the developmental progress of the child if they do not seek resources to assist development. Advice from paediatric specialists for parents to view their children as normal needs to be balanced with assistance for parents to access services to support optimal growth and development of their child.

Interpreter-facilitated cross-language interviews: a research note

This research note focuses on interpreter-facilitated cross-language qualitative interviews. Although researchers have written about strategies and procedures for working with interpreters, rarely have they offered adequate detail to determine the relative merits of various approaches, and little attention has been paid to the influence that interpreters have on the validity of qualitative data. We advance this body of literature by describing and critically examining the strategies and procedures we used to work with an interpreter to conduct qualitative interviews with Mandarin-speaking grandparents who participated in our study of intergenerational social support during the transition to parenthood. In addition, we examine the influence that our strategies and procedures had on the data generation process and on the validity of the data. Drawing on our experiences, we argue that with adequate preparation, validity checks, and the supplementary strategies that we describe in this article, an interpreter-facilitated interview approach to generating data in cross-language studies can be an effective alternative to more commonly used and more laborious and expensive translation practices.

Health as a resource for everyday life: advancing the conceptualization.

This paper examines the conceptualization of health as a resource and the implications that such a definition has for public health programs and policies. First introduced in the Ottawa Charter for Health Promotion, health is commonly defined by practitioners, policy makers, and scholars as a resource for everyday life. However, despite frequent references to health as a resource, little attention has been paid to the meaning of this one-line phrase. Thus, we draw on a multidisciplinary body of literature to examine key features of health that characterize it as a resource, as well as its similarities, differences, and associations with other resources. We argue that, as a resource, health is appropriately conceptualized as a type of capital that can be invested in by individuals and societal institutions to achieve positive health returns. Similar to human capital, health is embodied in individuals, and, as such, it is not a tradable resource like money. Health cannot be exchanged or sold for goods and services and it cannot be obtained directly in exchange for goods and services. Instead, as a type of capital, health is a stock of biopsychosocial resources that people can draw on to participate in society. Although health shares some characteristics with human capital, we contend that health is not a component of human capital, as some scholars indicate. Lastly, we maintain that there are important program and policy implications, both positive and negative, of adopting an economic definition of health. 1 This paper is an expanded version of a presentation made at the Canadian Public Health Associations 97th Annual Conference, Vancouver, B.C., May 2006.

Poverty Status, Health Behaviours, and Health: Implications for Social Assistance and Health Care Policy

This study investigated the relationships among poverty status, health behaviours, and the health of 130 Albertans living in poor families. For the purposes of this study, poverty status indicated whether poor families were receiving social assistance along with comprehensive health care benefits or whether they were working poor without comprehensive health care benefits. Findings from seven separate path analyses indicate that poverty status was differentially related to the health of participants. Specifically, working poor respondents were found to be generally healthier than their social assistance counterparts except in those instances in which the working poor were prevented from filling needed prescriptions because they lacked the economic resources to do so. The paper concludes with a discussion of the implications of these findings for social assistance and health care policies.

Implementation of provincial/territorial health goals in Canada

During the past two decades, policy makers in most of Canadas provinces and territories developed broad population-level goal statements about desired health or health and social outcomes. The health goals development process used in each province/territory has been described in government documents and studied by a small number of researchers. However, there is a lack of published research examining the implementation and use of the health goals since they were developed. To begin to fill this gap, we conducted a study between 1998 and 2000 that examined the implementation of provincial/territorial health goals in Canada. Our findings indicate that as the 1990s drew to a close, provincial/territorial health goals were not being used explicitly by policy makers at either provincial/territorial or regional levels in most provinces in Canada to guide health policy and program development, implementation, or evaluation. Instead, the majority of health ministry and regional policy makers were employing strategic/business plans that, at best, reflected or were similar to the original provincial/territorial health goals. Moreover, even though all provinces and the NWT/Nunavut had health goals associated with broad social, economic, and physical environment health determinants, regional-level policy makers were giving priority to health care system goals over all other types of goals. We discuss our findings in relation to studies about health goals in other countries, and we suggest implications that our findings have for both future research and health policy.

Dis-integrated policy: welfare-to-work participants' experiences of integrating paid work and unpaid family work

Using a critical feminist theoretical lens, we followed 17 families for one year – as they attempted to make the transition from welfare to work – eliciting narrative accounts of their day-to-day lives. We used an institutional–ethnographic methodology to analyse the data. Our study shows that the juncture at which unpaid caring work and paid employment meet may be more difficult to negotiate for low-income lone-parent families than for coupled, middle-class employed families. Findings reveal that the unpaid work that happened on the edges of a paid work day, what we refer to as ‘the work outside the work’, took considerable time and energy for participants, making it difficult for them to procure and/or sustain employment. This was due to a number of factors including their limited access to economic and non-economic resources, and the complex nature of their lives, including struggles with day-to-day functioning and childcare arrangements. These challenges, combined with the realities of the low-income labour market made it difficult, if not impossible, for most participants to effectively integrate work and family. These findings suggest that the dis-integrated nature of welfare-to-work policies, which overlooks the actualities of low-income parents’ lives, limits families’ ability to become self-sufficient.

The Self-Sufficiency Trap: A Critical Examination of Welfare-to-Work

This article examines the notion of self-sufficiency as the central goal of recent policy efforts in Canada to move social assistance recipients into the labor market. The authors base their examination on a longitudinal, institutional-ethnographic study of 17 welfare-to-work participants attempting to make the transition from social assistance to employment in the province of Alberta, Canada. Findings from a thematic analysis of in-depth interviews with participants about their day-to-day experiences show that there is a considerable gap between “the promise” and “the reality” of welfare-to-work programs. This gap reveals the difficulties of relying on the goal of self-sufficiency for all citizens, demonstrating how, as an abstract ideological notion, self-sufficiency has shaped concrete policy orientations that affect marginalized citizens by overpromising and underdelivering sustainable employment.

Anticipating Parenthood: Women's and Men's Meanings, Expectations, and Idea(l)s in Canada

The study purpose was to explicate meanings, expectations, and contexts of parenting as women and men prepared to become parents for the first time. We used a prospective, qualitative study design informed by symbolic interactionist and critical feminist perspectives. In-depth interviews were conducted during pregnancy with 21 expectant mothers and 18 expectant fathers, including 18 couples reflecting socioeconomic and cultural diversity in a western Canadian city. We identified a main theme of life-altering and all-consuming responsibility that conveyed participants’ meanings of being a parent and included subthemes: shared or individual responsibility, status change, partial knowing, and reorienting. Participants initiated the reproduction of gendered sociocultural ideals of parenthood before the birth of their infant. Dominant social discourses and ideals shaped their meanings and expectations, ultimately constraining the alternatives they envisioned for themselves as they prepared to become parents.

Welfare reforms in Canada

This study examines the development of impoverished pre-school children before and after the implementation of mandatory welfare-to-work initiatives in Canada. Using data from the 1994/95 and 1998/99 cycles of the National Longitudinal Survey of Children and Youth, we explore the relationships that impoverished families’ income source and family income status have with pre-school childrens school readiness. Findings indicate that both before and after the implementation of mandatory welfare-to-work initiatives, children in working poor families had higher school readiness scores than their peers whose families receive social assisntance, independent of family environment characteristics that differentiated working poor and social assistance poor families. In addition, both before and after the implementation of mandatory welfare-to-work initiatives, school readiness scores of poor children were lower than scores for non-poor children, with children living in families that had incomes at least 200 percent of the low-income cut-offs being the only group with scores above the expected standard of 100. In sum, our study fails to provide evidence that by the end of the 1990s welfare reforms supported the concurrent policy goal of improving the well-being of Canadian children in poverty.