Department of Family and Community Medicine, University of Toronto, and Inner City Health Research Unit, St. Michael's Hospital, Toronto, Ontario, M4X 1K2, Canada. leah_steele@camh.net
Major social policy changes were implemented in Canada in the last decade with few efforts to examine their potential health effects.
We sought to determine the impact of a large reduction in welfare benefits on use of ambulatory physician mental health services in areas with high levels of welfare dependency relative to areas with low levels of welfare dependency.
The setting was Toronto, Canada. Data sources included census, provincial health insurance, and municipal welfare data. We used generalized estimating equations to compare ambulatory mental health service rates by neighborhood level of welfare dependency before and after a 21.6% reduction in welfare payments.
There were no long-term relative differences by welfare dependency in mental health service use before compared with after the policy change. There was a very small short-term increase in mental health visits to generalists in the 6 months after the policy change. We demonstrated a marked gradient in psychiatric service use with low welfare dependency areas having significantly higher rates of use than high welfare dependency areas.
We demonstrated a mismatch between known levels of need for care and levels of psychiatric use. We conclude that where use of services is not tightly linked to need for services, utilization data may be unsuitable for evaluating programs or policies. Social policy changes with potential health effects should have integrated evaluations planned at the time of policy implementation.
Normalization and rehabilitation as objects of socio-political measures concerning the mentally retarded in Denmark and the Federal Republic of Germany: an intercultural comparative study.
This is a report on first results of a research project which tries to develop statements concerning the transferability of the concept of normalization as a basis of the care for the mentally handicapped from the Scandinavian into the German context. The intercultural comparative study is chosen as the appropriate method. This is done on the basis of a socio-political comparison of the situation and practice of public services in both countries, as well as on the basis of a comparison of selected service regions. In this paper we do report on results on that socio-political comparison. There is a difference between the comparison of structural characteristics of social systems, the comparison of socio-political measures and the comparison of social tendencies and problems which have effects on the situation of the mentally retarded. In the centre of this statement is a nearby aspect of the structures' comparison, that is the comparison of the objects of public care for the mentally handicapped in Denmark and the FRG. These aims are defined within the specific arguments for legislative standardisations. In Denmark this aim is paraphrased by the term "normalization", which means to arrange the life of a handicapped as normal as possible. In Germany there is an alignment about the objective "rehabilitation", which is formulated most comprehensively as the integration of the handicapped into work, profession and society. An analysis of the normative contents shows a close conformity in the conceptions of the aims. In contrast to this we find practically basic organisational and structural differences in the systems of public services which in essence are connected with the different social systems of both countries and the different development of reform processes in this subject.
This paper addresses the effects of chronic poverty on people with serious mental illness. More specifically, we are concerned with the extent to which welfare restructuring, by deepening the poverty facing people with serious mental illness, undermines the expressed intent of mental health policy to improve the quality of life (QOL) of this population. The province of Ontario in Canada forms the setting for the study. The paper first examines recent trends in mental health care and social assistance policy in Ontario. While income support is consistently recognized as a core element of mental health care, welfare restructuring has led to a significant decline in the real value of income supports received by people with serious mental illness. The paper then examines the implications of this trend for the QOL of residential care facility tenants in Hamilton, Ontario. Here, the case study is explicitly connected to QOL scholarship. In addition, the study is grounded in an analysis of the broader transformation of the welfare state in Ontario. Interview data suggest that tenants experience chronic poverty that has a deleterious impact on multiple life domains including basic needs, family, social relations, leisure and self-esteem. Implications for research and policy are discussed.
To investigate whether the cognitive development of young children in poverty is affected by activities of their primary caregiver and by household income source, which are two components of family poverty experience that have been affected by recent welfare reforms.
Bivariate and multivariate analyses were used to examine the relationships that caregiver activity, household income source, and family characteristics (family income adequacy, caregiver depressive symptoms, caregiver education) have with the cognitive development of 59 impoverished children less than three years old.
Of the three poverty experience variables included in the multivariate analysis, only employment as the exclusive source of household income had an independent relationship (positive) with children's cognitive development. Two of the family characteristics, income adequacy and caregiver education, also were associated with the children's cognitive score, and they were both better relative predictors than the employment-only income source variable. Income adequacy was positively associated and caregiver education was negatively associated with children's cognitive development.
Although recent welfare reforms, in combination with economic growth and declining unemployment, have changed the poverty experience of young families by increasing the proportion that secure at least part of their income from employment, our study provides preliminary evidence that these reforms have made little difference for most young impoverished children. Instead, our findings suggest that the cognitive development of young children is influenced as much by the actual amount of household income as by their parents' activity and source of income.
