health and social organisations facing differences - the detailed project


Background of the project

Nowadays, healthcare and social organisations are confronted with highly differentiated, pluralistic societies. As a result of steadily increasing migration and significant changes in lifestyle in most European countries, the challenges that Welfare states - and related healthcare and social organisations - have to deal with are also more specific. They thus demand differentiated measures in order to provide equity in accessibility to the services and quality of health and social care. Complex and heterogeneous modern societies require the quality of healthcare and social organisations to be able to respond to new individual needs, such as the implementation of new information strategies, improved communication and language skills, and the incorporation of innovative measures in regular procedures (for instance, see Domenig 2007).

The increased differentiation in modern societies is most pronounced in cities, especially in urban areas with a high mobile population. Cities attract people from all over the world with diverse origins, religious practices, socioeconomic backgrounds and everyday practices (Cattacin 2009b). Consequently, modern cities and their healthcare and social organisations are forced to respond to this heterogeneity and demographic change in urban areas. Although policies regarding health needs are usually made on a nationwide level, cities offer an interesting context for the investigation of healthcare and social organisations, because they are especially confronted with highly diversified lifestyles and are therefore particularly affected by inequity in health and social care. It is also in urban areas that we notice a concentrated mobilisation of special resources and an innovative, specialised infrastructure, implemented at a local level and supported through the participation of all sorts of stakeholders in order to better respond to the needs of a highly differentiated population in the immediate surroundings (Cattacin 2011).

Responses of healthcare and social organisations to diversity have so far focused on specific target groups by the implementation of specialised health and social care for migrant populations, women or disabled people, without realising that the adaption of services for specific target groups always run the risk of creating inequalities between certain social categories. The focus on a single identity marker does not take into account all the existing differences of users. It neglects the risk of multiple discrimination, based on diverse lived realities and the interdependency of social divisions (see debate about intersectionality, for instance Hancock 2007; Knapp 2005; Walby, Armstrong and Strid 2012; Verloo 2006). Ignoring the complexity of social identities and the intersection of various overlapping layers of oppression can produce different forms of multiple discriminations regarding the accessibility of healthcare and social services and quality of care (FRA 2013). The analysis of inequalities with the conception of homogenous social categories such as gender, origin, age, disability, sexual orientation and religion runs the risk that social differences be perceived in a static, stereotypical way, focusing on specific needs of these categories and ignoring people’s individual and social realities and practices. The reality of different social categories is questioned, as people’s needs are most often characterised by an overlapping of many differences, group memberships and the uniqueness of the individual (Johnson and Munch 2009).

Therefore for the creation of equity in healthcare and social organisations, differences should be viewed as a new normality in society, rather than something unusual. Healthcare and social organisations need to find a way to handle this new normality and to find answers to major changes in society by preventing multiple forms of discrimination and implementing person-centred measures and more individualised practices for everybody, no matter who they are.

To investigate the responses of healthcare systems to diversity this research project will be conducted at the scale of urban neighbourhoods, focusing on low-threshold healthcare and social organisations within five European cities, which are characterised by highly diversified and differentiated populations. The main objective of this comparative study is to examine how these selected healthcare and social organisations react to the diversified and multiple needs of an increasing heterogeneous population and the way they deal with complex personal life situations and differentiated users’ needs.

The investigation will collect information in local low-threshold healthcare and social organisations by interviewing both health professionals and users. This provides information from two perspectives and allows for a qualitative comparison of users’ and as professionals’ experiences. Comparing neighbourhoods from different countries allows us to break down national boundaries and to broaden our scope to an international comparison of policies and their practical implementation on a local urban level. The investigation aims to uncover similarities and differences in policies and practices, while taking into consideration the specific historical, political, social and economic contexts of these cities and their national embeddedness. Furthermore, traditions – and path dependencies - could serve as potential resources for the future development of efficient, effective and innovative difference-sensitive measures of good quality in healthcare and social organisations (Cattacin, Chimienti and Björngren Cuadra 2007). Better recognition of societal complexities and individual heterogeneity in healthcare and social organisations would be an essential measure for tackling multiple forms of discrimination, the benefits of which could be reaped by all of society.

Main objectives of the study:

  • Evaluate and compare the health policies in terms of difference sensitivity in the selected healthcare and social organisations. Analyse the strategic and organisational instruments of the organisations to favour equity for its users, bearing in mind national health policies and specificities of Welfare regimes. (Equity in policies / organisation)
  • Analyse the practices of the health professionals. In other words, determine how health professionals of low-threshold healthcare and social organisations are facing highly diversified needs and complex life-situations of their users. (Equity in care / organisation / users)
  • Analyse the accessibility of services for the inhabitants of these neighbourhoods. (Equity in access / organisation / users)
  • Decipher whether healthcare and social organisations include community-based strategies that enable users to participate in decision-making processes and favour their empowerment. (Equity in participation / organisation / users)
  • Analyse the inclusion of the healthcare and social organisations into networks that promote equity (Promoting equity / organisation)
This qualitative analyse will allow us to:

  • Determine criteria for difference sensitivity and instruments for assessing it.
  • Identify levers of change, which can be used to promote the adoption of difference-sensitive policies and develop theoretical frameworks and work plans.
  • Carve out the advantages and drawbacks of the different healthcare and social organisations within the selected neighbourhoods.
  • Define measures to overcome problems of accessibility or quality of healthcare and social organisations.

Methodology

Based on the comparative method, our aim is to draw together similarities and differences of a restricted number of cases in a single, coherent framework, in order to have the possibility to compare the strategies and practices of the then selected healthcare and social organisations (small n strategy).

To collect our information, we will use a panel of mixed, qualitative methods:

  • Observation of the selected neighbourhoods. Exploring literature, local reports, annual reports, secondary statistical data, etc. Analysis of the five selected neighbourhoods as well as their different legislation and policies concerning healthcare organisations. Identifying local competencies in public health and urban concepts of public health.
  • Observation in healthcare  and social organisations, which means intensive involvement with the stakeholders of the selected organisations, including unstructured encounters. All observations will be written down in so-called field notices.
  • Semi-structured interviews with professionals and heads of the healthcare and social organisations.
  • Semi-structured interviews with users of the healthcare and social organisations. All interviews will be recorded and transcripted/translated.

Bibliography

Cattacin, Sandro (2009b). "Differences in the City: Parallel Worlds, Migration, and Inclusion of Differences in the Urban Space", in Hochschild, Jennifer L. and John H. Mollenkopf (eds). Bringing outsiders in : transatlantic perspectives on immigrant political incorporation. Ithaca: Cornell University Press, p. 250-259.

Cattacin, Sandro (2011). "Urbane Vielfalt und Innovation", in Schweizerische Akademie der Geistes- und Sozialwissenschaften (ed.). Von der Deklaration zur Umsetzung – Schutz und Förderung der kulturellen Vielfalt in der Schweiz. Bern: SAGW, p. 47-52.

Cattacin, Sandro, Milena Chimienti and Carin Björngren Cuadra (2007). Difference Sensitivity in the Field of Migration and Health. National policies compared. Geneva: Working Paper No 1 of the Departement of sociology

Dixon Woods, Mary (2005). Vulnerable groups and access to health care: a critical interpretive review. London: Report for the National Co-ordinating Centre for NHS Service Delivery and Organisation. R & D (NCCSDO).

Domenig, Dagmar (2007). "Transcultural competence in the Swiss health care system", in Domenig, Dagmar et al. (eds). Overcoming Barriers – migration, marginalisation and access to health and social services. Amsterdam: Foundation RegenboogAMOC Correlation Network, p. 7-12.

Domenig, Dagmar (2007b). "Das Konzept der transkulturellen Kompetenz", in Domenig, Dagmar (ed.). Transkulturelle Kompetenz. Lehrbuch für Pflege-, Gesundheits- und Sozialberufe. 2., vollständig überarbeitete und erweiterte Auflage. Bern: Hans Huber, p. 165-189.

Easthope, Antony (2002). Privileging Difference. Houndmills, Basingstoke, Hampshire: Palgrave.

FRA, European Union Agency For Fundamental Rights (2013). Inequalities and multiple discrimination in access to and quality of healthcare. Luxembourg: FRA, European Union Agency For Fundamental Rights.

Hancock, Marie-Ange (2007). "When Multiplication Doesn't Equal Quick Addition: Examining Intersectionality as a Research Paradigm." Perspectives on Politics Vol. 5(No. 1): 63 - 79.

Johnson, Yvonne M. and Shari Munch (2009). "Fundamental Contradictions in Cultural Competence." Social Work 54(3): 220-231.

Knapp, Gudrun-Axeli (2005). "Race, Class, Gender: Reclaiming Baggage in Fast Travelling Theories." European Journal of Women's Studies 12: 249-265.

Verloo, Mieke (2006). "Multiple Inequalities, Intersectionality and the European Union." European Journal of Women's Studies 13 (3): 211-228.

Walby, Sylvia, Jo Armstrong and Sofia Strid (2012). "Intersectionality: Multiple Inequalities in Social Theory." Sociology 46(2): 224-240.