Social capital, bridging capital & rural health policy

1. Social capital, bridging capital & rural health policy Jane Farmer Centre for Rural Health, Inverness, Scotland

2. What? • Scotland… • Healthy, resilient communities & social capital • The theory of building social capital • The reality… • The reality in different countries • Involving policy & other stakeholders • Questions for future policy

3. Centre for Rural Health A word about CRH UHI Millennium Institute and The University of Aberdeen working in partnership • Since 2000 • Collaboration UHI & UoA • 14 staff/ 8 PhD students Academic evidence base • Ways to provide rural services • Health, care & community roles • Community involvement • Tools/methods for measuring • & modelling change impacts RURAL REAL-LIFE APPLY TO CHALLENGES

4. Inverness

5. The policy place in Scotland • Delivering for Remote & Rural Health • “community resilience” • Better Health Better Care – “mutuality” • Neo-liberalism • Globalisation • Recession • Scotland – less marketised than England… ‘good’ & ‘bad’ • (OECD rural policy review)

6. Health service-related concerns of remote areas Higher & rising % of older people • Chronic & complex illness Migration patterns (Fear of?) service erosion Security Access to A&E/ (risk) Appropriate economic development? • Market failure Transport issues Infrastructure issues Available & affordable good housing Inconsistent weather [Insular-ism & conflict]

8. What is a healthy, resilient community? • Government seeks… • Secure (new CFRs & emergency models) • Looking after each other/ civic society • Free personal care – means – no domestic care etc…. [so participation!!!] • Healthy – walking clubs/ active • Self-care… • Anticipatory care…

9. =???? Fantastic visionary new opportunity? OR Roll-back of the welfare state…?

10. A Project about older people as a positive force, doing things for communities, doing things for themselves

11. O4O:Older people for Older people

12. O4O is about Responding to population change Sustaining remote communities Changing the way people think Making a start on seeing older people as a positive force

13. What is O4O? • Mechanism to involve (older) people in basic level service provision for older people • Different models of doing this in different partners & communities • Volunteering • Social enterprise • Work with communities • Involve ‘business’ development • Built on local needs & resources • Cross-generational

14. What sorts of services? • Good neighbour / social support • Domestic help • Meals, shopping • Lifts/ transport • Educational support • Support for self care • First response/triage • Support for community alarm schemes • Snow clearing & wood-chopping

15. Partners • Highland – growing ageing population • Dumfries & Galloway – employment opportunities • Northern Ireland – post-conflict • North Karelia – heavy demand for older people’s services • Lulea – develop volunteering • Kainuu – learn from the project • Sommersooq, Greenland

16. Greenland Survey of older people in dispersed remote communities What they do What they’d like to do Activity & participation

17. The O4O model Local citizens explore their needs What would help keep older people living healthily in their own homes & communities? What would most help? Process… Develop a social organisation… Social enterprise Voluntary organisation Co-operative O4O doesn’t give them money

18. Why social organisations? Policy says… Social organisations/ civic society makes… Social capital Psychological health & wellbeing Physical health & wellbeing Low evidence base!

19. O4O – the theory • SC in the community • People help each other & build networks • Build organisations & build networks • Work with us/ partner organisations – bridging • Volunteering = good for health • Once built this capital can be applied to other things (capacity) • + they have new ‘services’

20. At first that required… Cohering Supporting Mentoring Looking for funding Supporting bids

21. Now that’s involving Education for capacity building Business planning & development Developing local social entrepreneurs

22. What are communities doing? • Highland…. • Transport scheme • Supported housing • Helping • Heritage-identity-meeting place-cafe • Karelia, Finland…. • Volunteering • Dumfries & Galloway…. • Extending Foodtrain and other… • Greenland…. • Needs & activities of older people • N.Ireland…. • Shaping social enterprise ideas • Lulea, Sweden…. • Village co-operatives • Inter-generational IT • Cafe

23. Contextual issues • Scotland – SE – heavily promoted • Sweden (North – welfarist/left) • Enterprise is a ‘dirty’ word • Finland – SE restrictions & meaning • Volunteering is ok • N. Ireland – post conflict • Greenland – hugely dispersed

24. Researching the impact of O4Os Individual impacts Health Helping 2. Community impacts Health Participation Volunteering 3. Service provider impacts Costs Activity Falls, care packages, emergency admissions

25. Some survey findings • 60.8% response: 1500 people 55+ (r&r) • 34% aware of O4O • 88% had helped a neighbour (6 months) • 13% provided unpaid personal care • 31% thought they could influence local decisions • 50% willing to use skills to help others (+39% ‘it depends’) • 28% on management committee • 33% had participated in community projects • 5% said health ‘poor’ • 12% no access to a vehicle • 22% had been held back by ‘emotional problems’ in 4 weeks

26. A concern • Replacing existing social capital (informal helping & reciprocity…. • …with formal … • Disrupting evolved schemes • … though are those exclusive…?

27. And in Canada….! “…the central concern arising from these reforms in Canada, as elsewhere, is that the NPM reforms place matters of efficiency above those of equity and entitlement and that the negative impacts of these reforms are felt most intensely among less well off individuals and communities…” “…each of the 43 [institutions] is findings its own solution to the problem of meeting expanding demands with limited resources, and this is creating diversity in local capacity to respond to demands for assistance…” “…limits to community capacity among older people to provide for themselves and each other…” • Cloutier-Fisher, D., Joseph, A.E., 2000. Long-term care restructuring in rural Ontario: retrieving community service user and provider narratives. Social Science & Medicine 50, 1037-45. • Hanlon, N.T., Rosenberg, M.W., 1998. Not-so-new public management and the denial of geography: Ontario health-care reform in the 1990s. Environment and Planning C: Government and Policy 16(5), 559 – 572. • Hanlon, N.T., Halseth, G., Clasby, R., Pow, V., 2007. The place embeddedness of social care: restructuring work and welfare in Mackenzie, BC. Health & Place 13, 466-481. • Skinner, M.W., Rosenberg, M.W., 2006. Managing competition in the countryside: non-profit and for-profit perceptions of long-term care in rural Ontario. Social Science & Medicine, 63, 2864-76.

28. The realities of O4O…(OMG!) • For communities: • - exogenous ‘social engineering’? • - enterprising? • - extent of capacity • - internal community conflict • when it comes to the crunch… • is it possible to get beyond the grant? (how do you make social enterprise work in small communities) • why us/ why now/ want paternalism

29. For service providers • At management level: want it, but not to support its birth • Models of sustainable (small) community enterprise • At operational level – threatening and risky • Availability of data to show change + how to change For support agencies • Providing training & support that fits remote & rural communities • Beyond advising into doing • Targets based on outcomes = social entrepreneurs • Government • Only interested if it works

30. In different countries • Sweden • Business model & paradigm shift? • Finland • Volunteering? Apathy… • Greenland • Some villages more engaged than others • Alcohol, bingo, etc….. • N Ireland

31. Partners & partnership working

32. Policy people….are integral • Change & innovation at government level • Local health authority • Bemused? Distanced… • Local council • Does it work, make it work, waste of time • Two years ahead of itself • Ambulance service • Interested in how to engage with communities • Want to integrate with our transport scheme • Regional development agency • Right now we are interested in telemedicine…

33. Future policy… • Impacts… • Health, service provision, does anyone care – enough? • Models of social enterprise provision for tiny communities – which? • Is there really the capacity? • Is it the role of researchers…?

34. My questions for you… • What are your experiences? • Can (and should) the health service explicitly seek to grow community capacity? If so, how? • Is social enterprise, as promoted by government, really to build capacity or just to shift service provision? • Does social enterprise have a role in health & social care provision? • How can it be made to work in small communities? • What is different about Aus rural health & Scottish rural health (context) that would affect outcomes of a thing like O4O?

35. Centre for Rural Health jane.farmer@uhi.ac.uk www.abdn.ac.uk/crh