Social capital, bridging capital

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Social capital, bridging capital rural health
policy

• Jane Farmer
• Centre for Rural Health, Inverness, Scotland

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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

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A word about CRH
Centre for Rural Health
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
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Inverness
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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)

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Health service-related concerns of remote areas

• Higher rising of older people
• Chronic complex illness
• Migration patterns
• (Fear of?) service erosion
• Security Access to AE/ (risk)
• Appropriate economic development?
• Market failure
• Transport issues
• Infrastructure issues
• Available affordable good housing
• Inconsistent weather
• Insular-ism conflict

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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

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????

• Fantastic visionary new opportunity?
• OR
• Roll-back of the welfare state?

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A Project about older people as a positive
force, doing things for communities, doing
things for themselves
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O4OOlder people for Older people
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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

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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

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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

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Partners

• Highland growing ageing population
• Dumfries Galloway employment opportunities
• Northern Ireland post-conflict
• North Karelia heavy demand for older peoples
  services
• Lulea develop volunteering
• Kainuu learn from the project
• Sommersooq, Greenland

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Greenland

• Survey of older people in dispersed remote
  communities
• What they do
• What theyd like to do
• Activity participation

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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 doesnt give them money

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Why social organisations?

• Policy says
• Social organisations/ civic society makes
• Social capital
• Psychological health wellbeing
• Physical health wellbeing
• Low evidence base!

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• 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

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At first that required

• Cohering
• Supporting
• Mentoring
• Looking for funding
• Supporting bids

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Now thats involving

• Education for capacity building
• Business planning development
• Developing local social entrepreneurs

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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

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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

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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

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Some survey findings

• 60.8 response 1500 people 55 (rr)
• 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

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A concern

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

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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.

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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

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• 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

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In different countries

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

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Partners partnership working
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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

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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?

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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?

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Centre for Rural Health jane.farmer_at_uhi.ac.uk www.
abdn.ac.uk/crh