Water planners and policy analysts need to pay closer attention to the behavioral aspects of water use, including the use of nonprice measures such as norms, public communications, and intrinsic motivations. Empirical research has shown that people are motivated by normative as well as economic incentives when it comes to water. In fact, this research finds that after exposure to feedback about water use, adding an economic incentive (rebate) for reducing water use holds no additional power. In other cases, nonprice measures can be a way to increase the salience, and subsequently, effectiveness of any adopted pricing mechanisms. We review these empirical findings and locate them within more general literature on normative incentives for behavioral change. Given increasing water scarcity and decreasing water security in cities, policy planners need to make more room for normative incentives when designing rules for proenvironmental behavior.
Behavioral Interventions as Policy Instruments to Manage Household Water Use
Leong Ching and Swee Kiat Tay
Disability and Rural Health
Rayna Sage, Genna Mashinchi, and Craig Ravesloot
The ways in which disability impacts people and their health in rural places are a result of the interaction between the person and the rural environment in which they live. Disability is defined as ongoing difficulties engaging in daily activities and social roles due to physical or mental conditions. The United Nations Convention on the Rights of People with Disabilities (UN-CRPD) implemented policy in 2008 that recognized that disabled people are worthy of autonomy and dignity. The social and physical environment are constructed in ableist ways that make it difficult for people with disabilities to realize their independence and this is particularly true in many rural places. Person–environment fit and urbanormativity (the favoring of urban spaces at the expense of rural ones) are important concepts in understanding the experiences of rural disabled people. There is little existing research regarding the epidemiology of disability and rural health, but rural people report higher and earlier rates of disability than urban people and rural places have higher rates of older adults with higher rates of disability. Furthermore, rural people with disabilities experience various secondary health conditions and higher rates of mortality compared to urban people with disabilties. The lack of access to health care and advocacy help explain some of the differences in health outcomes when comparing rural and urban people. The disability rights movement led to the creation of different types of advocacy and service organizations across the globe to address these disparities. An important way to improve the experiences and health of rural people with disabilities is to ensure they have access to quality and dependable in-home services and community-based rehabilitation, which currently tend to be under-funded with dramatic worker shortages in many rural places. A final promising approach to improving the health of rural disabled people is through evidence-based health promotion programming that targets early indicators of health problemsand recovery and health-sustaining efforts following a health problem.
Ensuring the Public Value of Long-Term Care Services
Joseph E. Ibrahim
Many seniors needing social and clinical care come from vulnerable populations that have difficulty accessing services, a great need for those services, and/or potentially impaired decision-making skills. At the same time, when seniors use services on a routine basis, they become increasingly dependent on the individual service provider. The aged care sector has a duty to provide “public value”—that is, to provide a valuable contribution to society within existing resource constraints. This requires more than simply addressing the basic individual needs of care recipients. Ethical factors must be considered in policies around services to vulnerable seniors and potential issues in addressing suboptimal quality of care, neglect, and abuse of seniors, as demonstrated by continuing public news of poor care provided to seniors in nursing homes, social care, and residential care settings.
Health Care Access for Migrants in Europe
Catherine A. O'Donnell
Migration is a reality of today’s world, with over one billion migrants worldwide. While many choose to move voluntarily, others are forced to migrate due to economic reasons or to flee war, conflict, or persecution. Such migrants often find themselves in precarious and marginalized situations—particularly asylum seekers, refugees, and undocumented or irregular migrants. While often viewed as a single group, the legal status and entitlements of these three groups are different. This has implications for their ability to access health care; in addition, rights and entitlements vary across the 28 countries of the European Union and across different parts of national health systems. The lack of entitlement to receive care, including primary and secondary care, is a significant barrier for many asylum seekers and refugees and an even greater barrier for undocumented migrants. Other barriers include different health profiles and awareness of chronic disease risk amongst migrants; awareness of the organization of health systems in host countries; and language and communication. The use of professional interpreters can help to overcome communication barriers, but entitlement to free interpreting services is highly variable. Host countries need to consider how to ensure their health systems are “migrant-friendly”: solutions include provision of professional interpreters; ensuring that health care staff are aware of migrants’ rights to access health care; and increasing knowledge of migrants in relation to the organization of the health care system in their host country and how to access care, for example through the use of patient navigators. However, perhaps one of the greatest facilitators for migrants will be a more favorable political situation, which stops demonizing people who are forced to migrate due to situations out of their control.
The Health Economic-Industrial Complex (HEIC) and a New Public Health Perspective
José Gomes Temporão and Carlos Augusto Grabois Gadelha
The health economic-industrial complex concept was developed in Brazil in the early 2000s, integrating a structuralist view of the political economy with a public health vision. This perspective advances, in relation to sectoral approaches in health industries and services, toward a systemic approach to the productive environment, focusing on the dimensions of innovation and universal access to health. Health production is seen in an interdependent way, recognizing that the different industrial and service sectors have strong articulations that need to be integrated. The shift toward a universal care model that focuses on human and social needs requires a productive knowledge base that favors promotion, prevention, and local and permanent healthcare, requiring new productive patterns of goods and services and innovation. Therefore, these dimensions are not conceptually apart from each other, considering an analytical and political point of view. The production, care, and sustainability of universal health systems are understood in an integrated and systemic way. Within this vision, a cognitive leap is presented in relation to the traditional health economics, linked to the allocation of scarce resources, to a vision of health political economy that favors the development, expansion, and transformation of the health system and its economic and industrial base. Health is conceived as a moral right of citizenship and a vital space for the development of countries (and for global health), generating social inclusion, equity, innovation, and a possibility for the cooperation between countries and peoples. The Brazilian experience is an exemplary case of association between the development of theoretical conception and its implementation in the national health policy that led to the link between economic development policies and social policies. It was possible to advance both conceptually in terms of a vision of health and social well-being and in contributing to a new paradigm of public policies. This perspective allowed the guidance of guide industrial development and services toward the human needs and universal health systems, considering the challenges brought by the context of an ongoing fourth technological revolution.
The Intersections of Resistance and Health
Resistance refers to a range of actions such as marches, strikes, and civil disobedience. It also refers to less visible and even hidden acts like sabotage. Perhaps more subtly, it refers to discourse and knowledge; how issues are thought or spoken about could be an act of resistance. While the concept of resistance is far from settled, it is a concept that has broad applications and has been applied to better understand a range of actions and struggles. Its relationship to health, however, has often been overlooked or taken for granted. This is despite resistance having an influential role in securing a number of important health related gains and pushing back against powers that would otherwise harm health. Resistance has also been triggered by concerns about health, or framed around issues related to health. The intersections of resistance and health, however, are far more complex. Resistance has challenged and shaped health related knowledge and practice, and health in itself has been used as an act of resistance. Charting the intersections of health and resistance is not only important in itself; it also sheds light on how disruption, dispute, and opposition can shape health and well-being.
Public Health and the UN Sustainable Development Goals
Claire E. Brolan
The COVID-19 crisis—the most catastrophic international public health emergency since the Spanish influenza 100 years ago—provides impetus to review the significance of public and global health in the context of Sustainable Development Goal (SDG) achievement. When countries unanimously adopted the 17 SDGs in September 2015, stakeholders had mixed views on global health goal SDG 3 (Good Health and Well-Being). Concern arose over the feasibility of achieving SDG 3 by 2030 when countries pursued its nine targets and four means of implementation with sixteen other ambitious global goals. Nonetheless, health surely cuts across the SDG framework: for instance, the underlying health determinants are expressed in many goals as is urban and planetary health. Although health (and its different constructions) is central to overall SDG achievement, SDG success depends on a paradigm shift toward whole-of-government policy and planning. Indeed, the 2030 Agenda echoes calls for a Health in All Policies (HiAP) approach to public health programming. This depends on another paradigm shift in public health tertiary education, practitioner training, and policy skills development within and beyond ministries of health. Added to this are the underlying problematics around SDG health financing, human resources for health, health target and indicator localization for equitable country responses that leave no one behind, strengthening civil registration and vital statistics systems for inclusive and accountable health implementation, and the sidelining of human rights from SDG metrics. While COVID-19 has derailed SDG efforts, it could also be the ultimate game changer for intergenerational human and environmental health transformation. Yet strong global health governance and rights-based approaches remain key.
The Role of Service User Preferences and User-Centered Approaches in Adult Social Care
Helen Dickinson and Robin Miller
In recent years we have seen growing interest in a range of countries around how service user preferences can be accommodated in adult social care and how these services might be oriented to be more user-centered. There is a diverse array of different initiatives that might be classified as creating more user-centered approaches. Those at the strategic (macro) and organizational (meso) levels typically have greater amounts of evidence available than those at the individual (micro) level. However, many of these struggle to significantly disrupt power relations and clearly demonstrate an impact on service users. Those at the micro level more readily demonstrate impact, although the very local nature of these interventions means that they are not always well evaluated, and lessons may not be easy to transfer from one context to another. Overall, there is no system that has managed to reorient its adult social care system in a wholesale way; this is an issue that requires both technical and cultural change. Such changes take time to achieve, but there is much that can be learned from the existing evidence base.
Urban Health and Disaster Resilience
David Sanderson, Ronak Patel, and Kelsey Gleason
As cities and towns across the world continue to grow to accommodate most of the world’s population increase, so too are they increasingly and often disproportionately exposed to the threat of natural hazards—including those worsened by climate change—such as floods, earthquakes, windstorms, and fires. Efforts that aim to enhance and safeguard urban health are those that seek to build the resilience of people and systems before, during, and after disasters. Yet where these efforts fail or fail to exist, components of vulnerability and urban diversity inform disaster risk. Taking a systems approach is especially essential to recognize the interconnected, complex, and dynamic issues that include and impact on the spectrum of urban health.
Violence and Health
Maria Cecília de Souza Minayo and Saul Franco
Violence is a problem that accompanies the trajectory of humanity, but it presents itself in different ways in each society and throughout its historical development. Despite having different meanings according to the field of knowledge from which it is addressed and the institutions that tackle it, there are some common elements in the definition of this phenomenon. It is acknowledged as the intentional use of force and power by individuals, groups, classes, or countries to impose themselves on others, causing harm and limiting or denying rights. Its most frequent and visible forms include homicides, suicides, war, and terrorism, but violence is also articulated and manifested in less visible forms, such as gender violence, domestic violence, and enforced disappearances. Although attention to the consequences of different forms of violence has always been part of health services, its formal and global inclusion in health sector policies and guidelines is very recent. It was only in 1996 that the World Health Organization acknowledged it as a priority in the health programs of all countries. Violence affects individual and collective health; causes deaths, injuries, and physical and mental trauma; decreases the quality of life; and impairs the well-being of people, communities, and nations. At the same time, violence poses problems for health researchers trying to understand the complexity of its causes, its dynamics, and the different ways of dealing with it. It also poses serious challenges to health systems and services for the care of victims and perpetrators and the formulation of interdisciplinary, multi-professional, inter-sectoral, and socially articulated confrontation and prevention policies and programs.
Water Tariffs in Spain
Fernando Arbués and Marián García-Valiñas
In the current context of climate change, water scarcity has become the center of an intense debate in recent years. Spain is a country affected by strong regional differences in terms of weather; thus, the quality and availability of water resources vary widely depending on the area, and the country is plagued by droughts and problems with water quality. Nevertheless, urban water prices in Spain are among the lowest in the European Union. Moreover, it is a federal country where subcentral governments (regional and local) are autonomous entities with different responsibilities in the design of water policies. The extremely atomized local panorama and the strong power of the regional governments have led to a highly complex system with a wide range of water price levels and structures. Since the heterogeneity is so great, this article focuses on the tariffs related to the water supply service in the 15 largest Spanish cities. In general, urban water tariffs commonly distinguish between residential and non-residential users. Additionally, there are usually specific tariffs for different customer categories within both residential and non-residential users, which are not always justified in terms of the equity principle. It is important to note that in most cities the eligibility criteria for these special tariffs usually add more complexity to the tariff system and adversely affect horizontal equity. All these factors contribute to the great complexity of Spain’s water-pricing map. The heterogeneous tariff system found in most Spanish cities runs counter to equity principles and can send the wrong signal to users about water scarcity, thereby hindering compliance with the resource sustainability objective. Thus, most Spanish cities require a simplification of the tariff system.