News from Project A04

01.12.2020

CRC Advent Calender

Every morning we open a new window, displaying news from the work of CRC 1342 - a research result, an interview, an anecdote or a fun fact from a research trip. Gabriela de Carvalho from project A04 gets us started.

"Bias towards the North may hinder novel knowledge production"

Gabriela de Carvalho, Achim Schmid and Johanna Fischer have examined the literature on health care system classifications. The existing typologies, the team has found, have a strong Global North bias and thus fail to capture important features of health care systems of the Global South. Gabriela de Carvalho, the first author of the paper published in Global Social Policy, explains some details of their findings and what this means for researchers and policy makers.

1- Collage Gabriela PAper.jpg (461 KB)

Foto: Achim Schmid, Gabriela de Carvalho, Johanna Fischer (left to right)


You have reviewed the literature for existing classifications of health care systems and found that they are poorly suited to support research on the Global South. What is the reason?

Gabriela de Carvalho: The main goal of our research was to evaluate the health care system typology literature and its ability to capture the particularities of health care systems of the Global South. The findings of our study points to limitations of several features of existing typologies: their coverage, methods used, and criteria they build on. Regarding coverage, health care systems of LMICs (low- and middle-income countries) are rarely taken into consideration in the literature, as classified cases consist of a 1:5 ratio of Global South to Global North countries. With respect to methods, the overreliance on inductive approaches to classification often excludes countries that cannot be measured in numeric terms. Health statistics mostly focus on the Global North, and has only recently included more data on countries from the South, hampering the analysis of arrangements beyond high-income nations. The use of inductive typologies to classify systems may result in poorly informed classifications especially if the study aims at the creation of a tool for applicability beyond their sample of cases. With regard to the criteria and characteristics health care systems are compared by, dominant features of health care systems that mostly exist in LMICs such as the segmentation of the system for different population groups, are not taken into consideration in many typologies. This often results in typologies that do not capture the empirical reality of the South.

In your paper you write that the health care systems in many countries of the Global South are very different from those of the Global North. What are the most important points?

Gabriela de Carvalho: All health care systems regardless of the country face numerous challenges and the current pandemic made this even more evident. Still, it is undeniable that systems of the Global South endure even greater financial and technical constraints. Besides larger disparities in health care per capita spending, number of health care professionals, and burden of diseases, LMICs are more prone to rely on international actors (transnational organisations, INGOs, and third countries) to finance, provide services and even regulate their systems. Another very important characteristic of many health care systems of the Global South is segmentation, the coexistence of different schemes targeting different population groups according to income, social status and/or type of employment. As a general rule, the poor are beneficiaries of public services due to their exclusion from formal employment, while the upper classes are covered by social and/or private insurance. This stratification leads to extensive health inequalities, as public services only provide basic care, and supplementary services are only used by those who are able to afford them.

What do you see as the reasons why these aspects have not been sufficiently considered in the classification literature so far?

Gabriela de Carvalho: In general, we believe that scientific research is still concentrated in and revolve around OECD countries due to data availability, financial and technical resources, institutional capacity, and the interest of researchers. Of course, recent decades have seen an expansion of (health care systems) scholarship on LMICs, mainly in the form of in-depth case studies, but it still lacks in comparison to the Global North literature, especially when systematic comparison is concerned. If more varied cases are not taken into account, the literature will continue to only partially represent the empirical reality, amplifying the ‘invisibility’ of less studies countries/regions. Particularly to the scholarship we are analysing, it is clear that classification and the development of meaningful typologies is much more complicated when dealing with countries of the Global South. Reasons for that vary from segmentation/parallel (public) systems, parts of the population and/or health services left to markets, and the existence of less „mature”systems. While systems found in the Global North can also be mixed or hybrids in some way, it is much harder to condense the information and assign an LMIC to an ideal type.

What are the consequences of the mismatch between the existing classifications in the literature and the health systems existing in the Global South - for scientific research and for practice/policy?

Gabriela de Carvalho: As the literature often relies on health care systems of the Global North to develop classificatory tools, it seems reasonable to assume that the models resulting from these typologies are more prominent and influential in shaping researchers and policymakers’ ideas of what a health care system does – and should – look like. We argue that high-income examples can be (mis)interpreted as portraying ‘best’ models or ‘benchmarks’, which may lead to standard setting for other countries, disregarding particular and fundamental characteristics of health care systems in LMICs. This could also translate into policy advice being modelled in terms of the well-known types. For scientific research, this bias towards the North may hinder novel knowledge production that could potentially focus on less analysed cases, as research tends to gravitate around seminal works, leaving aside unfamiliar cases or new theoretical considerations.


Read the full paper (Open Access): Classifications of health care systems: Do existing typologies reflect the particularities of the Global South?

More about the research of Gabriela de Carvalho, Achim Schmid and Johanna Fischer and the whole project A04 team:
Global Developments in Health Care Systems and Long-term Care as a New Social Risk


Contact:
Gabriela De Carvalho
CRC 1342: Global Dynamics of Social Policy
Mary-Somerville-Straße 7
28359 Bremen
Phone: +49 421 218-57078
E-Mail: decarvalho@uni-bremen.de

Johanna Fischer
CRC 1342: Global Dynamics of Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-57074
E-Mail: johanna.fischer@uni-bremen.de

Dr. Achim Schmid
CRC 1342: Global Dynamics of Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58526
E-Mail: aschmid@uni-bremen.de

Prof. Dr. Heinz Rothgang
Prof. Dr. Heinz Rothgang
CRC member Heinz Rothgang welcomes the Federal Government's legislative proposal. However, the jobs could only be filled if the federal states changed their binding quotas for highly qualified staff.

The Federal Government has adopted a legislative proposal under which 20,000 additional positions for auxiliary staff in full-time inpatient care for the elderly in Germany are to be financed by the nursing care insurance scheme. This is not intended to increase the contribution of those in need of care.

CRC member Heinz Rothgang, who together with colleagues has developed a procedure for the standardised assessment of personnel requirements in care institutions, evaluates the proposed legislation positively: "It is a first step - no more and no less. The proposal itself is good and sound for now," he said in an interview with buten un binnen. However, the new assessment procedure revealed that a total of 100,000 additional full-time jobs will be needed in long-term care nationwide, which corresponds to an increase in personnel of one third compared to today. "We need about three to four percent more skilled workers in Germany," said Rothgang, "but 70 percent more auxiliary staff.

The planned financing of the 20,000 auxiliary staff positions via the long-term care insurance scheme is a necessary precondition, but regulations at state level stand in the way of practical implementation. "In almost all federal states ... we demand a skilled labour share of 50 percent of the nursing staff. If a facility falls below this level, legal action and even closure is looming," Rothgang said in an interview. The federal states will therefore have to change these regulations, otherwise there is a risk that the positions will not be filled.

Rothgang does not expect the quality of nursing care to decline if the ratio of skilled staff falls: "If auxiliary staff is added without cutting jobs for skilled staff, this should not lead to disadvantages. If additional unskilled workers take the pressure off the skilled workers, this will result in an improved quality of care - with a decreasing ratio of skilled workers".

The final report of the project for the development and testing of the scientifically based procedure for the standardised assessment of personnel requirements in care facilities was approved and published on 23.09.2020.


Contact:
Prof. Dr. Heinz Rothgang
CRC 1342: Global Dynamics of Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58557
E-Mail: rothgang@uni-bremen.de

Project A04 "Global developments in health care systems and in long-term care as a new social risk" is offering internships lasting 2-4 months (20-39 hours/week).

Project A04 is part of the Collaborative Research Centre (CRC) 1342 "Global Dynamics of Social Policy" and focuses on tracing the development of social policy in the fields of health care and long-term care in countries worldwide. Our research aims at pinpointing introduction times and major reforms of health care and long-term care systems and identifying different types of systems as well as factors shaping their development. The project team consists of seven researchers and is directed by Prof. Heinz Rothgang, Dr. Lorraine Frisina Doetter and Prof. Sebastian Haunss. For more information on the project A04 and the CRC please see: https://www.socialpolicydynamics.de/projects/project-area-aglobal-dynamics/project-a04/en/

Tasks

The internship will mainly focus on in-depth research on the historical development of health care systems and/or longterm care systems in one or in several countries. You will search and review relevant academic literature, reports and legal documents and summarize the results. Ideally, this work will feed into writing 5-7 page country briefs which will be published in our CRC 1342 Social Policy Country Brief Series. Additional tasks might also include the collection of quantitative data and literature research and management on health and long-term care.

Requirements

  • Interest in health and/or long-term care policies
  • Very good knowledge of English and experience in writing English texts
  • Experience with literature review and/or data research


Desirable

  • Basic knowledge of social policy, health care policy and/or long-term care policy
  • Knowledge of EndNote
  • Additional language skills (French would be an asset)
  • Knowledge of or interest in politics or policies in specific regions/countries in the Global South


Offer

We offer a cooperative working environment in a friendly, interdisciplinary, and multicultural team at one of the major research projects on comparative social policy study in Germany, where you get the opportunity to apply and develop your skills and knowledge. The internship provides you with insights in working in academia and the possibility to attend (online) meetings of the A04 project, and (digital) events of the CRC 1342 and SOCIUM. During your internship, you have the opportunity to author one or several Social Policy Country Briefs which will be published in our country brief series. If interested, writing your MA thesis related to the project is a possibility as well.

Conditions

Internships can be flexibly arranged in the period between September 2020 and March 2021 and should last approximately 2-4 month. Weekly working time should range between 20-39 hours. Please state your preferences for period, length, and weekly hours in your application. Concrete modalities will then be coordinated during the hiring
process.

Due to the restrictions caused by the SARS-CoV-2 pandemic, work will usually have to be conducted from home and meetings and coordination will take place online.

Application

If you are interested in an internship at the project A04 please send your application to Prof. Dr. Sebastian Haunss (sebastian.haunss@uni-bremen.de). Your application should include a CV, a short letter of motivation as well as a current transcript of records as a PDF document. Please specify your preferred work modalities in the application as well. In case of questions on the internship please contact Sebastian Haunss.


Contact:
Prof. Dr. Sebastian Haunss
CRC 1342: Global Dynamics of Social Policy
Mary-Somerville-Straße 7
28359 Bremen
Phone: +49 421 218-58572
E-Mail: sebastian.haunss@uni-bremen.de

Prof. Dr. Kerstin Martens, Prof. Dr. Marianne Ulriksen, Sharla Plant, Dr. Lorraine Frisina Doetter, Prof. Dr. Delia González de Reufels
Prof. Dr. Kerstin Martens, Prof. Dr. Marianne Ulriksen, Sharla Plant, Dr. Lorraine Frisina Doetter, Prof. Dr. Delia González de Reufels
In a workshop with publisher Sharla Plant the editorial board finalised its plan for the next 18 months and developed ideas for further volumes.

At the beginning of December, the editors of the new CRC Palgrave Macmillan book series "Global Dynamics of Social Policy", Lorraine Frisina Doetter, Delia González de Reufels, Kerstin Martens and Marianne Ulriksen met with Palgrave publisher Sharla Plant in Bremen. It was jointly agreed that three volumes would be published next year:

  • Carina Schmitt (Ed.): Social Protection in the Global South
  • Lutz Leisering (Ed.): A Hundred Years of Social Security in Middle-Income Countries
  • Kerstin Martens, Dennis Niemann & Alexandra Kaasch (Ed.): International Organizations in Global Social Policy


Subsequently, the draft of an edited volume was discussed, which will tell a short history of socio-political turning points worldwide in about 40 short articles. The contributions are exclusively provided by members of CRC 1342 and are based on results of its 15 projects. The volume will be published in the first half of 2021.

After the editors had decided on a design for the Palgrave CRC series, Sharla Plant met in the afternoon with around a dozen authors who presented their ideas for further volumes in individual discussions. These ideas will be finalised in the coming months.

The Collaborative Research Centre 1342 and Palgrave McMillan are publishing a new book series. The first volumes will be released in early 2020.

The CRC 1342 and Palgrave McMillan launched this series in order to publish research findings produced within CRC 1342, as well as from external colleagues.

This series welcomes studies on the waves, ruptures and transformative periods of welfare state expansion and retrenchment globally, that is, across nation states and the world as well as across history since the inception of the modern Western welfare state in the nineteenth century. It takes a comprehensive and globalized perspective on social policy, and the approach will help to locate and explain episodes of retrenchment, austerity, and tendencies toward de-welfarization in particular countries, policy areas and/or social risk-groups by reference to prior, simultaneous or anticipated episodes of expansion or contraction in other countries, areas, and risks.

One of the aims of this series is to address the different constellations that emerge between political and economic actors including international and intergovernmental organizations, political actors and bodies, and business enterprises. A better understanding of these dynamics improves the reader’s grasp of social policy making, social policy outputs, and ultimately the outcomes of social policy.

The editors of the series are the CRC 1342 members Lorraine Frisina Doetter, Delia González de Reufels and Kerstin Martens, as well as Marianne Ulriksen (University of Southern Denmark/University of Johannesburg).


Contact:
Dr. Lorraine Frisina Doetter
CRC 1342: Global Dynamics of Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58561
E-Mail: frisina@uni-bremen.de

Prof. Dr. Delia González de Reufels
CRC 1342: Global Dynamics of Social Policy, Institut für Geschichtswissenschaft / FB 08
Universitäts-Boulevard 13
28359 Bremen
Phone: +49 421 218-67200
E-Mail: dgr@uni-bremen.de

Prof. Dr. Kerstin Martens
CRC 1342: Global Dynamics of Social Policy, Institute for Intercultural and International Studies
Mary-Somerville-Straße 7
28359 Bremen
Phone: +49 421 218-67498
E-Mail: martensk@uni-bremen.de

Sebastian Haunss, director of project A04, is conducting research on social conflicts. In an interview with the Süddeutsche Zeitung he explains why the "Fridays for Future" movement is so successful and what tangible political results can be expected.

"SZ: Let's say I'm really annoyed about the reconstruction of Munich Central Station. How would I have to protest to stop it?

Sebastian Haunss: Well, there is no clear answer to that from a scientific perspective. Previous studies, for example of the anti-nuclear movement, have shown that a large and long-lasting mobilisation is important, the support of political elites and a majority of the population in favour of the cause. It is helpful to have an open opportunity structure, i.e. opportunities to be heard in the political system. The German system is relatively open because the municipal, federal and national levels each provide access. In the case of the anti-nuclear movement, Chernobyl was also an event that contributed to its success. But there is very little overarching research on conditions for success - and the research that exists cannot be applied to any protest.

So: If many people join in, if others approve of the cause and if a few politicians listen ...".

For copyright reasons, we cannot reproduce the entire interview on this page. You can find the complete text here at Süddeutsche Zeitung (in German only).


Contact:
Prof. Dr. Sebastian Haunss
CRC 1342: Global Dynamics of Social Policy
Mary-Somerville-Straße 7
28359 Bremen
Phone: +49 421 218-58572
E-Mail: sebastian.haunss@uni-bremen.de

Prof Dr Heinz Rothgang
Prof Dr Heinz Rothgang
Selected scientists from ten EU countries met with representatives of the Commission, Eurostat, the OED and European NGOs to discuss issues of access, quality assurance and sustainability of care provision systems.

CRC 1342 member Heinz Rothgang took part in the EU Commission's workshop on "Mutual Learing" in the field of social security systems for long-term care on 7 and 8 March. Selected scientists from ten EU countries discussed with representatives of the Commission, Eurostat, the OED and European NGOs on questions of access, quality assurance and sustainability of long-term care provision systems. They also discussed the possibility of improving comparative reporting on these issues at EU level. Heinz Rothgang presented in particular the perspective of Germany's long-term care insurance.

"Social security systems for the need for long-term care are the most recent branch of social security in the European Union. At the same time, they are the area in which the Member States' social security systems differ most," says Rothgang. "This makes it all the more important to initiate mutual learning processes between the Member States".

There are now many data and studies on social security systems for long-term care dependency, says Rothgang. However, international comparison is difficult: "Although it is possible to formulate a common, rather abstract definition of the need for long-term care, national definitions must be used for comparative figures. However, these definitions are not easily comparable, so that it is already difficult to compare the number of people in need of long-term care". According to Rothgang, one solution would be a vignette study. "This would involve presenting well-described cases to those responsible at national level and requiring them to indicate what benefits the described person receives in their country". Together with the national data, a comparable picture would emerge.

Following the intensified discussion at European level in recent years of indicators of the quality of outcomes, Rothgang added that it was now clear "that we cannot do without indicators of structural and process quality either".


Contact:
Prof. Dr. Heinz Rothgang
CRC 1342: Global Dynamics of Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58557
E-Mail: rothgang@uni-bremen.de

Prof Dr Heinz Rothgang
Prof Dr Heinz Rothgang
Technological solutions and devices for long-term care are being developed worldwide. In an interview with the TV station Radio Bremen, CRC member Heinz Rothgang has evaluated whether robots and IT are suitable for coping with the long-term care crisis.

"The use of robots and IT in long-term care is certainly part of the future, but it is not the only solution to the long-term care crisis," said Heinz Rothgang, director of projects A04 and B07, in the programme "buten und binnen" on Radio Bremen. "Technology can support but not replace people. Because care means communication and human affection". Technology cannot offer this. It can support and reduce the burden on caregivers, however, through sensor technology, remote monitoring and the like.

Rothgang is not concerned that humanity will suffer as soon as robots and IT are used in care. He rather has doubts that meaningful technical solutions will find their way into long-term care at all, as the use of technology in this area is generally looked upon with skepticism.

Heinz Rothgang and his staff at Socium are therefore investigating what wishes and needs for technical assistance really exist among people in need of long-term care as well as among care-givers. The aim is to ensure that technical solutions are developed that are actually applied effectively.

In "buten und binnen", Rothgang also emphasised that the attractiveness of the nursing profession must be increased considering the long-term care crisis, so that more people want to work in this field.

The entire interview with Heinz Rothgang (in German only): "buten und binnen" from 14.02.2019


Contact:
Prof. Dr. Heinz Rothgang
CRC 1342: Global Dynamics of Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58557
E-Mail: rothgang@uni-bremen.de

Sigrid Lupieri
Sigrid Lupieri
Lupieri is a PhD candidate at the University of Cambridge and will stay in Bremen for three months, collaborating with project A04.

Thanks to the generous support of an Alexander von Humboldt Foundation grant, we are delighted to be hosting Sigrid Lupieri at the CRC and SOCIUM as a guest researcher for the period of 01 September to 30 November 2018. As a PhD candidate at the University of Cambridge, her research analyses the factors influencing the allocation of health care resources to older Syrian refugees in Jordan.

Ms. Lupieri's previous experience includes working at UNESCO and UNDP in New Delhi and New York, as well as several years as a journalist in Armenia, Georgia, Germany and the U.S. She holds master’s degrees in journalism (Northwestern University) and modern European history (University of Cambridge), and a BA in foreign languages and literatures from the University of Udine, Italy. During her stay at our center, Ms. Lupieri will be working in close collaboration with the A04 project.


Contact:
Dr. Lorraine Frisina Doetter
CRC 1342: Global Dynamics of Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58561
E-Mail: frisina@uni-bremen.de

Alexaner Polte
Alexaner Polte
Of course there is pressure at the university too, says Alexander Polte. In this interview he explains why scientific work nevertheless is relaxing for him and why he had lived in an old people's home in his early 20s.

 

When you were a little boy, what was your first dream career?
That changed frequently because I had many interests: sometimes I wanted to become an architect, sometimes a doctor, then something completely different.

When did you realise that you wanted to become a scientist?
In the second half of my studies. Before that everything was still a bit vague and I just wanted to graduate first.

What did you study?
Sociology and psychology at the TU Dresden. During my studies I worked as a student trainee in software testing. I realised quickly that I wanted to do network analysis. So I continuously specialised in this field and wrote my diploma thesis using this method. During my thesis I noticed that I like scientific work most and that I would like to do a PhD.

What is it that you like about scientific work?
The Openness. You are approaching your research with an open mind and try to avoid possible sources of error. This is both exciting and relaxing, because you don't have to force a result, as it may happen in the private sector. At the university you feel pressure too, to publish as much as possible and to raise third-party funding, but in the end it is our task to keep up this open minded approach to research.

And why didn't you become a natural scientist?
Because I'm interested in how society works. In social sciences, we are constantly confronted with chaos because the field is so complex. I think that is exciting.

To understand the chaos?
Exactly. Or at least to develop a feeling for it. In addition, at first I had no great need to devote myself to mathematics. But what changed during my studies.

Before your studies you were in Slovakia for a voluntary social year. Why did you choose Slovakia? Did you speak Slavic back then?
No, I couldn't. I've never been to Slovakia before. I had applied for a European Voluntary Service and a volunteer association offered me: Why don't you go to Slovakia? You can teach there. And so I went to Lipany in Slovakia.

What did you teach there?
Mostly German and sometimes English. I have taught at two elementary schools and a grammar school, where I mainly gave conversation classes.

Do you still have private or professional connections to Slovakia?
I still have friends there; I still have contact with old colleagues. My scientific work, that deals with health and long-term care systems, is hardly connected to Slovakia. Besides the fun fact, that I lived in a Slovak old people's home.

How did this happen?
The organisation that managed my European volunteer job also provides positions in an old people's home. In the old people’s home there are rooma for the volunteers. That's how I ended up there.

What was your impression of Slovak old people's homes?
The nurses were overworked, they almost walked on their gums: too much work for too few employees. Basically, the same situation as in Germany. But still the atmosphere is very warm and friendly. And the food is good!

Can you outline your role in the SFB?
We investigate the dynamics of health systems and long-term care systems. My main focus is to assess the international interdependencies and how they affect the types of health or long-term care systems. There can be many different interdependencies: economic, political and cultural. This network component will be my research area. It is an interdisciplinary project, which we hope will open up many opportunities for cooperation with the other projects involved in the CRC.

Dear Alexander, thank you very much and good luck with your research!


Contact:
Alexander Polte
CRC 1342: Global Dynamics of Social Policy
Mary-Somerville-Straße 7
28359 Bremen
Phone: +49 421 218-57063
E-Mail: alexander.polte@uni-bremen.de