Policy and system change and community coalitions: outcomes from allies against asthma.

Objectives. We assessed policy and system changes and health outcomes produced by the Allies Against Asthma program, a 5-year collaborative effort by 7 community coalitions to address childhood asthma. We also explored associations between community engagement and outcomes. Methods. We interviewed a sample of 1,477 parents of children with asthma in coalition target areas and comparison areas at baseline and 1 year to assess quality-of-life and symptom changes. An extensive tracking and documentation procedure and a survey of 284 participating individuals and organizations were used to ascertain policy and system changes and community engagement levels. Results. A total of 89 policy and system changes were achieved, ranging from changes in interinstitutional and intrainstitutional practices to statewide legislation. Allies children experienced fewer daytime (P = .008) and nighttime (P = .004) asthma symptoms than comparison children. In addition, Allies parents felt less helpless, frightened, and angry (P = .01) about their child's asthma. Type of community engagement was associated with number of policy and system changes. Conclusions. Community coalitions can successfully achieve asthma policy and system changes and improve health outcomes. Increased core and ongoing community stakeholder participation rather than a higher overall number of participants was associated with more change.

Care workers, care drain, and care chains: reflections on care, migration, and citizenship.

In this article, we discuss a case study that deals with the care chain phenomenon and focuses on the question of how Poland and the Ukraine as sending countries and Poland as a receiving country are affected and deal with female migrant domestic workers. We look at the ways in which these women organize care replacement for their families left behind and at those families' care strategies. As public discourse in both countries is reacting to the feminization of migration in a form that specifically questions the social citizenship obligations of these women, we also look at the media portrayal of the situation of nonmigrating children. Finally, we explore how different aspects of citizenship matter in transnational care work migration movements.

Hierarchization and segmentation of informal care markets in Slovenia.

The article is the result of qualitative research of informal care markets in Slovenia in the field of childcare, elder care, and cleaning. The author assesses Slovenia's position in the "global care chain" and finds that "local care chains" prevail in the field of childcare and elder care, while a co-occurrence of female gender, "other" ethnicity, and poverty is typical in the field of household cleaning. The main emphasis of the article is on the analysis of hierarchization of the informal market of care work according to following two criteria: social reputation of individual type of care work and citizenship status of care workers.

Care of older people in migration contexts: local and transnational arrangements between Peru and Spain.

Care arrangements for the elderly are becoming a main social process in contemporary societies due to socio-political and lifestyle changes over the last few decades. The family and the State play a basic role in the construction of care systems and in the establishment of strategies to access care resources. In the present context of migration, these resources interact at a transnational level, challenging family and State migratory regimes. These new realities need the recognition of basic international social rights, as the experiences of Peruvians living in a migration context in Spain show.

Rethinking care through social reproduction: articulating circuits of migration.

Care has come to dominate much feminist research on globalized migrations and the transfer of labor from the South to the North, while the older concept of reproduction had been pushed into the background but is now becoming the subject of debates on the commodification of care in the household and changes in welfare state policies. This article argues that we could achieve a better understanding of the different modalities and trajectories of care in the reproduction of individuals, families, and communities, both of migrant and nonmigrant populations by articulating the diverse circuits of migration, in particular that of labor and the family. In doing this, I go back to the earlier North American writing on racialized minorities and migrants and stratified social reproduction. I also explore insights from current Asian studies of gendered circuits of migration connecting labor and marriage migrations as well as the notion of global householding that highlights the gender politics of social reproduction operating within and beyond households in institutional and welfare architectures. In contrast to Asia, there has relatively been little exploration in European studies of the articulation of labor and family migrations through the lens of social reproduction. However, connecting the different types of migration enables us to achieve a more complex understanding of care trajectories and their contribution to social reproduction.

Grandfather caregivers: race and ethnic differences in poverty.

We use data from the 2006 American Community Survey to examine race and ethnic differences in the effects of marital status and co-residence of the middle generation on the likelihood of poverty among grandfathers who have primary responsibility for co-resident grandchildren (N = 3,379). Logistic regression results indicate that race/ethnicity and household composition are significant predictors of poverty for grandfather caregivers: non-Hispanic white grandfathers, those who are married, and those with a co-resident middle generation are the least likely to be poor. The effects of race/ethnicity, marital status, and the presence of a middle generation are, however, contingent upon one another. Specifically, the negative effect of being married is lower among grandfathers who are Hispanic, African American, non-Hispanic, and non-Hispanics of other race/ethnic groups compared to whites. In addition, having a middle generation in the home has a larger negative effect on poverty for race/ethnic minority grandfathers than for non-Hispanic whites. Finally, the combined effects of marriage and a middle generation vary across race/ethnic group and are associated with lower chances of poverty among some groups compared with others. We use the theory of cumulative disadvantage to interpret these findings and suggest that race/ethnicity and household composition are synergistically related to economic resources for grandfather caregivers.

Patient and carer participation in old age psychiatry in England. Part I: a systemic perspective of the historical and policy context.

BACKGROUND: Patient and carer participation in old age psychiatry is less developed than in other areas of mental health. What can we learn from the historical context about increasing participation and how can it be conceptualized? METHODS: The historical and policy context of patient and carer participation in the National Health Service is reviewed and related to the development of old age psychiatry in England and the parallel development of the mental health user movement. RESULTS: Systemic theory is offered as a way of understanding how partnership between healthcare professionals, patients and carers might lead to service evolution by bringing a range of perspectives together in order to co-construct a mutually influenced outcome. It is further suggested that this might empower not only patients and carers but also healthcare staff at a time when they are under increasing pressures. CONCLUSIONS: Old age psychiatry patients and carers struggle to be heard but have much to offer to services in partnership with healthcare professionals as partners and allies in service development.

Harsh choices: Chinese women's paid work and unpaid care responsibilities under economic reform.

China's economic reforms over the past three decades have dramatically changed the mechanisms for allocating goods and labour in both market and non-market spheres. This article examines the social and economic trends that intensify the pressure on the care economy, and on women in particular in playing their dual roles as care givers and income earners in post-reform China. The analysis sheds light on three critical but neglected issues. How does the reform process reshape the institutional arrangements of care for children and elders? How does the changing care economy affect women's choices between paid work and unpaid care responsibilities? And what are the implications of women's work­family conflicts for the well-being of women and their families? The authors call for a gendered approach to both social and labour market policies, with investments in support of social reproduction services so as to ease the pressures on women.

Stratified familialism: the care regime in India through the lens of childcare.

This article explores the political and social economy of care in India through a focus on childcare practices, from the viewpoint of the care giver ­ a perspective frequently ignored or touched on only generally in earlier discussions on development or social policy. It is argued that the care regime is an ad hoc summation of informal, stratified practices. It is shaped by the institutional context, in particular the economic and social inequalities of work and livelihoods, as well as trends and absences in state economic and social policy. Central to the dynamics of care practices in India is the ideology of gendered familialism in public discourse and policy, which reiterates care as a familial and female responsibility and works to devalue and diminish the dimensions of care. By delineating the range of institutions through which everyday childcare practices are organized, this contribution draws out the differentiations and actualities of stratified familialism and care. At one end of the spectrum are those who have the possibility to retain familial carers at home and supplement them with paid and other institutional carers; at the other are those who are neither able to retain family members at home nor fill the care gap through formal institutions.

What is love? The materiality of care in Ghanaian transnational families.

In the West, economics and intimacy are assumed to occupy separate ­ even antithetical ­ domains. In Ghanaian family life, however, affection is understood to be expressed through the distribution of material resources across generations and a person's life cycle. Such an understanding of love means that migrant parents who leave their children behind in Ghana can continue to be good parents by sending remittances, and, in fact, may be considered better parents than caregivers who stay and are poorer. This construction of love also means that children tend to attach themselves to more financially secure caregivers over those with fewer economic opportunities ­ to men in favour of women, to those abroad over those in Ghana. It is precisely because love is signalled through material exchanges that children long to be with parental migrants far away who support them and feel abandoned by those parents who do not. The intertwining of economic and emotional ties in Ghanaian transnational families has significant implications for policy, as discussed in the conclusion.

"Let us help them to raise their children into good citizens": the Lone-Parent Families Act and the wages of care-giving in Israel.

Based on the assumption that the construction of meaning in the process of policy-making is crucial if we wish to understand the gender outcomes of social policy, this article analyzes the parliamentary debates that preceded and accompanied the legislation of the Israeli Mono-Parental Families Act, 1992. It focuses on the enunciation of gender roles and relations in the discourses that framed and justified the Act as well as on how the capacity to establish and maintain autonomous households was constructed and legitimized. Two sets of discourses emerged during the deliberations over the Act, each of which endeavored to interpret the needs, identities, and capacities for action among lone-parent families. The article shows how a specific version of the capacity to establish and maintain autonomous households­that of caregivers who happen to be workers­was privileged in the policy paradigm underlying the Act. The alternative vision­that of workers with caregiving responsibilities­was marginalized and eventually disregarded in the final wording and implementation of the Act. The article concludes with an analysis of the socio-political processes that underlie the prioritization of the version, which was ultimately expressed in the implementation of the Act. It is suggested that a state-level collective identity project shaped by demographic concerns and geo-political factors and changes in the political economy combined to define the needs, identities, and capacities for action of lone-parent families in terms of a model of motherhood in which care-giving trumped paid work.

The politics and power in caregiving for identity: insights for Indian residential school truth and reconciliation.

The authors examine the politics of caregiving for identity to enrich scholarship about power. They report on a qualitative study with Aboriginal mothers who parent in the wake of the Canadian Indian residential schools (IRS). Just as this system disrupted familial caregiving to assimilate Aboriginal Peoples, data show some mothers now strive to organize their caregiving in ways that serve decolonization and community empowerment. Building on their expertise, the authors argue that counter-colonial family policy investments to support such caregiving should factor in any just compensation for the IRS system if its population, and not just individual, costs are to be redressed.

A arte de cuidar: saúde, espiritualidade e educação / El arte de cuidar: salud, espiritualidad y educación / The art of caring: health, spirituality and education

Cuidar constitui-se em um dos fundamentos da mãe natureza. A grande maioria das espécies, sejam vegetais ou animais do nosso planeta, tem, em algum grau, desenvolvida essa característica aparentemente inata e que parece estar ligada à própria manutenção e sustentação da vida. Enquanto nos vegetais a habilidade do cuidar se prende ao auto-cuidado, no sentido de preservação da vida, ela acaba por se desenvolver e aprimorar chegando ao seu ápice na espécie humana. Ao observarmos o processo de desenvolvimento e evolução da vida, a habilidade do cuidar, ganhou uma aparente vantagem competitiva no processo de evolução. E ao que parece fez uma simbiose de tal maneira com a própria Vida, como a entranhar-se na sua essência, que agora existiria uma indissociabilidade destas, ou seja, vida e cuidar tornaram-se sinônimos no processo de evolução.O cuidar, pois, parece ser um refinamento e um dos propósitos da vida, mas que só poderia ser entendido nesse sentido se considerarmos por uma perspectiva de transcendência ou de um projeto do seu Criador. Palavras-chave: Cuidadores. Saúde. Espiritualidade. (AU)

Caring is one of the bases of Mother Nature. Most species of our planet, be they vegetal or animal, has in some degree developed the apparently innate characteristic of caring, which seems to be linked to the very maintenance and sustaining of life. While in vegetables the ability of caring is linked to self-care, in the sense of preserving life, it is developed and improved and reaches its apex in the human species. When observing the process of development and evolution of life, we see that the ability of caring achieved an apparent competitive advantage in the evolution process. It seems it made such a symbiosis with Life itself that it penetrated its very essence. Thus, now Life and Caring are so intertwined that became synonymous in the evolutionary process. Caring seems therefore to be a refinement and one of the purposes of life, but could only be understood in this sense if we consider it from a perspective of transcendence or a design of its Creator. Keywords: Caretakers. Health. Spirituality. (AU)

El cuidar constituye un de los fundamentos de la madre naturaleza. La mayoría de las especies de nuestro planeta, sean vegetales o animales, tiene desarrollada en alguno grado esa característica aparentemente innata y que parece vincularse a la propia manutención y sustentación de la vida. Mientras en los vegetales la habilidad del cuidarse se liga al autocuidado, en lo sentido de preservación de la vida, esa habilidad termina por se desarrollar y afinar, llegando a su ápice en la especie humana. Cuando observamos el proceso de desarrollo y evolución de la vida, la habilidad del cuidar adquiere una aparente ventaja competitiva en el proceso de evolución. Y, al menos aparentemente, ha hecho tan grande simbiosis con la propia Vida, que es como se hubiese una enorme penetración en su esencia, lo que hace una esas dos entidades, Vida y Cuidar, porque, al menos aparentemente, parece ser un perfeccionamiento e uno de los propósitos de la vida, pero que solo podría ser entendido, en ese sentido, se consideradas desde una perspectiva de trascendência o de un designio de su Creador. Palabras-llave: Cuidadores. Salud. Espiritualidad. (AU)

Blurring boundaries, distant companions: non-kin female caregivers for children in colonial India (nineteenth and twentieth centuries).

This paper examines the history of child-care by non-kin, "non-family" members and their representations in colonial India. It focuses primarily on Bengal and relies on several genres of literary documents. Bengal harboured the seat of the British imperial capital in the city of Calcutta until 1911 and its culture was shaped in unique ways compared with other Indian cities. Based on a reading of select literary documents such as European advice manuals and Bengali personal narratives, the paper argues that the relationship between caregivers and children in colonial households attests to the building of new ties and deep ambiguous, multi-dimensional relationships with non-kin members thereby revealing the plasticity of Indian families where sociocultural boundaries were blurred and intimate relationships forged. Beginning with the literary representation of a wet-nurse in Mahasweta Devi's short story Breast-Giver, the paper delves into the world of European and Indian accounts to recuperate the history of the caregivers. It demonstrates that despite the emphasis of recent scholars that the construction of a respectable middle-class identity was based on a sharp distinction from lower social groups, such as working women and prostitutes, the history of child-care by hired domestics reveals the sharing of a common world by different caste-class groups and the interpenetration of the two domains of culture.

Who cares for me? Grandparents, nannies and babysitters caring for children in contemporary Italy.

This paper illustrates the factors and features of the revival of paid care and domestic work in Italy. While Italy is experiencing a boom in the recourse to carers for the elderly, there is not a corresponding expansion in paid private childcare, in spite of growing female employment and limited public services for children. One of the reasons for this is the growing involvement of grandparents in childcare. In Italy, a country characterised by a "Mediterranean welfare regime", people also have recourse to their own mothers (and fathers) to care for their children, in spite of the fact that they can afford to pay for childminding and babysitting. Thus it is not only (migrant) domestic workers who frequently rely on their parents to care for their own children, an issue widely discussed in the literature on global care chains. Their employers, too, may rely on them. Grandparents, however, have turned out to play an important role in childcare not only in Italy but also in Western countries with better childcare services. Focusing on these issues, the paper contributes both to the debate on global care chains and to that on the role of the family within different welfare systems.

[Take care of a child, one work like any other?]. / Prendre soin d'un enfant, un travail comme un autre?

This article has its roots in the basic contradictions, which go back to the eighteenth and nineteenth centuries, between the self-interest and the care of others, exemplified by the delegation of responsibility for the care of children and other vulnerable persons. This splitting of human life-supporting activities has sealed women's dependence on men by setting off the lucrative area from the private, non-lucrative sphere of activities. These contradictions become paradoxical as soon as we consider the delegation of responsibility for the care of a child to someone not related to the child. This article addresses the question of how the child's developmental needs can be met without damage to his/her sensitivity, and his/her perception of others or of the cooperation involved. As soon as it is born, the child, a thoroughly interactive being, discerns the relationships it entertains with those who are in charge of him/her. The persons - mostly women - who take care of the child are not interchangeable, since they bring their own subjectivity into their dealings with the child and this is reciprocal. The women's skills, frequently thought to be "undefinable", but which many women, whether related or not to the child, have developed or should develop, are brought into play and are either transmitted or acquired in the course of their care of the child; these skills are not by nature "feminine skills", but they require a great deal of reactivity and sensitivity and therefore, many child professionals, mothers' aids and children's care-takers in the home are hurt and insulted by the low esteem in which they are held. These skills and human qualities, which are the result of feelings more than of formalised knowledge, techniques or theories - albeit these are also necessary - make child care and child rearing an art. These skills seem to be in total contradiction with those that are current in the world of labour, where the tempo of work, flexibility of working hours, the evaluation criteria and anxiety are conditioned by economic considerations and rest on purely monetary factors. Finally, a recognition of these sensitive qualities - when it is given - must of necessity be inter-subjective but also be societal. The latter requires a new, different organisation of the labour world, one which recognises the diversity of human activities, where each can find a sense of social usefulness by contributing to the satisfaction of others' social needs and having one's own needs satisfied by others - by many others. This would presuppose reversing the meaning of the division of labour and of life-maintaining activities by placing greater emphasis on "interest in others".

[Greek nannies in Rome?]. / Des nourrices grecques à Rome?

In Roman society, parents often entrusted their newborn to a wet nurse, usually a slave or a lower-class freeborn woman, who normally lived with them. It was advised to choose with care the right person, as milk is not a neutral bodily substance but transmits many properties, physical and moral. Soranus devotes an entire chapter to the meticulous inspection of the nurse's milk and temper. The nurse's character must be checked as thoroughly as her physical health. The mind of the newborn, compared with wax, is from the start and forever impressed positively or negatively. Mnesitheus and others even advise choosing a woman resembling physically the mother, or a handsome person; Favorinus and others reject violently the recourse to wet nursing as immoral; submitting the child to the pernicious influence of a foreign non-kin person implies the destruction of family ties. Wet nurses had to follow a specific diet and to accept giving up their sexual life, which would corrupt the milk in case of a new pregnancy. Roman upper-class families attributed different qualities to nurses according to their ethnic origin: Egyptians were allegedly fond of children, Thracians robust and devoted, Spartans tough. The best were the Greeks, because they would teach Greek language - and culture - to their nurslings. The nurse's social function was extensive. Her role did not stop at the weaning period. Much evidence shows that she was a lifelong companion. In positive circumstances, she could construct non-kin relationships and became, through connections not of blood but of milk, a member of an extended family. Funerary inscriptions and literary sources show that some nurses were rewarded by freedom. Breast-feeding also created milk-ties between the nurslings, who could gain social elevation thanks to this bonding.

Historical overview.

Lessons from the past, challenges for the future in family caregiving.