Working towards health equity for ethnic minority elders: spanning the boundaries of neighbourhood governance.

PURPOSE: This paper analyses how neighbourhood governance of social care affects the scope for frontline workers to address health inequities of older ethnic minorities. We critically discuss how an area-based, generic approach to service provision limits and enables frontline workers' efforts to reach out to ethnic minority elders, using a relational approach to place. This approach emphasises social and cultural distances to social care and understands efforts to bridge these distances as "relational work". DESIGN/METHODOLOGY/APPROACH: The authors conducted a two-year multiple case study of the cities of Nijmegen and The Hague, the Netherlands, following the development of policies and practices relevant to ethnic minority elders. They conducted 44 semi-structured interviews with managers, policy officers and frontline workers as well as 295 h of participant observation at network events and meeting activities. FINDINGS: Relational work was open-ended and consisted of a continuous reorientation of goals and means. In some cases, frontline workers spanned neighbourhood boundaries to connect with professional networks, key figures and places meaningful to ethnic minority elders. While neighbourhood governance is attuned to equality, relational work practice fosters possibilities for achieving equity. RESEARCH LIMITATIONS/IMPLICATIONS: Further research on achieving equity in relational work practice and more explicit policy support of relational work is needed. ORIGINALITY/VALUE: The paper contributes empirical knowledge about how neighbourhood governance of social care affects ethnic minority elders. It translates a relational view of place into a "situational" social justice approach.

[The impact of neighbourhood-based work on helping older migrants gain access to care : Older migrants and neighbourhood-based work in care and social services]. / De impact van het wijkgerichte werken voor de toeleiding naar zorg van oudere migranten : Oudere migranten en het wijkgerichte werken in zorg en welzijn.

This article studies how older migrants gain access to care through neighbourhood-based forms of working. In the Netherlands, the neighbourhood is increasingly viewed as an ideal place to organize care and social services, close to citizens. To this end, municipalities are developing neighbourhood structures and facilities in which local providers cooperate. In our qualitative research we studied the developments in crafting practices relevant to access to care of older migrants in the city of Nijmegen, the Netherlands. In Nijmegen the new neighbourhood structures are only partly successful in helping older migrants gain access to care. Older migrants visit neighbourhood facilities not for the services these facilities provide, but because of the presence of care professionals who speak the same language, or share the same cultural background as do these older migrants. These caregivers are able to bridge the mental distance between the health care system and the lifeworld of older migrants. Relations also arise outside the neighbourhood structures, for instance at culture-specific day care facilities. To prevent too great a claim on professionals with a migration background, agreements between the city of Nijmegen and local providers to enhance cultural sensitivity should be better monitored.