This paper examines the nature of public opinion concerning the National Health Service. Data from two series of national surveys covering the period 1983–92 are used to analyse trends in opinion. OPCS data for 1991–2 are examined in more detail to investigate the determinants of satisfaction with health services. A range of demographic, socio-economic and health status characteristics, as well as media coverage of health-related issues, are found to be significantly related to expressions of satisfaction with the NHS, in addition to recent experience of using health services. The complexity of the formation and expression of public opinion is acknowledged. In particular, the importance of taking note of the methodological implications and political context associated with expressions of public opinion is emphasised.

Ringen has advocated the use of both income and deprivation criteria in identifying those excluded from society due to lack of resources, a widely accepted definition of poverty. We illustrate with Irish data how this might be done, paying particular attention to how appropriate indicators of deprivation are to be selected. The results show that employing both income and deprivation criteria rather than income alone can make a substantial difference to both the extent and composition of measured poverty. This highlights the restrictive nature of poverty conceived in terms of exclusion rather than minimum rights to resources.

The hospice sector has expanded and diversified rapidly in recent years and has become associated with the provision of highly specialised, good quality care for the dying. However, as resources for health and social care are increasingly stretched, it will become necessary to demonstrate, rather than to assert, that the hospice sector provides superior care. This paper considers critically the methodology that has been used in the evaluation of the effectiveness of hospice care, focusing on the design of evaluations, what is measured, who measures it and how it has been measured in practice.

It is proposed in this article to integrate housewives into tax and benefit systems, in their own right, on the basis of what can be considered as ‘work’ in their case: housekeeping for a husband. The implications as regards the assessment of working time and earnings are examined, as well as the consequences from the point of view of liability to income tax and National Insurance contributions. The basis proposed would serve to recognise personal rights to social benefits to replace rights that are derived from a husband.

The author reviews a number of objections raised by the proposal. She considers that what is at stake is the selective protection of some men's domestic comforts, the status of housekeeping as an occupation and womens' freedom of occupational choice. A section is devoted to family responsibilities because they are often confused with housekeeping. In spite of the weight of habit and vested interest, the author thinks that it is possible to make progress while preserving the individual rights of older generations of women.

Responses from both voluntary organisations and statutory authorities to the community care legislation and the policy guidance stressed the importance of maintaining the concept of ‘partnership’ as local authorities move towards becoming ‘enabling authorities’. Using data from intensive observation and interviewing in two inner and two outer London Boroughs, this paper examines the nature of the redefined partnership and the implications of the emerging contract culture for voluntary organisations.

Studies of appeals in social security have tended to focus on the structure and performance of tribunals and other appeal bodies. Housing benefit differs from most other social security benefits in having a mandatory ‘internal review’ by officers before a disputed decision can be heard by the review board. The article draws on an evaluation of the housing benefit review system and shows how its two-tier structure has allowed wide variations in practice to develop among local authorities, such that officers can effectively control or manage claimants' access to the formal appeal hearing. We conclude that the existing structure obscures rather than enhances claimants' appeal rights in this area and discuss the possibilities for change.

Up until very recently, the international debate on health inequality tended to disregard the issue of specifying equity objectives precisely. This was unfortunate, given the importance of normative analysis for understanding why people care about social justice in the field of health; the extent to which specific types of inequality are compatible with equity; how the concept should be measured; and how rational policies may be formulated and monitored. This article critically appraises six well established approaches to defining equity—egality, entitlement, the decent minimum, utilitarianism, Rawlsian maximin, and envy-free allocations—as well as two alternative formulations recently proposed by health economists—equity as choice and health maximisation. All of these are found wanting in some respect when applied to the health sector. It is argued that Sen's ‘capabilities’ concepts, strangely ignored by health services researchers in the past, could prove an effective framework within which to organise research and policy formulation in the area of health and health care inequality.

In Denmark, Norway and Sweden mothers of young children have a higher employment rate than have the mothers of other Western European countries. To make high quality childcare universally available is regarded as a national concern, and as part of the welfare state commitment. It is also often regarded as a precondition of mothers' employment. The modes of state intervention and the structure of child-care provision are basically the same in all three countries, yet this paper questions the commonly made assumption that Scandinavian reproduction policies are developed in accordance with one common model. The interrelationship between welfare state, market and family differs between the countries. While in Denmark and Sweden national policies supported the dual role of mothers in production and social reproduction, this was not the case in Norwegian policies in which the concept of the employed mother made only modest impact. Not surprisingly, Denmark and Sweden are more successful in approaching national aims for provision of childcare and also in facilitating mothers' labour market participation.

The paper examines the formulation and implementation of abortion politics in Israel. Liberalisation of abortion, triggered by the need to enable poor women to terminate unwanted pregnancies, enjoyed wide consensus. The highly controversial repeal of the social-cause clause, prompted by coalition bargaining, was aimed at encouraging fertility. Both policies failed to realise intentions of decision-makers. Liberalisation of abortion did not result in population control among the poor; restriction of abortion did not lead to increasing birth rates. The reasons for the unsuccessful impact are grounded in the hidden agenda, caused by the incompatibility between two policy goals: curbing birth rates among the poor and encouraging fertility among the Jewish population on the whole. The hidden agenda hindered the achievement of impact: population control policy was not followed up by family planning. Population growth policy was not followed up by economic incentives.

The social security structure has been seen as a serious disincentive to the employment of women married to unemployed men. The implied significance of this disincentive is not apparent from verbal accounts, where only a minority of such women cite social security considerations as having any direct relevance in their own labour force experience. Recent research, critical of the social security model, has been conducted with a view to exploring the employment strategies of couples. In such research, economic structure is seen as the context of household employment strategies but not, it appears, as part of their substance; household level processes and ‘external’ economic processes are separated. In this respect, such approaches parallel the social security model. The present paper is based on an analysis of the household circumstances and employment histories of 790 couples in Hartlepool. Our findings suggest that ‘strategies’ regarding household income maintenance are patterned in relation to labour demand and occupational opportunity. This association contributes to the coincidence of spouses' employment status and is indicative of the problems of separating employment demand and labour supply processes, a separation which leads the social policy literature to overstate the significance of social security disincentives to employment.

Canada, like all industrialised countries, has become concerned over health care costs. Canada has reason to be concerned, with the most expensive system, on a per capita basis, of any country with national health insurance. This paper briefly reviews Canada's health care system, examines the rhetoric being adopted throughout the country at the current time, and discusses the changes which are now occurring. An assessment of whether change will lead to a more cost efficient and appropriate system for an aging society is then presented. It is concluded that there are profound changes taking place in the health care system in all provinces in Canada. Most of the changes to date reflect a restricting of current medical care by making ineligible previously eligible procedures, introducing user fees where there were none before, and in some instances including means testing where there was none before. In addition, hospital budgets are being cut and beds are being closed. However, a corresponding expansion of community programmes, while evident in the rhetoric, is less evident within current actions.

The principal aim of law centres is to service the claims of poor and low income people in the field of social welfare law. Their successes and limitations in realising this aim constitute the major part of this paper. Levels of demand, the satisfaction of unmet legal needs and the role played by law centres in the spectrum of advice services are important factors in assessing their mission. No assessment can be complete, however, without taking into account the internal problems faced by law centres—such as, funding, caseload levels, and rationing procedures. This paper argues that the formation of a national network of law centres would help to solve many of their operational difficulties and to position them more effectively within the spectrum of legal advice services.

In examining the sex of beneficiaries of income maintenance programmes, several country-specific studies suggest a pattern of segregation between women and men in access to types of benefit. Men are more likely to be recipients of social insurance benefits, whilst women often must rely on means-tested programmes, and frequently their claims to insurance benefits are via their husband. This conclusion is re-examined through a comparison of insurance and means-tested programmes in the UK, the US, the Netherlands, and Sweden. The purpose is to determine, first, to what extent such a pattern of segregation emerges in the four countries and, second, what mechanisms operate to exclude or include women. The comparison reveals that the Swedish case deviates from the other three countries, and policy constructions inhibiting and promoting greater equality between women and men in access to social benefits are discussed. The results also have theoretical implications for dual welfare as an analytical framework and feminist thinking about the welfare state.

Elderly clients usually express satisfaction with their services when they are asked. Surveys of clients and carers therefore have to take this tendency into account. It is important not to ask direct questions and to allow for positive, neutral and negative responses, otherwise positive responses will be overestimated. A survey of clients and carers served by a community psychogeriatric service indicated that the way a service is delivered can be more important than what is provided. The differences between staff and user perceptions of services are analysed. There are theoretical reasons for the differences connected with the combination of care and control exercised by service providers. There are also practical reasons in terms of staff perceptions, which are dominated by process, and client perceptions, which are more directly influenced by the services as they are actually delivered. Attempts to incorporate users' views into the processes of service delivery need to understand these differences and to acknowledge the limitations of user satisfaction surveys.

By 1985 community care, of which the home help service is one of the cornerstones, was on the brink of a major change which would fundamentally affect targeting. The new focus is a concentration on those in greatest need, responsiveness to the needs of carers, and to the potential for the self financing of care. The analysis given here indicates that huge changes in targeting of the service will have been needed from the situation in 1985 to meet these new policies, changes which might be expected to move the service away from its traditional role of monitoring the very old living alone. Analysis of the period between 1980 and 1985, using the General Household Survey, shows that the targeting effect of new policies is not easy to predict. The slight increase in home care during the period did not reflect an improvement in targeting on the demonstrably most needy, but instead apparently spread the service more widely. Re-examination of equity, territorial and gender issues shows that only limited progress had been made. Indeed, gender discrimination may even have increased.

While the UK may not wish to go as far as some other countries in allocating community care according to fixed eligibility criteria, come what may, targeting concepts will be increasingly salient for monitoring the community care policy's achievement.

In Britain there has been a long tradition of research into associations between area of residence and health. Rarely has this involved investigating socio-economic or cultural features of areas that might influence health; usually studies use area level data, for example about specific pathogens or about levels of deprivation, as surrogates for individual level data, rather than being interested in the areas themselves. This paper reviews the literature on the relationship between area and health. It advocates directly studying features of the local social and physical environment which might promote or inhibit health, illustrating this approach with some findings from a study in the West of Scotland, and suggests that improvements in public health might be achieved by focusing on places as well as on people.