Has the Gender Revolution Stalled? Geary Lecture Series 49 December 2020.

We examine change in multiple indicators of gender inequality for the period of 1970 to 2018 for the United States, and post-1990 data on some of those indicators for the Republic of Ireland. We consider gender inequality and its trend over time in educational attainment, employment, fields of study in higher education, occupations, and earnings. We conclude that there has been dramatic progress in movement toward gender equality, but, in recent decades, change has slowed, and, on some indicators, stalled entirely. The slowdown on some indicators and stall on others suggests that further movement toward gender equality will only occur if there is substantial institutional and cultural change, such as an increase in men’s participation in household and care work, governmental provision of childcare, and adoption by employers of policies that reduce gender discrimination and help both men and women combine jobs with family care responsibilities

Is there a caring class? Intergenerational transmission of care work

Most research on intergenerational social reproduction has been concerned with upward and downward movements across rank-ordered, “big-class” categories or along continuous gradients of status, income, or skill. An exception is the more nominal conceptualization of the social structure offered in recent research that focuses on qualitative differences in life conditions across occupational “micro classes.” The present analysis broadens this nominal approach by considering social reproduction across an important qualitative dimension that bridges multiple occupations: whether or not one’s work centrally involves care. Based on data from the U.S. General Social Surveys, results provide little evidence that care work is transmitted from parents to children. While women and men whose parents worked in care are more likely to do so themselves, this association is attributable to a general tendency for people to work in the same detailed occupation as their parents. Parents pass along their vertical status positions, and sometimes their specific occupations, but not care work as such. Parent–child similarity in caring outcomes likely reflects transmission of values, skills, knowledge, and network ties that are specific to detailed occupations, rather than attributable to care work broadly defined

Care and the Neoliberal Individual

© 2017, Journal of Economic Issues / Association for Evolutionary Economics. Abstract: This article explores two conflicting ethical systems: neoliberalism and institutionalism. Neoliberalism’s foundations support an overarching ethic of individual autonomy and individual responsibility. Institutionalism contrasts this conception with a view of human beings as relational. The ethical foundation of such a view requires a meta-ethic of interpersonal responsibility that supports an ethic of care

Mobilizing management knowledge in healthcare : institutional imperatives and professional and organizational mediating effects

Recent changes within UK healthcare have had dramatic consequences for management and put managerial capabilities firmly under the spotlight. Yet, despite extensive research on managers, comparatively little is known about how they acquire and apply their management knowledge and how this is influenced by their professional background and organizational context. Drawing upon work that distinguishes between different forms of knowledge, managers’ mobilization of management knowledge is examined in the light of recent changes in healthcare. Case study evidence is presented from diverse managerial groups across three types of hospital trust (acute, care and specialist). The analysis demonstrates the mediating effects of interactions between professional background and organizational context on knowledge mobilization and highlights how current pressures on public services are reinforcing a reliance on existing management practices, creating enormous challenges for management learning in this sector

'I'm sure we made it a better study…': Experiences of adults with intellectual disabilities and parent carers of patient and public involvement in a health research study.

Patient and public involvement is considered integral to health research in the United Kingdom; however, studies documenting the involvement of adults with intellectual disabilities and parent carers in health research studies are scarce. Through group interviews, this study explored the perspectives and experiences of a group of adults with intellectual disabilities and a group of parent carers about their collaborative/participatory involvement in a 3-year study which explored the effectiveness of annual health checks for adults with intellectual disabilities. Thematic analysis identified five key themes consistent across both groups; authenticity of participation, working together, generating new outcome measures, dissemination of findings and involvement in future research. Although reported anecdotally rather than originating from the analysis, increased self-confidence is also discussed. The groups' unique perspectives led to insights not previously considered by the research team which led to important recommendations to inform healthcare practice

A "masculinização" da produção de leite.

O fortalecimento de organizações sociais que possibilitaram fazer da produção de leite uma atividade destinada ao mercado provocou profundas mudanças na divisão sexual do trabalho. A análise sociológica das trocas intradomiciliares nos estabelecimentos rurais familiares mostra que tradições culturais, diferenças de poder entre os gêneros e contextos sociais que ampliam diferenças de acesso aos mercados entre homens e mulheres são as bases sociais e culturais de uma hierarquia estruturada segundo sexo e geração, no qual as mulheres, especialmente as mais jovens, ocupam posições de grande desvantagem. Com o fortalecimento de cooperativas, a produção de leite passou a ocupar um lugar de destaque no provimento de recursos da família, mas o domínio da atividade foi deslocado para o controle masculino. Esse foi um dos resultados não esperados da forma como as organizações conduziram o processo de modernização da produção e de reestruturação dos mercados, que reforçaram ainda mais o domínio masculino sobre a produção familiar e um aumento das desigualdades de gênero no acesso aos recursos

Pay for Performance for Specialised Care in England: Strengths and Weaknesses

Pay-for-Performance (P4P) schemes have become increasingly common internationally, yet evidence of their effectiveness remains ambiguous. P4P has been widely used in England for over a decade both in primary and secondary care. A prominent P4P programme in secondary care is the Commissioning for Quality and Innovation (CQUIN) framework. The most recent addition to this framework is Prescribed Specialised Services (PSS) CQUIN, introduced into the NHS in England in 2013. This study offers a review and critique of the PSS CQUIN scheme for specialised care. A key feature of PSS CQUIN is that whilst it is centrally developed, performance targets are agreed locally. This means that there is variation across providers in the schemes selected from the national menu, the achievement level needed to earn payment, and the proportion of the overall payment attached to each scheme. Specific schemes vary in terms of what is incentivised – structure, process and/or outcome – and how they are incentivised. Centralised versus decentralised decision making, the nature of the performance measures, the tiered payment structure and the dynamic nature of the schemes have created a sophisticated but complex P4P programme which requires evaluation to understand the effect of such incentives on specialised care

The Ups and Downs in Women's Employment: Shifting Composition or Behavior from 1970 to 2010?

This paper tracks factors contributing to the ups and downs in women’s employment from 1970 to 2010 using regression decompositions focusing on whether changes are due to shifts in the means (composition of women) or due to shifts in coefficients (inclinations of women to work for pay). Compositional shifts in education exerted a positive effect on women’s employment across all decades, while shifts in the composition of other family income, particularly at the highest deciles, depressed married women’s employment over the 1990s contributing to the slowdown in this decade. A positive coefficient effect of education was found in all decades, except the 1990s, when the effect was negative, depressing women’s employment. Further, positive coefficient results for other family income at the highest deciles bolstered married women’s employment over the 1990s. Models are run separately for married and single women demonstrating the varying results of other family income by marital status. This research was supported in part by an Upjohn Institute Early Career Research Award

Preliminary effects and acceptability of a co-produced physical activity referral intervention

Objectives: To explore the preliminary effects and acceptability of a co-produced physical activity referral intervention. Study Design: Longitudinal design with data collected at baseline and post a 12-week physical activity referral intervention. Setting. Community leisure centre. Methods: 32 adults with controlled lifestyle-related health conditions took part in a physical activity referral intervention (co-produced by a multidisciplinary stakeholder group) comprising 12 weeks’ subsidised fitness centre access plus four behaviour change consultations. A complete case analysis (t-tests and magnitude-based inferences) was conducted to assess baseline-to-12-week change in physical activity, cardiometabolic, and psychological measures. Semi-structured interviews were conducted (n=12) to explore experiences of the intervention. Results: Mean improvements were observed in cardiorespiratory fitness-2 (3.6 ml.kg.-1min-1 (95% confidence interval 1.9 to 5.4) P<0.001) and moderate-to-vigorous physical activity (12.6 min.day (95% CI 4.3 to 29.6) P=0.013). Participants were positive about the support from exercise referral practitioners, but experienced some challenges in a busy and under staffed gym environment. Conclusions: A co-produced physical activity referral intervention elicited short-term improvements in physical activity and cardiometabolic health. Further refinements may be required, via ongoing feedback between stakeholders, researchers and service users, to achieve the intended holistic physical activity focus of the intervention, prior to a definitive trial

Does outcome measurement of treatment for substance use disorder reflect the personal concerns of patients? A scoping review of measures recommended in Europe

There are a growing number of authors stating that outcome measurement in treatment for substance use disorders should go beyond substance use and include other bio-psycho-social variables of interest. However, little is known about which topics tend to be covered by outcome measures and whether they reflect the typical concerns of this patient group. This study followed a scoping review methodology in which 42 outcome measures recommended by an EU agency for substance use disorders were reviewed. We identified the domains of problems covered by these 42 measures and then compared them with 54 domains derived from patients, in a previous study. We also explored how similar the existing measures were in terms of domains covered, and which patient derived domains tended to be represented in those measures. We identified 31domains of problems across the 42 measures, with ‘substance use’ and ‘psychological health’ among the commonest. Most measures were similar in content to each other and multidimensional. Almost all domains of problems identified in the outcome measures corresponded to concerns reported by patients. On the other hand, we found that several topics of relevance for patients were not covered by any of the measure included in our study. This suggests that existing outcome measurement does not always target aspects that affect patients’ lives, as reported directly by patients. Our study shows that outcome measurement needs to adopt a more flexible and comprehensive approach, by taking on board the problems experienced by patients in this population