Canada's Compassionate Care Benefit:Is it an adequate public health response to addressing the issue of caregiver burden in end-of-life care?

Background: An increasingly significant public health issue in Canada, and elsewhere throughout the developed world, pertains to the provision of adequate palliative/end-of-life (P/EOL) care. Informal caregivers who take on the responsibility of providing P/EOL care often experience negative physical, mental, emotional, social and economic consequences. In this article, we specifically examine how Canada's Compassionate Care Benefit (CCB) - a contributory benefits social program aimed at informal P/EOL caregivers - operates as a public health response in sustaining informal caregivers providing P/EOL care, and whether or not it adequately addresses known aspects of caregiver burden that are addressed within the population health promotion (PHP) model. Methods. As part of a national evaluation of Canada's Compassionate Care Benefit, 57 telephone interviews were conducted with Canadian informal P/EOL caregivers in 5 different provinces, pertaining to the strengths and weaknesses of the CCB and the general caregiving experience. Interview data was coded with Nvivo software and emerging themes were identified by the research team, with such findings published elsewhere. The purpose of the present analysis was identified after comparing the findings to the literature specific to caregiver burden and public health, after which data was analyzed using the PHP model as a guiding framework. Results: Informal caregivers spoke to several of the determinants of health outlined in the PHP model that are implicated in their burden experience: gender, income and social status, working conditions, health and social services, social support network, and personal health practises and coping strategies. They recognized the need for improving the CCB to better address these determinants. Conclusions: This study, from the perspective of family caregivers, demonstrates that the CCB is not living up to its full potential in sustaining informal P/EOL caregivers. Effort is required to transform the CCB so that it may fulfill the potential it holds for serving as one public health response to caregiver burden that forms part of a healthy public policy that addresses the determinants of this burden. © 2011 Williams et al; licensee BioMed Central Ltd.

Successful but Unappealing: Fifteen Years of Workplace Partnership in Ireland:Special Issue: Partnership, Collaboration and Mutual Gains

This paper presents the first comprehensive review and assessment of Ireland's influential 15-year experiment with workplace partnership. The paper reviews the outcomes of workplace partnership and explains the limited adoption of partnership in the private and public sectors, drawing on the authors' experiences as participants in policy initiatives concerned with promoting partnership in the workplace. Although the promotion of partnership was to the fore in public policy between the late 1990s to the onset of the recession and successful outcomes were reported for the main stakeholders where partnerships were established, the paper explains why the concept nevertheless remained largely unappealing across the private and public sectors.

Navigating Risk: Understanding the Impact of the Conflict on Children and Young People in Northern Ireland:Special Issue: Northern Ireland: 20 Years After the Cease-Fires

Twenty years on from the 1994 cease-fires, Northern Ireland is a markedly safer place for children and young people to grow up. However, for a significant number, growing up in post-conflict Northern Ireland has brought with it continued risks and high levels of marginalization. Many young people growing up on the sharp edge of the transition have continued to experience troubling levels of poverty, lower educational attainment, poor standards of childhood health, and sustained exposure to risk-laden environments. Reflecting on interdisciplinary research carried out since the start of the “transition” to peace, this article emphasizes the impact that embedded structural inequalities continue to have on the social, physical, mental, and emotional well-being of many children and young people. In shining a light on the enduring legacy of the conflict, this article moves to argue that greater attention needs to be given to the ongoing socioeconomic factors that result in limited lifetime opportunities, marginalization, and sustained poverty for many young people growing up in “peacetime” Northern Ireland.

Parties, cleavages, and issue evolution: The case of the religious-secular cleavage in Chile

Several recent articles have reached different conclusions regarding the impact of the religious–secular cleavage in Chile. The resolution of this debate has important consequences for the understanding of cleavages. Studies subscribing to the view that parties have considerable agency in the maintenance of cleavages have found that religiosity no longer affects vote choice, while studies rooted in a sociological perspective argue that religiosity still matters. We show that the reason for the discrepant results is because a partisan realignment is underway, whereby religious voters are gradually shifting their loyalties from the parties of the left to the parties of the right, matching a division that has taken place at the elite level. These results are consistent with an issue evolution perspective, which provides a clearer articulation of how cleavages form than either the agency or the sociological approaches.