Supporting the case for “progressive universalism” in health visiting: Scottish mothers and health visitors’ perspectives on targeting and rationing health visiting services, with a focus on the Lothian Child Concern Model.

Aims. To explore parents and professionals’ experience of family assessment in health visiting (public health nursing), with a focus on the Lothian Child Concern Model (LCCM). Background. Health visitors (HVs) currently assess families as requiring core, additional or intensive support, and offer support at a corresponding level. The majority of families are assessed as core and receive no pro-active support beyond the early days. Previous assessment tools, consisting of checklists, have been criticised as being ineffective in identifying a range of health needs and unacceptable to parents and HVs. The LCCM model was developed and introduced in the study area to promote a partnership approach with parents and assess strengths as well as difficulties in parents’ capacity to care for their child. Methods. Qualitative methods were used. Ten mothers and twelve HVs took part in individual semi-structured interviews. Results. Most mothers were aware of the assessment process but some felt that they were not involved in the decision making process. Explaining the assessment process to parents is problematic and not all HVs do so. The assessment process was stressful for some mothers. HVs find the model useful for structuring and documenting the assessment process. Many believe that most families benefit from some support, using public health approaches. Families are often assessed as core because there are insufficient resources to support all those who meet the criteria of the additional category, and managers assess caseloads in terms of families with child protection concerns. Conclusions. The study findings support the concept of “progressive universalism” which provides a continuum of intensity of support to families, depending on need. Mothers would like better partnership working with HVs. Relevance to clinical practice. The study endorses proposed policy changes to re-establish the public health role of HVs and to lower the threshold for families to qualify for support.

Constructive Universalism: Sen and Sensitivity to Difference

Amartya Sen’s capability approach is, on the one hand, in line with universalism such as exhibited in Martha Nussbaum’s capabilities approach and Len Doyal and Ian Gough’s human need theory. On the other hand, his approach puts priority on people’s “self-evaluation” of capabilities and needs. The latter emphasis makes his approach distinctly sensitive to people’s differences such as gender, ethnicity, disability, sexual orientation, etc.. One could ask, however, how successfully the former commitment to universalism relates to this latter feature that places importance on taking difference seriously. This question is especially relevant with respect to global justice and gender, for example. To offer a potential answers to this question is main goal of this paper.

The Grounding of Regional Integration for Brazil: Universalism, Sovereignty and Elite Perception

The aim of this article is to analyse the meaning of Mercosur for Brazilian foreign policy. To this end, we discuss the perceptions of the Brazilian elites concerning the regional integration process. The defence of the principle of inter-governmentalism is related to the conception of Mercosur's place within Brazil's international relations. The fact that principles such as universalism and sovereignty are very highly valued ends up affecting the deepening of the integration. The hypothesis of this article is that the Mercosur structure is in line with the perceptions of part of the Brazilian elites, which has put less emphasis on integration since the late 1990s. Our argument is that the current structure is insufficient to guarantee the dynamics of integration.

Access for All? The promise and problems of universalism.

In what follows, I explore why the question of ‘access for all’ is both important and difficult. Beginning by treating it as a contested claim, I will consider some of its political, institutional and professional implications. What do I mean by saying that access for all is a contested claim? First of all, it is a claim – a demand that access for all needs to be created. It is a claim about change. To demand ‘access for all’ is to speak about, and speak against, social conditions that are unjust, unequal or excluding. At its simplest, then, to claim ‘access for all’ is to address social arrangements in which all people do not have access. Secondly, it is a claim made by – or on behalf of – specific social groups against their experience of exclusion, marginalization or subordination. I have added these other terms because I think that ‘exclusion’ is too simple, and too problematic, a term to capture all the aspects of unjust social arrangements that produce claims for ‘access’.1 Access is a demand to be treated equitably in relation to a range of valued social resources, conditions and relationships. It is a claim to be a member: of the society, the polity or the nation. It is a claim to be a citizen: to possess rights and the capacity to make legitimate demands on the state. It is a claim on the apparatuses and agencies that sustain social citizenship: citizenship brings with it access to benefits, services and rights of ‘fair dealing’ or ‘fair treatment’. As this last point suggests, it is a claim about equality: the expectation that all citizens will be dealt with by public agencies in ways that are not discriminatory or oppressive.