An Under-Appreciated Occupation: Community Care Workers and Their Employment Conditions

Community care workers (CCWs) perform a vital service in the health care system. The work that they do provides substantial cost savings to the health care system (National Institute for Occupational Safety and Health [NIOSH], 2010: 1) and governments rely on their work, which can be unpaid, to sustain public health services (Community Care Workers Forum, 2010: 1). Despite the important role that community health care has within the primary health care (PHC) system, the occupation is not well recognised and seldom has fringe benefits. Salaries remain low and CCWs experience poor working conditions with numerous hazards to their health and safety. This essay investigates two main issues: how socially useful the work is that CCWs do and whether CCWs have to struggle to do their work, given that their workplace is the community. To answer these questions, we begin by analysing CCWs’ contribution to the health sector, then describe the work that they do and examine the difficulties that they face in their employment conditions, including an analysis of how social determinants of health affect their work, and we conclude by considering what future scenarios lie ahead.

CCWs, also known as ‘home-based carers’, provide health care services in households, and play an increasingly important role in the trend towards a PHC-dominated health care system (World Health Organization [WHO], 2007: 1). In 1978, an international conference at Alma-Ata affirmed that PHC is key to achieving developmental goals (WHO, 1978: 1). Since the late 20^th century this affirmation has resulted in a restructuring of health care systems, such as ‘task-shifting’ responsibilities downwards to less qualified occupations in order to improve service delivery (Lund & Budlender, 2009: 23). In particular, this translates into extra responsibilities being placed on CCWs. In South Africa, the National Health Insurance scheme provides a fresh opportunity to campaign for a strengthened PHC system supported by community-level workers (ibid.). On the one hand, research shows rapid health improvements where CCWs visit households regularly (Sanders & Reynolds, 2011). However, on the other hand, this needs to be well-resourced and appropriate training given, in order to prevent extra risks being placed on CCWs, or care responsibilities being placed on unskilled health care volunteers or unpaid care-givers (Lund, 2010: 505).

With this understanding of the role that CCWs play in the health care system, let us now look closer at the nature of the occupation itself. CCWs offer services in people’s homes other than their own, such as helping with activities in daily living (bathing, eating and getting out of bed); delivering medical services, such as administering medication; changing dressings; or giving massages and palliative care (NIOSH, 2010: 1). As we have seen, their work is necessary and beneficial for health outcomes, yet, in South Africa, their salaries remain disproportionately small and unregulated, and they have minimal access to health insurance or pension schemes (Lund, 2010: 500). Furthermore, CCWs are exposed to many health and safety risks due to the nature of their job and the environment that they work in. For example, they are often assigned to HIV/AIDS or TB programmes (Sanders & Reynolds, 2011), so are at greater risk of contracting these diseases (a biological hazard). Many CCWs work in communities where there is violence, or in households with domestic violence, which can lead to stress (a psycho-social hazard) or injury. Other hazards include ergonomic hazards (such as lifting people and bending over), physical hazards (such as negotiating street traffic or aggressive animals) and environmental hazards (such as pollution, in low-income communities). With a “precarious” employment status (Lund, 2010: 503) and an income between R500 and R1 500 per month (Samson, 2008, as cited in Lund, 2010: 501), it is perhaps surprising that CCWs are numerous. Research has shown that CCWs’ motivation work comes from the desire to care for others (The Industrial Health Resource Group [IHRG], 2012: 5), and also the hope that it will lead to better employment prospects (Lund, 2010: 504).

Another set of factors that impact the work of CCWs is the social determinants of health. The social determinants of health directly impact the work that CCWs do because they are at the front line of PHC, leading them to deal with unhealthy socio-economic, cultural and environmental conditions, living and working conditions, social and community influences and individual lifestyle factors (Bradshaw, 2008: 53-60). For example, inequality in society, or having a low socio-economic position, is associated will poor health (Bradshaw, 2008: 53). The material wellbeing of clients can also make it difficult to provide care, such as when there is no electricity to cook food (Orner, 2006: 237). Traditional environmental concerns are sanitation and clean water. Modern environmental concerns include industrial pollutants and climate change (Bradshaw, 2008: 54). Food security is a constraint on living conditions, while nutrition and feeding programmes support care work (Lund, 2010: 507). Housing subsidies also determine the living conditions of clients (ibid.). Individual lifestyle factors that impact on health include unsafe sex, alcohol use, tobacco use, lack of physical exercise and unhealthy diets (Bradshaw, 2008: 60). In South Africa, these social determinants of health are exacerbated by a so-called ‘quadruple burden of disease’ due to high rates of poverty, non-communicable disease, violence-related injuries and HIV/AIDS.

To summarize, we have seen that CCWs struggle to do the work they do because of their terms of employment and because of their working conditions. To explore this directly from the CCWs’ point of view, let us analyse a statement made by an anonymous group of care workers, working for an NGO in Cape Town:

“Some people think that we are lucky to have work. The truth is that we are subsidising the government. We are doing the work the government is supposed to do, doing it for wages which are too low. The unemployed are doing it for free. Yes, we are all there, doing that important work. We are giving care. Of course this makes us proud. But still we say: it is not easy to go and face this every day.”

(IHRG, 2012: 5)

This statement shows us that this group feels exploited, that they are unfairly given a burden that the government is meant to shoulder. They say that the work they do is difficult to “face … every day” (ibid.). This feeling is reflected in a study on unpaid caregivers of people living with AIDS, which found that the caregivers struggled emotionally (Orner, 2006: 238). For example, the carers dealt with stigmatization, poverty, poor infrastructure, a lack of affordable transport and an overburden of duties – simultaneously caring for many different clients and still fulfilling the role of a carer in their own households. The precarious terms of employment and a lack of freedom to unionize is reflected in the first group’s decision to remain anonymous (IHRG, 2012: 4).

Although the first group feels exploited, their comment shows us, as with other examples, that CCWs feel that their work is important. CCWs care for others even when the work is unpaid, out of a sense of responsibility and love towards their clients (Orner, 2006: 239). They are motivated to do their job, although they do not feel as if it is enough to solve all the social and health-related problems that they see (IHRG, 2012: 4-5).

In conclusion, we have seen that CCWs work is vitally important, yet their terms of employment are exploitative and employment conditions are unhealthy. The work that they do strengthens the PHC system and reduces the financial and physical burden on the health care sector. Health and safety hazards are a key concern, and CCWs are exposed to social determinants of ill health more than the average person. CCWs struggle against resource scarcity and with emotional burdens, but they continue to do their work out of a sense of pride in helping those who are in need.

[1 302 words]

October 2014

References

Bradshaw, D. 2008. Determinants of health and their trends. In South African health review 2008. P. Barron. Ed. South Africa: Health Systems Trust. 51-70.

Industrial Health Resource Group [IHRG]. 2012. Struggling for health, struggling to give care. Health and Safety Networker. 8: 4-5.

Lund, F. & Budlender, D. 2009. Paid care providers in South Africa: nurses, domestic workers and home-based care workers. (UNRISD Research report no. 4). Geneva: United Nations Research Institute for Social Development.

Lund, F. 2010. Hierarchies of care work in South Africa: nurses, social workers and home-based care workers. International Labour Review. 149(4): 495-509.

National Institute for Occupational Safety and Health [NIOSH]. 2010. Introduction. In Occupational hazards in home healthcare. (NIOSH hazard review, DHHS publication no. 2010-125). United States: Centres for Disease Control and Prevention, Department of Health and Human Services. 1-2.

Orner, P. 2006. Psychological impacts on caregivers of people living with AIDS. AIDS Care. 18(3): 236-40.

Sanders, D. & Reynolds, T. 2011. Community care givers hold the key. Cape Times (Cape Town). 20 September.

World Health Organization [WHO]. 1978. Declaration of Alma-Ata. Proceedings of the International Conference on Primary Health Care. 6-12 September 1978. Alma-Ata, USSR: World Health Organization.

WHO. 2007. Community health workers: what do we know about them? The state of the evidence on programmes, activities, costs and impact on health outcomes of using community health workers. Geneva: Department of Human Resources for Health, World Health Organisation. Available: http://www.who.int/hrh/documents/community_health_workers_brief.pdf [2014, 17 October].

Non-Communicable Diseases: Their Causes, and Implications for Intervention and Prevention

This essay investigates social determinants of health, specifically looking at non-communicable diseases, and argues that structural interventions in the economy and society are necessary to reduce the prevalence of non-communicable diseases (NCDs). Sociologists study health demographics because patterns of health change across classes, cultures, genders and countries. Disease does not have solely biological causes, but is also determined by factors such as the socio-cultural environment, economic status, living and working conditions and government legislation. Many NCDs, defined as diseases which cannot be passed from person to person, have such characteristics. Cardiovascular diseases, chronic respiratory diseases, cancers and diabetes are the four most prevalent NCDs, and the four biggest risk factors are alcohol use, tobacco use, unhealthy diets and a less active lifestyle. When looking at the causes of NCDs, this essay argues that people engage in unhealthy activities not because they lack the willpower to abstain, but because they are placed in a social and economic construct which constrains the choices that they are able to make, encourages unhealthy behaviour and prevents them from disengaging from those activities. Governmental and civil society organisations are therefore placed with the responsibility to intervene. Obesity will be looked at as an example of a risk factor for NCDs and a brief discussion on legislation for smoking in public will be included.

Firstly, let us consider of the prevalence, and environmental causes of, NCDs. NCDs account for a large and growing proportion of deaths across the world (World Health Organisation [WHO], 2013), and thus should be the focus for disease prevention policies. Indeed, 68% of deaths worldwide are the result of NCDs (WHO, 2014a). The distribution of NCDs reflects socioeconomic disparities, with the urban poor being the most affected (Schaay, Sanders & Kruger, 2011: 5). 80% of NCD deaths occur in low- and middle-income countries (WHO, 2013). A well-known report on inequalities in health, the Black Report, found material possessions to be a strong indicator of health (Townsend & Davidson, 1982, as cited in Coulson, Goldstein & Ntuli, 1998: 3). NCDs present a particular challenge to poor people due to the high cost and duration of treatment required, a factor that forces millions into poverty and undermines poverty reduction initiatives (WHO, 2013). Vulnerable and socially disadvantaged people are affected more often because they are exposed to greater levels of risk factors associated with NCDs when compared to people of higher social standing (WHO, 2013; WHO, 2014b). For example, low-income and marginalized communities face a lack of access to affordable, healthy food in the neighbourhood (Centres for Disease Control and Prevention [CDC], 2010: 2); less safe communities, a lack of park facilities and a lack of pavements which reduces physical activity (Meyers, 2008: 25; CDC, 2010: 2); exposure to hazardous chemicals in the community environment and workplace (Meyers, 2008: 23-24); and a lack of community resources and awareness to help abusers of alcohol (Maring & Braun, 2006: 1). The first two points are examples of risk factors which lead to overweight and obesity.

Let us define ‘obesity’ more clearly. Obesity is a disease which has a prevalence that is significantly large and increasing, and is a major risk factor for NCDs (WHO, 2014c; ‘disease’ is a term attributed to obesity in e.g. Goedecke, Jennings & Lambert, 2006: 67). An estimated 1.3 billion people globally are obese or overweight, with the proportion of the overweight population in some developing countries having tripled during the last 40 years (Goedecke, Jennings & Lambert, 2006: 65-66). Although obesity has not always been an area of concern, indeed it was a body shape “to be aimed at” in African and Pacific cultures (Moore, Aiken & Chapman, 2008: 250). Obesity, defined as a Body Mass Index[1] (BMI) of 30 or greater, increases the risk of developing NCDs such as diabetes, coronary heart disease (CHD), hypertension, cancer, psychological diseases and osteoarthritis (Goedecke, Jennings & Lambert, 2006: 69-70). A successful NCD prevention programme that targeted obesity and CHD will be presented later on.

The problem of NCDs can be viewed either from the perspective of the individual (who does not live a healthy lifestyle), or from the perspective of society (one that does not offer a satisfactory means of living a healthy lifestyle). The environmental causes mentioned above indicate that there are factors outside of the locus of control of the individual which contribute to NCD, and leads one to task the community and government with NCD prevention. Another perspective is that addiction to smoking, eating fatty foods or drinking alcohol could lead to NCD contraction. This perspective could view addiction as a moral deficit, the result of socio-cultural influences or as a psychological susceptibility (Fisher & Harrison, 2009), resulting in responses ranging from stigmatization to community-based prevention strategies to therapy and rehabilitation respectively.

Recognising the necessity of NCD prevention, one is led to ask how strategies are formulated and implemented. NCD prevention requires a national and community response, characterized by collaboration between public and private sectors. National health policies need to include NCD prevention strategies, and (preferably) an NCD directorate should be set up in order to manage and implement that policy (WHO, 2008: 16; Goedecke, Jennings & Lambert, 2006: 74). A multi-sectoral approach is required, as departments dealing with trade, taxation, education, food & agriculture and urban development have a significant influence on the success on prevention strategies (WHO, 2008: 13).

What are the important elements of national NCD prevention policies? Firstly, there should be a focus on building capacity in primary health care (PHC) to deal with NCDs. A focus on PHC is important in order to target the causes of NCD and prevent cases from progressing (until secondary health care treatment is needed). A PHC model of intervention focuses on strengthening the district health care system, delivering community-based services and promoting good health. As an example, physical activity can be promoted through ensuring that physical environments are safe and through community-led initiatives to promote exercise. A second element to NCD prevention policies is enforcing legislation. Protecting people from unnecessary exposure to harmful risk factors is essential, such as laws against smoking in public places, bans or restrictions on advertising for cigarettes and alcohol and restrictions on unhealthy food and sugary beverages. As an example, governments across the world regulate smoking, banning it indoors and in public spaces with moderate traffic, such as workplaces, alfresco dining settings, beaches, parks and sports stadia (Chapman, 2007: 160-162). Lastly, behaviour can be changed through awareness and education for the public, and the continuing education of medical personnel, about how to manage one’s lifestyle in a healthy way (WHO, 2008: 16). Throughout these intervention strategies, monitoring is essential.

A successful NCD prevention program can be found in North Karelia, Finland. The North Karelia Project was launched in 1972 in response to a local petition concerned with the high mortality rate due to coronary heart disease (CHD), of which obesity is a risk factor. In collaboration with local and national authorities, experts and the WHO, the ‘North Karelia Project’ was formulated. Over the next few decades, community organizations and individuals implemented strategies in the health sector, schools, NGOs, media, supermarkets and the food industry. The results show that major changes have taken place, with “the annual mortality rate of coronary heart disease in the middle-aged male population decreasing by 73% from the pre-program years (1967-71)” (Puska, 2002: 2) and with a similar reduction of cardiovascular disease mortality rates amongst women. Results also showed a reduction in smoking and lung cancer mortality rates (Puska, 2002: 2). Success factors included: (a) a sound theoretical framework; (b) strong community organization, with continuous monitoring and feedback; (c) the systematic involvement of the PHC system; (d) collaboration with the food industry; and (e) policy changes. This case shows that intervention programmes can successfully control NCD epidemics.

This essay has examined the social and economic causes of NCDs, and has recommended strategies for NCD prevention. We have found that, as with all diseases, the poor and marginalized fare the worst off. NCDs are unique in that they are caused primarily by unhealthy lifestyle decisions and the epidemic scale of NCDs requires a macro-level response from governments and communities. This response should be multi-sectoral and attention towards NCD prevention is required in health policies and practices. The modern need to remain healthy within an urban environment requires creative and informed solutions. As a final thought, the fight against NCDs may leave one to wonder what type of death is ‘desired’, or what type of death will be common once we have ‘won the battle’ against NCDs. Death by ‘old age’, a common response, is not a type of death in itself but represents a death due to frailty as opposed to significant exogenous factors.

[1 464 words]

September 2014

References

Centres for Disease Control and Prevention. 2010. Adult obesity. (Fact sheet). Available: http://www.cdc.gov/vitalsigns/pdf/2010-08-vitalsigns.pdf [2014, September 15].

Chapman, S. 2007. Public health advocacy and tobacco control: making smoking history. Oxford: Blackwell Publishing.

Coulson, N., Goldstein, S. & Ntuli, A. 1998. Promoting health in South Africa: an action manual. Sandton, South Africa: Heinemann.

Fisher, G.L., Harrison, T.C. 2009. Models of addiction. In Substance abuse: information for school counselors, social workers, therapists, and counselors. 4^th ed. Boston: Pearson. 35-49.

Goedecke, J.H., Jennings, C.L. & Lambert, E.V. 2006. Obesity in South Africa. In Chronic diseases of lifestyle in South Africa since 1995-2005. Steyn, K., Fourie, J. & Temple, N. (eds). (Technical report). Cape Town: South African Medical Research Council. 65-79.

Maring, E.F. & Braun, B. 2006. Drug, alcohol and tobacco use in rural, low-income families: an ecological risk and resilience perspective. Journal of Rural Community Psychology. E9(2). Available: http://www.marshall.edu/jrcp/Maring%20and%20Braun.pdf [2014, September 15].

Meyers, N. Ed. 2008. The changing environment and disease patterns. In Environmental threats to healthy aging: with a closer look at Alzheimer’s and Parkinson’s diseases. Boston: Physicians for Social Responsibility and Science and Environmental Health Network. 17-37.

Moore, S., Aiken, D. & Chapman, S. 2008. Sociology AS for AQA. 3^rd ed. London: Collins.

Puska, P. 2002. Successful prevention of non-communicable diseases: 25 year experiences with North Karelia Project in Finland. Public Health Medicine. 4(1): 5-7.

Schaay, N., Sanders, D. & Kruger, V. 2011. Overview of health sector reforms in South Africa. (Research report). London: DFID Human Development Resource Centre.

World Health Organization. 2008. 2008-2013 Action plan for the global strategy for the prevention and control of noncommunicable diseases. Geneva, Switzerland: WHO Document Production Services. Available: http://whqlibdoc.who.int/publications/2009/9789241597418_eng.pdf?ua=1 [2014, September 15].

World Health Organization. 2013. Noncommunicable diseases. (Fact sheet no. 355). Available: http://www.who.int/mediacentre/factsheets/fs355/en/ [2014, September 10].

World Health Organization. 2014a. The top 10 causes of death. (Fact sheet no. 310). Available: http://www.who.int/mediacentre/factsheets/fs310/en/ [2014, September 18].

World Health Organization. 2014b. Is physical activity a reality for all? Available: http://www.euro.who.int/en/health-topics/disease-prevention/physical-activity/data-and-statistics/is-physical-activity-a-reality-for-all [2014, September 15].

World Health Organization. 2014c. Obesity and overweight. (Fact sheet no. 311). Available: http://www.who.int/mediacentre/factsheets/fs311/en/ [2014, September 10].

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[1]BMI is calculated by one’s mass divided by the square of one’s height.

Reproduction of inequality through education in South African: a Bourdieuian approach

Educational outcomes in South Africa are highly unequal and reflect inequalities across socio-economic classes and racial groups. This essay will explore education-related causes of the reproduction of inequality across generations. Bourdieu’s ‘theory of practice’ can help to understand how structural inequalities reproduce themselves through education. The causes can be explained from either side of the learner-teacher dichotomy. Approaching the question from the side of the learner, one can draw upon an understanding of Bourdieu’s concepts of capital and habitus along with structural determinants of outcomes such as family background, neighbourhood, race and socio-economic status. According to Bourdieu, class structure is characterised by inequality due to differing amounts of economic, cultural and social capital that members of a society hold. The amount of capital one holds is a determinant of how one will fare in life, educational outcomes included. Learner outcomes can also be understood in terms of individual ‘agency’. Approaching the question from the side of the teacher, we find that inequality can be caused via culturally insensitive teaching methods, differences in human capital depending on salary and area, management of schools, school resources and the curriculum.

The first part of this essay discusses the relevance of Bourdieu’s theory of practice to the situation in South Africa. Cultural capital (tastes, knowledge of how social systems work, manner of speech, general awareness of culture and educational attainment) affects the receptiveness that a learner has towards the style of thinking required of education. It is heavily influenced by family background and the neighbourhood one lives in, but socioeconomic status also plays a role. The parents of poor learners who wish that their child excel academically do not have enough knowledge of how the education system works to be able to promote their child’s self-determination. For example, in a cross-sectional ethnographic study by Moore (2013) of poor mothers living in Cape Town, it was found that educational attainment decreased with age. Thus, the level of the mothers’ knowledge of how to succeed in school is lower than the level of knowledge that their child needs to possess. The 1995 October Household Survey shows a positive correlation between the mother’s highest grade attainment and the number of years of schooling that their child has completed, controlling for age (Anderson, Case & Lam, 2001: 47). This shows that family background affects a child’s receptiveness to education (a phenomenon in which Bourdieu’s theory is applicable). A focus on the mother as opposed to the father is relevant given the amount of time that women spend on childcare, and given the high proportion of women who enrol in educational institutions (De Lannoy, 2009: 87).

Let us consider how economic capital affects educational outcomes. That is, the financial resources and assets that one is able to draw upon in order to achieve goals. A learner who can draw on economic capital can utilize it to gain a higher level of education. Thus, economic capital gets transformed into cultural capital, which preserves class hierarchy over time. Better quality education is represented by better resourced schools, better quality of teaching and better management of schools. Van der Berg, et al. (2011: 8) state that the detrimental impact of poverty on educational outcomes is well-documented. After analysing the Southern and Eastern African Consortium for Monitoring Education Quality survey of 2007 (SACMEQ III), Van der Berg, et al. (ibid.: 8) concluded that poverty seems to have an even more detrimental effect on educational outcomes in South Africa when compared to other countries in Africa. The reasons they gave for this was not only centred around the burden of poverty, but also around the burden of a history of inequality during apartheid, which has resulted in poorly resourced historically black schools. Differences in educational outcomes still correlate strongly with the historic colour of the school, and race is still a determinant of education quality, drop-out rate, distance to school and future wage rate (Anderson, Case & Lam, 2001: 40-41; De Lannoy & Lake, 2009: 83-84; Van der Berg, et al., 2011: 7-10). Although Bourdieu’s concept of economic capital can explain why poverty and under-resourced schools disadvantage learners, his perspective (of class structure) has the limitation of not considering the effects of race in post-apartheid South Africa. Apartheid has also resulted in certain locations, those which were historically a non-white area, providing poor opportunities when compared to other locations. The broader effect of neighbourhood type and school type cannot be explained solely in terms of capital.

The second part of this essay looks at inadequacies within the South African education system. Although schools in South Africa are better resourced than neighbouring countries, outcomes are only marginally higher, and the standard of a pass remains low up until grade 11 (Van der Berg, et al., 2011: 4-9). 80% of the education budget is spent on personnel. However, it is difficult for the government to redistribute education inequality through personnel expenditure because better qualified and more experienced teachers prefer to teach in more affluent schools (ibid.: 3). Thus, the constraints on the quality of human capital in poor schools appears to be a chronic problem and the government has adopted a policy of focusing more its non-personnel expenditure on poor schools. Having said that, only certain types of resources are appropriate for a poor school. For example, data projectors require IT skills on the part of the teacher and would only be realistic in a classroom that has security measures put in place. A more necessary resource for poor schools appears to be textbooks (ibid: 13).

One of the ways which the education department has strived to address inequalities is through a reform of the curriculum. The reform aimed to address racial and occupational prejudices present in apartheid curricula. However, there are concerns that the new outcomes based education (OBE) curriculum is not cross-cultural enough (Jansen, 1998: 328) and is widely believed to have been an impediment to progress (Van der Berg, et al., 2011: 3). One could argue that learners who do not have the necessary cultural capital to understand the curriculum are at a disadvantage. OBE policy aims to encourage co-operative learning by putting the teacher in a more facilitative role as opposed to the traditional lecturing role, but the practicality of reforming teaching methods through policy has been criticised (Jansen, 1998: 325-326).

The issue of teaching methods is important. Bourdieu’s concept of habitus helps us to understand how teaching methods can be biased towards more affluent learners. Habitus is the automatic bodily responses that give the observer an understanding of the person’s background and affects the way teachers and potential employers perceive you which, in turn, affects their behaviour towards you. In the field of education, learners who are not intellectually stimulated at home will display a habitus in the classroom which will indicate their discomfort, which can lead to those learners being neglected and alienated in the classroom. Pager (1996) as cited in De Lannoy (2007: 11-12) talks about a “culture of learning in Khayelitsha secondary schools” which is anti-academic and reflects the low motivation and laziness of students, resulting in “chaos, lack of discipline and demoralisation … in many township schools”. Responses in interviews that De Lannoy and Pager conducted indicated that these attitudes are the results of family background. On the other hand, affluent learners have been socialized that they deserve to understand the work and be treated individually, and will impose their requests more strongly on teachers than poor learners. For these reasons, it is important to develop teaching practices that are responsive to the different mental states and behavioural dispositions that learners bring to school (Nash, 1990: 436).

To summarize, Bourdieu’s theory of the transmission of class can be applied to education in South Africa. This essay has highlighted the effect of cultural capital carried in family background, of economic capital held by an individual or school and of habitus carried by learners. On the other hand, Bourdieu’s theory is too focused on the transmission of socio-economic inequality and ignores racial inequality. Race is still a determinant of the quality of education received, not only because of its overlap with class, but also because of its overlap with neighbourhood type and resources available in a school. Thus, because of the legacy of apartheid, capital is transmitted within racial boundaries as well.

[1 383 words]

September 2014

References

Anderson, K.G., Case, A. & Lam, D. 2001. Causes and consequences of schooling outcomes in South Africa: Evidence from survey data. Social Dynamics: A journal of African studies. 27(1): 37-59. DOI: 10.1080/02533950108458703

De Lannoy, A. & Lake, L. 2009. Children’s access to education. In South African Child Gauge 2008/2009. Pendlebury S., Lake, L. & Smith, C. (Eds) Cape Town: Children’s Institute, University of Cape Town.

Jansen, J.D. 1998. Curriculum reform in South Africa: a critical analysis of outcomes-based education. Cambridge Journal of Education. 28(3): 321-331. DOI: 10.1080/0305764980280305

Moore, E. 2013. Transmission and change in motherhood: black mothers in three-generational Cape Town families. Journal of Southern African Studies. 39(1): 151-170. Available: http://dx.doi.org/10.1080/03057070.2013.764713 [2013, May 28]

Nash, R. 1990. Bourdieu on education and social and cultural reproduction. British Journal of Sociology of Education. 11(4): 431-447. Available: http://www.jstor.org/stable/1392877 [2008, September 16]

Van der Berg, S., Burger, C., Burger, R., de Vos, M., du Rand, G., Gustafsson, M., Moses, E., Shepherd, D., et al. 2011. Low quality education as a poverty trap. (Research report). Stellenbosch, South Africa: Social Policy Research Group, Department of Economics, Stellenbosch University.

The Effects of Race, Class and Gender on Care Provided for Children and Families in Contemporary South Africa

In this essay I will outline the effect of race, class and gender on the structure of families in contemporary South Africa. Family structures are influenced by the history of racial segregation in South Africa, household income, culture and the neighbourhood that they live in. Following an description of the structure of families in South African households, I will briefly consider how care is provided to children and families by the state and market. South Africa has a comprehensive social security system, as do many developing countries in Africa, which focuses on the child and family and includes financial, educational, healthcare and social service provisions.

Family structure is a key determinant of the care that is provided for children. In South Africa in particular, race, class and gender play a role in the structure of families. Just under half of all adolescents in South Africa live in a two-parent household, and half of that number is composed of nuclear families (Bray, Gooskens, Moses, Kahn, & Seekings, 2010). Thus, the traditional notion of a two-parent nuclear family is not reflected in the statistics. Parental absence is more common in low-income and/or African headed households. The relationship between income and family structure is less noted among African headed households as much as it is noted in coloured headed households, and no such relationship is discernable in white headed households due to their predominantly high-income status (Bray, Gooskens, et. al, 2010). Looking across population groups, children in African or coloured households are more likely to be cared for by a single parent or grandparent, whereas children in a white family are likely to be cared for by both their parents.

Apart from race and class, gender also varies how a household is structured. The responsibility for childcare is disproportionately skewed towards women, a phenomenon which has its origins in apartheid. The distance which separated African husbands from their wives due to migrant labour during the twentieth century increased the rate of extramarital affairs, and so rates of paternal absence and children born out of wedlock have remained high, even after pass laws were abolished in 1986 (Budlender & Lund, 2011). Only 12 percent of children and 20 percent of adolescents live without their mother (Bray, Gooskens, et. al, 2010). Paternal absence impacts the amount of time that fathers spend with their children, and thus a father-child emotional bond cannot be effectively created in many instances. This has serious implications for the child, who becomes more likely  to be involved with drugs, perform badly in school, lack self esteem, and, later on in life, be imprisoned, have emotional problems in relationships, commit rape or to commit suicide (Taylor, 2014). Paternal absence significantly reduces household income, which could explain the low income status of single- or no-parent households. For example, absent fathers contribute negligibly towards the financial burden of childcare. Of the fathers who are identified, many do not earn enough and are not required to contribute by law on the one hand, and court orders that have been issued are often ignored on the other. The Maintenance Act is poorly enforced. Thus, In a time when women are marrying less, women are increasingly left with a dual burden of breadwinner and childcarer (Budlender & Lund, 2011). Another explanation of the low income status of single- and no-parent households is that unemployed men put off marrying, which prevents low-income households from forming two-parent families. Paternal absence also contributes to the fact that women spend more time on caregiving than men, but it is not the only explanation. For example, the Time Use Survey of 2001 (Statistics South Africa, 2001) reveals that men living with children under the age of 18 years spend an average of 6 minutes a day on childcare, while their female counterparts spend an average of 64 minutes a day. The amount of time that women spend caring for children is higher than men even for those women who do not live in a household with children. An example of the readiness for women to care can be seen in the living arrangements of young immigrant women living in a host family’s household: care for children and housework is traded for living expenses while they search for other accommodation and a job. The high rate of unemployment can also be a contributor to the number of women caring for children. In a situation where households are complex and HIV/AIDS is rife, unemployed women can pick up the burden of caring for children both in their own household and outside (Budlender & Lund, 2011).

When one looks at the other side of the gender coin, maternal absence is sometimes also a feature in South African households. It is common for Xhosa women to live in an urban area, where there is better work, and to leave their young children in their rural homeland in the care of the grandmother (Budlender & Lund, 2011). This practice has historical origins. African men sought work in the mines or in the city in the twentieth century, separated from their families because of influx control. These fathers and husbands were not always successful, and in the 1970’s and 1980’s women also began to leave their homelands in search of work in urban areas. The structure of the household was thus heavily dictated by the state, not only for non-whites. Today, children who live in households in a suburb like Masiphumelele in Cape Town have typically spent a portion of their lives living without their parents, under the care of their grandmother in their rural homeland (Bray, Gooskens, et. al, 2010). As Bray, Gooskens, et. al puts it, these households have an “urban-focused but rural-rooted identity”. ‘Domestic fluidity’ – the ease with which family structures change over a short period of time – is a characteristic of many South African families. The cases mentioned thus far illustrate how the structure of a family impacts on the care that is provided for children living in that family.

I will now describe how the market and state interact with families. Parallel systems of private and public provision of education, healthcare and social services exist in South Africa, which perpetuate existent inequalities. The market caters for those who can afford private care, to the exclusion of those who can’t. However, state initiatives have supported families through grants, primary healthcare, basic education, early childhood development programmes and the Extended Public Works Programme, the last two of which directly address the problem of unemployment (albeit ineffectively). State grants have redistributed wealth across classes and have improved the life chances of children, both for households who access child grants and those who access a state pension (Budlender & Lund, 2011). For example, child grants improve children’s nutrition (Budlender & Lund, 2011). State pensions impact on both the pensioner and the household with whom it is shared. For example, state pensions often lead to the mother of a child leaving the household in search of work, leaving the child with the grandmother.

To summarize, race, class and gender shape the structure of families, which in turn determines who children are cared for and how they are cared for. Apartheid has shaped the structure of families, most notably through the pass laws, which have pulled fathers away from families and placed the responsibility of both childcare and income generation on women. The resulting household is complex and often multi-generational or represents a segment of a family which has its roots in another location. Families are supported by the state financially and through basic education, primary healthcare and free social services, but the quality of state-provided care is inferior to market-provided care and inequalities persist.

[1 276 words]

July 2014

References

Bray, R., Gooskens, I., Moses, S., Kahn, L., & Seekings, J. (2010). Discourses and realities of family life. In Growing up in the new South Africa: Childhood and adolescence in post-apartheid Cape Town. (pp. 48-96). Cape Town: HSRC Press.

Budlender, D., & Lund, F. (2011). South Africa: A legacy of family disruption. Development and Change, 42(4), 925-946.

Statistics South Africa. (2001). A Survey of Time Use. Pretoria: Statistics South Africa.

Taylor, T. (2014, January 28). South Africa's Absent Fathers. Retrieved July 31, 2014, from https://www.youtube.com/watch?v=ltLtSxpbcEg

Kofi Annan: His needs, satisfiers and ego defense mechanisms

University of Cape Town – Social Development – SWK1004S Assignment 1

Introduction

This essay will analyse a famous person in terms of concepts learnt during the SWK Basic Professional Interaction course at UCT. The two fields of study that will be focused on are Max-Neef’s human scale development (HSD) theory and the theory of ego defence mechanisms which has its origins in psychodynamic theory. In the first part of the essay, a biography will be given of the famous person, Kofi Annan, which will focus on events in his life that will be analysed in the essay. In the second part of the essay, an explanation of the theoretical principles and a background to each theory will be given before putting the theories to use. Each theory takes a different perspective on Kofi Annan and his environment. HSD is primarily concerned with identifying needs and how the environment satisfies those needs. Modern defence mechanism theory explains how the ego deals with conflicts between instinctual desires, morality, interpersonal relationships, and dramatic changes of reality.

Biography

Kofi Atta Annan, born in Kumasi, Gold Coast (now Ghana) in 1938, is an international civil servant, most famous for his involvement with the United Nations (UN) as Secretary-General. He has spent his life in civil service, occupying several positions in the UN during his career. Annan grew up as a child in a country fighting for independence, and witnessed the first democratic elections that brought Ghana under the leadership of Kwame Nkrumah.

Annan’s experiences in Ghana thus heavily influenced his interest in politics, development and his commitment to bringing development to Africa. During his schooling years, Annan engaged in debates with other students about the future of Ghana, taking the side against the nationalists as a democrat. In university, Annan joined the National Union of Ghanaian Students, which offered many opportunities. As vice-president, Annan was identified during a conference in Sierra Leone for his leadership potential and was offered an opportunity to study in the United States. This led to a scholarship-funded enrolment at Macalester College in St. Paul, Minnesota where he graduated with a bachelor’s degree in economics. After spending some time at the Graduate Institute of International Studies in Geneva, Annan’s career began at the World Health Organisation (WHO) in 1962.

The desire to make a contribution to Africa’s future is a persistent theme in Annan’s career and life. Following a rejection of a post in Nigeria due to the prospect of being treated as a local employee, Annan’s first move back from the US was in 1965, when he joined the UN Economic Commission for Africa. During a sabbatical leave, he returned to the US to complete a master’s degree in management and, upon completion, continued to work for the UN in Geneva. Annan continued to seek an opportunity to go back to Africa, and found one when he took up a post in 1974 as a manager of the Ghana Tourist Development Company within the Ministry of Tourism. The country that he returned to was, however, now characterised by military rule, bureaucratic inefficiency and corruption. The work ethic and cumbersome decision making frustrated Annan, who “saw little possibility of advancing the kind of change that was so necessary to Ghana’s – and Africa’s – progress” (Annan, 2012, p 27).

Annan then proceeded to serve the UN in various capacities, for the UN Emergency Force in Ismailia, the UN High Commissioner for Refugees in Geneva and in various senior posts in New York dealing with human resources, budget, finance, staff security and peacekeeping operations. While he served as Under-Secretary-General for Peacekeeping, he witnessed the civil war in Somalia, the Rwandan genocide, and the civil war in Bosnia-Herzegovina.

Kofi Annan has been criticized for the performance of the Department of Peacekeeping Operations during the Rwandan genocide. I outline here the course of events and external factors which may have proved difficult to control as an Under-Secretary-General. The UN took little action in Rwanda due to a lack of support from member countries, which resulted in a cautious attitude towards local troops that outnumbered them. Although the 1993 ceasefire between the predominantly Tutsi Rwandese Patriotic Front (RPF) and the Hutu-dominated government was backed by a peacekeeping agreement, the Security Council, especially the United States, were reluctant to send troops in to Rwanda and discouraged anything more than traditional peacekeeping (a non-offensive style based on the presence of UN troops with no open fire). When a few Belgian troops of the UN Assistance Mission in Rwanda (UNAMIR) were killed by the ruling party in April 1994, Belgian withdrawal was swift and soon afterwards the peacekeeping mission was voted out by the Security Council. With no UN presence, the international community watched the RPF-driven genocide take place. A second resolution (UNAMIR II) indicated international concern, but was not met with support from any country in the form of troops until August, when the bloodshed was clearly over.

In contrast to the Rwandan genocide, Annan distinguished himself by facilitating the transition of UN to NATO forces in Bosnia-Herzegovina during their civil war, and by facilitating the repatriation of more than 900 international staff from Iraq in 1990.

Directly following his appointment as Under-Secretary-General, Annan served two 5-year terms as Secretary-General of the United Nations, from 1997-2006. In that post, he advocated for human rights, the rule of law, the Millennium Development Goals (MDGs), Africa and the fight against disease. He created initiatives such as the Global Fund to fight HIV/AIDS, tuberculosis and malaria, adopted the UN’s first counter-terrorism strategy, convinced member countries to recognize their responsibility to protect other nations from genocide, war crimes, crimes against humanity and ethnic cleansing (a sentiment that was not present during, for example, the Rwandan genocide), and undertook a comprehensive program of institutional reform. He constantly strove to bring the organisation closer to the public by forging ties with civil society and the corporate sector.

Annan was jointly awarded the Nobel peace prize in 2001 in recognition for his work and has received many honorary degrees and awards. After his retirement from the position of Secretary-General, he has continued to play a role in international humanitarian issues, the most recent being his failed attempt to mediate a peace agreement in Syria. Nevertheless, he is a highly skilled mediator and holds a position of status that has considerable influence on politicians and rebel group leaders alike.

Human Scale Development

HSD theory gives a new paradigm on human development that focuses on human needs and is more suited to developing countries than traditional economic growth-focused developmental theories were. The primary thesis is that development cannot occur without economic growth, but economic growth does not necessarily lead to development. Thus, human needs, and how to satisfy them, should be the focus of any development policy. In contrast to Abraham Maslow’s hierarchy of human needs, Max-Neef, et al. (1991) postulates that human needs do not fall into a hierarchy and are finite and classifiable. Differences across space (nations, regions, communities) and historical time is the result of the way that those needs are satisfied. Satisfiers define a culture, and their effectiveness relies on the strength of the economy. For example, needs can be satisfied more synergistically and effectively in a developed country with more resources than in a developing country with fewer resources. Needs can be classified axiologically into nine categories: subsistence, protection, affection, understanding, participation, idleness, creation, identity and freedom; and existentially into four categories: being, having, doing and interacting. The two categories combine to form a matrix of needs. There are different types of satisfiers according to how they inhibit or facilitate the satisfaction of other needs – ranging from destructors, pseudo-satisfiers and inhibiting satisfiers to singular satisfiers and synergic satisfiers.

Needs

Although Max-Neef’s model can be used to think about the satisfiers in a nation, region or community, I have used it here to think about how a single person’s needs have been satisfied. Below, I have outlined some of Kofi Annan’s needs that I have identified, and the satisfier that relates to it.

		Existential categories
		Being	Having	Doing	Interacting
Axiological categories	Participation		A job in UN; involvement in international affairs post-resignation	Having opinions about how the UN should be run	Discussing international affairs within the UN and with the international community; being a mediator in conflict settings across the world
	Identity	A commitment to human rights issues, peace and security	Multiple awards, honorary degrees and the university education that he got as a young adult; offices that he has held during his career	His status has influence such that he is able to negotiate with politicians	His schedule is spread out across many different countries
	Understanding	Interested in politics – in debates at school he took the side of the democrats	A dearth of literature that he written in communication.	A bachelor’s degree in economics; training at the Graduate Institute of International Studies; a master’s degree in management.	Annan often mediated between countries and leaders in conflict.
	Protection		He is escorted by security personnel when in a dangerous area.	His work focuses on securing protection for vulnerable and war- affected people.
	Creation	Passion, determination, autonomy		As Secretary-General, Annan put in place initiatives such as the UN Global Compact to promote corporate social development; created the Global Fund; advocated the MDGs; established two new intergovernmental bodies: the Peacebuilding commission and the Human Rights Council; created the UN’s first counter-terrorism strategy	The audiences who listen to his speeches
	Affection	Self-esteem and determination	Annan was married to his first wife, Titi Alakija, for at least a decade and had two children with her. He is now married to his second wife, Nane Lagergren.

Types of satisfiers:

Here, I define satisfiers according to the degree to which they inhibit or promote the satisfaction of other needs

Pseudo-satisfiers

Satisfier	Need which it seemingly satisfies
Peacekeeping operations	Protection

Inhibiting satisfiers

Satisfier	Need	Needs, the satisfaction of which are inhibited
Being escorted by security when in a dangerous area	Protection	Affection, freedom, identity

Singular satisfiers

Satisfier	Need that it satisfies
His work focuses on securing protection for vulnerable and war-affected people	Protection

Synergic Satisfiers

Satisfier	Need	Needs, the satisfaction of which are stimulated
A job at the UN	Participation	Identity, creation, protection
Having opinions about how the UN should be run	Participation	Understanding, freedom
His status has influence such that he is able to negotiate with politicians	Identity	Participation

Defence Mechanisms

The modern theory of defence mechanisms focuses on the interaction of the ego with four sources of conflict – interpersonal relationships, conscience, id (desire) and dramatic changes of external reality.

Figure 1: Sources of conflict which act on the ego.

Source: Vaillant (1993, p. 29)

The ego is that part of the mind which interprets and synthesises internal and external reality in a way which is adaptive. The term ‘defence mechanisms’ refers to the strategies that the ego comes up with in order to cope with stressors. Vaillant (1993) believes that defence mechanisms are subconscious by nature, due to the unacceptable forms in which they exist. Even though some defence mechanisms, such as denial or passive aggression, do not lead to a healthy adaption, most of the time they are a natural and healthy part of everyday life – a coping strategy that can be employed if other coping strategies are not feasible. (Other coping strategies include social support and cognitive restructuring.) By adjusting our perception of reality, defence mechanisms help us around obstacles that would otherwise induce anxiety. An example can be seen with the ability of people on a rollercoaster ride to suppress their fear of heights and channel that energy into the feeling of enjoyment, or with the apparent calmness with which famous American test pilot Chuck Yeager was able to carry out his job (Vaillant, 1993). Defence mechanisms are only pathological in extreme cases, when the perception of reality is distorted to such an extent that the person develops a specific disorder. There are many different taxonomies of defence mechanisms, however I will refer to the most commonly agreed upon types which occur within a delineation of Mature, Immature, Neurotic or Psychotic. Only the latter three can lead to specific diseases, although they can, over time, transform into more mature forms of defence. The ego continues to develop throughout one’s life – below I have listed in order the possible stages that Annan could have gone through in his life thus far.

Altruism (Mature)

Altruism is the giving of the self for others, with a corresponding feeling of gratification for doing so. This type of defence mechanism is similar to, and can be preceded by reaction formation (the transformation of an unacceptable impulse into its opposite). Like altruism, in reaction formation the user projects what they desire onto an object. However, altruism is characterised by a feeling of gratification, whereas reaction formation causes a feeling of distress if the desire is acted upon. Altruism can also be compared with the immature defence projection, which also involves a projection of one’s self onto an object. In projection, the subject incorrectly attributes one’s faults with the object, whereas in altruism the subject correctly attributes one’s needs with the object. Annan utilizes altruism in reaction to the underdeveloped state of Ghana and Africa. He attributes his needs with the well-being of others and thus leads a life of self-sacrifice sacrifice in order to promote human rights, the millennium development goals, international peace and elimination of HIV/AIDS. He is also keen for others to take up an altruistic role, evident in is his “Global Compact” initiative, the “world’s largest effort to promote corporate social responsibility” (United Nations, 2014).

Rationalization (Neurotic)

Rationalization is a logical or socially acceptable reason that is given for our actions. It eases disappointment and provides an acceptable motive for our behaviour (SWK1004S lecture notes). The rationalization behind Annan’s decision about which nation(s) to serve is shaped by his experiences while working for the Ghana Tourist Company. The situation that he found in Ghana was frustrating to him and presented a conflict between his desire to serve the country he was born in and the reality that progress in Ghana would be slow and ineffective due to corruption, bureaucracy and military rule. His thoughts about this are as follows:

“In my own case, faced with forces I could not change, I reluctantly concluded that I would have to pursue my career outside my home country. My experience in Ghana reinforced my commitment to serving an international organization, which I knew my country – and others in the developing world – would rely on for support and advice. I realized that, for me, working for the UN was the best way to serve my country and my continent. The United Nations would from then on become my home.”

(Annan, 2012, p. 27)

From this excerpt we can clearly see how Annan is unconsciously pulling away from his desire to serve Ghana, but rationalizing it in a way that lets him believe that, by working for an international organization, he is still able to keep the best interests of Ghana at heart.

Idealization (Immature)

Idealization is when a person perceives something as perfect and entirely good. Annan idealizes the United Nations somewhat, believing that it holds the best solutions to international humanitarian issues. This is evident from his lifelong commitment to the organization and his belief that peacekeeping operations are effective. The United Nations has many shortfalls, most notably the bureaucratic and complicated structure of the organisation which prevents decisions from being made quickly and is characterised by conflict about overlaps in the functions of various subsidiaries. Secondly, the belief in peacekeeping is intrinsically an idealized belief. Peacekeeping operations rely on the notion that the country at risk of conflict respects the good intentions of the United Nations. More often than not, peacekeeping does not involve open combat and troops merely station themselves in order to make their presence felt. The theory is that their presence will deter conflict, although often the low numbers and lack of an emergency reserve undermines the intimidation of the UN. The operations that the UN peacekeeping operations carry out include the delivery of aid parcels the control of resources and protection of released prisoners of war. Evidently, these routine tasks (which do not create sustainable solutions in themselves) require idealization for the people involved to feel motivated to carry on with their job. Having said that Annan idealizes the UN, it is not a pervasive theme throughout his life, as he drove a process of institutional reform during his appointment as Secretary-General.

Distortion (Psychotic)

Distortion occurs when the ego alters one’s perception of reality in order to give a misleading account, and is employed in order to resolve a conflict within the mind. It is different to delusional projection in that it is more akin to the manic phase of bipolar disorder, whereas delusion results in depression. The conflict between the reality of civil war and the desire to put an end to it is bound to require an adjustment of perception by the ego. As a high-ranking official within the United Nations, Annan required a belief that his work was worthwhile, even when faced with the so-called “crisis in UN peacekeeping” during 1992-1995. Annan required an adaptive ego to deal with the interpersonal relationships, realities and issues of morality when in the UN headquarters. Defence mechanisms were clearly needed to avoid anxiety about the repercussions of his decisions, which have an effect on such a large scale, on so many people’s lives. Numerous sources of conflict can be identified during these years, such as the unwillingness of the United States and other member countries to risk their troops in peacekeeping missions (people), calls from commentators to do something about the violence taking place (people), the fact that UN troops are sometimes unlikely to be able to employ an effective peacekeeping / peace enforcement strategy and prevent situations  from getting out of control (reality), and the fact that innocent civilians are being harmed on the basis of race or political affiliation, and are affected by his decisions (conscience). Thus, the defence mechanism of distortion is employed by Annan in order to cope with these conflicting sources of input.

Conclusion

Kofi Annan has played an instrumental role in the international community. His career at the United Nations was challenging at times and required adaption in order to cope with the demands faced by him. Annan has managed to have many of his needs met through the work he does. Altruism has impacted on his life synergistically and has given him satisfaction and drive. His socialisation as a young man in a developing country prepared him for a life of civil service in which he has been passionate and skilful. Despite the challenges that the UN has faced under Annan’s leadership, as a Secretary-General he has distinguished himself and he stands out from his predecessors.

August 2014

Bibliography

Annan, K. (2012). Interventions: A life in war and peace. London: Penguin Books.

Annan, Kofi. (2009). Encyclopædia Britannica. Encyclopædia Britannica 2009 Deluxe Edition.  Chicago: Encyclopædia Britannica.

Defense Mechanisms. (n.d.). [SWK1004S lecture notes] Department of Social Development, University of Cape Town. Retrieved August 23, 2014:

https://vula.uct.ac.za/access/content/group/56fb8e2b-fe5a-4283-8de8-4f611a5a5815/Thulane_s%20section/DEFENSE%20MECHANISMS%20HANDOUT.pdf [secure server]

Max-Neef, M. (1991). Human scale development: Conception, application and further reflection. New York: Apex Press.

United Nations. (2014). Former United Nations Secretary General Kofi Annan. Retrieved August 22, 2014, from United Nations:

http://www.un.org/sg/formersg/annan.shtml

Vaillant, G.E. (1993). The Wisdom of the Ego. Cambridge, Massachusetts: Harvard University Press.