E. Social Care Services to Individuals by User-Owned Health Coops

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      by the International Co-operative Alliance ICA

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In addition to the services provided by social care co-
operatives, many services are delivered by health co-operatives,
particularly by user-owned enterprises, for which social care is
but an extension and specialization within their community-based,
member-participative approach and their emphasis on healthy
living.  Such provision could be considered a basis for
distinguishing sub-types among user-owned health co-operatives,
but this aspect is not pursued as only a few examples are
included, in this comprehensive review.  

The emphasis which most user-owned health co-operatives place
upon preventive health, including outreach to the communities in
which they operate, particularly to disadvantaged persons, allows
for an easy progression to programmes in social medicine and to
those in social care and welfare. An increasing proportion of
health co-operatives, in response to the concerns of their
members, extend their activities to social care.  This expresses
the entirely pragmatic view that alleviation of the social
problems faced by many individuals will in the long-term bring
an improvement in their health, and that of their families and
other carers, and consequently a reduction in the cost of
curative and rehabilitative care which would be charged
eventually to the co-operative.  In this context also, it
reflects the view of members that the facilities and staff of
their health co-operative provide the best base from which to
provide social care services, at least until such time as the
demand becomes so great that autonomous social care co-operatives
within the same community are the most appropriate organizational
response to social conditions. It also expresses the co-operative
principle of concern for the community. In the summaries of the
current situation set out below, information was obtained from
the same sources to which reference is made in the earlier
entries on health co-operatives proper, with few exceptions,
which are noted separately.

In Canada most co-operative health clinics provide social care
for the elderly, and act as the base for programmes such as that
of Alcoholics Anonymous.65/

In Japan the health co-operatives within the consumer co-
operative movement are concerned with all aspects of the well-
being of their members, and particularly, given the demographic
character of the population, that of elderly persons.  This
concern has taken on an added dimension with changes in
government policy which have included decentralization of
responsibility for social care programmes to local governments,
to communities and specifically to the families of persons
requiring care.  Given that demographic and socio-economic
processes have brought about a disintegration of communities and
families, the consumer-owned health co-operative movement
perceives its own function to be one of partial replacement of
the capability of communities for mutual assistance and supported
self-help.  The movement uses for this purpose the "han-groups",
backed by the advanced facilities and trained staff of their
health co-operatives.

The movement has recently extended its priorities and services
to the provision of support and rehabilitation services to
persons particularly in need. Given the demographic aging of the
Japanese population, the special needs of the elderly are being
given increasing attention. Health co-operatives are currently
promoting various kinds of home care for the elderly.  Attention
has been given to the use of networks of members and other
volunteers to provide support for daily living in their own homes
by helping in shopping, housework, preparation of meals and
taking baths.  Within its Five-Year Plan for the period 1995-2000
it is intended that each health co-operative establish
specialized institutions for the care of elderly persons,
including day-care centres, home-care programmes and residences
with full-care.  The role of health co-operatives is of
particular importance given that public health insurance caters
only for curative and rehabilitative, but not for preventive,

In the agricultural sector health co-operatives have developed
as part of the broad responsibilities of the "welfare
federations" which exist in each of the agricultural co-
operatives.  These formerly existed at the local level, now
amalgamated into large and multi-functional entities at sub-
prefectural and even prefectural levels.  Social care programmes
have been a primary concern from the inception of these bodies
and constitute a natural complement to the activities of health
co-operatives per se, rather than as an extension of these.  In
1979 the Central Union of Agricultural Co-operatives (JA-ZENCHU)
adopted a "Basic Policy of Better Living Activities of
Agricultural Cooperatives" which included, together with
components on health, consumer and cultural activities a section
on co-operative activities for elderly persons.

The demographic aging of rural communities has been greater than
the national average, and welfare federations have given
increasing attention to the problems of social care for elderly
persons, in association with emphasis to geriatric health within
their health co-operatives. To complement a more intensive system
of health care for the elderly, introduced in April 1993, home
help services were also introduced. Welfare federations have
begun to work very closely with local authorities in
predominantly rural regions on the design of comprehensive health
and social services in which they would be a principal
contributor and partner.67/

In Sweden the co-operatively organized and community-based health
care model "Medikoop", developed in the early 1990s by housing
and insurance co-operatives in collaboration with local
government authorities, envisages coordination of preventive
health care with care for the elderly.  Elderly members of
housing co-operatives have taken an interest in the organization
of co-operative primary health care, associated with home nursing
and home help services.  For example, in Snopptorp, a housing
area in Eskilstuna, home help and home nursing have been provided
by a co-operative since 1991.68/

In the United States health co-operatives usually extend
preventive and rehabilitative services to areas of "social
medicine" such as geriatric nursing and hospice care.  Some have
taken on purely social care services: for example the Group
Health Co-operative of Puget Sound provides alcohol and drug
treatment and teenage pregnancy programmes.  The United Seniors
Health Co-operative (USHC) in Washington D.C. is a prime example
of the combination of health and social care functions for the