Health on borrowed time? Prioritizing and meeting needs in low-income households

Abstract

Health care behaviour studies have tended to focus on health beliefs and other influences on decisions to consult professional health services. The practicalities, task scheduling and negotiations required to implement such decisions have received comparatively little attention. Whereas the role of kin and others as advisers in the lay referral network has been explored, their practical role in enabling or constraining the implementation of health care decisions has received scant attention. Research in low-income areas of Merseyside identified the decisions and social arrangements underpinning the use of primary health care services. The coordination and scheduling of tasks and related activities involved is considerable, demanding creativity and negotiation. Respondents’ accounts indicate that kin living in other households are more reliable and frequent sources of substitute care or transport than neighbours who may live in closer proximity. There are striking gender differences in the resources ‘borrowed’ from kin: women are more likely to provide substitute care, whilst men help with transport. These valuable, yet invisible, resources are not employed lightly, however. Their use is carefully measured and ‘saved up’ for emergencies, and on behalf of vulnerable dependants. As health services restructure, concentrating facilities in fewer locations and shifting care increasingly onto the ‘community’, more elaborate negotiations and strategies will be required of women as household managers and coordinators. In responding to local needs, health and social policy and professional practice will need to be flexible to take account of the complex realities of people's daily lives.