Local Social Context Research Articles

Ghana Citizenship Education: A Review from the Perspective of National Education Policy and Learning Models

This study aims to find out the perspective of national education policy and learning model of civic education in Ghana. This research uses a qualitative approach with a literature study method. The references in this study are divided into two, first, primary, namely journal articles that have high validity. Second, secondary, namely books and documents as an effort to minimize errors that are conceptual, procedural and praxis. Data analysis is gradual, namely, reduction, data display and verification. Civic education in Ghana begins at the primary level and continues through to tertiary education. The government of Ghana considers civic education an integral part of the national education system and has introduced policies and programs to strengthen civic teaching and learning throughout the education system. At the primary level, civic education is taught through social studies subjects, while at the secondary and tertiary levels it is provided as a separate subject. The Ghanaian government has also developed teaching materials and curricula dedicated to civic education, as well as conducted teacher training in integrating civic teaching into the curriculum and classroom activities. The teaching and learning model of Civic Education in Ghana emphasizes the local peaceful cultural and social context. The aim is to strengthen the values of cultural traditions and local wisdom that exist there.

Community climate commons for collective climate action

AbstractMitigating and adapting to climate change is a vital challenge that cannot rely solely on technology or macro policies but need also be tailored to local social and ecological contexts. As theory suggests, institutional designs that increase collective climate action could potentially speed up climate action in society. In this article we explore the concept of ‘community climate commons’ (CCCs) to foster interconnected and holistic approaches involving citizens and civil society in addressing climate change. Based on a systematic literature review, the aim is to further develop the concept of CCCs and to identify key features for the successful establishment of CCCs for the promotion of collective climate action. The results identify four key features for CCCs: (1) democratic organization with transformative leadership, (2) small group sizes with clear boundaries and existing rules‐in‐use for participation, (3) access to organizational structures, meeting places, social capital, collective identity, and social cohesion, and (4) external financial, political, and social support. In conclusion, CCCs have a real potential to foster a wider societal mobilization of collective climate action while simultaneously addressing other issues of concern in local communities.

국제개발협력과 로컬라이제이션: 이론적 변천과 실천적 적용

Purpose: By introducing localisation and exploring its key issues, this study aims to raise awareness of localisation within the context of international development cooperation in Korea and derive implications. Originality: Localisation is an approach for promoting sustainable development by strengthening local capacities and expanding the use of locally available resources, with its necessity being increasingly highlighted amid the global economic crisis and various international challenges. Methodology: This study analyzes key discourses of international development cooperation, the theoretical background and major concepts of localisation, as well as evaluation frameworks and issues, through a literature review. Result: Localisation is regarded as a key paradigm in international development cooperation, as it enhances the autonomy of partner countries and incorporates the local social and cultural context. Moreover, it has been identified as playing a significant role in reshaping power dynamics between donors and local actors, while fostering the active participation of local communities. Conclusion and Implication: The successful implementation of localisation necessitates equitable partnerships, active engagement of local communities, resolution of conflicts over control between donors and local entities, and a development approach that prioritizes sustainability. Addressing these challenges requires establishing a forum for dialogue grounded in mutual trust and cooperation between donors and local actors, thereby enhancing the sustainability of international development cooperation.

From consumption to context: assessing poverty and inequality across diverse socio-ecological systems in Ghana

Local social and ecological contexts influence the experience of poverty and inequality in a number of ways that include shaping livelihood opportunities and determining the available infrastructure, services and environmental resources, as well as people’s capacity to use them. The metrics used to define poverty and inequality function to guide local and international development policy but how these interact with the local ecological contexts is not well explored. We use a social-ecological systems (SES) lens to empirically examine how context relates to various measures of human well-being at a national scale in Ghana. Using a novel dataset constructed from the 100% Ghanian Census, we examine poverty and inequality at a fine population level across and within multiple dimensions of well-being. First, we describe how well-being varies within different Ghanian SES contexts. Second, we ask whether monetary consumption acts a good indicator for well-being across these contexts. Third, we examine measures of inequality in various metrics across SES types. We find consumption distributions differ across SES types and are markedly distinct from regional distributions based on political boundaries. Rates of improved well-being are positively correlated with consumption levels in all SES types, but correlations are weaker in less-developed contexts like, rangelands and wildlands. Finally, while consumption inequality is quite consistent across SES types, inequality in other measures of living standards (housing, water, sanitation, etc) increases dramatically in SES types as population density and infrastructural development decreases. We advocate that SES types should be recognized as distinct contexts in which actions to mitigate poverty and inequality should better incorporate the challenges unique to each.

Socio-cultural adaptation of Mental Health First Aid to insular religious communities: the case of ultra-Orthodox society in Israel

ABSTRACT Objective The introduction of Mental Health First Aid (MHFA) in Israel has required a dynamic adaptation of the curriculum to the local social, cultural and religious context. The adaptation to the Jewish ultra-Orthodox community has been particularly rigorous and challenging. This article aims to analyse this process, its principles and steps, as well as the challenges and dilemmas it entails. Method The article employs a qualitative case study design, specifically, the instrumental case study. The adaptation procedure includes five steps: engaging local experts, organising focus groups, collaboration with communities, pilot testing in diverse communities, and iterative feedback loops. The article draws primarily on the perspectives of 45 community members, rabbis and health professionals who participated in four focus groups. Results The adaptation in ultra-Orthodox society addressed stigmatisation, silencing and concealment of mental health issues; gender segregation; educational gaps; and cultural misunderstandings of healthcare approaches. We demonstrate the need to modify the language, scenarios and examples in the curriculum, and engage with religious leaders and educational institutions. This process raises professional and ethical dilemmas, such as how MHFA should approach topics that remain unspoken in ultra-Orthodox communities. Discussion This case demonstrates that cultural adaptation is vital but may be insufficient. Attention should also be paid to social and structural forces, such as social hierarchies and systemic discrimination. A structurally competent approach should be adopted. This is the first case of accommodating MHFA for an insular religious group. It can contribute to adapting MHFA to other insular, encompassing, high-tension religious communities worldwide.

Common good in the urban context – insights from theoretical frameworks

The objective of the study is to analyse the role of the concept of common good in the contemporary field of urban studies. Through an interdisciplinary literature review, the basic explanation of the concept or common good is presented with a focus on common good in the urban environment. This work examines how urban commons became significant in scientific and public debates, translatable into tangible projects. The research results prove the academic and policy discussions focus on urban commons both in theoretical and engaged implementation of experiments in local urban governance. The notion of common good in the urban context, applied in territorial governance practices as commons, has an expanded international geographical reach, popularised within theoretical and more empirical approaches. The findings reveal a correlation between the discourse on urban commons and the proliferation of thematic debates and models; grassroots projects, demonstrating varied impacts by local social, cultural and policy contexts. In conclusion to the study of consecutive contemporary theories, the need to provide accurate elaboration on an urban commoning framework can be stated. This is a gap to bridge for enabling practical sustainable applications.

Penalaran dalam Media Lokal: Analisis Opini Pada Kabar Madura

This study aims to analyse reasoning in the opinion columns of Kabar Madura, a prominent local newspaper in Madura. The research employs a qualitative approach with a descriptive-analytical design to understand and evaluate the quality of argumentation in these opinion columns. Data were collected through content analysis and discourse analysis of opinion articles published within a specific timeframe. The findings reveal that while many articles demonstrate effective rhetorical use and a critical approach, there are deficiencies in evidence presentation and logical consistency. More experienced writers tend to construct stronger arguments supported by relevant evidence, whereas less experienced writers often struggle to formulate coherent and logical arguments. This variation in argumentative quality indicates a need for writer training and capacity development. Additionally, the analysis shows that some articles adopt a critical approach that aids readers in understanding the complexities of local issues. The local social and cultural context also influences reasoning in the opinion columns, with articles relevant to the daily lives of the Madurese community receiving more positive responses. The study concludes that enhancing reasoning quality in opinion columns can improve the credibility and impact of local media in shaping public opinion. Practical recommendations include providing training for writers and further research encompassing more local media and mixed methods for more comprehensive results. This research contributes significantly to the development of more critical and responsible journalism within the local media context in Indonesia.

The Awakening and Challenges of Women's Rights: A Comparative Study under the Influence of the American Revolution and the French Revolution

Both the American Revolution and the French Revolution saw the emergence of women's rights in the modern West to a certain extent. Although both the French Revolution and the American Revolution were characterised by the struggle for women's rights, there were notable differences in the specific ways, times, and challenges they faced. This paper compares the emancipatory effects of the two revolutions on women and the independent links between women's emancipation in the local social and political contexts. It reveals that women's emancipation in the modern West was influenced by the unique internal structure of each country's society at the time. It is revealed that during the French Revolution, women's struggle for rights was more centred on the domestic and social level than on direct participation in the political decision-making process due to the development of capitalism in France. Conversely, women in the American Revolution were more concerned with political, legal, and social issues. This essay will examine the chronology of the pre-revolutionary, revolutionary, and post-revolutionary periods, with a focus on the differing national and revolutionary contexts of the two countries, the varying status of women, and the divergent approaches to the fight for women's rights.

Assessing the Determinants of the Usage of Contraceptive in Family Planning in Punjab, Pakistan

Background: Contraceptive use is pivotal for managing birth rates, particularly in regions with high fertility such as Pakistan. This study highlights the role of family planning in controlling population growth by assessing the determinants affecting contraceptive usage in Punjab, a province characterized by diverse demographic and socio-economic conditions. Objective: The research aims to evaluate the impact of education, age, residential area, residential status, and media access on contraceptive use among ever-married women in Punjab, Pakistan. Methods: Data from the 'Annual Contraceptive Performance Report 2019-20' by the Pakistan Bureau of Statistics were analyzed. A total of 78,563 ever-married women were sampled using random stratified techniques. Multiple statistical tests, including logistic regression, chi-square, and independent sample t-tests, were applied to identify key factors influencing contraceptive usage. Results: Educational level, residential area, status, wealth index quintiles, and media access were significantly associated with contraceptive use across Punjab. Statistical analysis showed that women's age and the number of children significantly affected contraceptive use. Key predictors identified include media access, reproductive history, and residential characteristics, with media access and residential area being particularly impactful. Conclusion: This study confirms that socioeconomic and demographic factors significantly influence contraceptive usage in Punjab. Enhanced focus on education and targeted media campaigns could improve family planning outcomes. Effective interventions should consider local cultural and social contexts to increase contraceptive uptake.

Study of the Role of Productive Waqf in Improving Community Welfare: A Qualitative Study at Rohmatul Ummah Islamic Boarding School Ringinrejo, Kediri, Indonesia

Productive waqf has been recognized as a potential instrument in improving community welfare. This research aims to understand in depth how productive waqf is implemented at the Rohmatul Ummah Islamic Boarding School, as well as its impact on the welfare of the surrounding community. This research uses a qualitative approach with a case study at the Rohmatul Ummah Islamic Boarding School. Data was collected through in-depth interviews with Islamic boarding school administrators, waqf nazhir, waqf beneficiaries, as well as direct observation of productive activities managed by the waqf. Data analysis was carried out thematically. The research results show that productive waqf at the Rohmatul Ummah Islamic Boarding School is managed professionally and transparently. Waqf funds are used to finance various productive activities, such as agriculture, animal husbandry and micro businesses. This activity provides direct economic benefits to beneficiaries, such as increased income, employment opportunities, and access to basic needs. Apart from that, productive waqf also provides positive social impacts, such as improving the quality of education, health and the environment. Productive waqf has a significant role in improving the welfare of the community around the Rohmatul Ummah Islamic Boarding School. This research recommends that this model of productive waqf management in Islamic boarding schools can be replicated in other places, taking into account the local social and economic context.

Lithic stories of broken relations after the Storegga tsunami in Mesolithic western Norway?

ABSTRACT Major changes in lithic technologies are often explained by either migration or crisis. Here we argue that continuity and minor adjustments in lithic production can tell equally dramatic tales of altered social situations. We base our interpretations on identified lithic blade production concepts and raw materials at 30 sites dating 7500–5000BC, i.e. from before and after the massive Storegga tsunami hit the coast of western South-Norway around 6150BC. Regional continuation, but also local variations in lithic production are interpreted inspired by a machine-oriented ontological framework. The tsunami disrupts the environment, society and its lithic traditions are affected. Although no immediate major breaks are observed, sometime after the tsunami, societies or lithic production as ‘machines’ in separate regions had begun to hum to different tunes. We suggest that variation in tsunami impact had created differing local social contexts which in turn pushed the lithic traditions down diverging paths.

Religious Moderation Realizes Harmonization of The Malay Islamic Community in South Sumatra

This study aims to examine the perspective of the Malay Islamic community on religious moderation in South Sumatra. In the context of increasing globalization, religious moderation is becoming an important and relevant issue, especially in the South Sumatra region which has a significant Malay Islamic population. This research uses quantitative methods with survey methods with stakeholders from various walks of life, including religious leaders, youth, and Malay communities. The results of the study show First, that there is general agreement that religious moderation in South Sumatra is expected to increase tolerance and unity among religious communities. However, there are also different perceptions, where some feel that religious moderation can threaten their traditional values and cultural identity. Second, the results of this study also found that the understanding of religious moderation in South Sumatra is strongly influenced by the local social, economic, and political context. The contribution of this research lies in a deeper understanding of the Malay Islamic community's perspective on religious moderation in South Sumatra. Third, the results of this study show the importance of strengthening strong local identities to support community participation in stable democratic processes and efforts to create a harmonious and inclusive environment in the region. Fourth, the results of this study also show that dialogue between religious communities and religious groups, can build better understanding between each other, reduce tensions, and create more solid conditions for democratic stability.

“Gender wars” and populist politics in South Korea

The 2022 South Korean presidential election campaign saw populist politicians, especially conservative parties, leverage gender conflicts and misogyny to attract young male swing voters. But there has been limited scholarly attention to the connection between gender and populist politics, particularly in South Korea, with research primarily focused on women's voting patterns, their political party representation, and on populist politics in the US, Europe, and Latin America. Existing research identifies that common strategies employed by populist politicians include anti-feminist discourses, reference to crises in masculinity, and appeals to emotion and affect. This paper examines how South Korean populist politics has utilized gender conflicts since democratization, considering the evolution of ‘gender wars’ in the South Korean context. It specifically delves into the strategies employed by conservative populist politicians from the People Power Party (PPP) during the 2022 election campaigns. These strategies, although similar to those of right-wing populists in Europe and the US, emphasized three key issues unique to South Korea: compulsory military service, low fertility rates, and the dismantling of the Ministry of Gender Equality and Family. This South Korean case contributes significantly to academic discussions about populist politics and gender, contextualized within the local political, social, and cultural context.

Changing Health Information on COVID-19 Vaccination in Asia

The informational domain related to COVID-19 reflects the degree of uncertainty and pace of evolution of the pandemic. This places a burden on peoples’ searches for information to guide their choices, importantly including for COVID-19 vaccines. Thus, it is important for health communications that support vaccination campaigns to attenuate vaccine hesitancy to be accessible, including in terms of readability, and adapted to the evolving pandemic. This paper aims to understand internet searches on COVID-19 vaccination, specifically the mix of sources and readability of the sources over a two-year period (2021–2023) in Singapore, Hong Kong, and the Philippines, for search results in English, as English is a main language for each of these locations. The sources accessed through online searches in June 2021 and May 2023 were categorized by type of source and whether they were from one of the focal locations or elsewhere. The readability of information from web-search results was assessed using a set of readability tests (Flesch–Kincaid Reading Ease, Flesch–Kincaid Grade Level, Gunning Fog Index, Coleman–Liau Index, and Simple Measure of Gobbledygook Grade level). Over the two-year period there was an increase in government sources and reduction in mass media sources with distinct local patterns. Local government sources increased in Singapore whereas foreign government and multi-lateral organization sources increased in Hong Kong, with the Philippines being an intermediate pattern. In contrast to the changing mix of sources, the readability tests indicate a low proportion of URLs scoring within recommended readability thresholds across locations and types of sources over the two years. Information on COVID-19 vaccine development and deployment is an important part of health communications that includes internet search. The paper contributes to understanding health communications during a pandemic, including mix of local and non-local sources and contingency on local social and health context.

Ethnic density and first episode psychosis in the British Pakistani population: findings from the East Lancashire Early Intervention Service.

Elevated risk of psychosis for ethnic minority groups has generally been shown to be mitigated by high ethnic density. However, past survey studies examining UK Pakistani populations have shown an absence of protective ethnic density effects, which is not observed in other South Asian groups. To assess the ethnic density effect at a local neighbourhood level, in the UK Pakistani population in East Lancashire. Data was collected by the East Lancashire Early Intervention Service, identifying all cases of first episode psychosis (FEP) within their catchment area between 2012 and 2020. Multilevel Poisson regression analyses were used to compare incidence rates between Pakistani and White majority groups, while controlling for age, gender and area-level deprivation. The ethnic density effect was also examined by comparing incidence rates across high and low density areas. A total of 455 cases of FEP (364 White, 91 Pakistani) were identified. The Pakistani group had a higher incidence of FEP compared to the White majority population. A clear effect of ethnic density on rates of FEP was shown, with those in low density areas having higher incidence rates compared to the White majority, whereas incidence rates in high density areas did not significantly differ. Within the Pakistani group, a dose-response effect was also observed, with risk of FEP increasing incrementally as ethnic density decreased. Higher ethnic density related to lower risk of FEP within the Pakistani population in East Lancashire, highlighting the impact of local social context on psychosis incidence.

Designing Integrated IT Architecture for Health Monitoring Internet of Things: Findings Exploratory Study

IT integration with healthcare, mainly through Internet of Things-based health monitoring systems, is crucial to improving healthcare management in the digital age. However, challenges remain in the design of an integrated IT architecture that can support the sustainability and effectiveness of IoT health monitoring systems, which still need to be addressed. The shortcomings in the literature related to the application of a holistic IT architecture framework to address these challenges indicate a knowledge gap that needs to be filled. Through the application of the TOGAF methodology, this research seeks to design and analyze an integrated IT architecture for IoT-based health monitoring systems in Indonesia, taking a qualitative approach through case studies, in-depth interviews, and document analysis. The main findings show that the application of the TOGAF framework successfully addresses the challenges of interoperability, data security, and system scalability by effectively integrating IoT technologies in the healthcare environment and considering the local social and infrastructural context. The implementation of the IT architecture developed based on the TOGAF methodology demonstrated improved coordination between IoT devices and backend systems, facilitated secure and real-time data flow, and accommodated the scalability and sustainability needs of the system. The findings have significant implications in supporting the development of more efficient and effective health monitoring systems, offering strategic guidance for system developers, policymakers, and IT practitioners within the healthcare sector.

The need for an evidence-led approach to rewilding

This paper characterises current rewilding activities in the UK, through the analysis of 66 rewilding projects. Project information was obtained from online data (65 %), and direct mail data requests (35 %). The analyses showed an exponential growth in the number of new rewilding projects since 2010, with 8 % of projects started prior to 2000, and 60 % initiated after 2010. Seventy-three percent of projects involved rewilding areas of less than 1000 ha, 17 % being between 1000 and 10,000 ha, and 9 % greater than 10,000 ha. In Scotland, 80 % of the area being rewilded involved mountain, heath and bog habitats. For England the largest rewilded areas (58 %) were semi-natural or improved grasslands. Fifty-six percent of sites were formerly used for livestock farming, and 24 % for arable cultivation. A total of 72 % of sites employed tree planting, 64 % introduced herbivores, and 33 % introduced non-herbivores. The removal of sheep and cattle took place in 51 % of projects, with deer control in 33 %, wetland creation in 39 %, and the removal of artificial drainage in 36 % of projects. There was a close geographical proximity between rewilding sites and Sites of Special Scientific Interest (SSSI), with 69 % of areas being within 4 km, and only two sites greater than 8 km. Twelve project funding sources were recorded, and most projects utilised multiple funding sources. The benefits of an evidence-led and nationally co-ordinated rewilding approach were identified in relation to using well-established decision tools and frameworks to enhance future rewilding spatial planning. This would allow the development of a map of ‘appropriate’ rewilding areas, based on landscape scale characteristics, national species and habitat priorities, and predicted future landscape changes. Importantly, these ‘target’ areas would also be sensitive to local social, economic and agricultural contexts.

Perceptual Narrowing in Face Processing: Reviewing the Factors Influencing its Onset and Offset

AbstractAn infant's face‐ and speech‐processing system develops during the first year from broad and non‐specific to becoming a system that is tuned to the faces and languages to which they are most exposed. This phenomenon is called perceptual narrowing. Before 9 months of age, infants are capable of discriminating and recognizing individuals from any type of race/species faces. However, with increased exposure to own‐race and own‐species faces and lack of exposure to other types of faces, by 9 months of age, they have improved their ability to discriminate own‐race faces, while they show increased difficulty in the discrimination of faces from other races and species. According to the literature, we can conclude that, by 12 months of age, most human perceptual systems have become perceptually tuned and adult‐like; however, this is not true. In the following sections, we will argue that perceptual narrowing for faces occurs during the same developmental period as it does for language, and that it can be prevented or modulated with sufficient exposure to unfamiliar sounds or face types. We conclude that narrowing has been designed by natural selection to tailor an individual's cognition to their local social context. It might occur for every domain pertaining to social communication—from speech processing to emotion or gesture perception—in a process that gradually adapts the infant to their native social group.

Interplay of socio-economic and environmental factors in shaping urban plant biodiversity: a comprehensive analysis

Urban environments are dynamic landscapes shaped by a multitude of factors, including environmental conditions and socio-economic influences. This study systematically investigates how various factors shape urban plant diversity in Haikou City, Hainan Province, China, focusing on 30 key drivers including socio-economic aspects, biophysical conditions, landscape elements, and management practices. Our research methodology involved a comprehensive analysis of these factors’ impact on six types of urban plant species: spontaneous, native spontaneous, exotic spontaneous, cultivated, native cultivated, and exotic cultivated. Conducted in urban areas with varying population densities and landscape features, our sampling approach aimed to understand the species’ distribution patterns. We discovered significant correlations between plant species diversity and specific environmental and socio-economic variables. Our results indicate that spontaneous species are prevalent in densely populated areas with strong social ties, whereas areas rich in tree and shrub cover see fewer such species. Native cultivated species favor more serene, less urbanized landscapes, while exotic cultivated species are predominantly found in economically affluent areas with diverse vegetation. These findings offer valuable insights for urban planning and biodiversity conservation, emphasizing the need for customized greening strategies that align with local environmental and social contexts. By adopting such tailored approaches, urban planners can more effectively manage landscapes, enrich green spaces, and foster biodiverse, sustainable ecosystems. This research not only enhances our understanding of urban plant biodiversity but also lays the groundwork for future studies and policy-making, promoting harmonious integration of diverse plant life within urban settings.

Reablement for the new generation elderly in the Netherlands, a personalised integrated care approach.

Introduction: The new generation elderly, the babyboomers, expect that elderly-care reflects their need to remain independent. In general elderly are perceived as inactive and vulnerable with negative outcomes on quality of care. However babyboomers don’t identify themselves as elderly and they have a higher level of self-efficacy. An elderly-care organisation in a medium-sized town in the Netherlands, strived for a suitable care design, that meets expectations of babyboomers and wanted to know how this care design could be implemented in the local setting.
 Theory/methods: The implementation Framework for Aged Care, developed by Meyers (1), was applied to a practice-oriented trajectory design. This framework is a fit-for-purpose implementation framework in the local social, cultural and economic context. The applied methodologies were literature research, desk and field research, which resulted in problem-clarification, an intervention design and an implementation advice. 
 Results: Self-efficacy and self-reliance are determinants which influence the measure of independence of babyboomers. Therefore it is necessary for elderly-care to give attention to the increasing independence needs of babyboomers. Literature states that reablement is an effective intervention which increases independence by influencing self-efficacy and self-reliance. Reablement is a time-bound (six to twelve weeks) interdisciplinary, intensive and person- and goal orientated intervention in the homecare setting, delivered by trained staff (2). Homecare staff is not yet trained in the current situation to work from a perspective that increases independence. Therefore a training programme and reablement trajectory was developed based on literature. This training program focusses on changing behavioural determinants of homecare staff by using social influence from peers. Babyboomers can only be empowered to increase self-efficacy and self-reliance if homecare staff believes they contribute to this independence. The Implementation strategy was mainly oriented on the adoption of reablement, since this is a condition of success of reablement. 
 Discussion: There is a risk of using untrained staff in reablement which may have negative outcomes on independence. Homecare staff can feel devalued as they perceive part of their care-role ‘to care for’ instead of ‘to care that’. 
 Conclusions: By influencing the determinants of homecare staff and babyboomers, reablement shows to be effective by focusing on increasing independence of babyboomers. After a training programme which uses the social influence of peers, reablement can be implemented in the local context.
 Lessons learned: How we perceive elderly has an influence on the outcome and organisation of elderly care. Scandinavian research shows that reablement can be an intervention with positive societal effects on care in general and the prevailing paradigm of getting older.