October 5, 2022 • 40 mins
Centre for Care Researcher, Dr Duncan Fisher welcomes Professor Teppo Kröger, Director of the Centre of Excellence in Research on Ageing and Care (CoE AgeCare), to the podcast to talk about Teppo's recent publication, 'Care Poverty: When Older People’s Needs Remain Unmet' (click here to read the book).
Visit the website for the Centre of Excellence in Research on Ageing and Care (CoE AgeCare)
Other useful links mentioned in this episode
Article written by Teppo about links between care and disability studies
The CARE MATTERS Podcast is produced by Dan Williamson at the Centre for Care.
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(00:05):
The Care Matters podcast is
brought to youby the ESRC Centre for Care and CIRCLE,
the Centre for International Researchon Care, Labour
and Equalities.
In this series,
our researchers welcome expertsin the field and those giving or receiving
care to discuss crucial issuesin social care as we collectively attempt
(00:30):
to make a positive differenceto how care is experienced
and provided.
Hello and welcome to Care Matters,
the podcast from the Economicand Social Research Council, Centre
for Care and the University of Sheffield'sCIRCLE Research Centre.
(00:51):
My name is Duncan Fisher and I am aresearch associate at the Centre for Care.
We are delighted to welcome hereto Halifax Hall in Sheffield,
Professor Teppo Kröger as our guest,and in this podcast
I will be talking with him about his newlypublished book on Care Poverty.
Welcome to Sheffieldand to Care Matters Teppo.
(01:14):
Thank you, Duncan.
Teppo Kröger is professor of socialand public policy
at the Department of Social Sciencesand Philosophy of the University
of Jyvaskyla, Finland,and also a part time professor
of the Centre for CareResearch in Bergen, Norway.
He's director of the Centre of Excellencein Research on Ageing and Care,
(01:36):
which is a major research investmentby the Academy of Finland,
consisting of around 60 researchersfrom the universities
of the Jyvaskyla, Tampere and Helsinki.
He has studied social care for 30 yearsfrom a number of different perspectives,
oftenin international collaboration, combining
(01:57):
different research approachesand developing new conceptual frameworks,
including welfare,municipality, demographic panic,
care capital and care poverty.
In addition to care poverty,he has written comparative
research on social care,the state of the art
and articlesin a number of international journals,
(02:19):
including the Journal of Social Policy,Critical Social Policy,
Health and Social Careand the Community and Ageing and Society.
He has co-edited books, including
combining Paid Work and Family Care,which was co-edited
along with Professor Sue Yeandle,the director of the Centre for Care.
(02:40):
Again, a warm welcome to your Teppo.
Thanks.
I'd like to start Teppo,Could you please introduce the book
and tell our audiencewhat a little bit about what it's about?
Yeah, well, this
book is a product of aquite a long, long process.
Maybe,
maybe
(03:00):
even 20 years.
I've been trying to think of an approach
to social care, long term carethat would not only focus on on
on resources or services
that are provided,but it would really dig into the key
question that I think that we shouldreally be focussing on that.
(03:23):
That is whether people who need help
and support,whether whether they really get it or not.
And that's really the the key
key idea or the keyquestion of of of this book.
And then then I've been usingand developing
the term care povertyto to stand for a situation
(03:44):
where people don't receive enoughor adequate help and support and care.
And this book is on the one hand, it's
introducing this conceptand it's it's backgrounds.
And on the other hand,it also tries to combine this concept
to existing research on unmet needs.
(04:06):
And then it also aims to summarisethe earlier literature on on this topic.
And so in terms of the ideasthat you mentioned there,
how did the process of developingthose ideas
towards something of book length?
So that could you say a little bitabout how that that happened?
Well,
(04:27):
it is really taking quite a
quite a whilefor me to to think that how how
this approach should be
presented and developed.
And actually,
I use the same concept already.
Was it was it 17 years ago in an article
(04:49):
about lone parentsand their child care arrangements.
But but then since thenI've been trying to also to use it
in the context of, of carefor older people.
And we we brought an empirical articlein, in Finland
that used this term, an approach
(05:10):
that came out three years ago, I think.
But already then I felt that this isthis is such
quite a large issue and topic
that it's not possible really to dig
into it.
In, in, in just a brief, short article
that I need a longer format to discuss it
(05:33):
from different approachesand try to try to cover it properly.
So, so then, then
I thought out of the
it means a book that it'skind of the only way to
discuss it enough
from from different perspectivesis really to write a book.
Thank you.
And can you maybe just say a little bitabout the I guess, the
(05:57):
the kind of parameters of the researchbecause and you mentioned data,
but you previously used the termand the context of lone parent.
And I know that you've written,for example, that
although care, poverty or unmet need
could be experienced in residential care,
your book, for example,is not including that that setting.
(06:21):
Is that right? Yeah, that'sthat's that's right.
This this book is really focussing on
all the people who live in the communitycommunity in their own homes.
And it's, it's that,that is the focus of of it, even though
I do think that the concept couldbe applied also in other other contexts.
(06:42):
So it's
not limitedjust to this, this, this topic.
But but in this book,
I try to use
and combinethree different kinds of literature.
And for myself, I think the most important
literature is, is feminist
(07:02):
social policy,which I've been reading since, since
being a young student thenand what has really impacted
my, my thinking already for four decades.
But then, then in addition to that,I have been reading
general theological studies,
particularly social gerontology,and about long term care.
(07:25):
But then
there's also a third stream of literature
that I then try to combine in
the book is literature on research,
on social inequalitiesand particularly poverty research. So.
I tried to bring these three
(07:47):
properties togetherto provide a kind of a new, new
starting point on new conceptualperspective
into into care,and particularly to inadequate care.
Well,I think that gives us a good sort of basis
to to move on to discusssome of the content of the book.
(08:08):
So I was really struck by the openingof the book introduction.
And you give examples of new storiesfrom different places
about the consequences of care, poverty,and that's something
that you returned to in one of the laterchapters.
Can you say a bit more about this?
How does the book relate to everydaylife and care?
(08:29):
Well,
I hope it doesrelate to everyday life and care,
even though the book mostly consists ofof going through earlier literature
and making some conclusions based on that.
But but actually,
I think at least my
motivation comes from really from, from,from the everyday life
(08:51):
and being really worriedabout the situation of many of the people
who cannot receive the,the, the help and support
they would needin, in their everyday lives.
And as you said, I also use some media
stories of real life caseswhere the consequences
(09:15):
of of this lack of help and supporthad been quite dramatic, even even fatal.
And I think that this is a real riskin in in situations
where where people are leftwithout proper attention and care.
And and I think it was also
why I included these
(09:37):
these media narratives
was that I see that it'swe should see that
this is really an importantand a vital and critical issue.
It's not just a theoretical issue,but it's really something
that affects people's lives insometimes in very dramatic ways. Hmm.
(09:59):
Yeah.
And I would certainlythat the examples that you gave were
were very dramatic and and sad really and.
Yeah. And quite moving.
So the concept you mentioned aboutdeveloping the concept of care, poverty
has similarities with terms that you'vementioned already, such as unmet need.
And in the book, you talk about the caregap and the care deficit.
(10:23):
But why why have you chosen specifically
to to develop and focus on care, poverty?
Yeah, well,
actually,all these other terms are also also
useful.
And I'd been using them myself in mymy texts earlier
and I see that they really have haveimportant contribution.
(10:47):
But I still was kind of lacking
a concept that that could kind of
combine different levelsand different approaches.
For example, this care gap and caredeficit terms that are often used for
in social policy discussions,they usually focus on on very much
(11:08):
on the macro level, on the social level,which is, of course extremely important.
But then then you don't really seethe individual level,
the situations of of individual olderpeople
and their struggles and problemsin their daily lives.
So, so
(11:28):
and actually the term unmet need is quite,quite the opposite.
It really,really focuses on the individual level
and particularly thusthese quantitative analyses
of all of the factorsthat that affect people's situations.
But then you kindof have missed the, the, the
(11:50):
larger picture,
the the social
background,
the the inequalities that are present
in our societiesand really inflames the the
who gets enough supportand who who doesn't
and and using this term care
(12:12):
poverty was my way to try to combine
the individual level and the social leveland also to learn
from the long tradition of
of research and their agitation of poverty
and apply their their conceptsand approaches to to the study of care.
(12:32):
Okay. Thank you.
And so can you maybe just say a little bitmore about the mechanics of that?
Because you mentioned about how we haveand we know what people.
People's needs may be are.
But but in terms of care, poverty
is about more than thatinteraction with the level of
care that's available.
(12:54):
And your book is not only services, it'salso this including you
include informal care as well, don't you,within your remit or your scope.
Yeah. Yeah, that's that, that's true.
That'sthat's also quite a lot of literature
that focusesparticularly on, on care services and, and
(13:15):
formal care.
And it's.
Qualitiesand whether people are happy with that.
That's also important.
A strand of of research, I think.
But still,if we look only on on on formal care.
The problem is that that we still don'tknow whether people have enough
care and adequate care or not, becauseeven if they don't receive formal care
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or adequate formal care,they might get get the help
from their familiesor friends or social network networks.
And that
key question to me, at least,
is that whether they are peoplewho are totally left without
adequate help, whether it comes from
the formal care servicesor from the informal networks.
(14:03):
And that is why I think that we shouldlook at both at the same time, both
both the care service systems
and their provisions and their problems,but also at what
of what families and friends are doingand what they are able
to do or unable to do.
So only if we look at both, both sides
(14:25):
at the same timewe get a full picture, I think.
Thank you.
That's a very interesting point.Thank you.
So you mentioned in the bookalso the difference between
and what your use of the termcare, poverty and other terms
that listeners may be familiar with, suchas food poverty, fuel poverty in the UK.
(14:46):
Certainly these have been and termsthat we've heard quite a lot in the last
the last few years.
So how does care poverty differfrom from these terms?
Yeah, it does differ because
actually these there's food poverty,fuel poverty.
They are still kind of subcategoriesof economic poverty,
(15:08):
lack of material resources.
But in the case of cardboard,that is not really the case.
It's not about material deprivation.
It's about deprivationof adequate help as poor.
So so it's really I would sayit's a parallel concept to poverty,
not not a sub concept of of poverty.
(15:30):
And this is it's kind ofwe are looking at different issues.
Poverty, food poverty,fuel poverty is really about
these material conditions and care poverty
is about care and help and support.
And usually you really arguethat this is something
that is worthyof specific focus in its own right.
(15:52):
There's a distinct form of
inequality, really.
Social inequality.
Yeah.
That that that that iswhat I'm, I'm saying
saying in the bookbecause I think it's it's really
it creates two groups of people,
those who receive
adequate help and supportand those who don't.
(16:14):
And in my eyes, this is a it's it's
a real
phenomenon.
And it's reallya kind of inequality in itself.
It doesn't go back to other kindsof inequalities,
like like poverty or material deprivationor other kind of issues.
(16:39):
It's it's an issue in itself on its own.
Right, I think. Okay.
Thank you. And
that leads quite well into the next thingI was going to ask you about.
And because one of the purposes ofthe book
is bringing togetherthe state of the are, as you call it, the
the evidence,the existing evidence on care, poverty.
(17:00):
Can you tell us a bit aboutwhat is already known about the issue
and some of thethe factors and and consequences around.
Yes. I must say that that that
it was more difficult than I thought to
to bring this literature togetherand summarise it,
because I found out that the the methodsand and terms and opera
(17:26):
rationalisations actually differquite a lot from each other. So.
So sometimes it was quite difficult to
to put these, the findingsof these different studies together.
But, but still on, on a general levelthere,
it is quite clear that that we have
the issue of care poverty.
(17:48):
It exists in every country.
Studies from all all countrieswhere where this has been studied,
there have found a certain levelof of of unmet needs
and inadequate care.
Some countries
seem to seem to have had more,
(18:09):
particularly countries in Eastern Europe,
southern Europe.
Maybe this bit contradictory evidence
from countrieslike like like the UK or the US.
There are studiesthat show very high levels of,
of care, poverty or unmet needs.
On the other hand, there are some studiesthat show considerably lower levels.
(18:33):
So so the evidence is not very consistent.
And I think this partly because
different studies use different methods.
Nordic countriesseem to be doing quite well.
This maybe most studies come from Swedenthat seems to be
have have very low levelof of of care poverty.
(18:55):
But still they are still olderpeople in Sweden as well
who don't have the Met
needs met in an adequate manner.
So it's it seems that no countryis free free from this problem.
There are certain
factors that that seem to come up
(19:17):
in almost all all studies.
And actually,these are not a very surprising fact.
This health status is clearly linked toto the situation.
So the the worse
the health status
that the more they arecare needs are usually the more
(19:38):
they are also unmet needsand and the higher is kept.
Poverty income level does affect
care, poverty,but not always and in every case.
So there is a bit
some some contradictions in the evidence.
But but in general,
poverty clearly is connected to povertyquite often.
(20:02):
So it is is is a major factor.
But then
living alone is, is really
very clearly a major, major
risk factor for poor care. Poor is.
So if you don't have anybodyto live together with you,
then then you are really certainlyin a risk group,
particularly when you have staffwho have extensive care needs.
(20:27):
And then finally, there's
also a chapter on, on on consequences of
of care poverty And and there
there's already
a growing body of evidencethat shows that actually this situation
where where older people don'treceive the help and support they need,
(20:50):
it has many kinds of consequences.
It affects their health.
It affects their quality of life
that they they they
suffer in many ways, also socially.
And it leads to easily
to a kind of a vicious circlewhere where things
(21:12):
the health condition and the everyday life
are get moreand more problems all the time.
But it also seems to affect the use ofof health care
and also the useof residential social care.
So so the more there they are,there is poverty
(21:33):
amongst olderthe older population, the higher the the
the use of of hospital careor also institutional care,
which kind of tells us that that care.
But it also has consequencesand of costs for
for for health and social care systems.
(21:56):
And some costs could be avoided
if the level of care,but it would be lower.
Thank you very much.
There's lots of interconnectionsunder with
with healthand with formal and informal care.
And and as you say,between care, poverty and
and more and more material poverty.
(22:16):
You've mentioned youryour belief for years and your notion
that this is a really importantand important issue.
And whywhy should we be concerned about this?
Why should we be concernedabout care, poverty?
Of course,the basic starting point is that
is that our populations in inin every country
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are really quite rapidly ageing,which means that the
the number of people with care needsand a need for help and support is, is, is
increasing all the time.
So, so this the,the risks that are connected
with, with care needs,not not having them met, also going up.
(23:00):
So this is becoming really a major issue.
It's not not about a small minority
of of all the peoplewho might be at this risk.
But it's it'sit's becoming really a major.
Very, very typical part of of
(23:20):
life course
and of the population.
So it's it's it's reallya key issue, actually, in our societies,
particularly in the near future,where we will all all of our societies
will enter this super agesociety stage in their development.
And of course, also from from a actually,
(23:43):
I, I am a social workerby my background and, and
of course, the situation of, of people
where they cannot get
adequate help and supportbut but that need to suffer
in many ways that that is something
that our societies
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shouldn't be accepting.
It's it's it's also a moral issue.
It's a ethical issue.
And it really goes to the basics of
of the the the of of our welfare systems,why they exist
and what they should be doingand accomplishing.
You mentioned thereand we use the term super age
(24:29):
and which maybe
I think a lot of our listenerswill be aware of the general
trend of rapidly ageing populations,but maybe the super age term, maybe
you could just briefly say a little bitmore about what you mean by that. Yes.
Well, this term comes fromfrom from the UN, and that has
defineda super age society to mean a society
(24:52):
where more than 20% of the totalpopulation
is aged 65 years or older.
And these kind of societies are increasing
rapidly in the world.
Thank you.
And in terms of policy then,so part of the
in the conclusion to the book, partlywhat you do is you're essentially
(25:16):
making a call for increased evidenceabout this about this issue
and what may be some of the policy ideasor directions
that that could be taken to combator to alleviate care, poverty.
I think thisthere's a need for more work on this.
And I hope that my colleagues
(25:37):
will take up this
challenge.
But but certainly in thein the book already, we can see that
that based on the current
available evidence, we can
see that that kind of a universal
care.
service systemthat tries to cover the whole population
(25:59):
is certainly certainly quite
efficient in decreasing
the level of care poverty in a nation
like like Sweden or Norway.
But then
there can also be different kind
of programmes or interventions
(26:22):
that that could be particularly focussed
on, on those groups of older peoplewho are most
at risk of, of care poverty.
And that isthat is people with with low incomes
with the most health problemswith with the highest
(26:44):
care needs, and particularly older peopleliving alone.
So if these groups are providedparticularly support
and also whether they are
situations are known and checked,
that that could certainly helpto keep the level of care poverty
(27:05):
on a decent, decent level.
But I think this this is really an areawe where we need much more research
and also also the
effort of of peoplewho are working with policies
and practises to really to develop thethe the the approaches.
I think that many of of the
(27:27):
the policies and services that already.
exist are actually doing doinggood work in this respect.
But but that might happen probably
without without really knowing
the processes and mechanismhow how it goes, go.
(27:50):
So I think there really needs to be more,more attention to, to this issue
and these practises and policies and,and certainly need for
development and improvement.
Now that the book is out there
and has been published.
What what are your hopes?
(28:11):
What are your hopes for it
as intended for a particular audiencewho may find it useful?
Who may find it helpful?
Who might find it interesting?
It's an open access book,which means that actually,
I'm. I just
hope that people will find it. And
and and see it useful
(28:32):
in taking the discussion furtherand maybe opening
some new new perspectivesand ideas to to the situation.
An issue of of of whether peoplewhether all people really receive
the help that they they need.
Certainly
the book is, in a way written
(28:54):
for my my colleague researchers
in in different countries in Europe,but also
out out of Europe actually also.
Also, I hope that there could be some usealso in the Global South
for for the book and its approaches,
(29:14):
particularly when it also tries to include
informal care, not just not just the
formal long term care systems.
And and I actually hope that
maybe some people also workingwith with policy in practise would find it
useful in their workwhen they are trying to develop the, the
(29:37):
existing
systems and and interventions
and and their campaigns as well.
I also think that there need to be more,more, more
attention to to, to this issue.
And I really hope that that indifferent countries there could be more,
more, more workand more attention, attention to it
(29:59):
and maybe even some some some campaigns to
to really provide
care that is is required
and needed by by older people,particularly in these
in these risk groups.
So actually, it's really
I hope that there could be quite a broad,broad audience,
(30:21):
people coming from different backgroundsand different countries as well
that could find the book useful.
And if you had.
Have you had people been in touch so far?
Have you had any feedback or.
I got some feedback.
And I and I also
have been
in contact with with colleaguesfrom different countries who say that they
(30:43):
they are interested in in tryingto use this approach in their research.
I think at the moment
there are at least
three countries where colleagues have have
recently made research proposals
using the the the approach .
And I certainly hopethat it could be more more in the future.
(31:08):
And in terms of the
the process and your writing of the book,
is there anything that that you learntduring this,
during the writing, during the processthat you could pass on to others,
and particularly those who may be newto writing books or longer pieces of work.
Is there anything you could share
(31:28):
potentially with maybe youngerlisteners, our listeners here
still at
postgraduate or doctoral levelor even early career researchers?
Well, I think I learnt that writing booksis not rocket science, really.
It just.
It's just like writinga long piece of paper or.
(31:50):
Or two to it.
It's also a great opportunityto really focus
on a specific issue.
I spend more time on that
and select a few approaches,
key approachesthat then you can develop in the chapters.
And of course it's it's quite important toto have the key idea, the whole
(32:15):
in your mind the whole timeso that you or your book
is a coherent piece of work
and not just kind of a fragmentary.
But but I really it was really
a very interesting experienceand I would recommend that.
But, but also, please be
(32:36):
have a patient with yourself.
And, and, and I must say that the writingtook much longer than I thought.
So. So it's it's a bit difficult to do
with very strict deadlines or timetables.
But but certainly I would recommend it
to to to younger
(32:58):
early career researchers
as well as to more seniorones like like myself.
And what about the kind of nutsand bolts of the process?
So like the idea of pitching your bookor finding a publisher.
Getting feedbackand getting people involved in editing.
Yeah, well, well, I, I could say that I, I
(33:19):
was in, in a conference
or a quite several years agowhere I went to the,
to a publisher to
just to askkind of first reaction to my, my, my
book idea, which was not so clearat that time.
I had the conceptand some of some preliminary thoughts,
(33:40):
but I didn't have anyany even an idea paper to to show.
But I just went to I went to the publisher
desk and asked what what, whatwhat do you think?
How does it sound to you?
And and I actuallyI got a very positive response to that.
And, and and I that was really exciting,
(34:02):
I must say, because at that time,I was sort of not
so self-confident with the with the
with thethe concept or the book or the idea.
But that was great encouragement.
And of course, I'd been
discussing quite a lot with my colleaguesgiving presentations
in seminars and conferencesand always getting good feedback,
(34:24):
also critical feedback oftenon, on what I'd been planning and, and
all those
discussions and allthe feedback I have received have always
helped to, to go forward in the process
and get also my own thoughts clearer.
So I think it's one, one
(34:47):
good to get away is really to just go
go forward to tell about your ideas to, to
publishers and also to your colleagues
in different
places, conferences, seminars
and maybe also privatelywith with your close colleagues.
(35:08):
And that that how it gradually develops
into into a book with with with time.
Thank you very much.
Just a couple of questionsto ask you beyond the beyond the book
in the life of the book.
I guess a broader questionreally about you mentioned that you were
you were a social workerpreviously before you and before
(35:31):
you beganyour career in universities, in academia.
And how would how would you say
that your interestsin care and research in care?
How did they how did they develop?
I think that that my
my three years as a social workernot such a long time.
But but they really made me to think thinkand to see the issues on
(35:56):
on all on the practise level and or
and in the lives of of ordinary people.
And and this has been quite a
major perspectivealso in my research work over the years.
And and I think very clearly in this bookthat that I'm really trying to to
(36:20):
kind of combinethis kind of theoretical approaches
with with the researchthat that looks into people's
lives and and and discusseswhat kind of consequences
our social and healthcare services
have have in people's lives.
(36:40):
So I think that this kind of interestsinterest for
for both for macro and micro
in a way comes from on the onehand, from my my, my background
as a social worker and then from mymy training as an academic.
So I think that
that that is somethingthat that is quite quite.
(37:02):
Basic,
basic
or the fundamental approach
in all the work that I'm doing, including
this book.
And a final questionand before we we conclude,
are there any particular academics
(37:23):
or academic works that have influenced you
and especially those in relation to care
because there are audiencesinterested in this this topic,
are there any particular worksor academics that have influenced you.
While they're there? There are many, many.
Of course, I should mention my my mentorprofessor, Jorma Sipilä from from Finland
(37:47):
and and also Professor Anneli Anttonen,who have been kind of the precursor
in international comparative careresearch.
But, but then Iwhen I was that PhD student
and early career research,I really read quite a lot of previous
research on care,particularly feminist social policy.
(38:07):
There were many, many great classics,for example, by Claire Ungerson,
who had a major, major impacton my thinking.
And later,
I also have been reading disabilitystudies and for example, Jenny Morris.
Her writings have really influencedmy, my thinking a lot.
And but they are
they are really quite, quite many, many,I must say.
(38:29):
But I must add that a lot of thatthat the literature that
maybe that I read quite early in my careerwhere really from from the UK
and I think they have really had a majorimpact on, on my thinking and my work.
And of course you've written an article
about the, the connectionsand the between care and disability
(38:52):
studies, which is a reallyis a really interesting article.
It's been very useful in my own own work.
So therefore.
Just before we finish,can you please share with our listeners
how they can get a hold of your book?
While that is actually quite easy,I think you can just Google it
(39:12):
with my with my name,all the term 'care poverty'
and you can find the open, open accessbook available from from the Springer
Link website.
But it's also possible to buy a buya copy, a paperback or a hardback copy
from from from the Internet
(39:33):
, actually,from all all Internet bookshops.
It seems to be available.
So I think it's very easy to find itif you wish.
And I hope that some a few ofyou would like to take a look.
So sorry just to say that, you know,people can Google it, but the the books
available through Springer Link. Yes.
Because Palgrave Macmillan, my publisher,is part of the Springer Company.
(39:58):
So it's the Springer Link websitewhere you can find.
Okay, thank you.
For more episodesand the Care Matters series
and to learn more about the Centrefor Care, please follow the link
and the episode descriptionfor a website and social media channels.
All that remains for me to dois to thank our esteemed guest, Professor
(40:19):
Teppo Kröger.So thank you very much, Teppo.
Thank you, Duncan.
And to thank you for listening. Thank you.
The Care Matters podcast is
brought to youby the ESRC Centre for Care and CIRCLE,
the Centre for International Researchon Care, Labour
and Equalities.
In this series,
our researchers welcome expertsin the field and those giving or receiving
care to discuss crucial issuesin social care as we collectively attempt
(00:30):
to make a positive differenceto how care is experienced
and provided.
Hello and welcome to Care Matters,
the podcast from the Economicand Social Research Council, Centre
for Care and the University of Sheffield'sCIRCLE Research Centre.
(00:51):
My name is Duncan Fisher and I am aresearch associate at the Centre for Care.
We are delighted to welcome hereto Halifax Hall in Sheffield,
Professor Teppo Kröger as our guest,and in this podcast
I will be talking with him about his newlypublished book on Care Poverty.
Welcome to Sheffieldand to Care Matters Teppo.
(01:14):
Thank you, Duncan.
Teppo Kröger is professor of socialand public policy
at the Department of Social Sciencesand Philosophy of the University
of Jyvaskyla, Finland,and also a part time professor
of the Centre for CareResearch in Bergen, Norway.
He's director of the Centre of Excellencein Research on Ageing and Care,
(01:36):
which is a major research investmentby the Academy of Finland,
consisting of around 60 researchersfrom the universities
of the Jyvaskyla, Tampere and Helsinki.
He has studied social care for 30 yearsfrom a number of different perspectives,
oftenin international collaboration, combining
(01:57):
different research approachesand developing new conceptual frameworks,
including welfare,municipality, demographic panic,
care capital and care poverty.
In addition to care poverty,he has written comparative
research on social care,the state of the art
and articlesin a number of international journals,
(02:19):
including the Journal of Social Policy,Critical Social Policy,
Health and Social Careand the Community and Ageing and Society.
He has co-edited books, including
combining Paid Work and Family Care,which was co-edited
along with Professor Sue Yeandle,the director of the Centre for Care.
(02:40):
Again, a warm welcome to your Teppo.
Thanks.
I'd like to start Teppo,Could you please introduce the book
and tell our audiencewhat a little bit about what it's about?
Yeah, well, this
book is a product of aquite a long, long process.
Maybe,
maybe
(03:00):
even 20 years.
I've been trying to think of an approach
to social care, long term carethat would not only focus on on
on resources or services
that are provided,but it would really dig into the key
question that I think that we shouldreally be focussing on that.
(03:23):
That is whether people who need help
and support,whether whether they really get it or not.
And that's really the the key
key idea or the keyquestion of of of this book.
And then then I've been usingand developing
the term care povertyto to stand for a situation
(03:44):
where people don't receive enoughor adequate help and support and care.
And this book is on the one hand, it's
introducing this conceptand it's it's backgrounds.
And on the other hand,it also tries to combine this concept
to existing research on unmet needs.
(04:06):
And then it also aims to summarisethe earlier literature on on this topic.
And so in terms of the ideasthat you mentioned there,
how did the process of developingthose ideas
towards something of book length?
So that could you say a little bitabout how that that happened?
Well,
(04:27):
it is really taking quite a
quite a whilefor me to to think that how how
this approach should be
presented and developed.
And actually,
I use the same concept already.
Was it was it 17 years ago in an article
(04:49):
about lone parentsand their child care arrangements.
But but then since thenI've been trying to also to use it
in the context of, of carefor older people.
And we we brought an empirical articlein, in Finland
that used this term, an approach
(05:10):
that came out three years ago, I think.
But already then I felt that this isthis is such
quite a large issue and topic
that it's not possible really to dig
into it.
In, in, in just a brief, short article
that I need a longer format to discuss it
(05:33):
from different approachesand try to try to cover it properly.
So, so then, then
I thought out of the
it means a book that it'skind of the only way to
discuss it enough
from from different perspectivesis really to write a book.
Thank you.
And can you maybe just say a little bitabout the I guess, the
(05:57):
the kind of parameters of the researchbecause and you mentioned data,
but you previously used the termand the context of lone parent.
And I know that you've written,for example, that
although care, poverty or unmet need
could be experienced in residential care,
your book, for example,is not including that that setting.
(06:21):
Is that right? Yeah, that'sthat's that's right.
This this book is really focussing on
all the people who live in the communitycommunity in their own homes.
And it's, it's that,that is the focus of of it, even though
I do think that the concept couldbe applied also in other other contexts.
(06:42):
So it's
not limitedjust to this, this, this topic.
But but in this book,
I try to use
and combinethree different kinds of literature.
And for myself, I think the most important
literature is, is feminist
(07:02):
social policy,which I've been reading since, since
being a young student thenand what has really impacted
my, my thinking already for four decades.
But then, then in addition to that,I have been reading
general theological studies,
particularly social gerontology,and about long term care.
(07:25):
But then
there's also a third stream of literature
that I then try to combine in
the book is literature on research,
on social inequalitiesand particularly poverty research. So.
I tried to bring these three
(07:47):
properties togetherto provide a kind of a new, new
starting point on new conceptualperspective
into into care,and particularly to inadequate care.
Well,I think that gives us a good sort of basis
to to move on to discusssome of the content of the book.
(08:08):
So I was really struck by the openingof the book introduction.
And you give examples of new storiesfrom different places
about the consequences of care, poverty,and that's something
that you returned to in one of the laterchapters.
Can you say a bit more about this?
How does the book relate to everydaylife and care?
(08:29):
Well,
I hope it doesrelate to everyday life and care,
even though the book mostly consists ofof going through earlier literature
and making some conclusions based on that.
But but actually,
I think at least my
motivation comes from really from, from,from the everyday life
(08:51):
and being really worriedabout the situation of many of the people
who cannot receive the,the, the help and support
they would needin, in their everyday lives.
And as you said, I also use some media
stories of real life caseswhere the consequences
(09:15):
of of this lack of help and supporthad been quite dramatic, even even fatal.
And I think that this is a real riskin in in situations
where where people are leftwithout proper attention and care.
And and I think it was also
why I included these
(09:37):
these media narratives
was that I see that it'swe should see that
this is really an importantand a vital and critical issue.
It's not just a theoretical issue,but it's really something
that affects people's lives insometimes in very dramatic ways. Hmm.
(09:59):
Yeah.
And I would certainlythat the examples that you gave were
were very dramatic and and sad really and.
Yeah. And quite moving.
So the concept you mentioned aboutdeveloping the concept of care, poverty
has similarities with terms that you'vementioned already, such as unmet need.
And in the book, you talk about the caregap and the care deficit.
(10:23):
But why why have you chosen specifically
to to develop and focus on care, poverty?
Yeah, well,
actually,all these other terms are also also
useful.
And I'd been using them myself in mymy texts earlier
and I see that they really have haveimportant contribution.
(10:47):
But I still was kind of lacking
a concept that that could kind of
combine different levelsand different approaches.
For example, this care gap and caredeficit terms that are often used for
in social policy discussions,they usually focus on on very much
(11:08):
on the macro level, on the social level,which is, of course extremely important.
But then then you don't really seethe individual level,
the situations of of individual olderpeople
and their struggles and problemsin their daily lives.
So, so
(11:28):
and actually the term unmet need is quite,quite the opposite.
It really,really focuses on the individual level
and particularly thusthese quantitative analyses
of all of the factorsthat that affect people's situations.
But then you kindof have missed the, the, the
(11:50):
larger picture,
the the social
background,
the the inequalities that are present
in our societiesand really inflames the the
who gets enough supportand who who doesn't
and and using this term care
(12:12):
poverty was my way to try to combine
the individual level and the social leveland also to learn
from the long tradition of
of research and their agitation of poverty
and apply their their conceptsand approaches to to the study of care.
(12:32):
Okay. Thank you.
And so can you maybe just say a little bitmore about the mechanics of that?
Because you mentioned about how we haveand we know what people.
People's needs may be are.
But but in terms of care, poverty
is about more than thatinteraction with the level of
care that's available.
(12:54):
And your book is not only services, it'salso this including you
include informal care as well, don't you,within your remit or your scope.
Yeah. Yeah, that's that, that's true.
That'sthat's also quite a lot of literature
that focusesparticularly on, on care services and, and
(13:15):
formal care.
And it's.
Qualitiesand whether people are happy with that.
That's also important.
A strand of of research, I think.
But still,if we look only on on on formal care.
The problem is that that we still don'tknow whether people have enough
care and adequate care or not, becauseeven if they don't receive formal care
(13:40):
or adequate formal care,they might get get the help
from their familiesor friends or social network networks.
And that
key question to me, at least,
is that whether they are peoplewho are totally left without
adequate help, whether it comes from
the formal care servicesor from the informal networks.
(14:03):
And that is why I think that we shouldlook at both at the same time, both
both the care service systems
and their provisions and their problems,but also at what
of what families and friends are doingand what they are able
to do or unable to do.
So only if we look at both, both sides
(14:25):
at the same timewe get a full picture, I think.
Thank you.
That's a very interesting point.Thank you.
So you mentioned in the bookalso the difference between
and what your use of the termcare, poverty and other terms
that listeners may be familiar with, suchas food poverty, fuel poverty in the UK.
(14:46):
Certainly these have been and termsthat we've heard quite a lot in the last
the last few years.
So how does care poverty differfrom from these terms?
Yeah, it does differ because
actually these there's food poverty,fuel poverty.
They are still kind of subcategoriesof economic poverty,
(15:08):
lack of material resources.
But in the case of cardboard,that is not really the case.
It's not about material deprivation.
It's about deprivationof adequate help as poor.
So so it's really I would sayit's a parallel concept to poverty,
not not a sub concept of of poverty.
(15:30):
And this is it's kind ofwe are looking at different issues.
Poverty, food poverty,fuel poverty is really about
these material conditions and care poverty
is about care and help and support.
And usually you really arguethat this is something
that is worthyof specific focus in its own right.
(15:52):
There's a distinct form of
inequality, really.
Social inequality.
Yeah.
That that that that iswhat I'm, I'm saying
saying in the bookbecause I think it's it's really
it creates two groups of people,
those who receive
adequate help and supportand those who don't.
(16:14):
And in my eyes, this is a it's it's
a real
phenomenon.
And it's reallya kind of inequality in itself.
It doesn't go back to other kindsof inequalities,
like like poverty or material deprivationor other kind of issues.
(16:39):
It's it's an issue in itself on its own.
Right, I think. Okay.
Thank you. And
that leads quite well into the next thingI was going to ask you about.
And because one of the purposes ofthe book
is bringing togetherthe state of the are, as you call it, the
the evidence,the existing evidence on care, poverty.
(17:00):
Can you tell us a bit aboutwhat is already known about the issue
and some of thethe factors and and consequences around.
Yes. I must say that that that
it was more difficult than I thought to
to bring this literature togetherand summarise it,
because I found out that the the methodsand and terms and opera
(17:26):
rationalisations actually differquite a lot from each other. So.
So sometimes it was quite difficult to
to put these, the findingsof these different studies together.
But, but still on, on a general levelthere,
it is quite clear that that we have
the issue of care poverty.
(17:48):
It exists in every country.
Studies from all all countrieswhere where this has been studied,
there have found a certain levelof of of unmet needs
and inadequate care.
Some countries
seem to seem to have had more,
(18:09):
particularly countries in Eastern Europe,
southern Europe.
Maybe this bit contradictory evidence
from countrieslike like like the UK or the US.
There are studiesthat show very high levels of,
of care, poverty or unmet needs.
On the other hand, there are some studiesthat show considerably lower levels.
(18:33):
So so the evidence is not very consistent.
And I think this partly because
different studies use different methods.
Nordic countriesseem to be doing quite well.
This maybe most studies come from Swedenthat seems to be
have have very low levelof of of care poverty.
(18:55):
But still they are still olderpeople in Sweden as well
who don't have the Met
needs met in an adequate manner.
So it's it seems that no countryis free free from this problem.
There are certain
factors that that seem to come up
(19:17):
in almost all all studies.
And actually,these are not a very surprising fact.
This health status is clearly linked toto the situation.
So the the worse
the health status
that the more they arecare needs are usually the more
(19:38):
they are also unmet needsand and the higher is kept.
Poverty income level does affect
care, poverty,but not always and in every case.
So there is a bit
some some contradictions in the evidence.
But but in general,
poverty clearly is connected to povertyquite often.
(20:02):
So it is is is a major factor.
But then
living alone is, is really
very clearly a major, major
risk factor for poor care. Poor is.
So if you don't have anybodyto live together with you,
then then you are really certainlyin a risk group,
particularly when you have staffwho have extensive care needs.
(20:27):
And then finally, there's
also a chapter on, on on consequences of
of care poverty And and there
there's already
a growing body of evidencethat shows that actually this situation
where where older people don'treceive the help and support they need,
(20:50):
it has many kinds of consequences.
It affects their health.
It affects their quality of life
that they they they
suffer in many ways, also socially.
And it leads to easily
to a kind of a vicious circlewhere where things
(21:12):
the health condition and the everyday life
are get moreand more problems all the time.
But it also seems to affect the use ofof health care
and also the useof residential social care.
So so the more there they are,there is poverty
(21:33):
amongst olderthe older population, the higher the the
the use of of hospital careor also institutional care,
which kind of tells us that that care.
But it also has consequencesand of costs for
for for health and social care systems.
(21:56):
And some costs could be avoided
if the level of care,but it would be lower.
Thank you very much.
There's lots of interconnectionsunder with
with healthand with formal and informal care.
And and as you say,between care, poverty and
and more and more material poverty.
(22:16):
You've mentioned youryour belief for years and your notion
that this is a really importantand important issue.
And whywhy should we be concerned about this?
Why should we be concernedabout care, poverty?
Of course,the basic starting point is that
is that our populations in inin every country
(22:38):
are really quite rapidly ageing,which means that the
the number of people with care needsand a need for help and support is, is, is
increasing all the time.
So, so this the,the risks that are connected
with, with care needs,not not having them met, also going up.
(23:00):
So this is becoming really a major issue.
It's not not about a small minority
of of all the peoplewho might be at this risk.
But it's it'sit's becoming really a major.
Very, very typical part of of
(23:20):
life course
and of the population.
So it's it's it's reallya key issue, actually, in our societies,
particularly in the near future,where we will all all of our societies
will enter this super agesociety stage in their development.
And of course, also from from a actually,
(23:43):
I, I am a social workerby my background and, and
of course, the situation of, of people
where they cannot get
adequate help and supportbut but that need to suffer
in many ways that that is something
that our societies
(24:05):
shouldn't be accepting.
It's it's it's also a moral issue.
It's a ethical issue.
And it really goes to the basics of
of the the the of of our welfare systems,why they exist
and what they should be doingand accomplishing.
You mentioned thereand we use the term super age
(24:29):
and which maybe
I think a lot of our listenerswill be aware of the general
trend of rapidly ageing populations,but maybe the super age term, maybe
you could just briefly say a little bitmore about what you mean by that. Yes.
Well, this term comes fromfrom from the UN, and that has
defineda super age society to mean a society
(24:52):
where more than 20% of the totalpopulation
is aged 65 years or older.
And these kind of societies are increasing
rapidly in the world.
Thank you.
And in terms of policy then,so part of the
in the conclusion to the book, partlywhat you do is you're essentially
(25:16):
making a call for increased evidenceabout this about this issue
and what may be some of the policy ideasor directions
that that could be taken to combator to alleviate care, poverty.
I think thisthere's a need for more work on this.
And I hope that my colleagues
(25:37):
will take up this
challenge.
But but certainly in thein the book already, we can see that
that based on the current
available evidence, we can
see that that kind of a universal
care.
service systemthat tries to cover the whole population
(25:59):
is certainly certainly quite
efficient in decreasing
the level of care poverty in a nation
like like Sweden or Norway.
But then
there can also be different kind
of programmes or interventions
(26:22):
that that could be particularly focussed
on, on those groups of older peoplewho are most
at risk of, of care poverty.
And that isthat is people with with low incomes
with the most health problemswith with the highest
(26:44):
care needs, and particularly older peopleliving alone.
So if these groups are providedparticularly support
and also whether they are
situations are known and checked,
that that could certainly helpto keep the level of care poverty
(27:05):
on a decent, decent level.
But I think this this is really an areawe where we need much more research
and also also the
effort of of peoplewho are working with policies
and practises to really to develop thethe the the approaches.
I think that many of of the
(27:27):
the policies and services that already.
exist are actually doing doinggood work in this respect.
But but that might happen probably
without without really knowing
the processes and mechanismhow how it goes, go.
(27:50):
So I think there really needs to be more,more attention to, to this issue
and these practises and policies and,and certainly need for
development and improvement.
Now that the book is out there
and has been published.
What what are your hopes?
(28:11):
What are your hopes for it
as intended for a particular audiencewho may find it useful?
Who may find it helpful?
Who might find it interesting?
It's an open access book,which means that actually,
I'm. I just
hope that people will find it. And
and and see it useful
(28:32):
in taking the discussion furtherand maybe opening
some new new perspectivesand ideas to to the situation.
An issue of of of whether peoplewhether all people really receive
the help that they they need.
Certainly
the book is, in a way written
(28:54):
for my my colleague researchers
in in different countries in Europe,but also
out out of Europe actually also.
Also, I hope that there could be some usealso in the Global South
for for the book and its approaches,
(29:14):
particularly when it also tries to include
informal care, not just not just the
formal long term care systems.
And and I actually hope that
maybe some people also workingwith with policy in practise would find it
useful in their workwhen they are trying to develop the, the
(29:37):
existing
systems and and interventions
and and their campaigns as well.
I also think that there need to be more,more, more
attention to to, to this issue.
And I really hope that that indifferent countries there could be more,
more, more workand more attention, attention to it
(29:59):
and maybe even some some some campaigns to
to really provide
care that is is required
and needed by by older people,particularly in these
in these risk groups.
So actually, it's really
I hope that there could be quite a broad,broad audience,
(30:21):
people coming from different backgroundsand different countries as well
that could find the book useful.
And if you had.
Have you had people been in touch so far?
Have you had any feedback or.
I got some feedback.
And I and I also
have been
in contact with with colleaguesfrom different countries who say that they
(30:43):
they are interested in in tryingto use this approach in their research.
I think at the moment
there are at least
three countries where colleagues have have
recently made research proposals
using the the the approach .
And I certainly hopethat it could be more more in the future.
(31:08):
And in terms of the
the process and your writing of the book,
is there anything that that you learntduring this,
during the writing, during the processthat you could pass on to others,
and particularly those who may be newto writing books or longer pieces of work.
Is there anything you could share
(31:28):
potentially with maybe youngerlisteners, our listeners here
still at
postgraduate or doctoral levelor even early career researchers?
Well, I think I learnt that writing booksis not rocket science, really.
It just.
It's just like writinga long piece of paper or.
(31:50):
Or two to it.
It's also a great opportunityto really focus
on a specific issue.
I spend more time on that
and select a few approaches,
key approachesthat then you can develop in the chapters.
And of course it's it's quite important toto have the key idea, the whole
(32:15):
in your mind the whole timeso that you or your book
is a coherent piece of work
and not just kind of a fragmentary.
But but I really it was really
a very interesting experienceand I would recommend that.
But, but also, please be
(32:36):
have a patient with yourself.
And, and, and I must say that the writingtook much longer than I thought.
So. So it's it's a bit difficult to do
with very strict deadlines or timetables.
But but certainly I would recommend it
to to to younger
(32:58):
early career researchers
as well as to more seniorones like like myself.
And what about the kind of nutsand bolts of the process?
So like the idea of pitching your bookor finding a publisher.
Getting feedbackand getting people involved in editing.
Yeah, well, well, I, I could say that I, I
(33:19):
was in, in a conference
or a quite several years agowhere I went to the,
to a publisher to
just to askkind of first reaction to my, my, my
book idea, which was not so clearat that time.
I had the conceptand some of some preliminary thoughts,
(33:40):
but I didn't have anyany even an idea paper to to show.
But I just went to I went to the publisher
desk and asked what what, whatwhat do you think?
How does it sound to you?
And and I actuallyI got a very positive response to that.
And, and and I that was really exciting,
(34:02):
I must say, because at that time,I was sort of not
so self-confident with the with the
with thethe concept or the book or the idea.
But that was great encouragement.
And of course, I'd been
discussing quite a lot with my colleaguesgiving presentations
in seminars and conferencesand always getting good feedback,
(34:24):
also critical feedback oftenon, on what I'd been planning and, and
all those
discussions and allthe feedback I have received have always
helped to, to go forward in the process
and get also my own thoughts clearer.
So I think it's one, one
(34:47):
good to get away is really to just go
go forward to tell about your ideas to, to
publishers and also to your colleagues
in different
places, conferences, seminars
and maybe also privatelywith with your close colleagues.
(35:08):
And that that how it gradually develops
into into a book with with with time.
Thank you very much.
Just a couple of questionsto ask you beyond the beyond the book
in the life of the book.
I guess a broader questionreally about you mentioned that you were
you were a social workerpreviously before you and before
(35:31):
you beganyour career in universities, in academia.
And how would how would you say
that your interestsin care and research in care?
How did they how did they develop?
I think that that my
my three years as a social workernot such a long time.
But but they really made me to think thinkand to see the issues on
(35:56):
on all on the practise level and or
and in the lives of of ordinary people.
And and this has been quite a
major perspectivealso in my research work over the years.
And and I think very clearly in this bookthat that I'm really trying to to
(36:20):
kind of combinethis kind of theoretical approaches
with with the researchthat that looks into people's
lives and and and discusseswhat kind of consequences
our social and healthcare services
have have in people's lives.
(36:40):
So I think that this kind of interestsinterest for
for both for macro and micro
in a way comes from on the onehand, from my my, my background
as a social worker and then from mymy training as an academic.
So I think that
that that is somethingthat that is quite quite.
(37:02):
Basic,
basic
or the fundamental approach
in all the work that I'm doing, including
this book.
And a final questionand before we we conclude,
are there any particular academics
(37:23):
or academic works that have influenced you
and especially those in relation to care
because there are audiencesinterested in this this topic,
are there any particular worksor academics that have influenced you.
While they're there? There are many, many.
Of course, I should mention my my mentorprofessor, Jorma Sipilä from from Finland
(37:47):
and and also Professor Anneli Anttonen,who have been kind of the precursor
in international comparative careresearch.
But, but then Iwhen I was that PhD student
and early career research,I really read quite a lot of previous
research on care,particularly feminist social policy.
(38:07):
There were many, many great classics,for example, by Claire Ungerson,
who had a major, major impacton my thinking.
And later,
I also have been reading disabilitystudies and for example, Jenny Morris.
Her writings have really influencedmy, my thinking a lot.
And but they are
they are really quite, quite many, many,I must say.
(38:29):
But I must add that a lot of thatthat the literature that
maybe that I read quite early in my careerwhere really from from the UK
and I think they have really had a majorimpact on, on my thinking and my work.
And of course you've written an article
about the, the connectionsand the between care and disability
(38:52):
studies, which is a reallyis a really interesting article.
It's been very useful in my own own work.
So therefore.
Just before we finish,can you please share with our listeners
how they can get a hold of your book?
While that is actually quite easy,I think you can just Google it
(39:12):
with my with my name,all the term 'care poverty'
and you can find the open, open accessbook available from from the Springer
Link website.
But it's also possible to buy a buya copy, a paperback or a hardback copy
from from from the Internet
(39:33):
, actually,from all all Internet bookshops.
It seems to be available.
So I think it's very easy to find itif you wish.
And I hope that some a few ofyou would like to take a look.
So sorry just to say that, you know,people can Google it, but the the books
available through Springer Link. Yes.
Because Palgrave Macmillan, my publisher,is part of the Springer Company.
(39:58):
So it's the Springer Link websitewhere you can find.
Okay, thank you.
For more episodesand the Care Matters series
and to learn more about the Centrefor Care, please follow the link
and the episode descriptionfor a website and social media channels.
All that remains for me to dois to thank our esteemed guest, Professor
(40:19):
Teppo Kröger.So thank you very much, Teppo.
Thank you, Duncan.
And to thank you for listening. Thank you.
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