First published in 1948, the International Social Security Review is the principal international quarterly publication in the field of social security.
This article assesses the effectiveness of pension provision and health insurance in preventing ill health among older people in developing countries. It argues that, until recently, social protection agendas devoted insufficient attention to health risk prevention, instead focusing on the reduction of income poverty through cash transfers. The article shows that there is little reliable evidence to indicate that providing older people with pension benefits enhances their health status and that these effects should not be taken for granted by policy‐makers. The article then focuses on the effect of inclusion in health insurance schemes on health outcomes for older people, with specific reference to outcomes related to hypertension. Drawing on newly‐available data from the World Health Organization for Ghana, Mexico and South Africa, it shows that older people with health insurance are marginally more likely to be aware of health conditions such as hypertension and more likely to have them under control. Nevertheless, the great majority of hypertensive older people, insured or uninsured, are not effectively treated. The chief barriers to treatment are shown to be mainly related to awareness and service provision, rather than financial ones. Consequently, the capacity of pensions or health insurance to enhance health outcomes for older people in such countries, including in rural areas, is heavily contingent upon health education, health screening and adequate health service provision. These interventions should be viewed as an integral element of mainstream social protection strategies, rather than adjuncts to them. Yet, in practice, social protection and health promotion continue to be treated as almost entirely separate spheres, thus presenting substantial institutional barriers to developing combined interventions.
An important contribution to preventing social insecurity can be made by strong social security programmes that promote collective as well as personal security: in particular, they act as built‐in automatic stabilizers with social and political as well as economic benefits for the whole society. By contrast, weaker systems have a destabilizing effect built in that reduces their preventive effectiveness. The ways in which social security systems can contribute to preventing social and economic insecurity have become less effective in many countries. Reasons for the relative neglect of prevention are considered together with the changes that have weakened systems' preventive elements specifically. The structural context within which social security policies have to work, particularly the quality and quantity of employment as well as the interaction with other public programmes, has of course a major effect on their ability to prevent. There is still much that can be achieved by schemes with closer attention directed to what is needed to prevent insecurity. Proposals to strengthen the preventive contribution in social security programmes are offered to promote greater debate of these issues and to restore the goal of prevention as a central objective.
Preventing social exclusion has become a critical issue in the European Union (EU) as a result of cutbacks in social expenditure imposed by Member States’ exploding debt. This issue sits at the intersection of employment and training policies and of reforms seeking to adapt social protection systems to the new realities of the present socio‐economic context (population ageing, family instability, massive unemployment, employment insecurity, in‐work poverty and persistent and increasing social inequality). This article will show that promoting social protection as part of a social investment approach is an excellent means of reconciling the objectives of equal opportunity over the life cycle, sustained economic performance (improved structural competitiveness) and strengthened social cohesion in the interest of collective well‐being. Particular emphasis is given to the need to promote universal and individual rights to mobility and lifelong training, which would constitute new social guarantees, offsetting requirements linked to labour market flexibility. The article also emphasizes the importance of incorporating these rights throughout the EU as part of a wider social protection floor. This would offer permanent protection against the risk of exclusion in the Union, promote the economic and social integration sought since the revised Lisbon Strategy (2003‐2005), and create confidence and hope among Europe's citizens.