First published in 1948, the International Social Security Review is the principal international quarterly publication in the field of social security.
The adoption of the International Labour Organization Recommendation concerning national floors of social protection, 2012 (No. 202) highlights the global importance of the extension of social security coverage. To maximize the positive impacts of coverage extension, not only should benefits and services be provided to the widest number of people and cover the greatest number of risks, but benefits have to be adequate. Whilst not without challenges, the level of coverage can be defined and measured. However, the definition of what is an adequate benefit is often less clear and has often relied on the use of one measure – the replacement ratio – to determine the relative adequacy of cash benefits. Given the multiple aims of social security systems, the use of a broader measure of adequacy that goes beyond cash benefit levels is not only more appropriate but necessary. In a context where financial constraints are arguably greater than ever, this article looks at the importance of adequacy and why such a broader consideration is required to measure the other aspects of benefit and service provision. It highlights how such a multivariable analysis could be constructed and the challenges of doing so. By attempting to measure if other goals of benefit provision are met – including quality of service, labour market aims, security of benefits and interaction with other stakeholders – the article seeks to contribute to widening the debate.
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.