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.
Nigeria has a predominantly youthful population and limited job opportunities in the formal labour market, which makes the search for formal employment difficult and can be conducive to the growth of exploitative working conditions. As one response to address the vulnerability of Nigerian workers, the Employee's Compensation Act was passed into law in December 2010. Of note, the Act includes provisions for compensation for mental health injuries, or “mental stress”, suffered in the course of employment. The article examines the strengths and weaknesses of the provisions, in particular the premise for mental health injury claims made in the Act. The wider policy implications of the Act as regards the development of compensation for mental health injuries in sub‐Saharan Africa are discussed and suggestions for the future review of the Act offered.
The informal workforce is growing worldwide, and changes in the global structure of employment and in places of employment mean that work is a source of hazard and ill‐health for many poorer workers. Yet informal workers do not have access to work‐related social security. They face high work‐related risks, but have little or no access to reliable formal or informal social protection. Citizen‐focused social security programmes, such as cash transfers, do not give enough attention to the needs of able‐bodied adults who work. Further, informal workplaces are not covered by the traditional discipline and practice of occupational health and safety (OHS), which is a necessary component of overall work‐related social security. In particular, poorer informal workers are ill‐placed to make use of possible preventive interventions, as they may lead to loss of income in the short term. A more inclusive approach will require changes in the institutional arrangements governing OHS, and should involve especially local authorities and informal worker organizations, who are developing influential international sectoral networks. In this regard, promising examples of negotiated and inclusive OHS policy reforms are presented. The broader challenge is to develop an expanded OHS that specifically includes informal workers as “workers”, rather than as “vulnerable citizens” who qualify only for poverty‐oriented social protection programmes, and that explicitly addresses preventive measures.