Voluntary Sector and Urban Health Systems

Abstract

Beyond the role of the state and private sector, the task of responding to increasingly complex challenges in delivering urban health care in the early 21 st century is being met by the voluntary sector. This chapter outlines some of the key critical points of debate concerning how the voluntary sector has moved into this focal position. The first half of the chapter traces how the role of the voluntary sector has followed a complex trajectory since being 'rediscovered' by the state in the 1970s, defined by three phases: as panacea, paradox and precarity. The second part of this chapter explores how the voluntary sector is both 'in' and 'of' cities: voluntary organisations concentrate there, but they have also cultivated greater cultural proximity and solidarity with urban residents' local values. Yet, relying on a sector that by default is more de-centralised and organic becomes a challenge in contexts where urban space is marked by various pressures around precarity of health services. for people with mental health issues (DeVerteuil 2015), disabilities (Power and Bartlett 2015), and support needs in older age (Milligan and Wiles 2010). Fundamentally, the health 'system' should be understood as more than solely 'health services': it can include urban transport, community networks, public amenities, and educational services. Indeed, any community-led resource that helps people's health and wellbeing can be included. Taken together, the actions of the voluntary sector and volunteers, both formal and informal, are rooted in the broader philosophy of voluntarism-that is, non-coerced action by civil society, usually for public benefit, outside the constraints of the state (Brandsen et al 2005). When seen in this light, the voluntary sector is a significant player in urban health, through a myriad of different initiatives, for example, community transport schemes, urban farms, and lifelong learning groups (e.g. Men's Sheds). Rather than solely offer a review of literature, the purpose of this chapter is to outline some of the key critical points of debate concerning how the voluntary sector is evolving and responding to the increasingly complex challenges in delivering urban health care in the early 21 st century, drawing on pertinent literature where relevant. It is a chapter of two halves. The

The political economy of healthcare access and Chicagoland health-oriented non-profit organizations

“…However, organized, inter-CBO coalitions can counter these effects and push back against limited funding, and create opportunities for the positive potential of crisis policy where concepts like solidarity can counter neoliberal approaches to crisis (Temenos, 2022). While not all community organizations included in this purposeful sample focus on healthcare services, in response to COVID-19, most provided some type of dedicated services assisting with basic healthcare access and thus part of the larger health system (Power and Skinner, 2017). Thus, this paper provides a unique and rare understanding of how suburban community organizations in the Chicago region experienced federal, state, and county government support and responded to challenges in the wake of the COVID-19 pandemic.…”

“…Similar work exists in Canada, but not necessarily within the United States (Cahuas, 2018;Veronis, 2013). This paper also contributes to research on how community organizations provide healthcare to marginalized groups, and suburban community organizations providing services (Power and Skinner, 2017).…”

“…Conceptually, the shadow state has been expanded on, identifying the voluntary sector not existing in only one capacity, often working for the communities it serves, but also subject to tension and extreme oversight by the state (DeVerteuil et al, 2020). As this applies to urban health systems specifically, the voluntary sector is multiscalar, diffused, and uneven in capacity, resources, and support, creating an unsteady structure of healthcare (Power and Skinner, 2017). Broadly, within the third sector, the unevenness in types of organizations and their community roles and in relation to the state and to one another was defined in relation to refugee community organizations (RCOs) (Benson, 2022).…”

“…There is a smaller population for mutual aid funds to draw from, and fewer funders, along with a more regional placement. This lack of infrastructure of civic institutions places more burden on suburban organizations to provide the same level of services as other groups located in Chicago proper with more access to such infrastructure (like mutual aid funds) (Power and Skinner, 2017). While creativity navigating the grant restrictions is common regardless of location, the ability to connect and coordinate with other organizations or mutual aid funds, or request even other local government resources (like a larger county or city government like Cook County or Chicago), is a type of civic institutional infrastructure more isolated Chicagoland suburban organizations lack.…”

The relational geographies of the voluntary sector: Disentangling the ballast of strangers

“…The advent of a universal welfare state in the Global North precipitated a long decline of the voluntary sector in the post-war period (DeVerteuil, 2011). But since the 1980s, the scale and scope of the voluntary sector as a vehicle for service delivery for the vulnerable has increased in lockstep with the receding welfare state, a mutualistic panacea for ameliorating the effects of devolved and increasingly dismantled public health and social care provision (Power and Skinner, 2019). Wolch (1990) was enormously influential in identifying a new partnership model between the state and the voluntary sector, one she defined as a shadow state, through which the welfare state could safely devolve risk and responsibility to non-state actors to fill the missing gaps.…”