five - Health/care, well-being and citizenship

Summary

Introduction

This chapter focuses on the provision of formal health/care services and considers their importance in relation to retirement migration. Health status is central to well-being and considerations around access to constituent resources (such as health and social services and climate) form a key concern both in migration decision-making (on the timing and location of moves, for example) and citizenship experience in the host state. Health status is not only a primary concern in retirement in its own right, it is also central to the exercise of agency. Mobility, not simply in terms of international moves but also in the sense of ‘getting about’ is so important to participation and autonomy in a more general sense.

From the outset it is useful to clarify a number of points, not least how the notion of ‘formal health/care services’ is used in subsequent discussions. The term ‘formal’ is used to differentiate the health/care services provided by the state, private and voluntary sectors from the often extensive informal welfare support provided to senior citizens by family members. It should be remembered, however, that in reality the types and extent of formal services available are very much underpinned by (often female) informal provision and assumptions about the role of familial welfare in meeting needs. So while this book, for the sake of clarity, considers formal health/care services in this chapter and informal care in Chapter Seven, a symbiotic relationship exists between the two. When considering the care of senior citizens distinctions between health and social care are also problematic. The boundary between health services and social services is blurred when both may often be crucial to the overall well-being of an older person. Deliberate use is therefore made of the term ‘health/care’ on a number of occasions.

The chapter is divided into two main parts. The first part provides a comparative outline of the formal health/care provisions available to senior citizens in the six participant countries. Recent developments are discussed and similarities and differences in approach noted. We have already referred in Chapter One to the importance of location in terms of access to resources. Citizenship entitlement of Community migrants in the host state is based on the principle of non-discrimination and not harmonisation.