Three discourses of Green Care: multifunctional agriculture, public health and social inclusion

Bettine B Bock and Simon J. Oosting, from the Cost 866 report; The Econics of Green Care in Agriculture.
IBN:978 1 907382284 August 2010

The Dutch model of Green Care often serves as an example of a
‘professional’ Green Care arrangement. It has many participants, it is well
organised, officially recognized and registered, and is well-paid through
official fees (Roest 2005 and 2007; Elings & Hassink 2006; Hassink et al.
2007). We therefore began our study by using the Dutch model as a point
of departure to develop a classification system. However, when comparing
green arrangements across Europe, it became obvious that the Dutch
model is far from common. In many countries Green Care arrangements
develop in different ways and follow a different logic (di Iacovo and
O’Connor 2009). The variety of GCAs cannot be covered by the Dutch
model. Moreover, taking the Dutch model as a point of reference gives the
impression that it represents the most desirable model that others may not
have fully achieved. As a result, the (socio-economic) value of other types
of GCAs will not be understood and may possibly be underestimated.
When comparing the different ways in which Green Care is presented and
discussed throughout Europe, the different ways in which it is organised,
and the different parties involved, three main models come to the fore.
These three European ‘discourses’ about Green Care are: 1) the model of
multifunctional agriculture, 2) the model of public health and 3) the model
of social inclusion.
In sociology, the concept of ‘discourse’ is used to conceptualise the basic
premises on which social practices are built. They typically include the
public representation of how something is and ought to be (the meaning), as
well as the public organization of phenomena (Edgar and Sedgwick 2003).
17
Discourses are ideal-types, which means that discourse research focuses on
and extrapolates differences and correspondences in order to understand the
particularity of different systems. In practice, differences can be less clear
and organisational forms can overlap. The same is true for the three main
discourses of Green Care presented in this chapter. In describing them, we
aim to understand which different frames of reference are guiding Green
Care arrangements and explain why Green Care is defined, perceived
and regulated differently in different countries. Not all arrangements will
fit perfectly into these categories and we may find multiple systems and
discourses in each country. Furthermore, the situation will most probably
become more mixed in the future as ideas from other countries and systems
are adopted. However, without clearly perceiving the differences, it is
difficult to understand and acknowledge the core substance and value
of different arrangements. This is necessary to model and calculate both
economic and social costs and benefits in a meaningful way.
The discourse of multifunctional agriculture
Most research in the Netherlands views Green Care activities as one
of many forms of producing extra income. Researchers calculate the
amount of income generated through this activity and analyse its relative
contribution to the farm’s function of costs and benefits (Hassink et al.
2007; Oltmer and Venema 2008; Roest 2005 and 2007; Van der Ploeg and
Roep 2003; Van der Ploeg et al. 2002). Within this frame of reference,
Green Care is perceived as part of the agricultural sector and one of the
new sources of farm income. At the same time, Green Care is presented as
one of the multiple new functions that agriculture can fulfil in an urbanising
society (Wiskerke 2007 and 2009). Green Care is typically represented as
‘care farming’, which highlights the importance of the setting within the
farm sector. Economic studies aim to demonstrate that Green Care now
constitutes one of the most important sources of income for multifunctional
farmers (Hassink et al. 2007).
The farm-focused discourse is reflected in the description of the Dutch
Green Care philosophy, which portrays the green and natural environment
as healthy and curative. But great importance is also attached to the
immersion in an ‘ordinary’ farm context, the involvement in ‘normal’ and
hence relevant and useful work and the social interaction with ‘normal’
farmers and a ‘normal’ family or family-like group of clients and farmer
18 The Economics of Green Care in Agriculture
(Elings and Hassink 2008; Hassink and Ketelaars 2003). Farmers should
of course know how to deal with their clients/patients, but they should
not become health professionals and they should not engage in explicit
therapeutic interaction. They should remain themselves, ‘real’ farmers
(Enders-Slegers 2008; Elings 2004). Ferwerda-Van Zonneveld et al. (2008)
described how important the farmer is for autistic children as role model
and attachment figure. They also concluded that farmers are important in
the care chain i.e., as personal intermediary between care institutions and
parents and for monitoring and evaluating the behaviour and performance
of clients in a non-institutional setting. Care farmers aim to provide
‘care’ in a new way, namely, on a small scale, with personal attention and
individual care. This approach differs from institutional care and other
forms of health care. Although care farming is an economic activity and
often an indispensable source of income, farmers often mention social
motives as the most important driver to initiate care activities on their farm
(Roest 2005).
Placing ‘Green Care’ in the context of multifunctional agriculture makes
sense if one examines the organisation of Green Care activities in the
Netherlands. Most Green Care activities take place on private farms under
supervision of the farmer (which can be male or female). Traditionally,
farmers have engaged in care activities on a voluntary basis, motivated
by feelings of social responsibility. In the course of the 1990’s, a growing
number of farmers started care as a commercial activity as one of several
diversifying strategies (Van der Ploeg 2003). In most cases, farmwomen
initiated such activities in order to create their own employment, as many
of them had experience working in the health care sector (Bock 2004).
Care farmers are paid for their activities by health care institutions,
which send their clients to the farm as an alternative location for ‘daily
activation programmes’ (occupational activity). They may also be paid by
health insurance (AWBZ) or directly by a customer using his/her personal
health care budget (PGB) (Elings and Hassink 2006). In all these cases,
the payment originates directly or indirectly from health insurance. Some
farmers also earn money out of Green Care activities by positioning
their care engagement as an added value to their agricultural products. In
this way, they can justify and receive a higher price. Care farming was
institutionally stimulated and supported by the Ministry of Agriculture,
Nature and Food Quality and the Ministry of Health, which (among others)
subsidised the foundation of a National Support Centre for Agriculture
and Care, in existence from 1998-2008 (Elings and Hassink 2006). During
that period, care farming has not only grown but also become more
professionalised. This has resulted in the development of certification
systems and education programmes, among others. A new national
association has now taken over their work (http://www.landbouwzorg.nl).
In addition, various regional associations have been set up.
The Dutch situation is unique in the European context. Based on the
SOFAR inventory and COST meetings, we may expect that the situation
to be similar only to Flanders (Goris et al. 2008) and Norway (Haugan
et al. 2006) and potentially Slovenia (di Iacovo and O’Connor 2009). In
Flanders, most green-care activities take place at ‘ordinary’ farms. The
payments are low, but regulated and fixed (40 euro per day) and paid
for by the Ministry of Agriculture. The payment for Green Care services
is considered as a compensation for loss in production (income). The
Flemish Ministry of Agriculture promotes Green Care but there are no
institutional arrangements with the health sector that take care of the
financial organisation (Goris et al. 2008). In Norway, farmers offer a wide
range of care services that include health care, child care, and educational
and recreational activities. Farmers are paid by the relevant public-sector
departments and are encouraged to sign an agreement with the local
authorities (Haugan et al. 2006). When the farmers have no health care
related education, they cooperate with health professionals. However,
there is also a growing number of Green Care oriented training courses
developed for farmers. In Slovenia, new rural development policies
recently started to offer some support for care farming as part of the
promotion of multifunctional agriculture and diversification (di Iacovo and
O’Connor 2009).
The discourse of public health
Other European countries frame ‘Green Care’ within the discourse of public
health and as being part of health promotion activities. This is the case
in Germany (Neuberger et al. 2006) and Austria (Wiesinger et al. 2006),
and probably also the UK, although Green Care in the UK demonstrates
characteristics of all three discourses (Hine 2008). The immersion in nature
and green labour is considered of therapeutic value and is part of a medical
plan of treatment. Green Care is one of many activities that should warrant
caring and curing, or in other words health restoration and protection,
20 The Economics of Green Care in Agriculture
disease prevention and health promotion (Hine 2008; Hine, Peacock and
Pretty 2008). Farmers may be involved as providers of the green (farm)
environment but are not perceived as important actors in the therapeutic
process. Green Care arrangements may take place at various locations but
always under the responsibility of health professionals.
Green Care is often part of holistic health care approaches, which attach
importance to recognising how health is embedded in specific physical and/
or socio-cultural contexts. This philosophy gives most importance to the
restorative effect of being in a natural environment (De Bruin et al. 2010;
Verheij et al. 2008; Kaplan 1995; Sempik and Aldridge 2006). Various
studies have been done which try to prove the health effectiveness of
Green Care. For example, they have shown how being on a farm stimulates
physical activity among elderly clients (De Bruin et al. 2009), which in turn
stimulates their appetite (De Bruin et al. 2010b). But some also consider
the mental and emotional benefits that results from caring for living objects
– be it animals (Ferwerda-van Zonneveld et al. 2008; Berget et al. 2008;
Berget and Braadstad 2008a/b; Bokkers 2006) or plants (Putz 2006; Ziwich
et al. 2008; Elings 2006). Some also underline the beneficial effects of
‘healthy’ landscapes (Van Elsen and Schuler 2008) and the importance of
the (physical and spiritual) experience of growth and change in natural
cycles and seasons (De Vries 2006). Losing contact with the earthly basis
of our existence may also be seen as a cause of illness; re-establishing
this context is perceived as restoring physical and mental well-being. In
Germany and Austria, this philosophy stems from the anthroposophist
movement but has also spread into conventional health care institutions.
In Austria and Germany, Green Care activities are generally located
at health care institutions and organised through hospital gardens and
institutional farms (Wiesinger et al. 2006; Neuberger et al. 2006). There
are few ‘ordinary’ farms involved in Green Care activities at their farm;
most of them are anthroposophist or organic farms. Given the relation to
innovative or ‘alternative’ health care paradigms, this is not surprising.
In the UK, Green Care activities are often part of institutional health
care arrangements but are increasingly also offered by private providers,
including farmers (see chapter 4.6).
How do these arrangements function economically? In many cases, Green
Care activities are paid for from institutional budgets just like any other
therapeutic activity. They may be financed by the Ministries of Health,
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health insurance, private health associations, and directly by clients. The
professionals involved are formally employed and receive wages. Some
of them may work as independent professionals that are paid official fees.
Institutional farms are part of the health care institution and financed
through regular budgets. In cases where a farmer is involved, he or she
is most probably also formally employed by the institution and paid for
according official wages. The primary farm products may be sold or used
in the institution. In both cases, the ‘profit’ (in cash or kind) is generally
property of the institution and not the farmer, even when reinvested into the
farm.
It remains to be seen if there are also more entrepreneurial arrangements
where (self-employed) farmers are paid for the delivery of ‘care products’
and function economically separate from the health care institution (similar
to the Dutch model). In the UK the ‘social entrepreneurship’ model seems
to enable such a provision of Green Care by private farmers within a public
health discourse (see chapter 4.6).
The discourse of social inclusion
A third discourse can be described as the discourse of social inclusion.
In most European countries, Green Care involves not only the caring and
curing of clients who are in ‘ill health’. Other activities such as school
visits, involvement of unemployed persons, prisoners or former drug
addicts are also grouped under Green Care (di Iacovo 2003). Some of these
activities, such as school visits, may also be grouped under the discourse
of public health as they provide education about healthy food and nutrition
and stimulate physical exercise and the experience of nature as part of
health promotion (Schuler 2008). Other activities explicitly mention social
(re)integration and social justice as their main objective.
Social inclusion is the main discourse of Green Care in Italy (di Iacovo
2008; di Iacovo et al. 2006; di Iacovo et al. 2009). Italian Green Care is
often organised by cooperatives, which engage in such activities as part of
their voluntary civic and political engagement. In addition, the increasingly
popular engagement in urban agriculture in the UK and the Netherlands
may be classified under the discourse of social inclusion. They promote the
participation in food production and experience of nature as contributing
to individual health and well-being, but also social cohesion and inclusion
22 The Economics of Green Care in Agriculture
of marginal groups especially in the poorer metropolitan districts (Jarosz
2008; Stobbelaar et al. 2006; Wiskerke 2009). Also in France and Ireland,
civic and voluntary engagement is an important driving force for the
provision of Green Care, which is organised by individual farmers and civic
associations generally without institutional support and in the absence of
formal regulations (di Iacovo and O’Connor 2009).
The engagement of long-time unemployed persons, former drug-addicts
and/or ex-prisoners in farm labour are part of a philosophy of social
reintegration, participation and social inclusion. The goal is to re-establish
the habit of working, build up knowledge and skills and build self-esteem.
These aspects should eventually enable them to find employment in the
regular labour market and re-integrate into society. Part of the philosophy
is also the belief that manual physical labour generates well-being as well
as the capacity for work (Hine 2008). Agriculture offers the type of manual,
unskilled labour that is running low on regular labour markets. Again, the
immersion in ‘normal’ work and working hours as well as the interaction
with ‘normal’ people are important values of Green Care arrangements.
Looking at those activities from the viewpoint of the providers of care,
social justice and an ethic of care are important elements of the philosophy.
They feel motivated and responsible for rendering modern society more
inclusive and offering a home and sense of belonging to those living on the
margins of society (di Iacovo 2008; Hine 2008).
The organisation and payment of such activities takes many forms.
Some Green Care is organised by formally recognised organizations,
e.g., rehabilitation centres, prisons or social services. In this case, public
social services budgets pay for the activities in question. The clients may
also receive compensation for their labour as part of the reintegration
process. This is the case in institutional farms that belong to a prison
or are set up for the purpose of social integration. When inmates work
for ‘ordinary’ farmers, the farmers may also pay them for their labour.
Farmers can receive payment from social services as an encouragement (or
compensation) for employing ‘difficult’ labourers. The commoditisation
of ‘care’ in the sale of ethical products also provides a kind of payment to
the farmer (Carbone, Gaito and Senni 2007). In many cases where Green
Care activities are part of the voluntary sector and organised as part of the
civic engagement of individuals, groups or social movements. In these
cases, there is no formal payment and monetary costs and benefits are not
considered to be important (di Iacovo 2008).
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2.2 Conclusion
These three discourses structure the wide variety of Green Care
arrangements into three major streams based on organisation and
philosophy. They also differ in financial arrangements and recognition
of costs and benefits, which we have shown to the extent possible based
on the limited information available. Chapter 4 contains a more detailed
analysis, with a discussion of the costs and benefits of specific Green
Care arrangements representing the three main discourses. Again, this
classification is ideal-typical. It describes Green Care arrangements as
belonging to one of three discourses. In practice, of course, Green Care
arrangements share characteristics of different discourses. Normally,
however, one discourse is prominent, as in the example of defining
organisation and payment. We have also described certain discourses
as dominant in certain countries. This does not exclude the presence of
different arrangements and it does certainly not exclude the possibility of
change. The main purpose of the classification is to analyse and clarify the
wide variety in Green Care arrangements in Europe in terms of organisation
and philosophy. Understanding how and why the different arrangements
function differently allows us to learn more about each one. Each way of
providing Green Care has different costs and benefits. One best solution
does not exist.