Background: We examined the association of housing affordability with physical and mental health in Hong Kong, where there is a lack of related research despite having the worst housing affordability problem in the world, considering potential mediating effect of deprivation. Methods: A stratified random sample of 1978 Hong Kong adults were surveyed. Housing affordability was defined using the residual-income (after housing costs) approach. Health-related quality of life was assessed by the Short-Form Health Survey version 2 (SF-12v2), from which the physical component summary (PCS) and mental component summary (MCS) measures were derived. Multivariable linear regressions were performed to assess associations of housing affordability with PCS and MCS scores, adjusting for sociodemographic, socioeconomic and lifestyle factors. Mediation analyses were also conducted to assess the mediating role of deprivation on the effect of housing affordability on PCS or MCS. Results: Dose–response relationships were observed between housing affordability and mean PCS score (β (95% CI) compared with the highest affordable fourth quartile: −2.53 (−4.05 to −1.01), −2.23 (−3.54 to −0.92), −0.64 (−1.80 to 0.51) for the first, second and third quartiles, respectively) and mean MCS score (β (95% CI): −3.87 (−5.30 to –2.45), −2.35 (−3.59 to −1.11), −1.28 (−2.40 to –0.17) for the first, second and third quartiles, respectively). Deprivation mediated 34.3% of the impact of housing unaffordability on PCS and 15.8% of that on MCS. Conclusions: Housing affordability affects physical and mental health, partially through deprivation, suggesting that housing policies targeting deprived individuals may help reduce health inequality in addition to targeting the housing affordability problem.

The fieldwork placement is recognized as one of the major components of social work education and a major determinant of its quality. A key aspect of the learning process in the fieldwork placement is the exposition of practice encounters to the students’ critical reflection. Given the importance of the process of ‘reflection’ or ‘reflective learning’, a qualitative study based on the reflective logs of social work students was conducted to explore the meaning of social work field education and the learning experiences of social work students during their placement. The study findings revealed that disturbing events experienced by students in their fieldwork were a catalyst to their reflective process. Meanwhile, their undue concern with knowledge and skills application within a circumscribed knowledge frame suggests the dominant influence of scientism and competence-based practice in social work, in which learning outcomes and instrumental and technical reasoning are highly emphasized. Discovery of ‘self’ was also the major premise in the students’ reflection logs, in which a majority of them took their prevailing self-identity as a constant state to be verified in interaction with others in the fieldwork placement. Reflexivity is manifested in asking fundamental questions about assumptions generated by formal and practice theories; it addresses the multiple interrelations between power and knowledge, and acknowledges the inclusion of self in the process of knowledge creation in social work practice. Its realization in social work education requires the social work educators’ reflexive examination of the dynamics that influence the construction of curriculum, which in turn construct our prospective social workers.

Against the achievement of nearly universal coverage for social health insurance for the elderly in China, a problem of inequity among different insurance schemes on health outcomes is still a big challenge for the health care system. Whether various health insurance schemes have divergent effects on health outcome is still a puzzle. Empirical evidence will be investigated in this study. This study employs a nationally representative survey database, the National Survey of the Aged Population in Urban/Rural China, to compare the changes of health outcomes among the elderly before and after the reform. A one-way ANOVA is utilized to detect disparities in health care expenditures and health status among different health insurance schemes. Multiple Linear Regression is applied later to examine the further effects of different insurance plans on health outcomes while controlling for other social determinants. The one-way ANOVA result illustrates that although the gaps in insurance reimbursements between the Urban Employee Basic Medical Insurance (UEBMI) and the other schemes, the New Rural Cooperative Medical Scheme (NCMS) and Urban Residents Basic Medical Insurance (URBMI) decreased, out-of-pocket spending accounts for a larger proportion of total health care expenditures, and the disparities among different insurances enlarged. Results of the Multiple Linear Regression suggest that UEBMI participants have better self-reported health status, physical functions and psychological wellbeing than URBMI and NCMS participants, and those uninsured. URBMI participants report better self-reported health than NCMS ones and uninsured people, while having worse psychological wellbeing compared with their NCMS counterparts. This research contributes to a transformation in health insurance studies from an emphasis on the opportunity-oriented health equity measured by coverage and healthcare accessibility to concern with outcome-based equity composed of health expenditure and health status. The results indicate that fragmented health insurance schemes generate inequitable health care utilization and health outcomes for the elderly. This study re-emphasizes the importance of reforming health insurance systems based on their health outcome rather than entitlement, which will particularly benefit the most vulnerable older groups.

Population growth and urbanization have resulted in the emergence of mega cities in recent decades. While compact urban fabrics and high residential density imply intensive interactions between man and environment, the living environment may be one of the most important factors affecting quality of life (QOL) of city dwellers. With this in mind, this paper seeks to understand the manners in which the residents relate themselves to the places they live and how they derive neighborhood and QOL, in such way that the relationship between living environment and QOL can be understood. A random telephone survey (N = 1,114) was conducted in Hong Kong. Results showed that different levels of neighborhood satisfaction varied in residents of different housing types and living environment was a significant predictor of resident’s QOL. Other than the architecture of housing, this paper highlights the importance of services and facilities for the development of social relations and community building. This paper may supplement to the Western QOL studies and provide reference for urban planning initiatives for Asian cities.