The adoption of the International Labour Organization Recommendation concerning national floors of social protection, 2012 (No. 202) highlights the global importance of the extension of social security coverage. To maximize the positive impacts of coverage extension, not only should benefits and services be provided to the widest number of people and cover the greatest number of risks, but benefits have to be adequate. Whilst not without challenges, the level of coverage can be defined and measured. However, the definition of what is an adequate benefit is often less clear and has often relied on the use of one measure – the replacement ratio – to determine the relative adequacy of cash benefits. Given the multiple aims of social security systems, the use of a broader measure of adequacy that goes beyond cash benefit levels is not only more appropriate but necessary. In a context where financial constraints are arguably greater than ever, this article looks at the importance of adequacy and why such a broader consideration is required to measure the other aspects of benefit and service provision. It highlights how such a multivariable analysis could be constructed and the challenges of doing so. By attempting to measure if other goals of benefit provision are met – including quality of service, labour market aims, security of benefits and interaction with other stakeholders – the article seeks to contribute to widening the debate.

Despite progress on extending social health protection coverage, most low‐income countries are still far from achieving universal health coverage and thus key objectives related to improvements in health, such as those aimed at by the Millennium Development Goals (MDGs), will almost certainly not be realized by 2015. Principally affected are the most vulnerable populations: the rural and urban poor and workers in the informal economy and their families. It is of particular concern that progress might not only remain limited but even be reversed if policies continue to fail to address the root causes of gaps and deficits in health coverage. This article provides evidence that these causes lie both within and beyond the health sector and are strongly related to poverty and other forms of vulnerability. It argues that sustainable progress towards universal health coverage can only be achieved in an adequate time frame when focusing simultaneously on i) extending health coverage and improving access to needed health care; ii) providing income security through income support to those in need; iii) addressing limitations, or the inability to participate, in income generation from work; and iv) implementing coherent policies within and across the social, economic and health sectors that set priorities on poverty alleviation. Such policies can best be implemented in the context of national social protection floors (SPF) that focus on access to at least essential health care and on providing at least basic income security over the life cycle to all in need. Implementing SPFs may result in breaking the mutual linkages between ill health, poverty and other vulnerabilities and achieving sustainable progress towards universal health coverage and other social protection objectives.

The effectiveness of social protection in combating poverty and vulnerability, cushioning shocks, attenuating inequality, and supporting long‐term growth is well‐established, but effective social protection systems have long been seen as an unaffordable luxury in many developing and low‐income countries. The social protection floor concept aims at providing a guaranteed minimum of social protection at a reasonable cost, even in resource‐constrained circumstances, serving as a platform for the gradual implementation of a full social protection system. Introducing and maintaining or extending the floor requires the mobilization of fiscal space, both immediately and in the future. The article argues that efforts to generate fiscal space must carefully consider issues of predictability, as well as the impact of present funding choices on fiscal and debt sustainability, macroeconomic stability, inequality, poverty reduction and growth, and hence on future fiscal space. It examines from this perspective some of the implications of generating fiscal space through additional domestic resource mobilization, expenditure reallocation or efficiency gains, reduction of debt service, or external funding. The article also presents some evidence of a wide range of recent interventions that have been financed at reasonable cost on a sustainable basis in countries at different levels of income and development, using both own resources and external funds.

In June 2012, the 101st session of the International Labour Conference (ILC) adopted the Recommendation concerning national floors of social protection, 2012 (No. 202). This article explores the linkages between Recommendation No. 202 and the pre‐existing International Labour Organization (ILO) social security standards and its complementarity with these. In response to the questions as to whether the existing ILO social security standards have lost their relevance and whether the new Recommendation has been adopted with a view to replacing the existing ones, the article concludes that its adoption not only complements but also broadens and strengthens the existing international social security code. Together, Recommendation No. 202 and the ILO social security Conventions are viewed as providing a complete and adequate normative framework for the establishment and maintenance of comprehensive social security systems.

Civil society wholeheartedly supports the concept of social protection floors and, in particular, the adoption of the ILO Recommendation concerning national floors of social protection, 2012 (No. 202). The implementation of social protection floors will be a great step forward towards the reduction of poverty and inequality as well as to the empowerment of people worldwide. The civil society movement is convinced that the rights‐based approach is the most effective way to design and implement empowering and sustainable social protection floors. With regard to the human rights‐based implementation of the social protection guarantees, it has four specific attention points: i) respect for the rights and dignity of people holding rights to social security; ii) full participation of civil society; iii) universal coverage at the local, national and international level; iv) and concern for vulnerable groups. Following the 101st International Labour Conference in 2012, 59 civil society organizations set up the “Coalition for a Social Protection Floor”, whose two main tasks are: to monitor and contribute to the universal implementation of social protection floors at local and national levels; and to promote the social protection floor concept in global policy‐making, such as in the discussions on the post‐2015 development agenda.

In the absence of a bilateral agreement for the portability and totalization of social security contributions between the United States and Mexico, this article examines the access to pension and health insurance benefits and employment status of older Mexican return migrants. We find that return migrants who have spent less than a year in the United States have a similar level of access to social security benefits as non‐migrants. Return migrants who have spent at least a year in the United States are less likely to have public health insurance or social security benefits, and could be more vulnerable to poverty in old age. These results inform the debate on a bilateral social security agreement between the United States and Mexico to improve return migrants' social security.

The Mbao Pension Plan is a voluntary individual account savings plan to which all workers in Kenya may contribute without regard to income or age. It is designed to provide a programme that is suitable for the unique nature of the informal sector and to encourage a savings culture for those workers. The key innovation is that low‐income workers can easily make small contributions at relatively low cost, considering the small contributions and small account balances. Participants can conveniently make contributions anytime and anywhere using their cell phones. This savings innovation is made possible by technological innovations that have reduced the costs of cell phones and airtime, and by the entrepreneurial innovation of mobile money. The plan is provided through private‐sector businesses.

Policy‐makers in advanced welfare states have increasingly expressed concerns over large numbers of working‐age people claiming social security support. Accordingly, policies aimed at reducing the level of “benefit dependency” have gained prominence. However, such policies rest on shaky empirical evidence. Systematic collections of national “caseload” data are rare, social security programmes overlap and administrative categories vary over time. The internationally inconsistent treatment of national transfer programmes provides a further challenge for cross‐national comparisons. This article first identifies and discusses several of these problems, and ways in which they may be addressed. It then employs administrative claimant data from six European countries as a way of illustrating trends over time and across countries. The underlying aim is to explore the scientific potential of benefit recipient numbers as an indicator for welfare state change over time and across countries.

The choice of the methodology used to produce a social security pension system's balance sheet is mainly determined by the system's financing approach. In this article, it is shown using the example of the Canada Pension Plan that if the assessment of the financial sustainability of a pay‐as‐you‐go or partially funded system is done through the means of an actuarial balance sheet, then the methodology used should take into account future contributions of current and future participants. The balance sheets produced using the open group approach, as well as methodologies used in United States and Sweden, are discussed.

Across the world, pension systems and their reforms are in a constant state of flux driven by a shifting focus, moving reform needs, and a changing enabling environment that reflect objective events but also changes in views and perception. The ongoing worldwide financial crisis and the adjustment to an uncertain “new normal” will make future pension systems different from past ones. The objectives of this article are: i) to briefly review recent and ongoing key changes that are triggering reforms; ii) to outline the main reform trends across pension pillars over the last two decades; and iii) to present key policy areas on which the pension reform community will need to focus to make a difference.

Chinese health care policy has undergone numerous reforms in recent years that have often led to new challenges, inciting the need for further reform. The most recent reforms attempt to find a middle path between public health care provision and commercial private insurance. In this way, China is following in the footsteps of countries that initially increased the role of privatization in the 1990s and at the beginning of the 21st century, but are now gearing towards public health care. However, this process of constant reform has led to a lack of transparency in the functioning of the health care system, provoking a loss in public trust. There remains an important degree of uncertainty about the future direction of developments in China. Nonetheless, a dual financing approach to health care using tax finance and social insurance might yet crystallize, offering a potential model to inform developments in other countries.

While public expenditure on health care and long‐term care (LTC) has been monitored for many years in European countries, far less attention has been paid to the financial consequences for older people of private out‐of‐pocket (OOP) expenditure necessary to access such care. Employing representative cross‐sectional data on the elderly populations of 11 European countries in 2004 from the Survey of Health, Ageing and Retirement in Europe (SHARE), we find that OOP payments for health care and LTC are very common among the elderly across European countries and such expenditures impact significantly on disposable income: up to 95 per cent of the elderly make OOP payments for health care and 5 per cent for LTC, resulting in income reductions of between 5 and 10 per cent, respectively. Failure to prevent financial ruin, as a consequence of excessive OOP payments, is evident in 0.7 per cent of elderly households utilizing health care and 0.5 per cent of elderly households utilizing LTC. Those particularly concerned are the poor, women and the very old.

This article takes a critical view of the United Kingdom government's design for the delivery of the Universal Credit (UC) benefit reforms. It is argued that the UC is destined to fail because of the policy's extension into specifying the means (“digital by default”) of delivery for such services. The authors argue that an unseen but ubiquitous set of “scale” management assumptions has been allowed to infiltrate the means by which the government intends to enact its headline policy objective to “make work pay”. Following Seddon's “Vanguard Method”, a practical example of how a better service was designed in a local authority housing benefits service is then examined. Results from this service include being able to deal with up to 50 per cent more demand, with fewer resources, in half the official target time. Finally, the article will conclude with a call for more evidence‐based policy.

Contextualizing the situation of orphans within the Southern African region and drawing on quantitative and qualitative field research, this article analyses care options and social protection policy for orphans in Mozambique, with its focus placed on children in orphan support centres. Seeking to offer new insights and greater understanding of the experiences of children in care and of the social protection available to them, the research highlights that orphaned children living in informal foster care arrangements are more likely to experience abuse, neglect and maltreatment than those living in non‐governmental care organizations. The research emphasizes the need for a more careful selection of foster families in which children are placed. Recommendations include the need to focus on capacity building and institutional reforms that provide social protection policies for orphaned children as part of an overall social protection floor. The monitoring and evaluation of organizations providing care to orphaned children is deemed a priority.

The example of Spain confirms the common view that contributory pension systems reproduce inequalities between the sexes that result from the nature of labour market structures and the sharing of family responsibilities. In general, women who stay at home are not entitled to their own pensions and are dependent on benefits of lower value such as survivors' pensions (derived entitlements) or non‐contributory pensions. In turn, women who work outside the home accrue lower entitlements than men and, consequently, lower old‐age or disability pensions (personal entitlements). The purpose of this article is to examine the figures for pension distribution by sex in Spain, review some of the pension policies that have been implemented since 2000, and propose direct action for progress in the transition from derived entitlements to personal entitlements. These proposals are designed to promote sex equality, defined as the right to equal well‐being and financial security in old age.

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.

An important contribution to preventing social insecurity can be made by strong social security programmes that promote collective as well as personal security: in particular, they act as built‐in automatic stabilizers with social and political as well as economic benefits for the whole society. By contrast, weaker systems have a destabilizing effect built in that reduces their preventive effectiveness. The ways in which social security systems can contribute to preventing social and economic insecurity have become less effective in many countries. Reasons for the relative neglect of prevention are considered together with the changes that have weakened systems' preventive elements specifically. The structural context within which social security policies have to work, particularly the quality and quantity of employment as well as the interaction with other public programmes, has of course a major effect on their ability to prevent. There is still much that can be achieved by schemes with closer attention directed to what is needed to prevent insecurity. Proposals to strengthen the preventive contribution in social security programmes are offered to promote greater debate of these issues and to restore the goal of prevention as a central objective.

Preventing social exclusion has become a critical issue in the European Union (EU) as a result of cutbacks in social expenditure imposed by Member States’ exploding debt. This issue sits at the intersection of employment and training policies and of reforms seeking to adapt social protection systems to the new realities of the present socio‐economic context (population ageing, family instability, massive unemployment, employment insecurity, in‐work poverty and persistent and increasing social inequality). This article will show that promoting social protection as part of a social investment approach is an excellent means of reconciling the objectives of equal opportunity over the life cycle, sustained economic performance (improved structural competitiveness) and strengthened social cohesion in the interest of collective well‐being. Particular emphasis is given to the need to promote universal and individual rights to mobility and lifelong training, which would constitute new social guarantees, offsetting requirements linked to labour market flexibility. The article also emphasizes the importance of incorporating these rights throughout the EU as part of a wider social protection floor. This would offer permanent protection against the risk of exclusion in the Union, promote the economic and social integration sought since the revised Lisbon Strategy (2003‐2005), and create confidence and hope among Europe's citizens.

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.