The emergence of citizen collectives for care: the role of social cohesion

Abstract Background Ageing populations and the ability to cure an increasing number of ailments put pressure on the health care sector. Meanwhile, care institutions retreat from rural areas and some governments emphasizes the need for citizens to find informal care primarily in their own social network. In The Netherlands, citizens increasingly respond by coming together to organize (in)formal care among themselves in ‘care collectives’. However, little is known about the conditions that need to be met for such collective action to develop, and explanations that go beyond an individualist perspective are particularly lacking. In this study, we aim to fill this gap, and specifically argue for the potential role of social cohesion to facilitate collective action among citizens through fostering a social identity, and through the prevalence of social relations that facilitate reciprocity and mutual trust among citizens. We further test whether these relations vary between municipalities, and whether they depend on the necessity for care services. Methods We obtain data on the location of care collectives from an extensive Dutch inventory and match it to register data from Statistics Netherlands from 2020. We create measures for neighborhood attachment and contact using the ‘ecometric approach’. We test our hypotheses with multilevel logistic regression models and multilevel event history analysis for a subset of the data that can be analyzed longitudinally. Results We find evidence for a positive association between neighborhood attachment and the emergence of a care collective, which is stronger if the necessity for care is higher. We do not find a relation between neighborhood contact and care collectives, nor do we find evidence that these relations vary between municipalities. We cannot replicate our positive associations in the longitudinal model, and thus remain reserved about their causal interpretation. Conclusions There is considerable variability in the extent to which neighborhoods organize care services collectively. Partly, this may be attributable to differences in the prevalence of neighborhood identity, which would imply that an increasing reliance on citizen collectives may increase inequality in access to healthcare. Further research should emphasize combing community-level information with data on individual participation in care collectives to delve deeper into the dynamics of invitation, representation and embeddedness than current data allows.