Understanding Care Farming as a swiftly developing sector in The Netherlands Jan Hassink Understanding Care Farming as a swiftly developing sector in The Netherlands Jan Hassink PhD Thesis 19 september 2017 © Jan Hassink 2017 Amsterdam Institute of Social Science Research University of Amsterdam Supervisors: Prof. dr. John Grin and dr. Willem Hulsink Cover photos: Care farm Hoeve Klein Mariendaal and Lieke Camerik Cover design: Ton van Wessel Understanding Care Farming as a swiftly developing sector in The Netherlands ACADEMISCH PROEFSCHRIFT ter verkrijging van de graad van doctor aan de Universiteit van Amsterdam op gezag van de Rector Magnificus Prof. dr. ir. K.I.J. Maex ten overstaan van een door het College voor Promoties ingestelde commissie, in het openbaar te verdedigen in de Agnietenkapel op dinsdag 19 september 2017, te 14 uur door Jan Hassink geboren te Voorst Promotiecommissie: Promotor: Prof. dr. J. Grin (Universiteit van Amsterdam) Copromotor: Dr. W. Hulsink (Erasmus Universiteit) Overige leden: Prof. dr. ir. J.S.C. Wiskerke (Wageningen Universiteit) Prof. dr. E.H.M. Moors (Universiteit Utrecht) Prof. dr. V.A.J.M. Schutjens (Universiteit van Amsterdam) dr. F.M. Bridoux (Universiteit van Amsterdam) dr. A.M.C. Loeber (Universiteit van Amsterdam) Faculteit der Maatschappij- en Gedragswetenschappen Table of contents Introduction 7 Chapter 1. Farming with care: the evolution of care farming in the Netherlands 23 Chapter 2. Multifunctional Agriculture Meets Health Care: Applying the Multi-Level Transition Sciences Perspective to Care Farming in the Netherlands 53 Chapter 3. Care Farms in the Netherlands: An Underexplored Example of Multifunctional Agriculture—Toward an Empirically Grounded, Organization-Theory-Based Typology 81 Chapter 4. Entrepreneurship in agriculture and healthcare: Different entry strategies of care farmers 117 Chapter 5. Identity formation and strategy development in overlapping institutional Fields. Different entry & alignment strategies of regional organizations of care farms into the healthcare domain 157 Chapter 6. New Practices of Farm-Based Community- Oriented Social Care Services in The Netherlands 189 Conclusions and implications 215 References 245 Summary 275 4 Samenvatting 287 References. Overview of published manuscripts 299 5 6 Introduction Care farming as a swiftly developing sector in The Netherlands Introduction Care farming or social farming, a swiftly developing sector across Europe (Hassink and van Dijk 2006; DiIacovo and O’Connor 2009), is an innovative practice where agricultural production is being combined with health and social services (Hassink and van Dijk 2006). It is an innovation at the crossroads of agriculture and health care, where the agricultural sector is actively involved in providing care for different client groups. Clients, or participants in the vocabulary of care farmers, are involved in agricultural production. Care farms offer day care, supported workplaces and/or residential places for clients with a variety of disabilities (Elings and Hassink 2008). Care farming is emerging in many European countries due to the increasing focus on different aspects of multifunctional agriculture, as well as concerns about public health expenditure and the efficacy of social services (Di Iacovo and O’Connor 2009). Care farming has reached different stages of development in different countries, and different orientations can be identified (Hassink 2009). In Italy and France, care farming is directed towards labour integration and care inclusion provided by community-based organizations like care cooperatives is dominant. In Norway, the Netherlands and Belgium (Flanders), care farming is mainly provided by private family farms and care farms are examples of agricultural diversification. In Germany, Austria, Ireland, Slovenia and Poland, most care farms are community-based care services offered by institutional partners (DiIacovo and O’Connor 2009; Vik and Farstad 2009; Dessein et al. 2013; Hassink 2009). Care farming has developed between and on top of two existing sectors, agriculture and health care. It can be understood as re-connecting two sectors that had become disconnected through modernization, 7 although traditionally there were always important connections. During the Middle Ages, many hospitals and monasteries looking after the sick had gardens as an adjunct to recuperation and healing (Frumkin 2001). People with psychological problems were employed for therapeutic reasons in agricultural settings, for instance on a farm at Saragossa Hospital in Spain (Foucault 1969). In the village of Geel in Flanders, care was provided in a rural agricultural setting since the 13th century (Roosens and van de Walle 2007). People with learning disabilities were employed, predominantly in the farming sector before industrialization (Wiesinger and Neuhauser 2006). In the 19th century, the hygienist movement promoted fresh air and sunshine and farm labor as key constituents of moral treatment and to regain capacity (Edgington 1997; Beattie 2011; Caldwell 2001; Parr 2007). Many institutions ran farms and were located in forests and rural areas, while farm produce helped institutions make ends meet (Porter 1992; Scull 2005). Labor was considered to contribute to the curing of patients (Canon Gehandicaptenzorg 2006). However, since the beginning of the 20th century, and especially since World War II, agriculture and health care largely dissected, mainly due to the processes of urbanization and intensification, rationalization and specialization in agriculture and medicalization, specialization and professionalization in health care (Schuitmaker 2012). Agriculture became knowledge- and capital-intensive, and therefore highly specialized, with traditional mixed farming splitting into livestock and crops and even beyond: towards pig or chicken farms, and eventually chicken farms specializing in egg or meat production (Geels 2009; Elzen et al. 2012). Through a similar process of modernization, health care became the responsibility of trained professionals. Health care institutions focussed on medication and therapy (Bakker et al. 2002; de Swaan 2004; Farla 2012; Schuitmaker 2012). Disease was mainly located in bodily dysfunction; lifestyles and life conditions were to a large extent neglected in pathology. Medicine was divided into disciplines that each focused on a particular class of dysfunctions, located in specific organs. Mind and body were considered largely separately. (Schuitmaker 2012) In this process, agriculture and health care, while each achieving significant successes in their respective areas, had drifted apart (Farla 2012). 8 The fact that, over the past twenty five years, agriculture and health were reconnected in so many European countries seems to point to some underlying factors. To be sure, a quick explanation of the ‘why’ is readily available. From the perspective of agriculture, at the core was the fact that, through modernization, agriculture has become a much less lucrative business, Since 1990, the extension of the EU has led to increasing competition. Meanwhile, concerns about the environment, animal welfare and homogenization of the landscape grew (Meerburg et al. 2009). In addition, since the 1992 MacSharry reforms - a response to budgetary pressures, liberalization of global food trade and the call for sustainable development (Grin and Marijnen 2011) – awareness has grown amongst farmers that real change is needed if they are to survive. Adding different sources of income to food production is one response. (Wilson 2008). We see the emergence of multifunctional agriculture. Farmers include nonagricultural activities that meet different societal demands, such as recreation and nature and landscape services (Durand and van Huylenbroeck 2003). It has been recognized that entrepreneurial skills were crucial to this transformation in agriculture (van der Ploeg et al. 2000). At the same time, traditional health care has come under pressure due to criticism regarding its narrow medical orientation and concerns about rising costs, leading to calls for the deinstitutionalization and socialization of care (Lamb and Bachrach 2001). The dominant paradigms in the health sector are changing, from an emphasis on disease and disease prevention and limitations (Nygren et al. 2005) toward a more positive approach focussing on health promotion and possibilities, and from care toward participation (Antonovsky 1987; Lindström and Eriksson 2006; Newman and Tonkens 2011; Fienig et al. 2011). Equally important, due to the so-called epidemiologic shift, non-communicable diseases (such as heart failure, diabetes, COPD) have replaced infectious diseases as the main focus of health care practices and policies (OECD 2013). Especially in case of such health problems, lifestyles, life conditions and mental pressure can no longer be neglected, both in diagnosis and in treatment. This has led to a re-appreciation of the healing effect of nature (RMNO 2007). 9 However, while these long-term trends are indeed important drivers, they still cannot explain why some initiatives failed, while others succeeded, why particular types of care farming emerged, why some care institutions supported and others opposed the development of care farms, and how regional and national support organizations developed. The aim here is to better understand the development of care farming as a sector by analyzing these questions. In other words, I am interested in the ‘how’ of the emergence of this new sector.