Month: November 2017

The English Patient

“You’ve heard of a French letter, yeah? Well, what’s a Dutch letter? A condom with clogs on so they can hear you coming” (boom boom).

“Did you hear about the two queers in a telephone box? They were ‘ringing’ (geddit?), ringing each other”.

And so I found myself transported back in time to when Jim Davidson was allowed, the mini metro was cutting edge technology and sexual assault was regarded as a little light flirting. A time when the classification of ‘rape’ was reserved for activities including the actual blindfolding and torture of young ladies in darkly lit back alleys in Whitechapel.

The ‘joker’ lay almost flat on his back on the opposite hospital bed. He wore, or rather was draped, in an NHS gown which barely covered his legs. The flap of the gown rode up so high on his thigh that it invited a shrivelled walnut shaped hairy scrotum to make its appearance, but thankfully we were spared. His dark sunken eyes and sallow complexion, his wrinkled turtle necked skin upholding a blotchy, mottled liver spotted complexion which, thanks to hair loss, covered his whole pate, were all testament to years of smoking. He rasped his jokes in between sucking in oxygen through plastic nasal speculae, while his rheumy eyes, long devoid of sparkle, attempted to project wit, but utterly failed to do so. Instead, Death’s bony fingers drummed impatiently on the bedside table, perhaps waiting for his cue, and certainly waiting for the end of the jokes.

“OH, DO SHUT UP”, Death silently boomed into his ear, “YOU ARE ALREADY LATE”.

Why it did not occur to Death to merely sever the plastic oxygen tube with one wing of the scythe is something to regret, no doubt, and to take to his grave, always supposing Death has a grave.

 

A hospital ward is not always a happy place.

It might be something to do with the people who go there. It might be something to do with the amount of forced cheer amid the pools of blood, piss and broken dreams. It is often a place in which a lifetime’s aspirations, vision and long hoped for achievement smash into the reality of desperation and blood flecked sputum often spewed out through clouds of alcohol infused breath and fag ash. A place where one hoped to live but come to die, where the milk of human kindness is not supposed to curdle, and where faith, hope and charity are not merely long faded memories or the names of a trio of white doe eyed fluffy kittens the vet accidentally put down after mixing up the lab results with that of a cancer riddled mutt with rabies.

The patients are not much better. especially when they tell jokes.

So, I find myself admitted for investigations and treatment after spending a brightly lit and noisy night in the ED. Ah, sleep, perchance to dream of fluffy pillows, soft warm duvets and dark peace. Imagine, if you can, being in a K hole but with operating theatre lights trained to hit your retina with the brightness of a thousand Hiroshimas. Noise assaults your every sense, you can even taste it. It’s not the EDs fault…for how else can they help assess, diagnose and treat humanity’s fear, stupidity and decrepitude. The only people at peace here are the near dead (and the actual dead).

“WELL, WHAT DID THEY EXPECT WITH THE ‘IRISHMAN WALKS INTO A BAR’ ROUTINE.”

 

I’m keeping my witticisms to the minimum over the next few days.

A scientologist homeopath in a K hole.

The Nursing Times reports on the falling number of nurses and midwives registered to work in the UK over the past few months.

Perhaps this does not matter to most of us as we worry about whether to buy our Christmas from John Lewis or J D Wetherspoon, or before concerning ourselves with the searing injustice and travesty that is some prancing git in a sparkly shirt being being shown the door before he has had the chance to enthral us with his pretty feet. Perhaps we believe that the real life Holby Cities truly are staffed with the beautiful, if very flawed, people who can perform miracles with just a twitch of a stethoscope, frowning and cries of ‘morphine stat’ before being covered in projectile vomit. Perhaps we think NHS staff smile through the mask of emetic substances dripping from their faces as they perform miracles every hour.

To take our minds off the future, when many of us will face our last days in some piss stained, overcrowded brightly neon lit corridor being looked after by an alcoholic doctor, and a Zimbabwean care assistant whose slim grasp of English is matched only by a desert dwelling Uzbek goat fucker with access to a torn, half copy of the Beano in which to learn verb conjugation, we stare at the TV screen promising us youthful skin, a drive on an empty mountain road and the chance to vote on some nonentity whose song we will not remember, will not buy and will merely momentarily dose us to kill the pain of ennui that is everyday life in consumer capitalism.

Nursing is being reduced to running around with a bucket, a mop and some hope, all aimed at stopping the bleeding. We all have orifices that need plugging from time to time lest we leave a trail like a pissed up slug on a mission to the next lettuce. However Florence Nightingale had higher hopes for the successors of her young ladies in training than being reduced to cleaning wounds with their own tears and the silk of parachutes from the nearby war museum. The measures of success on many shifts includes having the same number of live patients that you started with, avoiding a fight with a drunk (it is a bonus if the drunk is not the consultant) and being sprayed with non infectious urine. The great vision for the NHS includes the provision of care by families and a few care assistants. Registered Nursing, you know…the sort that includes people who might be able to spot if your babbling and loss of consciousness is not the result of being given the bill for care but is in fact the early stages of sepsis, is on its way out. Family care is fine, if your family is more Waltons than Addams. Do you really want your old mum, or your wife, poking her finger up your anus in order to clinically examine your tonsils? What your wife does in your spare time at home is your own business, but is she the right person to be prostate tickling in the intensive care unit when you are actually complaining of a headache?  Imagine Grandad, after a six pints of mild and bitter, pushing his way through the throng around your sick bed shouting; “stand back, I’ve got this” while brandishing a toilet brush and barely concealed menace?

This is what the ‘Austerity’ actually means. Hunt will blather about more training places…but we know ‘more’ is not the same as ‘enough’. Austerity, we should remember actually means the ‘dissembling of the protectionist state in order to facilitate the transfer of public services to private ownership’. Hunt know this…it is part of the plan. He once called the NHS a ‘great commercial opportunity’. Why should Hunt et al give a toss about hospitals and schools that they will never use? They are as disconnected from our social reality as a Scientologist homeopath in a K hole.

I’m sending Granddad over to Richmond House.

Socio-Political awareness among undergraduate student nurses.

Socio-Political awareness among undergraduate student nurses.

 

 

“For the remainder of this century, the most worthy goal that nurses can select is that of arousing their passion for a kind of political activism that will make a difference in their own lives and in the life of our society.”

 

(Peggy Chinn, 1984, quoted by Beall 2010).

 

 

Nurses have a history of engaging in health promotion and public health and both roles are reflected in the Nursing and Midwifery standards for education. However, current and future issues such as population ageing, new medical technologies, war, food security, health service access, equity and comprehensiveness  and climate change, suggest that their current understanding need to develop to adapt to a very different future. Nurses need to quickly move beyond adopting individualistic and behaviour changing perspectives (Kemppainen, Tossavainen and Turunen 2012), to that of also adopting an ethico-socio-political awareness and analysis (Falk-Raphael 2006). This should be based on a wider understanding of what health and health promotion may mean.

 

Various nursing theorists have suggested or implied that politics and political awareness and knowledge is, or ought to be, a component of nursing knowledge (Chopoorian 1986, Stevens 1989, Albarran 1995, Cameron et al 1995, Chinn 2000), and of nursing advocacy (Philips 2012) and leadership (Antrobus 1998, Cunningham and Kitson 2000).  Nancy Roper referred to the sociocultural, environmental and politico-economic factors influencing the Activities of Living, while also lamenting a lack of their application (Siviter 2002). Jill White (1995) developed Carper’s patterns of knowing to include the Socio-political domain; Jane Salvage (1985) argued that politics needs to be understood and acted upon and that nurses should ‘wake up and get out from under’. Celia Davies (1995) has written about the gendered nature of nursing and its ‘professional predicament’ and Michael Traynor (2013) has written a whole book on politics and the profession.

 

Other writers on the socio-political context include White (1985, 1986 and 1988), Lewenson (2000) and Falk Rafael (2006). Kath Melia (1984) illustrated the contextualised pressures on student nurses, while more recently Alexandra Hillman and colleagues (2013) has described how patient care can be compromised by the systems nurses work within. Tadd et al (2011) also outlined the context and its effects on dignity in care in acute hospitals. I have argued it is explicitly part of the sustainability agenda for nursing, while the social determinants/political determinants of health approach are predicated upon it. Other health concepts such as Barton and Grant’s (2006) health map, Lang and Rayner’s (2012) ecological public health domain and Ottersen et al’s (2014) focus on global governance for health centre it for health care delivery and outcomes.  The inequalities in health literature, for example “Fair society Healthy Lives” (Marmot 2010) and Danny Dorling (2013, 2014), refer to health being a matter for social justice and fairness.

 

Some authors have highlighted the health policy role for nurses (Ennen 2001, Fyffe 2009) which although advocating for nurse involvement in public policy making, does so probably within accepted frames of reference devoid of critical concepts such as Foucault’s ‘governmentality’ or deeper analyses of for example, managerialism, neoliberalism and the ‘capitalist class-command dynamic’ (Scambler 2015). Cameron et al (1995) argued for post structuralism and a focus on subject positions and discourse as tools for analysis, which could be usefully employed by critically aware nurses.

 

In the education and curriculum development literature writers such as Paulo Freire (1970), Carl Rogers (1969, 1983) Stephen Sterling (2001), David Orr (1994) and Peter Scrimshaw (1983) suggest that teaching and learning should go beyond skills teaching in an instrumental fashion to address personal growth and social transformation. Romyn (2000) discusses ‘emancipatory pedagogy’ in nurse education which accords with aspects of ‘provocative pedagogy’ (Morrall 2009). The sociological literature, for example critical social theory, marxism and feminism of course, are wholly socio-political in nature. For nursing, each has also something to say about the interplay between health, illness, society and gender.

 

 

Undergraduate Nursing – the missing link

 

 

It is my contention that undergraduate nursing education is one in which politics is largely absent in nursing curricula (Byrd 2012) and fails to equip student nurses with tools of analysis that renders them blind to social and political systems that are often unfair, unjust and oppressive. It also fails to politically socialise them. It is a self marginalised education denuded of any critical importance and ignores the vast sociological literature on health and illness. Nurse educators themselves, beyond a few ‘individual enthusiasts’ (Fyffe 2009), might lack the requisite skills or concepts to engage. This may result in the lack of politics or health policy in nurse education (Carnegie and Kiger 2009). This is not to say nursing education, as it currently is, lacks importance as the requirement for clean, kind and compassionate care will be emphasized daily in seminars, lectures and tutorials.

 

This assertion might be supported if it can be shown that student nurses lack a critical understanding of the socio-political context in which they work. This is not to say however that student nurses are not political or are not interested in politics. Rather that their interest and understanding especially in relation to health (delivery, funding, inequalities, access, outcomes and determinants) may be lacking and only slightly better than their peer groups. Further, that any student nurse who is active, interested and knowledgeable is so despite not because of nursing education. I take it as self evident that this matters and not merely for the reason that it suits the capitalist executive and political power elites to have a huge number of health workers (600,000 registrants in the UK alone) ignorant, confused, uninterested and inactive in regards to the eco, social and political determinants of health. We have nurses schooled in the biomedical aspects of health delivery (or rather disease treatment), but rather less in what I would inelegantly call the EcoPoliticoPsychoSocial (EPPS) approach to health. Student nurses are introduced to a BioPsychoSocial (BPS) model to health however, the curriculum process and learning experiences may often dilute this emphasizing the bio at the expense of the Psycho-Social while ignoring the Ecological. The ‘BPS’ becomes ‘Bps’.

 

To test the hypothesis that student nurses lack a critical understanding of a socio-political approach to health, a survey of student nurses in two or three HEI in the UK could be undertaken. Mccullough (2012) undertook a survey on politics in NI in which 81% of students claimed ‘not much knowledge’ of politics and 60% claimed either ‘never’ or ‘less than once a week’ to follow politics in the media. Of course a caveat in this must be that politics in this context may mean ‘Party, Westminster/Stormont politics rather than political issues.

 

 


 

What is Politics?

 

Chafee et al (2012) suggested that politics can be defined simply as ‘the process of influencing the scarce allocation of resources’ (p5). The RCN’s Frontline First, while laudable, is also a very narrowly focused campaign which is about resource (staff) allocation. However, this does not go far enough as it fails to engage with more critical analyses of power and the legitimacy of the exercise of power, concerning itself with more relatively mundane issues of resource allocation within uncritically accepted frames of reference. Politics is much more than knowing the manifestos of political parties or the internal machinations at Westminster. Political action is much more than the 5 year placing of crosses on ballot papers. Engaging in politics requires at least a critical understanding of power. Tony Benn outlined questions to ask the powerful: We should know who has power, what power they have, where did they get it from, in whose interest do they wield it, to whom are they accountable and how do we get rid of them? This does not apply only to Westminster, but in every organisation including an NHS Trust. Socio-political awareness also addresses the wider determinants of health as outlined in the Social Determinants of Health literature and in such books as ‘The Energy Glut’ (Roberts and Edwards 2010) ‘Lethal but Legal’ (Freudenberg 2014), ‘The Spirit Level’ (Wilkinson and Pickett 2010), ‘Unequal Health’ (Dorling 2013) and ‘Hard Times’ (Clark and Heath 2014).

 

If Russell Brand’s youtube site is any guide, or the interest in Jeremy Corbyn’s bid for the Labour leadership in 2015, many people are very interested in politics, just not the dominant media fed variety of political talking heads, and representatives of mainstream political parties. If we widen the definition of politics to include social movements around health, climate change and human rights then according to Paul Hawken (2007) there is a global ‘Blessed Unrest’ involving millions of people, a global ‘environmental and social justice movement’ that does not often appear in the mainstream media.

 

Nurses are a disparate group politically; nurses are not to be treated as an homogenous group for political purposes. For example, the free market nurse think tank Nurses for Reform (NFR):

 

“….long argued that the NHS is an essentially Stalinist, nationalised abhorrence and that Britain can do much better without its so called ‘principles’ (Cave 2010), although whether this group actually has a huge number of nurses supporting it has been questioned (Liberal Conspiracy 2010). Nonetheless the point remains that nurses will probably vote for all parties, and none, at elections. To what degree nurses are part of the ‘blessed unrest’ is unknown, Mcculloghs small survey does not answer that question.

 

 

Public Health and Health Promotion

 

 

Both of these two concepts are multi faceted, and nurses will draw upon their own definitions. If nurses are to ‘empower and enable’ people to increase control over and improve their health then this will require not only education to change individual behavior, but also a deep critical analysis of power and vested interests that often put profit before people and that result in inequalities in health outcomes. Nurses will then have to decide what their personal sphere of influence may be and work towards change in those areas. For some this will mean working on a one to one basis only, for others it may even result in taking part in organized political structures, be it pressure group or a political party.

 

 

 

 

 

 

 

 

 

 

Albarran J (1995) Should nurses be politically aware? British Journal of Nursing , 4 (8). pp. 461-466.

 

Antrobus S (1998) Political Leadership in Nursing. Nursing Management  5(4): 26-28

 

Barton H and Grant M (2006) A health map for the local human habitat. Journal of the Royal Society for the Promotion of Health . 126(6): 252-261.

 

Beall F (2010) The important role of nurses in political action  http://www.thefreelibrary.com/The+important+role+of+nurses+in+political+action.-a0234309354

 

Brown, S. G. (1996) Incorporating political socialization theory into baccalaureate

nursing education. Nursing Outlook. 44, 120 – 123

 

Byrd, M.E., Costello, J., Gremel, K., Blanchette, M.S. and Malloy, T.E. (2012) Political Astuteness of Baccalaureate Nursing Students Following an Active Learning Experience in Health Policy. Public Health Nursing. 29 (5), pp433-443.

 

Cameron P, Willis K and Crack G (1995) Education for change in a postmodern world: redefining revolution. Nurse Education Today 15 (5):336-340

 

Carnegie, E. and Kiger, A. (2009) Being and doing politics: an outdated model or 21st century reality, Journal of Advanced Nursing, 65(9), pp1976-1984.

 

Carper B (1974) Fundamental Patterns of Knowing in Nursing Advances in Nursing Science.

 

Cave T (2010) Nurses for Reform. BMJ  340: c1371 doi: http://dx.doi.org/10.1136/bmj.c1371

 

Chaffee, M.W., Mason, D. J. and Leavitt, J.K. (2012) A Framework for Action in Policy and Politics. in Mason, D.J., Leavitt, J.K. and Chaffee, M.W. (eds) Policy and Politics in Nursing and Healthcare. (6th edn) St Louis. Elsevier Saunders.

 

Chinn P (2000) Looking into the crystal ball: positioning ourselves for the year 2000. Nursing Outlook. 39 (6): 251-256

 

Chopoorian T (1986) Reconceptualiszing the Environment, in Moccia P ed. New Approaches in theory development. New York National league for Nursing

 

Clark T and Heath A (2015) Hard Times Inequality, Recession, Aftermath Yale University Press New Haven

 

Davies C (1995) Gender and the professional predicament of Nursing. Open University Press. Buckingham

 

Davies, C. (2004) Political leadership and the politics of nursing. Journal of Nursing

Management. 12:253-241

 

Dorling D (2013) Unequal health. Polity Press

 

Dorling D (2014) Inequality and the 1%. Verso Press.

 

Ennen K (2001) Shaping the future of practice through political activity: how nurses can influence health care policy. American Association of Occupational Health Nurses Journal  49(12): 557-569

 

Falk-Rafael A (2006) Globalization and global health: toward nursing praxis in the global community. Advances in Nursing Science. 29, 1, 2-14.

 

Freire P (1970) Pedagogy of the Oppressed. Penguin, London

Freudenberg N (2014) Lethal but Legal. OuP New York

Fyffe T (2009) Nursing shaping and influencing health and social care policy. Journal of Nursing Management 17 (6):698-706

Hawken P (2007) Blessed Unrest How the Largest Movement In the World Came Into Being
and Why No One Saw it Coming. Viking Press New York

Hillman, A., Tadd, W., Calnan, S., Calnan, M., Bayer, A., and Read, S. (2013) Risk, Governance and the experience of Care. Sociology of Health and Illness. doi: 10.1111/1467-9566.12017  pp1-17

 

Kemppainen, Tossavainen and Turunen (2012) Nurses’ roles in health promotion practice: an integrative review. Health Promotion 28(4):490-501

Lang T and Rayner G (2012) Ecological public health: the 21st century’s big idea? British Medical Journal 345:e5466 doi 10.1136/bmj.e5466 (online) http://www.cieh.org/assets/0/72/998/1022/1064/92246/dd0cbc07-a918-458f-9a03-a8935b5a5b8a.pdf

Lewenson S (2000) Nurses in the political arena. The public face of nursing. Springer. New York.

 

Liberal conspiracy (2010) Where are all the ‘nurses’ for reform? available at http://liberalconspiracy.org/2010/01/25/where-are-all-the-nurses-for-reform/ accessed 1st May 2015.

 

Mccullough S  An exploration of political awareness among a cohort of all field students in one University in Northern Ireland. Presentation at Queens University Belfast http://www.rcn.org.uk/__data/assets/pdf_file/0007/615958/4.3.1-McCullough.pdf

 

Melia K. 1984 Student nurses’ construction of occupational socialisation. Sociology of Health and Illness 6 (2): 132-151

 

Morrall P (2009) Provocation: reviving thinking in universities. In: Warne T and McAndrew

S (editors) Creative approaches in health and social care education and practice: Knowing me,

understanding you. London: Palgrave, Chapter 1

 

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Ottersen O,  Dasgupta J, Blouin C, Buss P,  Chongsuvivatwong  V, Frenk j, Fukuda-Parr S, Gawanas B, Giacaman R, Gyapong J, Leaning J, Marmot M, McNeill D, Mongella G, Moyo N, Mogedal S, Ntsaluba A, Ooms G, Bjertness E, Lie A, Moon S, Roalkvam S, Sandberg K and Scheel I. (2014) The Lancet-University of Oslo Commission on Global Governance for Health. The political origins of health inequity: prospects for change. The Lancet 383:630-667 February

 

Phillips C (2012) Nurses becoming political advocates Journal of Emergency Nursing 38 95) 470-471

 

Roberts, I and Edwards, P (2010) The Energy Glut. London: Zed Book

Rogers, C. (1969, 1983) Freedom to learn, revised as freedom to learn for the 80’s. Colombus. London.

Salvage J (1985) The Politics of Nursing. Heineman. London

 

Scambler G (2015) Taking Social Class seriously. Available at http://www.grahamscambler.com/taking-social-class-seriously/ accessed 1st May 2015.

 

Scambler G (2012) The Greedy Bastards Hypothesis. Available at https://grahamscambler.wordpress.com/2012/11/04/gbh-greedy-bastards-and-health-inequalities/

 

Siviter B (2002) Personal interview of Nancy Roper at RCN Congress, Association of Nursing Students, reported in Fall 2002 edition “The ANSwer” (RCN)

 

Sterling, S. (2001) Sustainable Education – Revisioning Learning and Change, Schumacher Briefings 6.Green Books, Dartington.

Scrimshaw, P. (1983) ‘Educational Ideologies’, Unit 2, E 204, Purpose and planning in curriculum’, Milton Keynes, Open University Press.

Stevens P (1989) A critical reconstruction of environment in nursing: implications for methodology. Advances in Nursing Science. 11(4):56-68

 

Tadd, W., Hillman, A., Calnan, S., Calnan, M., Bayer, T., and Read, S. (2011) Dignity in Practice: An exploration of the care of older adults in acute NHS Trusts. NIHR Service Delivery and Organisation Programme. Project 08/1819/218. NETSCC – SDO: Southampton

 

Traynor M (2013) Nursing in context: Policy, politics profession. Palgrave Macmillan Basingstoke.

 

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White R (1985) Political issues in Nursing Volume 1 Wiley Chichester

 

White R (1986) Political issues in Nursing Volume 2 Wiley Chichester

 

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Dirty Money – Lovely Jubbly.

Photo by Les Anderson on Unsplash

Now, let’s get something obvious out of the way. Do I like a fiddle? Do I like to pick a pocket or two? Do I enjoy getting away with it? Well, if the opportunity arises to save a few quid I will take it laughing all the way from the pub to the bank. Have I been known to engage in activities that should ideally stay in a dark cupboard lest the very beasts of hell are let loose to defeacate upon the heads of babies? In short, am I cleaner than a freshly scrubbed and laundered starched white cotton cloth? Yet I have to admit that perhaps I have let slip my moral standards from time to time. My righteousness is as a filthy rag rather than crisp white linen. Jesus died to save sinners, but when he saw my track record on all things nefarious, immoral and perverted, it was too much even for the son of God. He was referring to me when, upon the cross, he cried up to God saying “Forgive him, for he not only knows what he has done, but he has encouraged others to do similar, only with less embarassment and more lubricant”. Jesus wept. Not for sinners, but for the complete waste of time his 33 years on earth was spent in order to redeem my wretched black hearted soul. As the last nail was banged in, all he could think about was my irretrievably ungrateful indifference to his suffering while I considered the next venture into silk pantied and lace lined debauchery with a sweet, cherry lipped vicar’s daughter and her vibrator on the lawn at the Queen’s garden party. “Christ, all that healing and vintnery for bugger all” he thought before letting out a wet fart.

That established, am I qualified to consider the implications of the ‘Paradise Papers‘?

First, let us not forget the ‘Panama papers‘. This was the leak of over 11 million documents from law firm Mossack Fonseca and shed a little light on over 200,000 offshore entities. They contained personal financial information about wealthy individuals and public officials that had previously been kept private. Some of the Mossack Fonseca ‘shell’ corporations were used for illegal purposes, including fraud, tax evasion, and evading international sanctions. The Paradise papers are a similar leak from law firm Appleby which again shed light on offshore tax havens and the avoidance activities of wealthy individuals and corporations such as Apple.

‘Only the little people pay taxes’. I forget who said that, possibly someone as wealthy as Croesus and the morals of a rutting dog with easy access to a pack of bitches on heat. They share the same disdain and indifference towards others as they fuck anything that looks like it needs fucking as long is it feels good. They are now fucking the great British public by stealing a decent education from children, kicking the zimmer frames away from our grannies and laughing in the face of the mentally ill.

As dogs sniff arseholes, the wealthy sniff loopholes.

They are aided and abbetted in their endeavours by lawyers whose attachment to ethics is as loose as a coke fuelled casanova’s commitment to celibacy at an orgy. They are advised by accountants whose devotion to public service is in inverse proportion to their devotion to gaining pecuniary advantage, and serviced by politicians whose obseqiousness in the presence of wealth would make an Edwardian butler blush in embarrassment. The rules of the game are so rigged that not only is the line between good and evil blurred, it has been erased, deleted, rubbed out and thrown away waiting discovery and study by some future historian of 21st century moral philosophy. Plutocrats, the 0.01%, the ‘super-rich’ are so detached from the rest of us that not only do they think we should eat cake, we should pay them for the ingredients, the recipe and the aga to cook them in while they insert a finger of fudge to milk our collective prostates for more cash. Their moral universe is so distorted that they would consider buggering schoolboys over the high alter in St Paul’s Cathedral acceptable if the price was right. To them, the general public are bovine, nothing but a source of capital accumulation, and when we have lost our usefulness we are thrown away like a snot damped tissue in the gathering winds of an October gale.

Why do only fools and horses work?

 

Health based on Poverty and its measurement.

Photo by Adam Jang on Unsplash

Health based on Poverty and its measurement.

 

One of the explanatory frameworks, or ‘discourses’, for ill health and health inequalities around access to health services and health outcomes, is that of the ‘material deprivation’ thesis, which underpins much of the Marmot Review Fair Society Healthy Lives. It sits within a ‘Redistribution discourse’, which suggests the answer is redistribution of material resources. Alongside this is the ‘Psychosocial Comparison Thesis’, which underpins such work as Wilkinson and Pickett’s The Spirit Level. This forms part of the ‘Social Integrationist discourse’ in which reduction of social inequalities and better integration of marginalised groups is important.

 

Material deprivation focuses on a lack of resources to support healthy living while psychosocial comparison suggests one’s position in the social hierarchy, and the level of inequality in society, create psychosocial stress harmful to health. They are not mutually exclusive and of course might work together for some individuals resulting in poorer health outcomes for them. Being poor in a very unequal society is thus very harmful to health and results in gross inequalities in health.

 

A third explanatory framework is the ‘cultural thesis’ which suggests it is the culture of certain behaviours, attitudes, values and norms that are the root cause of ill health. Another term for this way of thinking is the ‘moral underclass discourse’. The answer is to make better choices and improve lifestyle activities such as stopping smoking, reducing alcohol consumption, exercising more and eating better. Poor people are disproportionately ill because of their poor life decisions. The ‘underclass’ make poor moral decisions and therefore bring ill health upon themselves. The material deprivation they experience is a result of their own poor life choices, their parents’ life choices, or it results from being ill, preventing them from working or making better life choices (the deserving poor).

 

The Consensual Method of measuring poverty.

 

A link between all three is material deprivation resulting from poverty, but what do we mean by poverty and how is it measured? In the UK we do not use the concept of absolute poverty, instead some reports are using the term ‘relative poverty’, one measure of which is the consensual method. The research project Poverty and Social Exclusion (PSE) outlines what this is. In short this focuses on deprivation as:

 

“enforced lack of necessities determined by public opinion”.

 

In the consensual approach we first need to establish what those items are that make up our ‘standard of living’ and then identify which of those items most people view as ‘necessities’. Consider a mobile phone as an item, if most people think this is a necessity, then not having one begins to identify oneself as poor. The necessities are what most people think everyone should be able to afford and which no one should be without. Poverty is where these deprivations impact on a person’s whole way of life; to measure poverty we need to know how many people there are whose ‘enforced lack of necessities’ affects their way of living. Note that those who choose not to have these necessities would not count.

 

Items that are necessary include the social as well as the material. The PSE have published data on what the public thinks those items are: for example, 96% of us think ‘heating to warm living areas of the home’, 94% think a ‘damp free home’ and 91% think ‘two meals a day for adults’ are some of the necessities. However some items go beyond ‘basic’ needs such as ‘visiting friends/family in hospital’ (90%), and ‘attending a wedding/funeral’ (79%).

 

What do you think everyone should be able to afford?

What do you think no one should be without?

 

Once we have these benchmarks, then we can start to measure the base line below which society considers people to be deprived. This is what is being attempted since 1983 and the ‘Breadline Britain’report.

 

The 2013 PSE first report ‘The impoverishment of the UK’ PSE first results: Living Standards’ indicates the scale and extent of poverty in the UK (the 6th richest country as measured by GDP per capita). One section of the report ‘Going backwards 1983-2012’ suggests that the proportion of households falling below minimum standards has doubled since 1983:

 

1. More children lead impoverished and restricted lives today than in 1999.

2. 5 million more people live in inadequate housing than in the 1990s.

3. 9% of households can’t heat their homes adequately today up from 5% in 1983 and 3% in 1999.

4. 33% of households experience below par living standards.

 

This is despite the fact that the UK is a far richer country now than it was in the 1980’s. The size of the economy has doubled over the last 30 years. This supports the claim that economic and wealth creation has benefitted the better off while families lower down continue to struggle to meet their basic needs.

 

Source: http://www.poverty.ac.uk/pse-research/going-backwards-1983-2012

 

If you emphasise that ill health and deprivation results from poor life choices, then you might not be interested that more and more families are experiencing deprivation of this kind. It is a case of them not taking up opportunities, not working hard at their education or not moving to where employment is higher, i.e. London and the South East. However, you might want to wonder why more and more families are making these poor life choices since the 1980’s, especially if during that time knowledge about what is the basis for a healthy life, is more easily accessible with the internet.

 

Or you might think that regardless of the fact that more people falling into this category, this does not mean that they are also more likely to experience health inequalities such as reductions in life expectancy. The data from such sources as the Community Health Profiles and that contained in ‘Fair Society, Healthy Lives’ and ‘The Spirit Level’ would suggest otherwise.

 

 

 

Source: http://www.poverty.ac.uk/pse-research/going-backwards-1983-2012

 

 

watch this video for a first hand account.

 

 

What are the implications of this knowledge for nurses? Is this a ‘social issue’ irrelevant to nursing practice?

 

 

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