Tag: poverty

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?

 

 

Poverty Privilege and Health

In two of the richest nations ever to have existed on planet earth we have a separation which allows affluent whites to exist in a bubble of privilege; a bubble of privilege which survives the shooting of police, deindustrialisation, poverty, precarity and the social gradient in health. Privilege understands and sees how radical losers exploit poverty and exclusion, but does not want to address social and economic structures; privilege understands that pain and anger can be turned both inward and outward but looks for solutions in the individual and ‘security’; privilege sees the transmission of poverty and exclusion only in the personal agency of the poor themselves.

Washington Heights is a suburb of the most segregated city in America. Charles lives in a part of Milwaukee where the residents are 99% white, yet a few blocks up are black neighbourhoods where shops are boarded up, many houses have repossession notices on their front doors, and the air is one of decay and poverty. The separation of black and white in Milwaukee is replicated in big cities right across the US, and separation breeds a lack of empathy.”

“Local authorities which report the highest rates of people facing severe and multiple disadvantage are mainly in the North of England, seaside towns and certain central London boroughs”

“Women who live in the least deprived parts of Kensington & Chelsea can expect almost a quarter of a century more of good health than their female counterparts in the most deprived part of the borough. For females at birth, the number of years an individual could expect to live in good health based on current rates – known as healthy life expectancy – differed by an average of 24.6 years between the most and least deprived parts of the borough” (ONS, 2015)

…and yet politicians like to focus on a ‘moral underclass’, blaming them for their behaviour that causes poverty. Drink and drugs are key factors in this regard:

“Ian Duncan Smith, Secretary of State for Work and Pensions, shocked readers of the Daily Mail with: ‘Addicts and alcoholics cost us £10billion a year, says Duncan Smith: Blitz launched to help people with drink drug problems find work’ “. (Glen Bramley LSE Blog)

There is a very old debate about whether poor people owe their circumstances to structural economic factors or to moral/behavioural failings. Sandra Carlisle in 2001 argued that there are ‘contested explanations, shifting discourses and ambiguous policies’  for health inequalities: there is the ‘Moral Underclass’ discourse, the ‘Social Integrationist’ Discourse and the ‘Redistrubutive’ discourse. Each has its own explanation as to why there are inequalities and then what to do about them.

Since Sandra Carlisle wrote her paper, there has been a a good deal of evidence to suggest that structural/economic forces are a major factor in people’s health and illness. There is some evidence also of ‘transmitted poverty‘ due to adverse childhood experiences. The misuse of Alcohol and Illegal substances (they are all drugs) are of course correlated:

“There is a huge overlap between the offender, substance misusing and homeless populations. For example, two thirds of people using homeless services are also either in the criminal justice system or in drug treatment in the same year”.

Many people faced with adverse social situations learn to cope, or they become fatalistic,  or they cling together in supportive communities or they become activists fighting for social justice.  Some self harm, some drink to excess, some go to University and become doctors or lawyers or politicians.  They exercise their personal agency and succeed or fail within structurally determined circumstances. They succeed, despite not because of, the activities and ideology of the privileged. A few of the successful however, then refuse to provide more ladders while shouting “I did it so can you”.

The lack of empathy, the total separation of lifeworlds, arises partly from moral intuitions that both blinds many politicians and commentators to alternative explanations pf poverty and binds them together in a bubble of privilege that prevents them from analysing the evidence. As we all do, they engage in post hoc rationalisations – in their case that that the poor are a moral underclass who are less intelligent, lazy, and hard working than the successful – to explain and justify their own positions.  This is almost a moral imperative, because not to blame the poor opens one up to the need to justify or critique the structural and economic privileges one has unequal access to. Placing the focus on the work, drinking and drug taking habits of a ‘moral underclass’ provides one with a sense of superiority and entitlement so much on show in both US and UK politics. No doubt the same occurs in Russia and China. To acknowledge that there are structural and economic conditions, for example the public school system or the service sector low wage economies,  or the inverse care law, opens up the middle class to accusations of champagne socialism.

This is a common tactic to deflect the argument away from an examination of causes to one of ‘ad hominem’.  Another tactic is to argue that the best way to address structural and economic factors is more of the same economic policies that have held sway especially in the US and UK. Indeed on a global scale the numbers of people living in absolute poverty is decreasing. Inequality is also decreasing with in the UK (gini coefficient). However these two factors are not the only issue.  Both the UK and the US are rich and other measures of inequality have increased, see for example the use of the Palma ratio. It matters greatly for very poor people to get incomes, and mortality rates, enjoyed by the poor in the UK and the US, but that is not enough as the social, health and political problems in both countries testify.

Privilege looks around and is satisfied knowing that the ‘have nots’ only have themselves to blame. They reach for the moral underclass theory and publish it relentlessly in their newspapers and commentary. They also have the wealth and political power to ensure this ideology is accepted by the poor themselves. However, many do not. In this context:

The losers get sick.

The losers get poor.

The losers get defeated.

The losers get mad.

The losers get even.

‘Many professions take losers as the object of their studies and as the basis for their existence. Social psychologists, social workers, nurses, doctors, social policy experts, criminologists, therapists and others who do not count themselves among the losers would be out of work without them. But with the best will in the world, their clients remains obscure to them: their empathy knows clearly-defined professional bounds’ (Enzensberger 2005). Enzensberger (2005) goes on to argue:

‘one thing is certain: the way humanity has organized itself – “capitalism”, “competition”, “empire”, “globalisation” – not only does the number of losers increase every day, but as in any large group, fragmentation soon sets in. In a chaotic, unfathomable process, the cohorts of the inferior, the defeated, the victims separate out. The loser may accept his fate and resign himself; the victim may demand satisfaction; the defeated may begin preparing for the next round. But the radical loser isolates himself, becomes invisible, guards his delusion, saves his energy, and waits for his hour to come’.

Shoots a Policeman, drives a truck through a crowd, blows himself up in an airport…..all the while privilege looks on in dumb uncomprehending horror calling for more security and economic crackdowns on the moral underclass upon whom the often middle class radical loser preys.

marxism and health care

Marxism and Health Care

You can also find this paper on my academic website:

http://plymouth.academia.edu/bennygoodman/Papers

 

Contents

 

 

Introduction. 2

 

1. An outline of Marxist philosophy. 3

 

2. From a philosophy to health. 9

 

3. The Social Determinants of Health and the health worker’s role. 11

 

References. 14

 

A worker’s speech to a doctor. 15

 

 

Introduction

 

The philosophers have only interpreted the world in various ways; the point is to change it”.    Theses on Feuerbach. XI  Marx K  c 1888

 

This paper is in three parts:

 

1)    An outline of Marxist philosophy.

2)    A discussion of its application to health.

3)    The Social Determinants of Health and the health worker’s role

 

Finally, Bertold Brecht’s poem ‘A worker’s speech to a doctor’ is presented for reflection.

 

This outline of Marxist philosophy focuses on 3 key ideas:

 

1)    Material Conditions. To understand our experience as human beings we must begin with rooting that experience in the material conditions of everyday life.

2)    Dialectical Materialism. Those material conditions of everyday life are characterised by conflicting social forces, the outcome of which ‘determines’ our experiences.

3)    Alienation. A result of our current material conditions of life is that we are alienated from our human self, from each other and from the nature of work.

 

These 3 lead us to consider that a fuller understanding of human health involves an analysis of the material conditions of living and its effects on health and illness; an understanding that competing and powerful groups shape those material conditions and that this shaping of material conditions results in alienating experiences and behaviours that lead people to make unhealthy lifestyle choices. These collectively are the ‘causes of the causes’ of ill health.

 

Marx never wrote explicitly about health problems, or the role of health professionals, his was an analysis of the progressing conditions of man in the pre modern (feudal, agrarian) and the modern (industrial) era, but it is in this analysis that we find the above ideas that may speak to us of some of the causes of a modern malaise.

 

The malaise is this. We live in an epoch of unprecedented wealth; financial, material and intellectual. The success of capitalism and technological advances, such as the internet, facilitate both the movement and development of capital and knowledge. Life expectancy and infant mortality have gone in the right directions. We live longer and in better health. Marx himself wrote very favourably about the ability of capitalism to be innovative and creative in furthering human progress.

 

However, alongside this wealth is continuing material poverty, a poverty of spirit as well as seemingly insurmountable problems: climate change, pre enlightenment religious fervour linked to terrorism, drug/alcohol abuse, and war. The United Nations struggles to contain inter state conflict and to deliver the promises of the Millenium Development goals. Alongside the huge increases in wealth, is the vastly increasing inequality in both social conditions, and inequalities in health and wealth of the global population. The gains ushered in by modernity are increasingly going to a wealthy ‘elite’ despite a growing middle class in many developing countries. We might be getting richer but we are not necessarily getting happier, and as austerity policies bite, many people are getting stressed, anxious and even suicidal.

 

Far from ushering in an era of global peace and prosperity the dominant mode of production, i.e. capitalism, is in urgent need of revision in order to meet the challenges the global community faces. If it does not do so, it might face what Jürgen Habermas called a ‘crisis of legitimacy’ as publics become less accepting of the social problems and the democratic deficit it seems to entail.

 

It is this cultural and economic critique that (neo) Marxist writers such Theodore Adorno, Louis Althusser, Jurgen Habermas and Antonio Gramsci have drawn attention to. In the 21st century these neo Marxist thinkers have been joined by writers who do not openly call themselves Marxist but they draw upon Marxist thinking, notably the idea of the material conditions of life affecting health e.g. The Black Report 1980 and the Marmot Review 2010; ideas around alienation affecting mental health, see Oliver James’ selfish capitalism;  and that of a ruling class elite see Graham Scambler’s ‘Greedy bastards hypothesis’.

 

 

1. An outline of Marxist philosophy

 

 

Condensing Marxist philosophy into a few paragraphs is just not possible. Therefore what follows is a snapshot, an interpretation (a thesis) open to critique and refutation (an antithesis) which may lead to a synthesis which in its turn may be challenged.

 

In 1844 Marx began collaborating with the affluent industrialist Friedrich Engels who was fresh from working as a mill manager in Manchester where he had been much affected by the poverty of the workers. The result was first The Holy Family and then in 1846 The German Ideology.

 

Marx’s understanding begins with the acceptance, his first premise, that it is the material conditions of man which conditions everything else, including man’s consciousness and his ‘ideas’. Thus his philosophical position is that of metaphysical naturalism.

 

‘The first premise of all human history is, of course, the existence of living human individuals. Thus the first fact to be established is the physical organisation of these individuals and their consequent relation to the rest of nature.’ (Marx and Engels 1846).

 

 

The focus is on the ‘physical organisation’ of human existence. Supernatural explanations (God or gods) for the condition of humanity are not needed. It is this premise that has led many, especially in the United States, to reject Marx from the outset as it is atheist in nature. History does not progress through ‘ideas’ alone, or though Allah’s or God’s will, or as a manifestation of Hegel’s ‘Geist’ (Spirit), but through the changing material conditions of existence, and the struggles of humanity to pacify the conditions of their existence. Look to how human beings in their physical existence organise themselves in their struggle to exist in a material physical world, as a starting point for social analysis.

 

 

‘In the social production of their existence, men inevitably enter Into definite relations, which are independent of their will, namely relations of production appropriate to a given stage in the development of their material forces of production. The totality of these relations of production constitutes the economic structure of society, the real foundation, on which arises a legal and political superstructure and to which correspond definite forms of social consciousness. The mode of production of material life conditions the general process of social, political and intellectual life.

 

It is not the consciousness of men that determines their existence, but their social existence that determines their consciousness.’ (Marx 1859).

 

Marx suggests that primarily we need to feed, drink, clothe and house ourselves and to do so we must enter into social relationships to achieve this. An examination of history reveals the form of those social relationships (the serf-lord, the working class-bourgeoisie) that exist in a particular economic mode of production (pre-agrarian, feudal and then capitalist). It is the ‘mode of production’, currently capitalism, that ‘determines’ the form of social relationships, and the ways we think. Therefore the feudal serf-lord relationship was swept away with the rise of industrial capitalism, it simply could not continue to exist as a dominant way of organising social life. One could no longer think as a feudal lord when the feudal mode of production disappeared, just as a feudal lord could not think like a merchant capitalist trading in goods across the globe because that mode or production did not yet exist.

 

 

 

 

 

 

 

 

 

Key concepts 

Means of production: land, tools, technologies

Forces of production: labour power and knowledge of technologies

Relations of production: the totality of social relationships that people must enter into to survive.

Mode of production:  a combination of the forces of production and relations of production.  Two modes are feudalism and capitalism.

 

 

 

 

In a society where there is no social provision for health, such as that in pre 1948 Britain, and which the dominant thinking is that all goods and services should be provided by private individuals rather than governments, then it is very difficult to think of a national health service paid for by taxes. This idea came about as part of the class struggle in industrial Britain when workers who could not afford to pay for doctors, finally got around to demanding health care irrespective of ability to pay. In the United States many people have accepted the idea that state provision for health is akin to Marxism and communism. The anti-Obama rhetoric on this issue is very clear on this point. Those with an interest in private medicine and those with a visceral hatred of state provision for anything, mounted a very successful campaign tapping into ordinary Americans love of individuality and scepticism about state involvement.

 

The form of the social relationships of production, e.g. proletarian – bourgeoisie, workers-ruling class, are defined by the mode of production. In the modern industrial era, this relationship is characterised by who owns and controls capital (the main means of production) and who does not (and only has their labour to sell).

 

This gives us the second concept: Dialectic Materialism. This suggests that if an understanding is required as to why we have the laws we do, the social relationships we have, the politics that are played out, the forms of artistic production and expression, and the health care systems that are in place, we have to understand our material existence based on the economic mode of production. This material existence includes the opposition of social classes that, through conflict and struggle in relationship to each other, gives rise to a new social order that in time may itself be challenged. Start with material conditions and then see that there are ‘dialectics’ or opposing social forces/classes at work. The sort of society you get results from the interplay of these two classes.

 

The dominant class in any historical era gets to set the agenda. If the subordinate class accepts the ruling class’ view on the proper social order then society ‘settles’ for a while. However, as the forces of production change with the development of new technologies for example, this impacts on the social relations of production, thus eventually changing the mode of production. This change of mode of production from feudalism to capitalism for example is not inevitable. Many so called ‘primitive societies’ have had sustainable social structures with an unchanged mode of production i.e. hunter-gatherer, for centuries. Marx realised however that capitalism was an extremely dynamic mode of production capable of unleashing upon the world social and technological revolutions never before seen or experienced.

 

Modern, globalised (post-industrial/financial and industrial) capitalism shapes our lives in deeply profound ways and it is to the nature of the 21st century form of capitalism that we should look to understand our modern social world and the world of ideas. Historical Materialism is the application of dialectic materialism to history and sociology. It is the view that social, political, artistic and cultural life is determined mainly by the material facts of economics and the forms of social relationships thus created, and not God or by human reasoning alone.

 

The health care system within capitalism results from this dialectical interplay between the social classes. Capitalism has now provided technologies and advances which allow for many different relationships and forms of health care to emerge, but at its heart is the relationship between its social relations of production: labour (proletarians) and capital (bourgeoisie). The exact nature of the health system differs from country to country, but it results from whichever social force is best able to set the agenda.

 

Currently, Capital, in the form of private sector corporations,  is dominant and channels funding, or withholds funding, for health care though its various spheres of influence.  If private sector corporations can influence Nation States to allow them to provide health services for a profit they will do so. If working class, i.e. labour, interests insist that health care is provided free at the point of delivery paid for out of general taxation, and that idea wins out, we end up with an NHS. In the UK, private sector corporate interests have successfully introduced market forces into a publicly funded state health system. In the United States, private sector health interests have blocked anything but the most basic of public funding for health. In many other countries the interplay between capital and labour has resulted in mixed public/private provision.

 

 

A defining characteristic of capitalism, Marx suggested, is that it alienates man from himself, from the true nature of work, from others and from nature. Alienation is suggested as a third concept in understanding modern existence, especially in terms of mental health and ideas of well-being. Anyone who only has their labour, skill or knowledge to sell in return for a wage or salary may reflect on the alienated meaning of their existence. Billions of workers are engaged in low pay, repetitive, precarious and zero contract hours to produce ‘stuff’ that ultimately is unsatisfying and which paradoxically leads to the consumption of more ‘stuff’ as a means of escape. There is now discussion of a ‘new dangerous class’ – ‘the precariat’.

 

Alienation may be partially moderated by consumption and by accepting the dominant ideas of what is the ‘good life’. In Roman times this was understood by the Emperors’ provision of bread and circuses. The plebeians needed distraction to prevent them from seeing the true nature of their subjugated existence. Soap operas and celebrity culture may have a similar function today. Other ways of ameliorating this alienation is through organised religion or a spiritual quest, or one can resort to easing the anomic pain with drugs and alcohol. We might also engage in art or philosophical musings to escape the feelings of disconnection from ourselves, our work, each other and from nature.

 

The ‘poverty of philosophy’ is its concerns with abstractions, ideas, ‘facts’ or consciousness devoid of their material context. That is, a philosophy or any understanding of how the world works which does not take into account the material conditions that man finds himself and the power relationships that result, is an empty philosophy. Removing the analysis of power relationships allows the ‘Ruling Class’ to promote their own interest in the form of ‘Ruling Ideas’. Therefore, encouraging people to ‘find themselves’ without a class analysis lets the ruling class completely off the hook because this requires no changes whatsoever in the mode of production. Capitalism can embrace any amount of ‘new age’ philosophy as long as that philosophy does not challenge  the basic power structures of wealth accumulation and distribution.

 

The counter culture in the 1960’s was initially threatening.  In being inviting young people to ‘drop out’, and with the advocacy of using LSD, capitalism would be deprived of workers who would shoulder their share of the burden. Of course the actual argument was couched in terms of ‘drugs are bad for you’, which is seen an easier sell to otherwise rebellious youth rather than ‘drug use may make you question the system’ which is not, and may actually be quite an appealing reason to take drugs.

 

The class which has the means of material production at its disposal, and which has control at the same time over the means of mental production, and over thinkers, as producers of ideas, can sell and promulgate those ideas as the ‘right ‘ones. The ruling class can regulate the production and distribution of ideas and define them to serve their own causes. ‘Liberty’ to the ruling class means something quite different to those who have nothing but the shirts on their backs. This does not mean there will not be rebels in thought and deed, only that ruling ideas tend to become ‘taken for granted’ and ‘common sense’ and anyone not willing to take part in selling their labour is then classed as deviant or criminal. Thus we have social and political issues with ‘out groups’ such as travellers, chavs, skivers v strivers. Countervailing voices are pushed to the margins and tolerated as long as they don’t do a anything practice to change things.

 

Escaping from these social relations of production is increasingly harder to do as more and more people in a globalised economy become part of the overall mode of production we call globalised capitalism.

 

To keep it that way, the ruling class, identified by Scambler as the Corporate Class Executive and the Political Power Elite, has at its disposal a Repressive State Apparatus: Police, Military, Executive government,  and an Ideological State Apparatus: newspapers, broadcast media, the churches/mosques. These act as agents of social control trying to prop up the legitimacy of current power structures and the structures of rewards and punishment. Ruling class interests are better served if the subjugated classes accept their position themselves and regulate themselves by accepting, as natural, the ruling systems. Democracy in this schema is a chimera, the State (party politics) exists mainly to serve the interests of the ruling class:

 

‘the modern Cabinet is but the executive committee for managing the affairs of the entire bourgeoisie’ (Communist Manifesto).

 

Ideas, and the definitions of ideas, such as the ‘rule of law’, ‘market forces’, ‘free trade’, presents particular class interests as being in the general social interest. It is as if these ideas float down like manna from heaven untainted by the need to serve a particular class interest. This may lead to hegemony, the political, social, ideological, economic dominance of one class over others in a system in which all are supposedly equal. A result of which may be that the subjugated class, by accepting the tenets, ideas and concepts of the dominant class has a false class consciousness, i.e. a false understanding of their true social position and interests. That is how you get low paid workers supporting social security cuts for low paid workers. Turkeys voting for Christmas.

 

The goal of philosophy should therefore be to reveal the true nature of abstract concepts e.g. parliamentary democracy and a health service, as arising from the material existence of those who produce them and the struggles of opposing social forces.

 

 

Reflecting on such a critical philosophy leads to certain questions. It may be argued that Marxism assists in developing a necessary critical perspective in that it’s key concepts asks us to engage in criticism which has:

 

‘plucked the imaginary flowers on the chain not in order that man shall continue to bear that chain without fantasy or consolation but so that he shall throw off the chain and pluck the living flower.’ (Marx 1843-4, p 244).

 

There is a need to get beyond the illusory to the real, to separate fantasy from reality, to free empirical butterflies from under the wheels of philosophical fantasy. Marxism argued that there is a material reality, often hidden by delusion, deception and class interests.

 

We may suggest that in the current era a global multinational corporatist class exists for whom such concepts of the maximisation of profit, shareholder value, the extraction of natural resources on an industrial scale and the value placed on market solutions to various social, political and health issues are dominant. It wants and needs a healthy workforce only as long as the costs are not threatening to profits. Hence the health needs of poverty stricken, war torn Africans are not a priority. The health care needs of unproductive members of society: children, students, the elderly, the sick, learning disabled and mentally ill, are a costly burden to be born if possible by individuals and families. This in practice means care is to be undertaken by women supported by patriarchal notions of biological determinism of female nurturing.

Capitalism allowed the welfare state to exist on sufferance in the UK and not all in the US. Now that it has decided that the welfare state is too costly in the UK, it is withdrawing state support as quickly as public opinion will allow it to go. Corporate class interest does not need this cost burden. It prefers privatising and individualising risk rather than being asked to support public health delivery systems. The ideology it sells includes an over emphasis on individual lifestyles choices as part of the ‘responsibility deal’. You are fat because you over eat. Simple. The solution? Stop eating. Simple.

 

2. From a philosophy to health

 

In any social, cultural and political activity, a Marxist analysis thus assumes a dominant class exists which continues to own, manage and control the means of production, distribution and exchange and the production of ruling ideas. Scambler (2013) in his “Greedy Bastards Hypothesis” identifies a ‘cabal’ of wealthy and influential individuals forming the Corporate Class Executive who work with the Political Power Elite to further their own interests over that of society. His example is the introduction of the UK’s Health and Social Care Act (2012) which opens up health service delivery to “any willing provider”, such as private sector organisations. Those now charged with buying health care provision, the Clinical Commissioning Groups led largely by Doctors, will be required to open up to tender the provision of services despite the potential conflict of interest whereby many doctors also have an interest in companies who will bid for that service.

 

What are the ruling ideas and whose interests do they serve? A current example is the UK government’s use of ‘Skivers v Strivers’ rhetoric aimed at gathering public support for the withdrawal of the State from welfare provision. This idea argues that because of an increasing welfare bill which exists in a time of ‘fiscal austerity’, “there is no money left” to pay for a range of social security benefits. Therefore individuals and families should work more to provide for themselves, to break free from an entitlement culture and welfare dependency that has been associated with social ills. It may suit the ruling class to say that there is no money left and indeed it is strictly true if one only thinks about government money. What is left for critics to point out is that there is a great deal of money but that it is owned by a very small number of people and often in secretive offshore tax havens where it cannot be touched. One estimate puts this figure at $32 trillion.

 

Marxist analysis, because it highlights opposing social forces,  asks the power questions: Who sets the political and social/health agenda and why? Who are the winners and losers in a global economy and health system? How are global resources for health allocated and why? What health issues get researched and supported and why? Who has the power and who is powerless?

 

 

A Marxist take on health may suggest.

 

  • Poverty is now accepted as linked to health, but often was denied.
  • The material conditions of life have a causal relationship to health and illness. Therefore to improve health outcomes, improve material conditions.
  • Capitalism will invest in profitable enterprises, so how do you ensure finance capital invests in highly expensive low/no profit care services?
  • The social and political causes of illness and disease have been overlooked and under researched.
  • Once people lose economic usefulness their value drops and their health needs are poorly served. Take elder care and its provision as an example.
  • Research into health needs may disproportionally favour the health needs of affluent societies and the affluent in affluent societies because that is where the investment returns are.
  • Health services may be about keeping workers as productive and as economically active as possible. Therefore health services are designed to establish productive capacity not human flourishing or well being. So they invest in high tech hospital services with clear medical outcomes.
  • The National Health Service is accepted by the ruling class as the provision of ‘bread and circuses’. The provision of health services buys off the discontent of the workers and only came into being by Marxist influenced social democratic politics.
  • Health systems may favour the wealthy and well off by the design and delivery of services that they want. See for example ‘The inverse care law’ and the Health and Social Care Act 2012.
  • A ruling class idea is that ‘Responsibility for health is the individual’s, who must also pay for its provision’ thus diverting attention away from injurious to health working and cultural practices.
  • Healthcare professionals are either unwittingly working in a system that is largely about keeping the worker healthy or are self serving professionals getting affluent on the back of the ill, poor and the vain.
  • A professional ethic which emphasises altruism masks self interest from professionals themselves and from others.
  • The medical profession is a self serving elite profession, diagnosing the wrong problem, overlooking iatrogenic illness and often coming up with unhelpful solutions. It is too focused on downstream solutions to health problems caused upstream.
  • Defining health needs solely in medical terms distracts attention from the political and social determinants of health.
  • Medical definitions of mental illness may construct a deviant subculture than can, and has to be, controlled.

 

 

 

 

3. The Social Determinants of Health and the health worker’s role

 

There are three main explanations for inequalities in health.

 

1)    Cultural/lifestyle.

2)    Material.

3)    Psychosocial.

 

The first focuses on the unhealthy lifestyle choices made by people, the second focuses on the material conditions of life and the third draws in social comparisons that people make between themselves. There is a fourth – the biological/hereditarian perspective which of course has explanatory power but cannot account for the unequal patterns of health and illness we see outlined in for example “Fair Society Healthy Lives” (The Marmot Review 2010).

 

Marx and Engels would certainly have seen how the material conditions of the English working class in the 19th century caused the ill health and disease seen in urban slums. These material conditions are part of the social determinants of health which:

 

“are the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels”. (World Health Organisation).

 

They are the ‘causes of the causes’ and help to explain, or at least ask us to consider why, people’s lifestyle choices for example smoking, are poor for their health. Marxists would look beyond simple explanations that blame poor people for smoking and seek to address why they are making those choices and who benefits from those choices. This is not to say that their choices are causally determined by tobacco companies, but it is to suggest that the interplay of material conditions, life chances and lifestyle choices are quite complex and open to subtle but powerful influences.

 

This too goes for obesity. Too much emphasise in getting individuals to eat less and exercise more while ignoring the production, marketing, distribution of high sugar, high calorie cheap foodstuffs through allowing industry to police itself with voluntary codes of practice is a partial solution. The context of food has also to address how we have replaced it with fossil fuels as a source of energy. We don’t walk, we drive. The automobile industry is not interested in public health, is antithetical to investment in public transport and the provision of cycling as active modes of transport.  Free market thinking in transport, leads to the insanity of Los Angeles freeways in the US, and the Beeching Rail cuts in the UK. Free markets are not always self-correcting, and when they do, they may leave a wave of ‘creative destruction’ in their wake.

 

Poverty and the poor material conditions of life are inextricably linked to illness and disease. It has been said that the poor are always with us and that we have had plague, famine and poverty since biblical days. Therefore the existence of ‘haves and have nots’ does not ‘prove’ Marxist philosophy.

 

However, understanding that the material conditions of life exist under a particular political and social structure, means understanding health in terms of poverty and how poverty is allowed to continue.  Poverty is a result of war, ideological conflict, famine and ruling ideas rather than it being a ‘natural’ state of affairs or god given. Poverty can be ameliorated if the ruling classes in each country have a mind to prioritise it as a goal.

 

The concept of a ruling class owning and controlling wealth and the production of ideas suggests that there is a global struggle for material well being, a struggle for the use and control of the means of production, and that the sides (classes) in this struggle are largely unequal in power and resources. There are winners and losers. Many more are on the losing side.

 

The losers get sick.

 

The losers get poor.

 

The losers get defeated.

 

The losers get mad.

 

The losers get even.

 

Health professionals focused on healing the individual sick and injured often can’t take the time to combat the forces that cause illness and injury.

 

‘Many professions take losers as the object of their studies and as the basis for their existence. Social psychologists, social workers, nurses, doctors, social policy experts, criminologists, therapists and others who do not count themselves among the losers would be out of work without them. But with the best will in the world, their clients remains obscure to them: their empathy knows clearly-defined professional bounds’ (Enzensberger 2005).

 

As Enzensberger (2005) goes on to argue:

 

‘one thing is certain: the way humanity has organized itself – “capitalism”, “competition”, “empire”, “globalisation” – not only does the number of losers increase every day, but as in any large group, fragmentation soon sets in. In a chaotic, unfathomable process, the cohorts of the inferior, the defeated, the victims separate out. The loser may accept his fate and resign himself; the victim may demand satisfaction; the defeated may begin preparing for the next round. But the radical loser isolates himself, becomes invisible, guards his delusion, saves his energy, and waits for his hour to come’.

 

Global capitalism has not yet solved this crisis for humanity. Marx offered revolution as an answer, a communist society….but so far the capitalism Marx knew has evolved partly due to the dialectical forces of marxist and socialist thinking , partly due to the advances in science and technology and partly due to religious philanthropy and humanist altruism.

 

What to do?

 

Health care professionals are motivated by many things, but they fool themselves to think it is a caring ethic alone that drives their practice. Caring and healing is socially and politically mediated, shaped by forces and agendas often tacitly accepted by professionals, often unknown by professionals, often ignored by professionals. Marx calls us to remove the flowers from the chains so that we may see health and illness as they really are, rooted in the material conditions of social life.

 

Health care ameliorates the worse ravages of post industrial and industrial capitalism, as well as producing some wonderful technological fixes for real human problems. But its success can only be seen to be so at the individual level. If the focus is kept at the individual then the real health issues can be hidden away, for medicine historically was largely silent in the face of poverty and inequity. Health care professionals, and the research they undertake, focus too much on the needs of the rich world and on the rich in the rich world, while practice may be based on profit not need. Quick fix expensive drugs with the promise of shareholder profits are preferred to painstaking analysis and costs of putting right social and political causes of illness – the material conditions of life that bring misery.

 

Health care professionals need to get political and join in the example of those few brave catholic priests in South America who engaged in liberation theology. Priests, who were engaged in activities unsupported by their masters in the Vatican, often suffered beatings and death while the Catholic hierarchy preferred to keep their dissent to prayer and sacraments. Religious, political and health care hierarchies may peddle an ‘its not our business leave it to the proper authorities’ ideology, however the social gradient in health and illness continues. Health care professionals know what makes people sick. Healthcare professionals know what makes people well. Healthcare professionals could argue for the focus of research and health care delivery to be turned on those known factors that lead to illness, depression and suicide. Resources should be sequestered away from the GB’s in their offshore tax havens towards meeting the needs of people. Governments should enforce a framework that ensures investment gets channelled into directions that improves human well-being even at the expense of short term shareholder profit. An ethic of civic duty and social care ought to replace an ethic of profit at all costs and that this ethic arising from moral teachings has also legislative force. Civic society must hold to account the GB’s and reclaim democracy for the people. This last however is a visionary forlorn hope, as utopian as Marx’s own dream of a communist society based ironically on a biblical event in the Book of Acts:

 

“From each according to his ability, to each according to his need”.

 

 

 

References

 

 

Enzensberger H (2005) The Radical Loser Der Speigel 7th  November 2005

http://www.signandsight.com/features/493.html accessed 5th April 2013

 

Marx K (1843)  A Contribution to the Critique of Hegel’s Philosophy of Right. Introduction. Early Writings.

 

Marx K. and Engels, F. (1846) The German Ideology Critique of Modern German Philosophy According to Its Representatives Feuerbach, B. Bauer and Stirner, and of German Socialism According to Its Various Prophets.

 

Marx K. (1859) A contribution to the critique of political economy (Preface).

 

Scambler, G. (2013) GBH: Greedy Bastards and health inequalities. 4th November http://grahamscambler.wordpress.com/2012/11/04/gbh-greedy-bastards-and-health-inequalities/    accessed 8th April 2013

 

 

 

 

 

 

 

 

 

 

 

 

 

A worker’s speech to a doctor    Bertold Brecht

 

 

We know what makes us ill.

When we are ill we are told

That it’s you who will heal us.

 

For ten years, we are told

You learned healing in fine schools

Built at the people’s expense

And to get your knowledge

Spent a fortune

So you must be able to heal.

 

Are you able to heal?

When we come to you

Our rags are torn off us

And you listen all over our naked body.

As to the cause of our illness

One glance at our rags would

Tell you more. It is the same cause that

Wears out

Our bodies and our clothes.

 

The pain in our shoulder comes

You say, from the damp; and this is also

The reason

For the stain on the wall of our flat.

So, tell us;

Where does the damp come from?

 

Too much work and too little food

Makes us feeble and thin.

Your prescription says:

Put on more weight.

You might as well tell a bullrush

Not to get wet.

 

You’ll no doubt say

You are innocent. The damp patch

On the walls of our flats

Tells the same story.

 

In an unequal world, what can I do?

In an unequal world, what can I do?

 

Peter Morrall (2009) argues that as health care professionals we know about the problems of the world and the issue for health for populations, but not do anything about it is an abrogation of moral responsibility. Morrall and Goodman (2012) challenge the higher education sector to engage in critical thinking to address global issues, but thinking that leads to action.

 

I always think of action at various levels:

 

Individual, group, organisation, national and international. You decide what you can do at any level. That may flow though from your increased awareness and learning.

 

For the UK a good start is the Equality Trust, based on the work of Richard  Wilkinson and Kate Pickett in their book ‘The Spirit Level’.  The website has excellent resources to raise understanding and awareness:  http://www.equalitytrust.org.uk.  This gives you the basic information and perhaps ideas about what might be done.

 

 

Another good source for information on a global scale is Hans Rosling’s http://www.gapminder.org  See also ‘Global Issues’ , Poverty Facts and Stats at http://www.globalissues.org/article/26/poverty-facts-and-stats

and of course the Joseph Rowntree Foundation: http://www.jrf.org.uk

 

 

So get yourself informed (consider journals and the quality press such as the Guardian) and then reflect on what you might want to do about it. There are online campaign groups through which you might voice your support such as http://www.compassonline.org.uk , a political movement, or Avaaz http://www.avaaz.org/en/ or consider one of the main political parties to lobby and support…think which ones are focused on equality and poverty as key planks in their work.

 

Stay sane and keep a sense of humour, learn to laugh at yourself, base positions on facts as well as expressed values, as no one likes an intense preachy ‘right on’ leftie.

 

 

 

Morrall, P. (2009) Sociology and Health. Routledge. London.

 

Morrall, P. and Goodman, B. (2012) Critical Thinking, Nurse Education and Universities: some thoughts on current issues and implications for nursing practice . Nurse Education Today (in press). 

Child Mortality, poverty, globalisation

Global Perspectives on Child Health.

 

It might be a little trite and clichéd to state that our future is bound up with the current health and welfare of our children. Nonetheless, it is a matter of ethical practice how the next generation is faring. This is not about creating a healthy workforce for the economy, that is a secondary (and possibly questionable) ethical aim. It is a good in itself, to care for children. As a society in our concerns for children, we should not rely on utilitarian ethics (i.e. the consideration of ‘what good comes of doing it’), this is about a ‘universal good’, one that applies in whatever time in whatever culture.

 

 To consider the issue of child health I would like us to think about:

 

1.  Issues – ethical practice what is our responsibility? To whom are we ethically responsible?

2.  What is the role of the nurse as a global citizen for health ?

3.  What are our actions that flow from this?

 

Issues:

 

“Considerable evidence suggests that neocolonialism, in the form of economic globalization as it has evolved since the 1980s, contributes significantly to the poverty and immense global burden of disease experienced by peoples of the developing world, as well as to escalating environmental degradation of alarming proportions. Nursing’s fundamental responsibilities to promote health, prevent disease, and alleviate suffering call for the expression of caring for humanity and environment through political activism at local, national, and international levels to bring about reforms of the current global economic order” (Falk-Rafael 2006).

Falk-Raphael implicitly draws upon a social determinants of health approach which argues:

 “The social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. The social determinants of health are mostly responsible for health inequities – the unfair and avoidable differences in health status seen within and between countries”.

Globalisation results in large capital flows, labour movement and displacement and the increasing dominance of TransNational Corporations (TNCs) on economic, social and political life. The demise of state power – its withdrawal from public services, the rise of TNCs and the primacy of the market are three voices guiding politics.

 

I would argue that there is a need for a fourth voice to defend global public goods such as health. This voice is civil society, which includes nurses. Collier (2008) suggests that we have a bottom billion stuck in poverty. Even for the Rich, threats to survival are not domestic but global. Perspectives are changing from local to global, the ethics of healthcare thus need to be discussed in this context. The WHO’s Millennium Development Goals also set a global policy framework.

 

The fact of children dying under the age of 5, and the concentration of that statistic in certain countries, is largely preventable. The developed rich nations of the West have achieved huge gains in child mortality, despite a socioeconomic gradient still evident. By that I mean the children of the poor are over represented in mortality statistics. This will be true in countries with high mortality rates (Nigeria, India and China). It is the children of the poor who die young.

 

Globalization cannot be the cause of poor child mortality rates, rather it is the poverty that existed before global capitalism that is the main cause. Therefore efforts at eradicating poverty will bring down the rates (along side simple things like fresh water, malaria nets and vaccinations). Global capitalism is producing the goods we need and improving the living conditions of many so that many countries will eventually join the developed west with their low mortality rates. However, we must not lose sight of the socioeconomic inequalities in health in the rich West. However, there is an ideology attached to globalization that would rather spend trillions of $s and £s on bank bail outs, military spending (estimated cost of the UK’s trident replacement  – anything between £20 and £100 billion) and the mismatch between research funding and the research need of low and middle income countries remains. This has been referred to, by the Global Forum for Health Research, as the 10:90 gap (10% of global funding going towards 90% of global needs –research favours the rich in the rich world).

 

Ethical practice. Paul Ricoeur suggested that ethics are about “aiming at the good life”, and so if this is the case we ought to consider the good for all. If everyone has a right to the opportunity for a good life, what should the Nursing response be? 

 

Consider the codes of Ethics that govern nursing practice. Where are they, and what do they say? Consider the international nursing codes of ethics rather than just the Nursing and Midwifery Council’s.

 

As stated above, child health should be a matter of universal concern to us all. To focus only on the children of the rich in the rich world, who already have a surfeit of resources and health access, may be an abrogation of our moral obligations as global citizens for health. There is therefore a need to think differently about our role in the world as a nursing community.

 

Acting Ethically as a nurse in a global community requires a need for Transformative thinking.

 

 

 

Part of that thinking involves seeing our selves as interconnected in systems on a finite planet. We have been told that climate change is the biggest threat to public health this century. Children already at risk in the developing world could face, some say are already facing, health threats from changing climates. Food shortages, droughts and crop failures have affected many parts of the world in 2012. Current economic practices are implicated in carbon emissions. Thus mitigating and adapting to climate change will be on the agenda in the developed world if we are to keep our gains. In the United Kingdom carbon reduction already is an NHS aim.

 

 

Child Mortality: the facts:

 

Use the websites below to gather a fuller picture of current trends in child mortality and the factors that reduce child deaths. Consider what role nurses can play in this. Think about the relationship between maternal health, family size, female education and child mortality.

 

Websites:

 

http://www.globalissues.org/about – facts about global health issues. Click on issues and then health issues for an overview.

 

http://www.un.org/millenniumgoals/childhealth.shtml – the WHO’s Millennium Development Goals.

 

http://www.gapminder.org/videos/reducing-child-mortality-a-moral-and-environmental-imperative/ -Hans Rosling on child mortality

 

 

Levels and Trends in Child Mortality 2012 http://www.unicef.org/videoaudio/PDFs/UNICEF_2012_child_mortality_for_web_0904.pdf   UNICEF.

 

Every Woman Every child is a United Nations campaign which acknowledges that the health of women and children are priorities, as reflected in the Millennium Development Goals (MDG 4 and 5). See box 1.

 

 

MDG 4 Reduce Child Mortality

MDG 5 Improve Maternal Health

 

By focusing on the maternal and child health it is hoped that we will help to maximise global health gains.

Box 1

 

What is Every Woman Every Child?

 

 

Launched by UN Secretary-General Ban Ki-moon during the United Nations Millennium Development Goals Summit in September 2010, Every Woman Every Child aims to save the lives of 16 million women and children by 2015. It is an unprecedented global movement that mobilizes and intensifies international and national action by governments, multilaterals, the private sector and civil society to address the major health challenges facing women and children around the world. The effort puts into action the Global Strategy for Women’s and Children’s Health, which presents a roadmap on how to enhance financing, strengthen policy and improve service on the ground for the most vulnerable women and children.

 

‘Every Woman Every Child’ http://www.everywomaneverychild.org/about

 

http://www.everywomaneverychild.org/images/content/files/global_strategy/full/20100914_gswch_en.pdf

 

Conclusion.

 

We know there is a huge disparity in the under 5 mortality rate (U5MR) and that this is linked to socioeconomic status. This may well be exacerbated by climate change. There are variances within countries as well as between them. We know that rates are falling on a global basis and many countries are making good progress. We also know that nurses are charged with having a health promotion and public health role to play. This could go beyond a medical approach (e.g. vaccinations) and adapt the social model of health. As global citizens nurses could address social determinants through individual actions as well as through their socio-political roles, the least of which means developing political awareness of such things as the UN’s ‘Every women every child’ campaign.

 

Benny Goodman 2012

Inequalities in health

Inequalities in Health

Annandale and Field (2008) argue:

“Inequalities in health between social groups are a resilient feature of British society and continue to be part of the social and political landscape of the 21st century”.

1. Consider you position on this question:

“Does Poverty and ill health arise from the failings of individuals or from failings of society”?

 

Write some first thoughts on this question and share with colleagues:

Consider what evidence you have for your position, can you refer to any?

 

Historical milestones:

 

Townsend, P. (1988) Inequalities in Health (The Black Report). Penguin. London.   What was its main conclusion?

 

That the main explanation for inequalities ‘was material deprivation’. The social environment which includes things like family size, unemployment, housing, income.

 

Acheson Report (1998). What did this report conclude?

 

Concurred with the Black report, and that the gap between top and bottom has widened. 

 

 

The Wanless Report (2008) ‘Layers of influence’, meaning what?

 

Combines lifestyle, behaviours and environmental explanations.

 

In November 2008, Professor Sir Michael Marmot was asked by the Secretary of State for Health to chair an independent review to propose the most effective evidence-based strategies for reducing health inequalities in England from 2010. The strategy includes policies and interventions that address the social determinants of health inequalities.

The Review had four tasks: 

  1. Identify, for the health inequalities challenge facing England, the evidence most relevant to underpinning future policy and action
  2. Show how this evidence could be translated into practice
  3. Advise on possible objectives and measures, building on the experience of the current targets on infant mortality and life expectancy
  4. Publish a report of the review’s work that will contribute to the development of a post-2010 health inequalities strateg

The Marmot Review (2010)

 

1. Go to the  Fairer Society Healthy Lives website. Find the executive summary

 

 

·        What are the key messages of the review? Explain in your own words.

·        How many policy objectives are there?

·        What are the key points from each?

 

 

2. Go to Marmot Indicators for local authorities (see above page)

a) South West in ‘select your region’, then select ‘Cornwall’

b) Do the same for Northeast and Newcastle, London and Hackney, London and Kensington and Chelsea.

c) open the pdfs…what are you looking at? Compare the data sets.

What explanations are given for the inequalities in health?

See Annandale and Field (2008) in Chapter 3 of Taylor, S. and Field, D. (2008) Sociology of Health and Health care. 4e Blackwell Oxford.

Or Inequalities in health, contested spaces

·         Outline the explanations in your own words:

1.       Heriditarian explanations: one’s biologically determined natural capacity, thus little can be done.

2.       Behavioural explanations: the lifestyle choices of individuals are the cause the answer is education (or punishment)

3.       Environmental explanations: one’s social position and material deprivation, the answer is structural.

 So, either individualistic/behaviourist and/or structural/materialist.

Contemporary explanations: there are overlaps, this is a simplified typology.

1.       Poverty/deprivation (structuralist/materialist – environmental).

2.       Psycho-social stress (structuralist/materialist – environmental -behavioural).

3.       Individual deficits (individualist/behavioural – hereditarian).

Solutions?

1.       ‘RED, MUD and SID’ – Redistribution, Moral Underclass and Social Integrationist discourses

2.       Work is needed at individual and/or community and /or social structure level.

 

Carlisle, S.  (2001) Inequalities in Health: contested explanations, shifting discourses and ambiguous polices. Critical Public health 11 (3)

 

 

 

Poverty in Cornwall

The Bishop of Truro is asking 9 supermarkets for boxes to be placed in their stores so that customers can donate food. This is supported by the county’s foodbank scheme.

According to Professor Townsend, poverty is defined as:

“Individuals, families and groups in the population can be said to be in poverty when they lack the resources to obtain the types of diet, participate in the activities, and have the living conditions and amenities which are customary, or are at least widely encouraged and approved, in the societies in which they belong”.

The government defines poverty as a family with two children living on less than £300 a week (BBC 2011). The Child Poverty Action group state that a measure of poverty is where household income is below 60 per cent of the median UK income after housing costs have been paid.

In June 2011 Cornwall council’s  Deprivation and Child Poverty report showed 19% (16,650) of under-16s living in poverty. Levels ranged from 2% in some areas to 58% on the Pengegon estate in Camborne.

Poverty therefore does not explain rioting, where are the street protests at this level of deprivation which equals that found elsewhere in the UK? This shows that simple cause-effect explanations for human behaviour are not adequate. Instead we must look to fuzzy analyses and solutions and come to understand that certain behaviours have different antecedents and require different tipping points. Poverty needs other variables which are not always measureable. Camborne as far as I know does not have a history of racial tension, police stop and search or gang culture. Neither does it have conspicious consumption and ostentatious privilege on show, the poorer areas do not sit cheek by jowl with Mansions. We would have to ask residents why they have not kicked up at this continuing level of disparity. Do they expect less? Have they internalised failure, are they ‘all in this together’?

Townsends definition perhaps illuminates. If poverty is experienced in relation to the ‘societies in which they belong’ then it may be posited that camborne society is sufficiently poor and cut off from privilege that residents do not feel excluded as they have little experience (apart from media projections) of social wealth? What protects camborne from looting? Poverty is certainly there but what is missing to turn this experience into social unrest?

Oh, by the way…donating food? In the UK ? Are we mad? What is it about society and people that we may think it necessary to donate food? Before you answer that, have you experienced living on 60% the median wage with two children for, say a year?

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