Tag: Sociology

Making our own histories – we can change things if we want to and are free to.

Musing on the freedom to act in society, and on the nature of capitalism and its pernicious effects upon us, it might do to consider that we are free to change and we are not free to change. Capitalism at once exists and acts and feels like a cage while at the same time does not exist and is also only a product of our own imaginations and our social relationships that we have chosen to engage in. This matters because real lives are affected by the decisions that others in positions of power take, and they take these decisions as if capitalism is immutable, all pervading, inevitable…as a fact of life. This then justifies the use of batons, tear gas and surveillance drones in civil society and in putting down protest, and it justifies fixing the legal, financial and political framework so that big money fulfills big money’s needs.

In response to a recent email exchange I engaged in, a suggestion was made to me that there is a tendency to ‘objectify’ capitalism in many discussions – to make it seem indeed like a cage – a thing that has its own almost material existence and ‘essence’. This means that we may talk about capitalism as if it has objective existence and also a fixed nature. Capitalism is, in Emile Durkheim’s phrase, ‘sui generis’ – ‘of its own kind’. This derives from thinking that capitalist society over time replaces individuals with others, yet the ‘essence’ of society will not necessarily change. Over the course of a few decades, many individuals die and are replaced, however, the society retains its distinctive character. It is a thing of itself existing independently of individuals. An entire society that is built in this manner has its own ‘essence’. It has this ‘essence’ before any individual currently living in it is born, and is therefore “independent of any individual” existing almost as an ‘objective fact.’ We acknowledge this objective existence when we use such phrases as “Society today is worse/better than it was back in the day when…”

Some commentators might use different labels for capitalism. For example ‘casino capitalism‘ or ‘responsible capitalism‘ which reflects thier differing understandings of what capitalist society might be like. This tendency to label and to treat it as an objective fact, however, may overlook the fact that capitalism, like any ism, is dynamic and on the move. Historically that has been true: we have seen mercantile capitalism, industrial capitalism, post industrial or financial capitalism. Nonetheless and however it has been labelled, we must remember that capitalism is not an ‘objective fact’, although it can certainly feel that way especially to those who feel the full force of economic decisions made in far away board rooms.

Capitalism is a dynamic ever changing social system which finds expression and manifestation in human social relationships. The ‘objectivity’ of capitalism is a chimera; we may reify it and miss the essential nature of human decision making and social relationships that underpins it. Susan Strange argued “economists simply do not understand how the global economy works” due to a poor understanding of power and an over-reliance on abstract economic models. In other words, economist are apt to treat capitalism and the working of markets based on a false premise: that there is a objective system that can be understood theoretically using mathematics and a theory of self interested utility maximising rational actors, the ‘homo economicus’ of JS Mill and Adam Smith. To be fair to Smith he tempered this view in his Theory of Moral Sentiments.

What economists often miss is that what we are talking about here is a set of human relationships characterised by an imbalance of power.

“Men make their own history, but they do not make it as they please; they do not make it under self-selected circumstances, but under circumstances existing already, given and transmitted from the past” (Marx). What have ‘we’ been given and transmitted from the past? Anti capitalist sentiment such as some of us in the sustainability or others in the Transition Towns movements express, are confronting Big Oil, and a cluster of high carbon social systems (John Urry) which are based on certain capitalist relations of production. ‘We’ ignore capitalist class relations at our peril. ‘We’ may confront power elites who have made, and are trying to continue to make, history in their own image: how that history will pan out depends on our collective and individual responses to Power, e.g. the Military-Industrial-Security complex, the World Bank, IMF, OECD, G8, Davos, Bilderberg (?), EU and other Regional blocs, the Trioka, the Corporate Class Executive and the Political Power Elite. We, e.g. ‘anti-capitalists’ or the Transition Towns or Environmentalists, are trying to remake history; history as we please, but within a certain socio-political context and power play not of our choosing. We do not have ‘self selected circumstances’ and that is what makes capitalism feel like a cage. Ask yourself: who has the guns?

For an example of circumstances being shaped by the powerful, note how successful the right wing press has been in sowing the seeds of doubt in the population about climate change,  and also for blaming the poor for their position while supporting austerity in the midst of one the greatest transfers of wealth from poor to uber rich (the 0.01%) we have seen, and the movement of private bank debt to sovereign public debt. There is ample evidence that the neoliberal agenda, which unites many of groups mentioned above, are antithetical to a ‘no growth economy’ and to social democracy.  In the West, there is only one game in town: growth based on neoliberal economics.

There are countervailing voices, e.g. Paul Hawken’s ‘Blessed Unrest’,  but some are increasingly despairing, Will Hutton articulates this well.

The post financial crash shifts of 2008 are playing out, but we don’t know in 10 years what this will look like. So far however, report after report shows the wealthy elite entrenching their power and wealth* while the occupy ‘movement’, the indignados, the precariat, come under increasing demonisation, e.g. skivers v strivers, surveillance and crack downs, using para militiary type tactics. The monolith of Capitalism stands while we crash against it.

Capitalist social relationships are backed by ideology and often force. Some argue it is the best of a bad lot, and that like democracy it is the worse system we have except for all the others, that it is the only game in town. Marx himself marvelled at its ability to produce abundance. However, is this really the best we can do? Is this really the best world in the best of all possible worlds? Growth capitalism, and there is no other sort, is leading us towards ecological disaster, while the social determinants of health result in inequalities in health whereby millions die prematurely and needlessly because of our socio-political arrangements.  Many of us bluster and blog and rage and rant and protest, some of us quietly get on with living differently, remaking our social relationships as best we can.

We are free but everywhere we are in chains.

 

*the richest 1,000 persons, just 0.003% of the adult population, increased their wealth over the last three years by £155bn. That is enough for themselves alone to pay off the entire current UK budget deficit and still leave them with £30bn to spare.

More greedy bastards

The Greedy Bastards Hypothesis (GBH).

 

Since the financial crash of 2008, populations became aware of what a certain class of people were up to. The word class itself however had fallen out of fashion as many commentators had pronounced the death of class politics preferring instead to think of us all being concerned with various ‘identities’. So, although many people understood that ‘rich’ people had advantages this did not lead to a ‘crisis of legitimation’ – many people either agreed with Peter Mandelson’s quip ‘“We are intensely relaxed about people getting filthy rich as long as they pay their taxes.” ,  or at least ignored it as the consumer and housing bubble kept inflating. People forgot that class relations still operate whether one ignores it or not.

Graham Scambler (2012a) has not forgotten.

The hypothesis asserts that there are:  “strategic behaviours at the core of the country’s capitalist-executive and power elite. The ‘capitalist-executive’ are a core ‘cabal’ of financiers, CEOs and Directors of large and largely transnational companies, and rentiers. These individuals were perfectly capable of ‘conspiring’ but despite being involved in fierce competition rarely had a need to do so in the post-1970s neo-liberal era of financial capitalism. This cabal has come to dominate the political class”.

As it turns out, the filthy rich are not even paying their fair share of taxes. Tax cuts have not reduced deficits, the GB’s have stashed them away. The banking ‘elite’ enjoy lifestyles beyond the dreams of avarice and threaten to leave the country if we cap bonuses.

So, in effect, democratic politics has been hijacked to serve the interests of a very select few.

Scambler also listed individuals who make up this cabal in 2009.

While Liam Fox calls for a freeze on public spending for three years and a reduction in capital gains tax to 0%, and while Osborne and Ian Duncan Smith continue to take money away from poorly paid working people, the richest 1000 people in the UK have increased their wealth in the last three years by £155bn, and the global elite sit on £13 trillion in offshore accounts. Austerity is only for the ‘little people’.

Scambler (2012b) also cites how private companies will be profiting from the re commodifying of the NHS and health care, as a result of the Health and Social care Act 2012. This he says is evidence of policy based evidence rather than evidence based policy and comes about as a result of corporate interests coming before individual health. This is what Lansley meant when he talked about taking responsibility for health…i.e. take out insurance. The current ConDem coalition is pushing through ideologically driven agendas while Labour sleeps. Maybe Miliband and co. know just how complicit Blair and Brown were in furthering class interests.

GB’s are what Scambler calls ‘Focused Autonomous Reflexives’ (FAR). That is to say that the ‘inner conversations’ these people have concerning social action tend to be self-referential, the inner conversation requires no confirmation by others, they are self-sustained. They have a ‘lone inner dialogue’ which then leads to action. If this is dominant then the person will not need to seek or require the involvement of others, he knows that the correct course of action does not need others to confirm that it is so.

Scambler (2013) has developed an ideal type of the FAR whose ‘mode of reflexivity’ has various 6 characteristics:

Firstly there is total commitment. The FAR’s overriding aim in life is increasing capital accumulation and personal wealth. Nothing less will do and any drift from that commitment is relative failure. Secondly there is a Nietzschian instinct based on Hobbesian view of human nature as nasty, brutish and short in a dog eat dog world, that does not quibble about cutting corners in a ruthless determination to succeed and gain advantage. Thirdly a fundamentalist ideology underpins action, there is no room for compromise “there is no alternative”; it is a standpoint born of vested interests. Fourthly there is cognitive insurance which nullifies any cognitive dissonance that might arise. Criticism that greed and responsibility for others suffering will not be internalized, for to admit that this might be the case would otherwise begin to sow the seeds of doubt that arise from cognitive dissonance.  Fifthly there is tunnel vision; the commitment to making money sidelines other matters often in gendered delegation of these matters to others. Finally what is known as lifeworld detachment. The ‘lifeworld’ is that area of everyday life where taken for granted day to day decisions are taken. For the FAR there is simply no time for the ordinary business of day to day decision making.

This is an ideal type and in the real world men will vary in their modes of thinking which direct their action. Those who rub shoulders of the GB’s can draw their own conclusions, however their ideological bias may prevent critical self-reflection of the results of their actions as they seek to shift the blame for financial collapse and budget deficits onto the ‘feckless poor’, the benefit cheats and the skivers.

Warren Buffet once stated “There’s class warfare, all right….but it’s my class, the rich class, that’s making war, and we’re winning.”

 

References.

Scambler. G. (2012b)  The Assault on ‘our’ NHS ! November 30th 2012 http://grahamscambler.wordpress.com

Scambler, G. (2012a) GBH Greedy Bastards and Health Inequalities November 4th   http://grahamscambler.wordpress.com/page/3/

Scambler, G. (2013) Resistance in unjust times: archer, structured agency and the Sociology of health inequalities. Sociology. 47 (1) 142-156

Defining Health

Defining Health

 

WHO definition of Health

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.

The Definition has not been amended since 1948.

This is a pretty idealistic view of health and does not take into account people with a mental or physical disability, who by the above definition are not healthy. Athletes who took part in the Paralympics in London in 2012 may disagree with the above as perhaps would Stephen Fry, who publicly discussed his own Bipolar disorder. The word ‘complete’ is controversial

However it allows us to list the:

Physical

Mental

Social

These 3 aspects of health take us beyond a biophysical definition.

 

There are other classificatory systems in existence such as the WHO Family of International Classifications, including the International Classification of Functioning, Disability and Health (ICF) and the International Classification of Diseases (ICD). These are commonly used to define and measure the components of health.

The WHO’s 1986 Ottawa Charter for Health Promotion further stated that health is not just a state, but also “a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities.”

So in this charter, health is seen as a ‘resource’.

The WHO also defines mental health as “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”.

Again this might sound a bit too idealistic in that people with a mental illness can also live ‘normal’ (whatever that is) lives. Why are they not healthy then?

The New Economics Foundation (Aked and Thompson 2011) argue that there are 5 ways to well-being (‘well-being’ is a component of health):

1. Connect…

With the people around you. With family, friends, colleagues and neighbours. At home, work, school or in your local community. Think of these as the cornerstones of your life and invest time in developing them. Building these connections will support and enrich you every day.

2. Be active…

Go for a walk or run. Step outside. Cycle. Play a game. Garden. Dance.Exercising makes you feel good. Most importantly, discover a physical activity you enjoy and that suits your level of mobility and fitness.

3. Take notice…

Be curious. Catch sight of the beautiful. Remark on the unusual. Notice the changing seasons. Savour the moment, whether you are walking to work, eating lunch or talking to friends. Be aware of the world around you and what you are feeling. Reflecting on your experiences will help you appreciate what matters to you.

4. Keep learning…

Try something new. Rediscover an old interest. Sign up for that course. Take on a different responsibility at work. Fix a bike. Learn to play an instrument or how to cook your favourite food. Set a challenge you will enjoy achieving. Learning new things will make you more confident as well as being fun.

5. Give…

Do something nice for a friend, or a stranger. Thank someone. Smile. Volunteer your time. Join a community group. Look out, as well as in. Seeing yourself, and your happiness, linked to the wider community can be incredibly rewarding and creates connections with the people around you.

Social Determinants of Health

The approach that has gained influence is that of understanding health as having social determinants (WHO 2008), while Barton and Grant (2006) have developed a health map illustrating the complex interplay of the physical and global environment, social relationships and individual biology.

The social determinants of health approach (WHO 2008) suggests ‘Social justice is a matter of life and death. It affects the way people live, their consequent chance of illness, and their risk of premature death. We watch in wonder as life expectancy and good health continue to increase in parts of the world and in alarm as they fail to improve in others’.

Thus we clearly see a link between ideas about what health is and social justice. Health is therefore inextricably bound up with how we organise our societies. It is no longer to be understood as a bio-physical concept only. WHO 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’.

See http://www.who.int/social_determinants/en/  (Commission on Social Determinants of Health 2008).

The Health Map

see: http://eprints.uwe.ac.uk/7863/2/The_health_map_2006_JRSH_article_-_post_print.pdf

Barton and Grant at about the same time produced a ‘health map’ and argued:

‘The environment in which we live is a major determinant of health and well-being. Modern town planning originated in the nineteenth century in response to basic health problems, but in the intervening years has become largely divorced from health. We have been literally building unhealthy conditions into our local human habitat.

 

Recent concerns about levels of physical activity, obesity, asthma and increasing environmental inequality have put planning back on the health agenda. It is widely recognised that public health is being compromised by both the manner of human intervention in the natural world and the manner of development activity in our built environment (Larkin, 2003). However, taking action is not necessarily simple. The links between health and settlements are often indirect and complex. A tool to improve understanding and foster collaboration between planning and health decision-makers is badly needed’.

The health map was inspired by theories about how the eco system interacts with biological species, which is clearly seen in the outer ring. An implication of seeing health in this manner is that the individual’s health is caught up in a web of complex systems and requires the ‘health’ of all manner of interacting physical and non-physical phenomena.

Healthy Planet, Healthy Lives?

Another view firmly connects the planet to people as a unitary whole arguing that as a result an individual is not healthy if the planet is not. This critiques a dualist view of reality in which we can separate physical human bodies from the physical universe, seeing them as two distinct entities. This may seem obvious to those of us living in western societies, as this is how we are brought up to consider how the world is. This has a long tradition but other philosophical traditions make no distinction between ‘man’ and ‘nature’:

“In this century it has become clear that the fundamental social problem is now the relationship between humankind as a whole and our global environment” (Loy 1988 p 302).

David Loy (1988 p140) argues, when contrasting Eastern traditions (nondualist) with mainly Western (Cartesian) dualism, that

“….there is no distinction between “internal” (mental) and “external” (physical), which means that trees and rocks and clouds, if they are not juxtaposed in memory with the “I” concept, will be experienced to be as much “my” mind as thought and feelings”.

This then is a non-dualist viewpoint in which ‘us’ includes the biosphere, we are indivisible as human beings from all life forms and all matter.

Industrialization has required the control of nature to serve humanities purposes. This control is based upon seeing ‘the self’ in opposition to nature, which Yagelski (2011) calls  ‘the problem of the self ‘:

“My argument here is that the prevailing Western sense of the self as an autonomous, thinking being that exists separately from the natural or physical world is really at the heart of the life-threatening environmental problems we face”.

 

These problems include: Ocean acidification, fertile soil erosion, species loss and the loss of biodiversity, fish species depletion, imbalances in the nitrogen and phosphorous cycles, fresh water scarcities, chemical pollution and stratospheric ozone depletion.

Rockström et al (2009) suggest that we need to urgently consider these issues to ensure there is a ‘safe operating space for humanity’.

Another view on health stemming from philosophers such as Aristotle who discussed eudaemonia or ‘flourishing’, or Amartya Sens’ views on ‘capabilities’ as an aspect of human health welfare:

Sen argued for five components in assessing ‘capability’:

1. The importance of real freedoms in the assessment of a person’s advantage.

2. Individual differences in the ability to transform resources into valuable activities.

3. The multi-variate nature of activities giving rise to happiness.

4. A balance of materialistic and nonmaterialistic factors in evaluating human welfare.

5. Concern for the distribution of opportunities within society.

This really stretches definitions of health to include ideas around welfare and the social and economic conditions for it.

Summary

Health involves our physical selves, the biology of our bodies which does not have to ‘perfect’. However health also involves our mental well-being, our abilities to cope with the world. Health involves social relationships and communities. Health involves our relationship to eco systems and other species. Health is therefore a complex concept that can be defined in various ways according to the perspectives we care to take on it.

Aked, J., and Thompson, S. (2011) Five ways to wellbeing. New applications, new ways of thinking. New Economics Foundation. London http://www.neweconomics.org/sites/neweconomics.org/files/Five_Ways_to_Wellbeing.pdf

Barton, H. and Grant, M. (2006) A health map for the local human

habitat.  The Journal for the Royal Society for the Promotion of

Health, 126 (6). pp. 252-253. ISSN 1466-4240

Larkin, M., (2003), Can cities be designed to fight obesity, The Lancet, 362, pp1046-7

Rockström, J., W. Steffen, K. Noone, Å. Persson, F. S. Chapin, III, E. Lambin, T. M. Lenton, M. Scheffer, C. Folke, H. Schellnhuber, B. Nykvist, C. A. De Wit, T. Hughes, S. van der Leeuw, H. Rodhe, S. Sörlin, P., K. Snyder, R. Costanza, U. Svedin, M. Falkenmark, L. Karlberg, R. W. Corell, V. J. Fabry, J. Hansen, B., Walker, D. Liverman, K. Richardson, P. Crutzen, and J. Foley. (2009). Planetary boundaries: exploring the safe operating space for humanity. Ecology and Society 14(2): 32. [online] URL: http://www.ecologyandsociety.org/vol14/iss2/art32/

World Health Organization. (1986) The Ottawa Charter for Health Promotion. Adopted at the First International Conference on Health Promotion, Ottawa, 21 November 1986 – WHO/HPR/HEP/95.1.

World Health Organization (2004). Promoting Mental Health: Concepts, Emerging evidence, Practice: A report of the World Health Organization, Department of Mental Health and Substance Abuse in collaboration with the Victorian Health Promotion Foundation and the University of Melbourne. World Health Organization. Geneva

Yagelski, R. [online] Computers, Literacy and Being. Teaching with technology for a sustainable futurehttp://www.albany.edu/faculty/rpy95/webtext/

Society, Socialisation and Culture

Sociology in Nursing

 

This short paper discusses the meaning of three key words:

 

·         Society

·         Socialisation

·         Culture

 

There will be other words in blue and bold which also have specific meanings. These are hyperlinks to Wikipedia which is a useful introduction, however you will have to access books and journals if you wish to discuss these terms in academic writing.

 

 

What does the terms ‘society’ mean?

 

A large group of people who relate to each other. That is to say they work, interact, live in a shared ‘space’ be that geographical, occupational or recreational. They of course are not all in kin or family relationships, with the nature of the relationship often being transactional (‘for a purpose’) rather than emotional. Therefore human societies can be characterized by a shared and distinctive culture and institutions.  A society may be described as the sum total of such relationships among its members. A society can be a particular ethnic group, such as for example those who grandparents may have been from the Indian subcontinent; a nation state, such as Scotland; or a broader cultural group, such as a Western (Anglo-American) society.

From a sociological perspective, a larger society often manifests stratification and/or dominancepatterns among the groups that make it up. For feminist thinkers, many societies are dominated by men and male ways of thinking (Patriarchy), for those of a marxist persuasion societies are dominated by ruling class elites and their ideologies.

In nursing, there is discussion that society is patriarchal. This results in male values and ways of doing things becoming to be seen as more important than female. Also because nursing is female dominated and medicine male dominated these male values often result in nursing being understood as an inferior profession (Goodman and Ley 2012 p36-41).

If it is a collaborative society, the members can benefit in ways that would not otherwise be possible if they remained as individuals. British society since 1948 generally agreed on the social funding, out of personal taxation, of a health care system we call the NHS. Currently British society is showing less cohesiveness (what Zygmunt Bauman calls ‘liquid modernity’) and arguments now arise on how the NHS should be funded or delivered. 

A society can also consist of like-minded people governed by their own norms and valueswithin a dominant, larger society. This is sometimes referred to as a subculture. For nursing we can think of subgroups, especially our professional subgroups, who may have shared norms and values and who may develop quite distinct views, knowledge and attitudes towards health. This means we need to examine our relationship as professionals to our patients and clients and to other professional groups.

In sociology a key issue for understanding how societies work was whether societies arise from the collection of individual actions of ‘free agents’ and therefore if this is the case we need to investigate these social actions at the small group and individual level; or whether societies are characterised as having groups and institutions within them all fulfilling various functions such as child rearing and therefore we need to investigate the functioning of society; or whether societies are riven with group conflict (be they class or gender conflicts) and therefore we need to investigate the nature of this conflict.

From the first viewpoint we could investigate the ‘presentation of self in everyday life’, (see the work of Ervin Goffman) that is to say, how do we go about our daily business ensuring we know what ‘actions’ we need to undertake, for example as a nurse, and how do we manage the impression people have of us? This involves the wearing of uniforms and ways of speaking so as to play the role of ‘professional’. From the second viewpoint we might want to investigate what being sick means for the functioning of society and thus what role should be played by a sick person (see the work of Talcott Parsons). What are the rights and responsibilities of the sick person in a proper functioning society? From the last viewpoint we would want to investigate if health care professionals really serve society as they say they do or whether they actually serve themselves and are in conflict with other groups in society. We would look at the structure of rewards and status in society of, for example, doctors and/or men as doctors (see the work of Ivan Illich).

 

 

 

Case study: Mid Staffordshire NHS Foundation Trust Inquiry March 2010

 

In 2010, Emily Cook (a health correspondent for a daily paper) reported that up to 1,200 patients may have died as a result of “shocking” treatment at Stafford Hospital. This story was based on a report by the Healthcare Commission which stated that Mid Staffordshire NHS Foundation Trust had an appalling and chaotic system of patient care.

The Healthcare commission (now the Care Quality Commission) had a role in examining the quality of care delivered by NHS organisations. The Commissions’ report argued that between 400 and 1,200 more people died than would have been expected during 2005 to 2008.

According to Cook, families described ‘Third World’ conditions in the hospital with some patients resorting to drinking water from flower vases because they were so thirsty.  Some of the conditions reported included filthy, blood and excrement crusted wards and bathrooms, patients being left in pain and needing the toilet, and being left sat in soiled bedding for hours and not given their regular medication. In one ward, 55 per cent of patients had pressure sores when only 10 per cent had sores on arrival.

The health minister at the time was concerned enough to order an inquiry. In a 452 page report, Robert Francis QC outlined the shortcomings in care in and argued “It was striking how many (patient’s) accounts related to basic nursing care as opposed to clinical errors leading to injury or death”. The conclusion was that patients were ‘routinely neglected’ in the context of cost cutting, targets and processes that lost sight of the basic need to provide safe care.

 

Many patients had their basic needs neglected:

 

·      Calls for help to use the bathroom were ignored.

·      Patients were left lying in soiled sheets.

·      Patients were left sat on commodes for hours.

·      Patients were left unwashed – at times for up to a month.

·      Food and drink was left out of reach.

·      Family members had to feed patients.

·      There was a failure to make basic observations.

·      Pain relief was given late.

·      Patients were discharged inappropriately.

·      There were poor standards of hygiene.

·      Families removed dressings and had to clean toilets.

 

 

 

The reasons outlined in the report for these deficiencies in care were as follows:

·      A chronic shortage of staff, particularly nursing staff, was largely responsible for the substandard care.

·      Morale at the Trust was low.

·      Many staff did their best in difficult circumstances, others showed a disturbing lack of compassion (my emphasis) towards their patients.

·      Staff who spoke out felt ignored and there is strong evidence that many were deterred from doing so through fear or bullying.

 

The Trust’s board was found to be:

 

“ disconnected from what was actually happening in the hospital and chose to rely on apparently favourable performance reports by outside bodies such as the Healthcare Commission, rather than effective internal assessment and feedback from staff and patients.

The Trust “failed to listen to patients’ concerns”, the Board did not “review the substance of complaints and incident reports were not given the necessary attention”.

 

Quotes are from   http://www.midstaffsinquiry.com/news.php?id=30

See http://www.midstaffsinquiry.com/ for the report into Mid Staffordshire NHS Trust.

 

 

 

Please read the case study above and then think about what this says about our society, how we are socialised and what a culture may mean.

 

Next I will address two key concepts in sociology – socialisation and culture – and relate them to what was going on at Mid Staffordshire and how they apply to your own nursing practice.

 

 

 

What is socialisation?

 

Staff at the Mid Staffordshire NHS FoundationTrust may have been socialised into a particular culture that was detrimental to good care. But what is meant by ‘socialisation’? 

One possible definition is as follows:

We may understand the idea that we are born into a society that has certain rules of behaviour and we, as human beings, learn these rules through a process of socialisation. Socialisation simply means the various ways we learn how to be a human being and are taught the basic rules of society we live in. (Goodman and Clemow, 2008, page 78).

 

Therefore socialisation is the process by which we learn the customs, norms, values, attitudes, beliefs, mores and behaviours of our society, i.e. how we acquire our culture. However, socialisation provides only a partial explanation for the acquisition of culture. People are not blank slates to be written on by our society. We are not robotic social actors blindly learning culture. Scientific research provides strong evidence that people are shaped by both social influences and their hard-wired biological makeup Genetic studies have shown that a person’s environment (socialisation) interacts with their genotype to influence their behavioural outcomes. So, society shapes us through socialisation and we also act as agents to socialise others. Our genes do not determine our behaviour and are in fact affected by the social environment.  

The following activity asks you to consider your own socialisation.

 

Activity

 

a. Think back to your first day at secondary school. How did you know how to behave with other pupils and with the teachers. How did you learn the formal (and informal rules) for being a pupil in class (i.e. how were you socialised as a pupil)?  

 

b. Think about right now and what is happening to socialise you first as a student and secondly as a nurse.

 

c. Now identify just one aspect of your health and how it has been shaped by your socialisation. Consider, for example, your alcohol consumption and the likelihood of developing problems with alcohol.

 

 

Socialisation shapes our behaviour in quite fundamental ways to the extent that we begin to feel that we could not behave in any other way. Take a common student pastime: drinking.  The use of alcohol in western society is seen very differently from that in a Muslim society. People living in Muslim families, in the UK as well as abroad, may well be socialised into very different views on drinking. Young westerners ‘feel’ that going to the pub is very normal and to be expected, whereas their counterparts from a devout Islamic background may not feel the same way. However as this example indicates socialisation is not so strong that behaviour never changes as young British Muslims may feel themselves being socialized into two different cultures and this results in a tension that has to be resolved.

 

A related idea is that of ‘Occupational’ socialisation i.e. how one learns the customs of an occupation. The suggestion here is that many occupations (and professions) have their own ways of speaking, dressing and acceptable modes of behaviour. Melia (1987) described the occupational socialisation of student nurses, while over 30 years old, this study sheds light on how we become the nurses we are and illustrated the tension felt by students as they juggle the demands of education and the service needs of the NHS. The clinical area demands a certain behaviour (doing the work) while the University expects another (studying).

 

As student your focus may be on learning about medications; their administration, prescription, side effects and contra indications and so you may wish to spend time asking about drugs or reading the British National Formulary while you are in practice. Your University may highly value this activity. Your clinical practice setting may also value this knowledge but what may be of more immediate importance is that you assist the qualified staff in actually administering the drugs themselves, time being too short to look up every single one. The university may value knowledge, the practice setting may value ‘getting the work done’.  Of value also is that knowing how to find out a piece of information that is specific to a particular patient or situation is perhaps more important than carrying the complete contents of the BNF around in your head.

 

What is culture?

 

The shared beliefs, norms values, attitudes, mores and behaviours of a society is its culture. This involves language use, the way we dress, the food we eat, what leisure we like, whether work is valued …even what sports we value. Into this mix are ideas about dominant and subordinate cultures, or sub-cultures, within wider culture. Culture is dynamic and subjective. It changes over time (sometimes rapidly). It is defined by those who are experiencing it and will mean different things to different people. Therefore, and from an understanding of how we become socialised into a culture as described above, we may see that culture affects how we behave, our attitudes and our values. At Mid Staffs the organizational culture was described as having elements of:

 

·      Bullying

·      Target driven priorities

·      Disengagement from management

·      Low staff morale

·      Isolation

·      Lack of candour

·      Acceptance of poor behaviours

·      Reliance on external assessment

·      Denial

 

So it can be hypothesised that despite professional codes of conduct some nursing staff were or socialised into accepting poor practice. Although staff did raise concerns, the culture was such that not enough was done to prevent poor quality care.

 

Socialisation and culture can be viewed as strong social ‘forces’ that shape how we go about our business in an organization. We may think we are completely free agents making free choices, but the experiences of nurses at Mid Staffs shows that the culture can very seriously affect behaviour, in this case the reporting of and delivery of inadequate care. Sociology moves us on from blaming individuals as the sole reason for poor care. Instead it asks us to investigate the social processes that affect individuals in an attempt to devise solutions which go beyond the individual and focus as well on the nature and culture of organisations in which people have to work.

 

Benny Goodman. 2012

 

 

 

 

 

Goodman, B. and Clemow, R. (2008) Nursing and Working with other people. p78. Learning Matters. Exeter.

 

Goodman, B., and Ley, T. (2012) Psychology and Sociology in Nursing. Learning Matters. Exeter.

 

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

 

 

 

 

sociology of sustainability

‘We are all locked in’ but can we escape the system?

 

 

“the apparently independent and autonomous system of industrialism has transgressed its logic and boundaries and has thereby begun a process of self-dissolution” Ulrich Beck.

 

 

Sociologically we can make the following observations about our current high carbon ‘economy-society’ (Urry 2011).  The starting point for an analysis of why society engages in particular practices and habits is the observation that energy is the base commodity upon which all other commodities exist (Urry 2011) and which therefore underpins behaviours, habits and practices.

 

Consider a society that does not have or has never had access to coal, gas or oil. All they have is the wind and water for energy. You don’t have to imagine it, those societies have been well documented and some still exist. Their habits and social practices are then based on the energy form that water and wind gives them. This is not to say that the energy commodity determines the social forms they create otherwise they would all look the same. It is to say however that energy as a base commodity has a good deal of influence.

 

Since the discovery of steam power based on coal, and then power based on oil and gas, our western societies were able to develop in particular ways until we designed a society that needs this form of energy. Thus, our community behaviours are implicitly locked into high carbon systems that are taken for granted. We live within a cluster of interdependent systems: 1) coal/gas electric grid power; 2) petrol, steel and automobile; 3) carbon military industrial complex; 4) suburban housing and domestic technologies; 5) airlines, leisure, foreign tourism. These are all oil/carbon based. To that add a food system: agribusiness, farm, supermarkets. Some of these have become very fashionable and then embedded into our everyday practice. We have become carbon addicts unable to go cold turkey even if we wanted to.

 

 

 

 

To date we have to accept that much of social science has been carbon blind and has analysed social practices without regard to the resource base and energy production that we now know are crucial in forming particular social practices. Economics as a discipline tries to explain human behaviour, but has limits as it has an overly ‘instrumentally orientated, rational planning, utility maximizing’ model of human behaviour (in its non Marxist form). That is to say it assumes we make our choices based on our consideration of our own needs and self interests. The Thatcher-Reagan revolution was predicated upon seeing the consumer as king and the individual as the best master of their own destinies. The market is where rational actors come together to make the best choices, so it follows that nothing should get in the way of market activity. John Urry critiques modern economics for failing to address the fundamental relationship between people and the material physical world:

 

most of the time people do not behave as individually rational separate economic consumers maximising their individual utility from the basket of goods and services they purchase and use given fixed unchanging preferences…(we are) creatures of social routine and habit…fashion and fad…(we are) locked into and reproduce different social practices and institutions, including families, households, social classes, genders, work groups, schools, ethnicities, generations, nations…. (Urry 2011 p4).

 

This really muddies the waters, it requires understanding that behaviour change results from myriad inputs raging from the ideological and analytical to the pragmatic availability of material resources at hand. It also requires us to consider issues of power over ‘rational’ actors, who has it and who exercises it and in whose interests? Therefore any new technological developments will operate in this ‘economy-society’ space.  So how do new habits form? What is fashion and what are the effects of this? Do we need ‘the fashionable imagination’ – is there a quality of mind that spots and encourages low carbon fashions which are supported by technologies and commodities that use less carbon based energy? This way of thinking may be doomed however, for even if we could spot the next low carbon fashion, the structure of the economy as it currently is run would militate against it for the reasons set out below.

 

 

 

So, we live in societies that are locked into high carbon systems. We are also being asked to change our behaviour to adopt low or zero carbon habits, fashions and social practices. “Deep greens” ask us to fundamentally change everything about how we live. This rejects all high carbon systems, and that means consumer capitalism. ‘Mainstream’ sustainability adopts a less radical approach. The focus is not on complete system overhaul but on incremental individual behaviour change while encouraging and being encouraged  by (‘nudged’) governments and corporations to do the right thing.

 

The emphasis on individual behaviour change through mechanisms of ‘behaviour change technologies’ (for example social marketing techniques or nudge theory) sit within a taken for granted neoliberal paradigm which sees the citizen consumer exercising their freedoms within deregulated markets. This is a technical-rational approach which assumes that there is no contradiction between greening our lifestyles and the capitalist system’s need for growth and consumption to increase.

 

This individual focus also obscures questions of collective social responsibility and power. Thus we have the project of the ‘carbon calculating’ consumer who may be nudged to do the right thing, to exercise choice within frameworks of governance that does not challenge the fundamentals of consumer capitalism chasing GDP growth.

 

A technology of behaviour change is the UK’s ‘Pro-environmental Behaviours Framework’. Social conduct can be divided up into segments (e.g. our travel behaviours) which are then amenable to intervention. We can re-engineer choices step by step. Behaviour forms under certain conditions which then can be manipulated using social marketing techniques. Concepts include: ‘Behavioural entry points’, ‘wedge behaviours’, ‘behavioural levers’, ‘choice editing’. There is a set of 12 headline behaviour goals categorised within 3 areas of consumption: 1) personal transport 2) homes and 3) Eco-products.  This is the ‘change the lighbulbs approach’ to climate change. 

 

The paradigm within which all of this sits is that of neoliberal consumer capitalism. This requires, no, has to have, 3% capital accumulation (Harvey 2010), deregulated markets and accelerating consumption. GDP growth is the central goal of economic policy. This form of capitalism also externalises costs, has cycles of crises due to the surplus capital accumulation problem (Harvey 2010) and relies on technological solutions (Ben-Ami 2010). It also wishes to rely on individual responsibility for health, welfare and social problems (e.g. Big Society solutions). Baumann calls it “a parasitic form of social arrangement which may stop its parasitic action only when the host organism is sucked dry of its life juices” (1993:215). The contradictions between consumer capitalism and sustainability are obscured, power and collective responsibility issues are marginalised. It produces two main approaches to carbon reduction:

 

1.    Macro economics cap and trade systems, e.g the EU’s Emission Trading System.

2.    Micro economic techniques designed to encourage pro environment consumer choice.

 

 

It is also based on the idea of the ‘self governing individualised subject’ (Homo economicus) which is a model of human behaviour not born out by the evidence.

 

What this seems to imply is that consumer capitalist societies will not address carbon reduction other than within this paradigm. If we are locked into clusters of high carbon systems and given the limits to growth (Meadows, Randers and Meadows 2004), planetary boundaries arguments (Rockstrom et al 2009) and ecological devastation then we will need to focus more and more on disaster management. David Selby made this point in 2007 in ‘as the heating happens’.  Behaviour change technologies such as the pro-environment behaviours change framework cannot address the fundamental driver of carbon emissions in anything like the time frame required because neoliberal capitalism will always outrun sustainability due to its need for growth and consumption. Its very mechanism is antithetical to sustainable living.

 

Webb (2012) suggests citizen consumer knowledge on climate change is patchy at best. Short term concerns over the practicalities, convenience and cost of domestic and social life unsurprisingly dominates longer term concerns. Surveys demonstrate that we on the one hand identify with the need to adopt a low carbon future but on the other hand adopt high carbon choices. This ‘value-action gap’ is seen by government as a non reflexive fact about self interest (we don’t think about  the contradictions in our answers) which is then seen as a barrier to change. In other words, self interest is supposed to drive behaviour but from a governments point of view we are not seeing our self interest as lying towards a low carbon future. We are paradoxically acting against our self interest. We value a low carbon future but we act as if we don’t because we are not reflecting on the connections.

 

However, surveys do not pick up the ‘situatedness’ of our response and the meaning we give to questions about low carbon living; cultural perspectives, social institutions and political values mediate the responses to attitudinal surveys and interpretations of climate science (Leiserowitz et al 2010). Therefore survey responses cannot be taken to be any true account of our actual preferences because our actual social practices are bounded by the material life we live in (the sorts of houses we have, the cars we drive, the products we buy).

 

 

 

We may be already in an era of peak oil, peak US power, peak welfare states and inequality reduction, peak water and gas availability. Given the limits to growth thesis, our ‘lock in’ to high carbon systems, the resistance to change and the needs of the economy for consumption and GDP growth which fuels that resistance there may be little else to do than prepare for the catastrophes to come. Sociology’s role will be in the field of disaster studies (Nursing will be part of that). Mental Health and Adult nursing may need to emphasise disaster and trauma management during ‘Peak Everything’.

 

 

 

 

 

 

 

 

 

Baumann, Z. (1993) Postmodern Ethics. Oxford Blackwell..

 

Ben-Ami, D (2010) Ferrari’s for all. Polity Bristol

 

Douglas, M., Wildavsky, A.B. (1982) Risk and Culture : An Essay on the Selection of Technical and Environmental Dangers. Berkley, University of California Press.

 

Harvey, D. (2010) The Enigma of capital and the crises of capitalism. Polity. Cambridge

 

Meadows, D., Randers, J., and Meadows, D. (2004). Limits to growth: the 30 year update. Earthscan. London.

 

Leiserowitz, A., Maibach, E., Roser-Renouf, C., Smith, N. and Dawson, E. (2010) Climategate, public opinion and the loss of trust. Yale Project on Climate Communication. July. [online] http://environment.yale.edu/climate/publications/climategate-public-opinion-and-the-loss-of-trust/

 

Urry, J. (2011) Climate Change and Society. Cambridge. Polity Press.

 

Rittel, H, and Webber, M. (1973) Dilemmas in a General Theory of Planning  pp. 155–169, Policy Sciences, Vol. 4, Elsevier Scientific Publishing Company, Inc., Amsterdam [Reprinted in N. Cross (ed.), Developments in Design Methodology, J. Wiley & Sons, Chichester, 1984, pp. 135–144

 

Rockström, J. Steffen, W., Noone, K. et al (2009) A safe operating space for humanity. Nature. 461. Pp 472-475. 24th September.  http://www.nature.com/nature/journal/v461/n7263/full/461472a.html accessed 8th January 2011

 

Selby, D. (2007) ‘As the heating happens: Education for sustainable development or education for sustainable contraction? Discourse, Power, Resistance Conference, Talking Truth to power’, http://www.esri.mmu.ac.uk/dpr_07/abstracts_07/index.php accessed 25th March 2009

 

Webb J (2012) Climate change and society: The chimera of behaviour change technologies. Sociology. 46(1): 109-125.

 

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