Category Archives: Health and well-being

Imagining the future: Growing older together?

Alexandra ChapmanAlexandra Chapman

There is a clear divergence emerging between each region in the UK in terms of the nature and pace of implementing a policy framework that supports older service users and promotes a person-centred framework.

Following devolution, Scotland and Wales have developed adult social care strategies underpinned by person-centred principles through divergent policies and provision from each other and England. Meanwhile, in Northern Ireland, policy developments have not progressed at the same pace as the rest of the UK and there has been emphasis on a person-centred policy for adult social care users. The acknowledged shift in dependency ratios and increasing social care projects have emphasised a sense of urgency to reform adult social care policy in Northern Ireland. Continue reading Imagining the future: Growing older together?

How politics and power create poor health: ‘I think they’re trying to kill folk aff’

Mhairi Mackenzie et al

By Mhairi Mackenzie, Chik Collins, John Connolly, Gerard McCartney, Mick Doyle

 

 

 

 

We know from decades of international research that power, politics and specific social and economic policies have a fundamental role in creating health.  These factors contribute very significantly to the gradient we see across income groups in terms of life expectancy and more general wellbeing.

However, many health policy researchers have identified how policies which claim to be about reducing health inequalities seldom squarely address these fundamental determinants of health.  Instead, policies have a distinct tendency to focus on changing the behaviours of (mainly) poor people. The message is often that people smoke too much, drink too much or don’t make the best use of services that are available to them.  These messages do not give proper consideration to why particular health damaging behaviours occur in particular places or why health is worse in certain places even in the absence of these behaviours. Even those policies which do start with a broader analysis of the problem of disparities in health are subject to lifestyle drift when it comes to putting policy into practice.  Although policy documents may state that the causes of poor health or inequalities in health are to do with poverty and deprivation, the interventions which actually operate on the ground focus much less (if at all) on changing people’s material circumstances and rather more on trying to change behaviours (which are in fact heavily shaped by material circumstances).

In light of the above, it is unsurprising that research in different countries also shows that when policy makers and practitioners talk about how health is created they tend not to give due regard to these known fundamental causes. Again, the emphasis is on explanations that focus on individual lifestyles. Behavioural interventions aimed at changing the lives of poor individuals clearly have a powerful draw on the attention of policy makers.  The reasons for this preference are many and varied and include the desire for quick policy wins over longer term action and the seductive appeal of short and simplistic causal pathways to health, in preference to having to deal, intellectually and practically, with the longer and more complex pathways which are actually at work.

Another reason, however, for the hardiness of the behavioural intervention as a policy tool – despite its apparent lack of success in addressing the problem – is that it fits within a broader contemporary political narrative.  That narrative tells us that individuals are responsible for making and breaking their own life chances.  Consequently, their health and social outcomes lie overwhelmingly in their own hands.  There is, in this view, ‘no such thing as society’, or at least no wider societal determinants which individuals can’t be expected to just over-ride through their personal choices and individual acts of will.  In this narrative the state’s role is to ‘nudge’, ‘activate’ or mandate individuals to do the right thing rather than to challenge fundamentally the existing power relations within society.

This kind of thinking is part of the wider set of discourses, policies and practices associated with neoliberalism.  These provide both the context in which, and the mechanisms through which, the lives of some communities have become in many ways much more difficult since the 1980s – and their existence and identity much more marginalised.  Research tells us that it is this fundamental part of the story of how poor health is created that is largely missing from the discourse of those in policy and practice.

In our recent Policy & Politics article: working-class discourses of politics, policy and health: ‘I don’t smoke; I don’t drink. The only thing wrong with me is my health’, we wanted to look at how people living in deprived communities – which had felt the brunt of deindustrialisation in the 1980s and had been at the sharp edge of austerity in current times – talked about how politics and policies had impacted on their health, and that of their families and their wider communities.  Unlike the messages from policymakers, our sample of participants in the towns of Kilmarnock and Cumnock in East Ayrshire, Scotland, brought vividly to life how it is that power, politics and social and economic policies are indeed a fundamental matter for health – at both an individual and community level.

Here are some of the things our participants told us:

They do not feel at all valued by political elites; on the contrary they are made to feel literally surplus to requirements. An ex-miner told us: ‘I’ve heated their bums wae coal…we’ve served wur cause. If they could dae away wae you noo, they would dae away wae you, because you’re a drain on society…They want me, noo, to work til I’m sixty-seven. I’ve no chance of working to I’m sixty-seven. I’ll no’ see sixty-seven.’ Similarly, another respondent, reflecting on ‘austerity’ and so-called ‘welfare reform’, simply said, “I think they’re trying to kill folk aff”.

They sense that deliberate action was taken by government to destroy the industries on which their communities had depended, and to undermine the strong and more solidaristic community relationships which had prevailed in the past. A respondent from Kilmarnock said: “She [Thatcher] allowed a’ the work to go abroad. And oor factories in Kilmarnock…we had a great town, and it just finished. Factory after factory, well-known brands…employers went. They all went wi’ a feeling o’ sorrow but it didnae help the workers.” Another ex-miner from Cumnock, reflecting on the 1984-85 Miners’ Strike across the UK, said: “looking back you can see the preparation got made. And they really backed the union into a corner … it was to diminish the power of the unions and fragment communities”.

Where ‘negative lifestyles’ exist within these communities, they are seen as closely connected to broader social and political circumstances. Another ex-miner told us how downwardly spiralling morale and behaviours in his community were rooted in changing circumstances: ‘The factories started slimmin doon, cutting workforces. The ability for young people to get into work was becoming limited. We started to see probably drugs in our community for the first time. And probably the excessive drinking was starting to take a hold as well…’ Further, not all of our participants were able to understand their current poor health in terms of their own behavioural decisions – as we indicate in the title of our research paper – one man in poor health summed up this personal conundrum by saying ‘I don’t drink; I don’t smoke – the only thing wrong with me is my health’.

Participants are conscious of current day political strategies to set poor and struggling communities apart from the rest of society. One young woman said: ‘They are using the media…tae bombard folk wi’ … the good old ‘divide and conquer’…it’s like stigmatising full groups at a time. It comes in waves. I mean, the immigrants’ll be due a shot…it’s a’ their fault. It’s like they’re trying to deliberately create this, ‘Everybody that’s on incapacity’s a scrounger.’”

All in all, our research participants provided a vivid articulation of links between politics, policies, deindustrialisation, damage to community fabric and impacts on health. We ask: given the way in which these lay participants’ understandings of health reflect (and enrich) the views of researchers, should our participants and the many who share their stories, actually be the ones educating policy makers and practitioners, rather than being seen as the recipients of perennially failing health education messages? What might be the impact of turning the traditional health education model on its head? How would such a shift in who is doing the educating be received by policy-makers and practitioners?

Mhairi Mackenzie is Professor of Public Policy in the School of Social and Political Sciences at the University of Glasgow.  Chik Collins is Professor of Applied Social Science in the School of Media, Culture and Society at the University of the West of Scotland. John Connolly is Senior Lecturer in Public Policy at the University of West of Scotland.  Mick Doyle works for the Scottish Community Development Centre. Gerry McCartney works for NHS Health Scotland.

If you enjoyed this blog you may also be interested to read Policy, Politics, Health, and Housing in the UK.

Reposted with kind permission from: http://discoversociety.org/2016/04/05/policy-briefing-how-politics-and-power-create-poor-health-i-think-theyre-trying-to-kill-folk-aff/

The Sugar Tax Debate: Should the Government Consider a U-turn?

Nasrul Ismail
Nasrul Ismail

The public health field is never short of controversies. On 22nd October 2015, Public Health England (PHE) published a report on Sugar Reduction: The Evidence for Action. The report recommends inter alia, an introduction of a sugar tax of between 10% and 20% on high sugar products such as soft drinks (PHE, 2015b). This has sparked endless debates within the academic and public domains. The vociferous debate sustains when subsequently, the government guarantees that there will be no tax imposition on sugary products, whilst insisting that there are other workable alternatives for tackling health issues, particularly obesity, as a result of overconsumption of products with a large amount of sugar.

Borrowing from the Nudging Theory, tax is seen as a ‘shove’, capable of prevailing the ‘upstream approach’ in public health (policy approach that can affect large populations, such as economic disincentives) through the preventative route (Local Government Association, 2013). This blog post seeks to explore whether the government should reconsider its initial decision not to impose a taxation on sugary products. It will take stock of the evidence that links sugar with obesity, and consider the success of a sugar tax in various countries in addressing the population’s health. It then goes on to explore the power of taxation in changing people’s behaviour and the potential benefit of such a measure on the NHS, before considering whether the tax on sugary products can address the failure of the Public Health Responsibility Deal between the government and the food industry. Continue reading The Sugar Tax Debate: Should the Government Consider a U-turn?

Talking public health

Katherine Smith
Katherine Smith

Policy & Politics talking public health in Milan last month with Editorial Advisory Board member Katherine Smith

In a session jointly sponsored by Policy & Politics and the University of Glasgow Social and Public Health Sciences Unit, leading international experts explored how public health professionals perceive the role of the alcohol, tobacco and food industries in shaping public policy. . The international panel of speakers, appearing at the 8th European Public Health Conference which took place in Milan on 14-17 October was chaired by Professor Oliver Razum, Dean of the School of Public Health at Bielefeld University, Germany. It included Professor Nicholas Freudenberg of City University New York, Dr Lori Dorfman from the Berkeley Media Studies Group and the University of California, Berkeley, School of Public Health, Dr Benjamin Hawkins from the London School of Hygiene and Tropical Medicine, Dr Heide Weishaar from the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow and Policy & Politics’ Editorial Advisory Board member Dr Kat Smith from the Global Public Health Unit, University of Edinburgh.   The session was organised by Heide and Kat along with Dr Shona Hilton of the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow. This blog sums up the issues discussed and sets out an agenda for future research in this area.

Tobacco, alcohol and processed food industries – Why are they viewed so differently?
Tobacco, alcohol and processed food industries – Why are they viewed so differently?

One of the few indisputable truths in life is that we will all, eventually, die but what we will die of, and at what age, is changing across the world, with non-communicable diseases (NCDs) increasingly accounting for excessive morbidity and mortality burdens. The growing prevalence of NCDs is triggering substantial policy concern, evident, for example, in the 2011 UN high level meeting on NCDs. Yet, it is clear there are very different ways of thinking about this ‘epidemiological transition’: it has been framed, on the one hand, as a consequence of the choices that individuals make and, on the other, as a consequence of the strategies Continue reading Talking public health

Community Resilience and Crisis Management: Policy Lessons from the Ground

Nicole George
Nicole George

Nicole George and Alastair Stark (University of Queensland) discuss their  recent contribution to the journal, Community Resilience and Crisis Management: policy lessons from the ground

The last months of 2010 and the first months of 2011 are remembered in Queensland as the ’summer of sorrow’. During this period, an unprecedented flood emergency inundated 78% of the north-eastern state’s territory. More than 60 lives were lost. 6 billion dollars of damage was done to public infrastructure while private insurance payouts to home-owners and businesses totalled more than 2 billion dollars.

Brisbane, Queensland’s capital city, did not escape this natural disaster. By the second week of January, residents and business owners in low-lying suburbs were caught off-guard as a flood moved rapidly down the Brisbane River.  They hastily evacuated what possessions they could, then watched with a sense of disbelief as muddy waters rose through their streets and two days later receded. When they could return to their water and mud sodden homes, and began to pick through the chaos of destroyed belongings, the true extent of the emergency became real for many.

In the days that followed, flood waters were replaced by floods of citizen-volunteers who gathered spontaneously in affected Continue reading Community Resilience and Crisis Management: Policy Lessons from the Ground

Setting the stage for another reform? Changing narratives around disability benefit recipients in the UK

Zach Morris
Zach Morris

by Zach Morris, School of Social Welfare, University of Berkeley, USA

The Department of Work and Pensions recently released the statistics for those who died after being found “fit for work,” and thus ineligible for disability benefits in the U.K. The Guardian reports that nearly 90 people a month are dying after being found fit for work. Caution is due, however, before interpreting the outcome of the assessment process as the cause of these deaths. Yet, the emergence of these figures and their wide reporting in the press shed light on how the public is coming to perceive the country’s recent experiment with disability benefit cuts. The growing attention to this issue could lead to increasing support for disability benefit recipients, which, as reported in my P&P article on the topic and shown below, has been in decline for many years. If so, now may prove an opportune time for political entrepreneurs Continue reading Setting the stage for another reform? Changing narratives around disability benefit recipients in the UK

Analysing devolved health policy in ‘interesting times’

Ellen Stewart
Ellen Stewart

Ellen Stewart (University of Edinburgh, UK) discusses her article “A mutual NHS? The emergence of distinctive public involvement policy in a devolved Scotland

In the last twelve months’ heated debates about the SNP’s evolving role in UK politics, there has been far too little focus on their record North of the border, where they have now been in Government for almost two full terms (first as a minority government from 2007-2011, and then, beating the odds of the electoral system, with an unexpected majority since 2011). The UK media has only occasionally engaged with this record in government, and these efforts have often been haphazard potted histories, shifting between judging Scotland’s policies or its outcomes, and between comparing them to the other countries of the UK, or to the pre-recession past.

The difficulty of discussing devolved policy in a measured fashion is not new, although it is certainly heightened in the current political climate. In 2011, when I sat down to write what was eventually published in Policy & Politics as ‘A mutual NHS: the emergence of distinctive public involvement policy in a devolved Scotland’, I was trying to pin down some substance behind the pervasive rhetoric of ‘mutuality’ in the Scottish NHS. Much academic analysis of the ‘distinctiveness’ of Scottish health policy has relied on data from interviews with politicians, civil servants Continue reading Analysing devolved health policy in ‘interesting times’