6 Dec, 11 | by BMJ Group
Wide gaps in life expectancy in the UK by social background have been widely recognised in recent years. With the current state of the economy, the scaling back of public services, and risks caused by fragmentation of the NHS, the elusive solutions to these complex problems may seem even harder to find.
Under the previous Labour Government, there were of course health inequalities targets–reducing inequalities in life expectancy and infant mortality. But alongside these were a range of policies targeting wider inequalities; the social determinants of health. Perhaps the most significant of these was the goal, established by Tony Blair, “to eradicate child poverty in a generation.” The pledge was a catalyst for a decade of investment and innovation, and ended just before the 2010 general election with all three main parties supporting the Child Poverty Act, a statutory commitment to work towards ending child poverty by 2020. In our new report “Decent Childhoods – Reframing the fight to end child poverty” – we review the approach under Labour, and, reflecting on its strengths, and weakness, suggest a route forward.
Labour’s ambition to end child poverty in a generation was admirable. It’s the kind of goal that politics should be about. That they have brought the other parties with them is also a great achievement. There are no definitive answers, there will never be NICE guidance on how to end child poverty, and having it as part of the political discussion is an important step forwards. Labour can also be proud of some of its achievements – living standards for the poorest improved, there was a large increase in lone parents accessing work, and education gaps narrowed. However their target to halve child poverty by 2010 was not met and there were some important blind spots. Some of these were in macro policy areas; but one important area relates more to how the issue was framed in language.
While politicians speak in one voice about their passion for ending child poverty, they are often heard speaking with equal vigour about the apparent cultures of those who use social security or social housing. No single, non-criminal, group in society is singled out for as much political opprobrium as these. In fact with the extent to which the discussion is framed by the subject of benefit fraud, politicians are often willing to conflate benefit receipt with criminality.
It is not just offensive; it is also ineffective if the interest is in achieving actual change, rather than scoring political points. The constant undermining of those who use the social security system negatively shapes the attitudes of both those individuals and the people who interact with them on a daily basis. This affects the health and self-confidence of those receiving services and is likely to foster prejudice amongst those who provide them; imagine the impact on patients and NHS staff of a high profile Government and media campaign against “health scroungers.”
But professionals also have a role here. In his landmark book Respect, Richard Sennett attempts to answer the question of how those who are “dependent” on services provided by the state or community can nevertheless retain their dignity and the respect of their peers. He concludes that the recognition of client autonomy is key; the acknowledgement that the people receiving services know more about their own lives than the people delivering them, however necessary the professional expertise is in order to provide help. The organisation Participle has developed the term “relational welfare” to describe the shift from a transactional model of service delivery to one that is “shared, collective, and relational.” Health has come on leaps and bounds in this regard, though we must always ask the question–do patients get the same hearing irrespective of background, do we consider their wider circumstances?
Jason Strelitz co-authored with Kate Bell “Decent Childhoods: reframing the fight to end child poverty,” published at www.decentchildhoods.org.uk, with the support of the Webb Memorial Trust.
Jason Strelitz is a public health registrar. He was previously a policy advisor for child poverty at Save the Children. He received his PhD from the Centre for the Analysis of Social Exclusion at the LSE.