Blog by Gerard Diver

LJMU’s Liverpool Health Commission (2019-2020) is a UK-wide project aimed at influencing the development of health policies in relation to the first 1000 days of life (covering the period from conception to age two). Prior to the arrival of the Coronavirus, the Commission had spent seven months gathering oral evidence from professionals working with mothers and infants (including vulnerable groups) and from mothers themselves. Since its launch in May 2019, its five fora (face-to-face meetings between Commissioners and participants, over 2 days across England, Wales, Scotland and N Ireland) have focussed on the issue of accessing key support services and identifying the barriers—real, potential, chronic, or acute—to achieving good health and well-being. Some of the obstacles highlighted have included financial, social, and cultural matters, related to the realization of the generic ‘right’ to health, against a backdrop of inherent vulnerabilities.

Challenges arose (and have been met) for example in terms of accessing the views of vulnerable persons who might not necessarily self-identify as such. The Commission has had to quickly build up relationships of trust with participants: as one key worker admitted, they had been quite fearful of the Commission’s interest in her opinions, lest they happened to be ‘funders in disguise’ attempting to check up on the running of a local project. Significantly, the face to face meetings between Commissioners, local health workers, and service users have tested the definition of the ‘right’ to access health. Some of the findings were not unexpected given the ongoing climate of austerity: the question of how best to allocate finite or scarce resources is a perennial, global issue, as the ongoing pandemic crisis so clearly indicates. The levels of socio-cultural ‘blockage’ revealed by the Commission’s work have been both nuanced and telling however, at times suggesting ingrained, systemic biases against some of the most vulnerable groups, not least in terms of their ability to access key services and social supports. For example, one young mother could not afford the bus fare to bring her child to a Children’s Centre while another key worker struggled to convince their local swimming pool of the benefits of holding short weekly sessions for socially isolated new mothers and babies. The psychological aspects of socio-economic, perhaps cultural, exclusions are far-reaching and inter-generational in terms of harms and, potentially, human rights infringements. As one participant observed, promoting good health was only one aspect of her work, with several of the girls in her group having already faced the loss of one or more of their new-born babies either to coerced adoption or to the care system. Preventing pregnancy—a medicalised response—was not the answer here, given that these young mothers actively wanted—indeed needed—to conceive and care for their infants. Accessing wider support to parent their children (or even have contact with them in some cases) was often the paramount concern.

Highlighting how the broader consequences of inadequate support can impact upon health outcomes (in terms of practice and policy) remains therefore a core aim of LJMU’s Liverpool Health Commission. As its findings to date evidence, key issues include rationing, rights, equity, and fairness in decision-making, whether framed in local or global terms. Arguably, a number of the systemic rights failings uncovered in the Commission’s pre-Covid-19 data might well be exacerbated, post-pandemic. There may well be newly impoverished, homeless, or estranged families, with further cuts to social security and health support systems via the forthcoming global recession seeming likely, as most daily government briefings confirm. The continuing work of the Commission seems set therefore to offer a sadly useful time-capsule analysis of health inequities ‘before and after’ the pandemic, as its work moves into, perhaps beyond, 2020. Temporary postponement of the remaining two fora highlight the far-reaching impacts of the current global crisis, but also underscores the fundamental nature of the right to access health services, with impacts beyond matters of medicine, including social exclusion and ingrained poverty.

That said, the project’s careful design is firmly grounded in the pro bono altruism of both academia and its Commissioners, who remain committed to engaging directly with the vulnerable, to bring about meaningful changes to policy and practice. (Arguably, the two remaining fora could even be held online, if needs must, to conclude evidence gathering and allow for a sort of ‘Lockdown—comparative’ analysis.) In any event, the final report will be of interest to a wide range of stakeholders (e.g. health professionals, psychologists, social workers, NGOs, drafters of law and policy) long after the dust settles upon this profound humanitarian crisis.

Liverpool Health Commission is an independent body established by Liverpool John Moores University (LJMU), conceived and led by Professor Valerie Fleming from the Faculty of Health. For further details, see www.ljmu.ac.uk/liverpool-health-commission.

Gerard Diver is Project Manager for the LJMU Liverpool Health Commission in the Faculty of Health at Liverpool John Moores University. Prior to working at LJMU, he spent twenty five years working in the community and voluntary sectors, including fifteen years as an elected representative. He is a former mayor of the city of Derry, and was a member of Northern Ireland’s Legislative Assembly (MLA).