Showing posts with label social welfare. Show all posts
Showing posts with label social welfare. Show all posts

Friday, 16 July 2021

(Re)taking liberties: Reclaiming positive freedom as a public health argument

Posted by Jack Nicholls, Lecturer in Social Work at Northumbria University

At the time of writing, the government intends to lift most remaining Covid restrictions still in place in England on July 19, widely touted as 'Freedom Day'. 

I recently passed my PhD viva defending a thesis that was concerned with the diverse ways a contested value concept is understood by human welfare professionals (in my case, 'social justice' and newly-qualified social workers). As a result of that undertaking, I am now habitually critical of the ways in which ethical and moral language is used and claimed for particular agendas. In the looming shadow of so-called 'Freedom Day', I have been thinking about how caring professions and health and wellbeing researchers might reclaim the word 'freedom' for ourselves.

Possibly in contrast to many of my wonderful colleagues in the caring professions and their associated research wings, I am in broad terms a libertarian rather than a collectivist*. Individual rights and freedoms - the ability to live as one chooses unfettered without just cause, to be different, to not fit or conform - are close to sacred to me. While I can be persuaded by arguments advanced by those of a more communitarian mindset, it is always despite, rather than because, they are communitarian. When, as I will here, express concern about the speed and totality of the easing of Covid restrictions, I do so from a liberty-minded philosophical position.

The 'Freedom Day' discourse draws almost entirely on the concept of negative liberty and is emblematic of a long-established idiolect that frames freedom (with personal responsibility) in a zero-sum game against statutory entitlement to and provision of help. Negative liberty refers to the absence of constraint and control. As an idea, it is of profound importance for those of us who believe rights and freedoms are inherent to personhood, and that it is for the state to uphold them, not hand them down as bounties and favours.

Sir Isaiah Berlin 
Alongside negative liberty however sits the concept of positive liberty (both liberty concepts were set out by Sir Isaiah Berlin (pictured right) in his 1958 lecture and subsequent written works). Positive liberty refers to the idea of freedom being enabled by active action and the provision of resources, facilities and support. The two work in tandem and, for the kind of libertarian I am, they are equally important and necessary for one another. Covid restrictions have impacted both our negative and positive liberties - the former by restricting our movement, travel and association, the latter, at least for many people, by restricting our incomes, our ability to access welfare, social security, safe transport, childcare and informal support networks.

The rationale for these actions, a rationale that was broadly accepted by the majority, can be understood as a trade-off with other positive freedoms, most notably seeking to keep as many people as possible, and particularly those at most risk of developing serious or fatal Covid symptoms, free from infection. It is a trade-off I would make again in a heartbeat under similar circumstances. That is part of why the present language about 'Freedom Day' is so galling, because for many, particularly those with high-risk health conditions, their families, and those who have not yet been able to be vaccinated, July 19 will not signal any kind of freedom. I can't tell you how much I'm looking forward to my first liberated Guinness, enjoyed in the hostelry and company I choose, with all the health risks confined to the pint glass. I can't do that on July 19, because the decision has been made to prioritise the negative liberty of those of us who can enjoy it over the positive liberty of those still at particularly serious risk. We aren’t choosing freedom; we are choosing some people’s freedom over that of others.

This situation behoves health and social service practitioners and researchers to consider whether we can reclaim the concept of freedom, particularly positive freedom, as a full and proper part of our value base and lexicon. I argue that we both can and should, for what are we if not participants in endeavours for more positive freedom through greater knowledge and better health and wellbeing. Freedom 'from' is fairly hollow and useless without meaningful freedom 'to', and though many who share my philosophical persuasion see an overbearing state as a legitimate risk to freedom of all kinds, no less important is freedom from preventable illness, pain, anxiety, suffering, burden, loss of control, and the wider contributors to health inequities, not least poverty and postcode.

Our professional fields, with the best of intentions, often couch our arguments in terms of the community or public good. Without besmirching the place and value of those arguments, it is my view that were we to speak also in terms of freedom, including individual freedom, we would do so with complete intellectual coherence and legitimacy. Rather than being unjustly tagged as over-cautious and dictatorial, we could put our criticism of the end of restrictions in pro-positive freedom language. Beyond that, we could reframe and bridge the unfounded but perceived gap between individual choice and public wellbeing, all while avoiding the former being reduced to callous responsibilisation, and the latter being unfairly painted as nannying control. We might even unlock a new set of tools for persuading individuals and institutions who are rarely engaged by welfarist, collectivist or even duty of care arguments about public health concerns. We've done it before; we rarely talk about the smoking ban nowadays, rather we refer to pubs and train stations being smoke-free. Likewise fat-free, alcohol-free - it's a nice word, and an effective one.

At this moment, whatever their diverse feelings about the end of restrictions (I should caveat, the end for some) freedom is high in the public consciousness. Let us who are concerned for public wellbeing liberate our arguments and reclaim the concept of freedom, particularly positive freedom, for ourselves.

*Collectivism: a social pattern in which individuals construe themselves as parts of collectives and are primarily motivated by duties to those collectives. More here: https://plato.stanford.edu/entries/culture-cogsci


Images:
2. Sir Isaiah Berlin by Rob C. Croes (ANEFO), CC0, via Wikimedia Commons


The views expressed in posts are those of the authors and do not necessarily reflect those of Fuse (the Centre for Translational Research in Public Health) or the author's employer or organisation.

Friday, 21 September 2018

Collaborating, meandering and consolidating to identify research priorities on welfare advice and health

Posted by Natalie Forster, Senior Research Assistant and Monique Lhussier, Associate Professor in Public Health and Wellbeing, Northumbria University and Fuse

As the judges of the Man Booker prize for fiction whittle down their long list and decide on the shortlist of books in the running for best novel of the year, we’ve been making a few (more research focused) lists of our own.

Setting aside our individual research plans and ambitions to focus on welfare and health
Funded by the NIHR School for Public Health Research, we are currently working collaboratively (from across Fuse, University College London, The University of Sheffield, and London School of Hygiene and Tropical Medicine) to set the future research agenda in the area of welfare advice and health. Working across this number of institutions, we have managed to set aside our individual research plans and ambitions and combine our expertise in a series of workshops to focus on the issues of welfare and health. Colleagues from the welfare advice sector have agreed to join us and are keeping the discussions grounded in the realities of practice, over the course of four workshops (this blog marks our half way point).

The first workshop saw us (tentatively at first) present our research to each other; with both our detailed topics and methodologies varying significantly, as one might expect. Deciding which research questions to pursue is a daunting task. Shortlisting questions was a delicate juggling act of managing our respective interests and expertise, while keeping practice perspective up front and centre, to ensure the usefulness of our future findings. This process also opened up fundamental discussions about the role of welfare advice in society, and how this should be studied.

One key area of debate concerns whether we should study the health impact of welfare advice, welfare itself, and/or systems of welfare provision in their broadest sense. At present, the UK boasts a welfare system that, in its complexity and inaccessibility, needs the intervention of advice services for users to access their entitlements. As researchers, should we therefore focus our attention on this hostile welfare environment, thought to perpetuate or deepen health inequalities, as opposed to advice services themselves? For example, a research emphasis on the health outcomes of advice might have been interesting but could play into wider failings to make benefits accessible if the advice-health relationship is proved any less than definitive. The group also considered whether advice services should be studied as an intervention or in terms of their function within society.

Further discussions centred around which outcomes, and particular user groups to focus on, and whether to study universal or means tested benefits, continuously swerving between the pragmatic and the theoretical, the national and the local. These fruitful meanderings were captured in a long list of possible research questions which we then worked to weigh up against agreed criteria. The result? A consolidated and (slightly!) shortened list of research questions, focused on five priority areas:
  1. Are there inequalities in the impact and reach of advice services across social groups? How/ does advice delivery mode matter?
  2. What are the individual and system level impacts of the de-implementation of advice services?
  3. What are the impacts of changes to welfare provision on children, inter-generationally and throughout the life course? 
  4. How do experiences of social welfare vary by social group, geographically and across generations? How do different identities combine to influence how social welfare is understood? 
  5. What is the impact of the rise in precarious employment and low wages on advice seeking and provision?
So quite a research agenda to fulfil! Throughout the remainder of the project, we’ll be engaging with advice sector representatives and recipients of advice to hear their views on the directions research in the area should take before developing concrete plans for how we could actually carry out this research. After that it’s time to commit pen to paper and draft those grant applications!

Friday, 22 September 2017

The impact of advice services on health: moving from gut feeling to concrete evidence

Introduced by Sonia Dalkin


Guest post by Alison Dunn, CEO of Citizens Advice Gateshead

Citizens Advice Gateshead provides independent, impartial, confidential and free advice to people who work or live in Gateshead about their rights and responsibilities. Gateshead is an area of high deprivation. Overall, Gateshead is the 73rd most deprived local authority in England, out of 326 local authorities. Nearly 23,600 (12%) people in Gateshead live in one of the 10% most deprived areas of England. Nearly 49,800 (25%) live in the 20% most deprived areas (Department for Communities and Local Government, 2015).

As a result, our work is predominantly around social welfare issues to include housing, money advice, welfare benefits, relationship and family issues, employment and consumer. In 2016/17 we helped 10,820 people with 71,487 advice issues. We estimate our work has a value to the wider governmental system of £11.5m.

Physical health and mental health are inextricably linked. People with a mental illness have higher rates of physical illness and tend to die 10 – 20 years earlier than the general population, largely from treatable conditions associated with modifiable risk factors such as smoking, obesity, substance abuse, and inadequate medical care (Mykletun et al. (2009). Poor mental health is associated with an increased risk of diseases such as cardiovascular disease (Dimsdale, 2008), cancer (Moreno-Smith et al., 2010) and diabetes (Faulenbach et al., 2012), while good mental health is a known protective factor. Poor physical health also increases the risk of people developing mental health problems.

For us, the link between our advice and health and wellbeing is obvious but persuading commissioners, policy makers and decision makers requires more than a gut feeling. So we feel very privileged indeed for the opportunity to work with Fuse and the research team at Northumbria University to investigate what we have always thought to be true, that our advice reduces stress and anxiety and improves wellbeing for our clients. 

The research constituted of a realist evaluation (the protocol of which is detailed here) of three of our more intensive services – one for those with enduring mental health conditions, one for young people, and one for those referred through their GP. The research indicated that stress was decreased and wellbeing increased as a result of accessing the service, using the Perceived Stress Scale and Warwick Edinburgh Mental Wellbeing Scale. The research also tells us that our intensive advice services increase the options available to our clients, allowing them to be able to participate in more activities to promote wellbeing and reduce isolation. The service also creates trusting relationships with our clients, which was essential in maintaining relationships in order to help clients with their issues. Finally, the service works as a buffer between the client and state organisations such as the job centre and the Department of Work and Pensions, allowing the two to interact more efficiently. 

We plan to maintain our relationship with the research team and we are starting to talk to them about how we can build on this work to learn even more about the link between advice services and the wellbeing of our beneficiaries.

If you would like more information related to Citizens Advice Gateshead, please visit our website: https://www.citizensadvicegateshead.org.uk/ 


References: 
  • DEPARTMENT FOR COMMUNITIES AND LOCAL GOVERNMENT. 2015. English indices of deprivation 2015 [Online]. Available: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/465791/English_Indices_of_Deprivation_2015_-_Statistical_Release.pdf [Accessed].
  • DIMSDALE, J. 2008. Psychological Stress and Cardiovascular Disease. Journal of the American College of Cardiology, 51, 1237-1246.
  • FAULENBACH, M., UTHOFF, H., SCHWEGLER, K., SPINAS, G., SCHMID, C. & WIESLI, P. 2012. Effect of psychological stress on glucose control in patients with Type 2 diabetes. Diabetic Medicine 29.
  • MORENO-SMITH, M., LUTGENDORF, S. & SOOD, A. 2010. Impact of stress on cancer metastasis. Future Oncology, 6, 1863-1881.
  • MYKLETUN, A., BJERKESET, O., OVERLAND, S., PRINCE, M., DEWEY, M. & STEWART, R. 2009. Levels of anxiety and depression as predictors of mortality: the HUNT study. British Journal of Psychiatry, 195, 118-125.
The research was funded by NIHR School for Public Health Research (SPHR) and is supported by Fuse (The Centre for Translational Research in Public Health). The views expressed are those of the research team and not necessarily those of the NHS, the NIHR or the Department of Health.