Posted by Paul Crawshaw
Consistent with the report overall, the key theme of this chapter is the promotion of greater individually responsibility for health behaviours and the adoption of so called ‘healthy lifestyles’: perennial themes for those with an interest in modern public health. Particularly striking is the proposal to offer ‘incentives’ for people to adopt more healthy lifestyles with the ultimate goal of reducing the ‘burden’ on the NHS, a ‘burden’ said to arise disproportionately from those who make ‘bad choices’. This is more broadly aligned with the theme, explicitly laid out in Rebalancing Risk and Responsibility, of encouraging greater civic responsibility outside the state. For too long, we are told, we have been accustomed to the state pooling risks. This has stripped us of our autonomy and the will to manage our own lives, and, most insidiously of all, has created dependency. We must learn to approach risks, we are told, in ways more akin to those adopted by, for example, the private health insurance companies, one of whom, interestingly, is the sponsor of this report.
|Is it time to finally stop victim blaming?|
These few sentences encapsulate for me the most troubling assumptions of this form of (not so) progressive conservatism. Implicit is an assumption that it is a lack of volition that prevents ‘people in low-economic groups’ from being physically active. Ignored are the wider structural determinants that lie behind the individuals’ ability to choose and the actions they do (or do not) take. This has been convincingly argued recently by Marchman Andersen et al in the Journal of Public Health. Similarly, by stating that ‘high risk groups’ (a terminology more at home in largely discredited health education campaigns of the 1980s) should act in order to make their impact on NHS resources ‘less disproportionate’, the author clearly suggests that it is the actions of these ‘groups’ that lead to excessive ‘burdens’ and that these in turn can be redressed by the groups themselves. Little credence is given to the argument that it is wider structural inequalities that result in poorer health, a position supported by overwhelming evidence (see Marmot, 2010 and many more). It is hard to imagine a clearer case of blaming the victim.
Control Shift does not sit in isolation and must be read in the context of a series of other recent ideological projects that have in common an overt statephobia. The most obvious examples here are the relentless pursuit of austerity (despite the wealth of evidence contra to this as a method for economic growth) and the promotion of a ‘big society’ based on voluntarism, participation and, of course, responsibility. Like the continued push for austerity, in Control Shift we witness a clear disregard for the weight of evidence, established in over thirty years of public health research into inequalities in health, that the key determinants of morbidity and mortality are not individual behaviours, but rather, lie in structural factors such as employment, income, housing, education and so on.
As much recent research has shown, access to these resources is far from equal in the UK, where the End Child Poverty coalition has recently reported up to 40% of children living below the breadline. How we expect people with unequal access to what many of us take for granted as basic resources to behave as ‘responsibly’ as their more affluent counterparts remains, for me, a mystery. What is less mysterious is the clear propensity of such ‘progressive’ conservatism to continue to blame the victim (as classic work such as that of Crawford (1977) established decades ago) as part of a thinly veiled ideological strategy (and remember, to paraphrase the Marxist Louis Althusser, the positing of the end of ideology is the ideological idea par excellence) that aims, not to encourage responsibility, but to shift it from the state to the individual, to construct society as an image of consumer marketplaces in which we are all responsible for our own choices. Sadly for the victims of structural inequality, they can only make the choices they can afford.