Choice and Responsibility

There is growing rhetoric in the media and within the NHS that the public needs to make better choices and take more responsibility for their own health. Who wouldn’t agree with that? Surely, we are the ones who ultimately choose what goes into our bodies – we choose our sugar intake and decide how much exercise we take, don’t we?

 

Well, given Philip Alston’s damning report on the the state of poverty and human rights in the UK, perhaps we should think a bit more deeply about this!

 

When we say that people ‘just need to make better choices and take more responsibility for their own health’, we need to recognise that it is far easier for some people in our communities than for others. When you’re living in poverty and you would have to spend over 42% of your income to eat the government’s recommended healthy diet, your choice is reduced. When you live in an area in which there is a far greater number of high street take-aways, due to how licencing works in your town and you can fill the hungry belly of your child with a £1 sausage roll or bag of chips, and you don’t have a microwave, or you can’t pay the electric bill because you’re on a scandalously expensive meter – then your choice is reduced.

 

When the transport you reply on to get to the shops has been cut and your nearest shops don’t sell much fruit or veg, so you fill up on carbohydrates and sugars, which meet your hunger, but increase your risk of diabetes – your choice is reduced. When you suffered several adverse childhood experiences in your early years and have never been able to get healing for the trauma and continue to find comfort for your pain in the food that you eat – your choice is reduced.

 

When the products you buy are now filled with a much higher calorie load than they were 20 years ago, and hidden sugars you didn’t even realise you were eating – then your choice is reduced. When you are one of the ones ‘back at work’ (because let’s remember there are more people in work now than ever before), but you’re on a zero hours contract and so you’re working 2-3 jobs a day, just to pay the rent, let alone the bills and getting no breaks in which you can sit down to actually digest your food, let alone make healthy choices from the work canteen that doesn’t actually supply any healthy choices – then your choice is reduced. When you are scraping everything together to make sure you don’t fall into more debt, whilst you are sitting with a benefit sanction for something that really wasn’t your fault and you are using a food bank for your meals and so healthy options are not in abundance (and let’s not even go there with sanitary products and how utterly dehumanizing the tampon tax is) – then your choice is reduced. When you have been kicked out of school because a no-tolerance policy left you in isolation or no-compassion and then you’re a drug runner for a local gang, where you feel like you fit in, but in fact, they own you….then your choice is reduced.

 

Let’s be a little more kind, can we? Let’s stop stupidly over-simplistic comments like – people should just take more responsibility for themselves. This is actually pretty impossible for nearly 14 million people in the UK. I’m not saying there is no choice and nor am I saying that people have no responsibility. I’m simply reminding us that it is a great deal easier for some than others and we are seeing child poverty on the rise and the health inequality gap widen – this isn’t because people in poverty are making bad choices – they simply have far less choice available to them!

 

So what needs to change? Government policy around austerity and universal credit, licensing, pricing, advertising laws, a living wage, the way we work with communities rather than doing things to them, a total renewal of our education system and a bunch more kindness in society as a start.

 

 

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Who is Responsible for Your Health?

Who should take responsibility for you health? Sounds like a straightforward question, doesn’t it? But I get so frustrated when complex issues get squashed into simplified, silo-thinking, ready for twitter or media sound bites, or the under-girding of political ideologies.

So….just as the economy is not just made up of the interplay between business and the household, but is in fact far more rich and complex, so too the interplay of responsibility for our own health.

Kate Raworth, really helpfully uses the following diagram to help us rethink the components of the economy. I would like to suggest that we use it to think about health, also.

So…who is responsible for your health and wellbeing?

  1. Your Family/Household
  2. Society/The Commons
  3. The Market
  4. The State
  5. You

In some ways, I feel like all of these are obvious, in their own way, but I will just unpack each one a little bit more.

 

Your Family/Household

We all have needs. We need to know we are provided for (water, food, clothes etc), safe, loved, welcome, encouraged, disciplined and given place to dream and live those dream out. It is the role of our families or the household to which we belong to ensure those things happen as we grow. So much of our ill-health, our brokenness and our long term physical and psychological pain is because these basic needs were never met and left us without a sense of wholeness. The lack of met need, has a huge impact on the development of our personality and character. When we speak of ‘personality disorders’, each type has it’s roots in early life when needs were unmet and therefore parts of the personality remained undeveloped. Let’s face it – no family is perfect! And so, I would argue, that all of us have ‘disordered personalities’, and until we confront the shadow parts of ourselves that are trying to overcome this sense of loss or inadequacy, we continue to project an ego version of ourselves to those around us. We do so to cover over this pain, but facing it head on and allowing ourselves to fess up to our deepest needs, would actually lead to us being a great deal more healthy.

When I work with head teachers and ask them what the biggest need they have in their school, the answer is almost always ‘parenting classes’. However, there are very few providers of this available (due to cuts at a county council level) and the classes available are often very ‘middle class’ in their approach. We need to completely rethink parenting classes in the context of the poverty-truth commission and think about less twee ways to really engage with communities about how we raise happy and healthy kids. The truth that Adverse Childhood Experiences are our greatest public health crisis is not going away. Grasping this nettle is going to be painful but really necessary if we are to breathe health and wellbeing into our society.

 

Society/The Commons

Just as we get our needs met by those in our immediate household, the same is true of society. The way we treat children, the things we expose them to, the way we love them and educate them has a massive impact on their current future health and wellbeing. It’s becoming clear that social media is causing significant harm to our mental health as a nation, particularly our young people, and yet we don’t know how to curb our enthusiasm for all our technology…let alone the rise of the robots…

The commons is fast disappearing, too easily privatized and made available to those who can afford it. How do we safeguard the commons and use it for the benefit of all? What would the Diggers say to us now? The breakdown of our communities, with increasing isolation and loneliness is having a detrimental effect on our wellbeing. What can we do to recover the spaces that belong to us all and help us rediscover the joy of connecting and being together?

The commons is also about our corporate voice. It is only really vast people movements, speaking with one voice that can really cause governments to sit up, listen and take heed of the needs of the people. It is only together, that we will make enough noise to change the health and wellbeing of all of us for the better. How might we speak and act together in a way that will take corporate responsibility for all our health and wellbeing?

 

The Market

Oh the benevolent hand of the market! If only…. But the Market plays an absolutely key (though currently over played) part in our economy and our health and wellbeing. We know for a fact that advertising is deliberately trying to misinform us so that we make irrational decisions. A key component is to make people feel worse about themselves so that they buy things they simply do not need. Supermarkets are being challenged for the ways they deliberately place products and arrange their stores to cause people to buy more unhealthy things and food chains are constantly trying to ‘up-sell’ their unhealthy products and downgrade our health in the process. They evangelize the masses with the idea that we are all free to make our own choices, but if this were so, they would not spend the billions of pounds involved in socially engineering our choices, so that we ‘freely’ choose that which harms us! Oh for a market that might redefine it’s moral code! The market could do SO much good, but unharnessed and left without true accountability or consequences, it serves to damage our health – something it is truly responsible for.

 

The State

The state has a vital role and responsibility in caring for all of our health and when it washes it’s hands of that responsibility or tries to pass it over, we see a massive rise in health inequalities and overall worse-health for all. The NHS in the UK is one of the great triumphs of the state. Providing brilliant healthcare for those who need it whenever they are unwell is truly amazing. Imagine not being able to afford this because it depended on keeping up with insurance bills. It is not uncommon for us to see people in General Practice, who literally cannot afford to feed their families any more and are having to make some incredibly difficult choices (made far worse by long school holidays). Easy to point the finger and start creating a narrative about how it’s “all their fault”, but far harder to hear the truth of what it is really like to be a lived-expert in poverty and the trap it creates and harder still to look to alternative solutions, rather than believe the austerity narrative. There is clear evidence that the more unequal a society becomes, the worse the health outcomes – both physical and mental. When the market is allowed to behave exactly as it wants, we also see the health of people suffer. It is only through the right kind of government that the market can be tamed. It is only with the right kind of legislation that the economy can be skewed towards redistribution and regeneration of the resources needed – this would need to include a radically feminist approach that works on behalf of women, in particular, for equal opportunity, pay and recognition of just how much the ‘household economy’ contributes to the overall wellbeing of the nation. It is only the right kind of leadership that will tackle the inequalities we see and refuse to be wined and dined into maintaining the status quo. It is only brave leadership that will take the ecological issues, like plastic in the oceans, massive over antibiotic use in animals, and ongoing air and river pollution that will give us a healthy planet and human population in the future.

 

You

And where possible, and for some given various health issues, this is more possible for some than others – we do not all have an equal starting place or a level playing field – where we can  – we do have a responsibility to ourselves and to the wider society to care for our own health and wellbeing, so that when the health and social services are needed, they are available for all. It also means using the health and social care services in a way that creates sustainability, being grateful for them and ensuring they and the people who work in them are not abused.

 

It’s complex, but it’s vital that too much emphasis is not put on any one area. We must not play the blame game, especially not towards individuals when we haven’t taken the time to hear their story, nor understood the wider context of the role of the other vital players on the field. Each aspect of the economy plays a massive role in the health and wellbeing of the nation, and it is high time that each plays it’s relevant part to its fullest ability.

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Perspective

Tweet Earlier this week I wrote another blog about the health inequalities we face in the North, compared to the South. Then I spent some time with a good friend of mine, who has spent much of his life in other countries. In what I’m about to write, I’m not negating the injustice that exists [Continue Reading …]

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Don’t Mind The Gap – Address It!

Tweet So, here it is in black and white: the health gap between the north and south is getting wider, and in fact it is now the worst it has been in over 50 years!   https://www.theguardian.com/society/2017/aug/08/alarming-rise-in-early-deaths-of-young-adults-in-the-north-of-england-study?CMP=Share_iOSApp_Other http://www.dailymail.co.uk/wires/pa/article-4770286/Death-records-growing-north-south-divide-study-finds.html?ito=email_share_article-top   I’ve blogged about this on here before, but the figures from this latest study are utterly stark: [Continue Reading …]

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