POVERTY, HEALTH AND SOCIAL EXCLUSION

1. POVERTY, HEALTH AND SOCIAL EXCLUSION What contribution can sociology make to an understanding of poverty and its impact on health?

2. INTRODUCTION ‘Inequality in health is the worst inequality of all. There is no more serious inequality than knowing you’ll die sooner because you’re badly off.’ Frank Dobson, Secretary of State for Health, 1997.

3. DEFINING POVERTY ‘Poverty means going short materially, socially and emotionally. It means spending less on food, on heating, and on clothing than someone on an average income. Above all, poverty takes away the tools to build the blocks for the future – your life chances. It steals away the opportunity to have a life unmarked by sickness, a decent education, a secure home and a long retirement’. Oppenheim and Harker, 1996:4.

4. DEFINING POVERTY Absolute Poverty Families are in poverty when their incomes are ‘insufficient to obtain the minimum necessities for the maintenance of physical efficiency’ B.S. Rowntree, 1941.

5. Relative Poverty ‘Individuals, families and groups in the population can be said to be in poverty when they lack the resources to obtain the types of diet, participate in the activities and have the living conditions and amenities which are customary, or at least widely encouraged or approved, in the societies to which they belong.’ Townsend, 1979.

6. SOCIAL EXCLUSION Refers to the ‘dynamic process of being shut out, fully or partially, from any of the social, economic, political and cultural systems which determine the social integration of a person in society.’ Walker and Walker, 1997.

7. MANIFESTATIONS OF EXCLUSION • Social – isolated, weak or limited social network. • Economic – un/employment, insecure, low paid work. • Political – links to above re.work, not registered to vote,no voice/disempowered. • Cultural – little opportunity to engage in varied range of cultural activities.

8. THE BLACK REPORT • Commissioned at end of 1970s by Labour government, chaired by Sir Douglas Black. • To review evidence on inequalities in health & suggest policy recommendations. • Published in 1980 at start of Thatcher's new Conservative administration. • Not widely disseminated – only 260 copies printed.

9. THE HEALTH DIVIDE • Subsequent edition published by Penguin in dual volume with Whitehead’s The Health Divide (1987) which updated the findings, edited by Peter Townsend and Nick Davidson. • This publication made the findings widely available and made for a shocking indictment on the state of the nation’s poor.

10. THE ACHESON REPORT (1998) • An independent inquiry into inequalities in health • Commissioned by the Labour Government • Access via internet: www.archive.official-documents.co.uk

11. MEASURING POVERTY • No official poverty line in Britain • Researchers use statistical indicators such as benefit provision required to bring people's income up to subsistence level • Most commonly used threshold of low income is 60% of median (middle) income.

12. Low Income Threshold 2002/3 before deducting housing costs: • Couple with no children - £194 • Single person - £118 • Couple with 2 children - £283 • Lone parent with 2 children - £207

13. EXTENT OF POVERTY IN BRITAIN • In 2002/3 12.4 million people on incomes below this income threshold • This represents a drop of 1.5 million since 1996/97 • In 2002/3 3.6 million children were living in households below this income threshold • The Black Report concluded that ‘above all, we consider that the abolition of child poverty should be adopted as a national goal for the 1980s.’Townsend & Davidson, 1988.

14. WHY ARE POOR PEOPLE POOR? Two main explanations: • Responsibility lies with the individual or group – ‘blame the victim’ • Structural forces in society shape disadvantage – ‘blame society’

15. BLAME THE VICTIM • Poor people are poor because of the things they do and the choices they make. • Culture of poverty into which poor children are socialised. Transmitted across generations – people resign themselves to their plight. • Cycle of poverty

16. BLAME THE SYSTEM • Emphasises wider social processes – political and economic factors – that produce conditions of poverty which are difficult for individuals to overcome. • For example – educational opportunities, employment patterns/opportunities. • Class, gender and ethnicity. • Taxation policies that benefit the better off. • Lack of affordable childcare that reduces parent’s (especially women and lone parents) ability to work.

17. POVERTY AND HEALTH INEQUALITIES • Social circumstances across the entire life-course – from birth to late adulthood – influence people’s health and well-being. • Different socio-economic indicators – income, wealth, educational attainment and occupational group – are all related to and help explain people’s health status. • Health inequalities are produced by the clustering of disadvantage – in opportunity, material circumstances and behaviours related to health – across people’s lives.

18. POVERTY IS BAD FOR YOUR HEALTH • Lack of resources (for food & shelter) can make one vulnerable to physical illness • Lack of control over one’s circumstances can be psychologically damaging • The coping strategies adopted by those on low income may lead to behaviour that damages health

19. POVERTY:THE IMPACT ON CHILDREN’S MENTAL HEALTH • 1 in 10 children in the UK had a clinically recognisable mental disorder in 2004 (Office for National Statistics) • Prevalence varied according to family characteristics: • More common among single-parent families • More common in families where both parents were unemployed • More common among children whose parents had no educational qualifications.

20. HEALTH RELATED BEHAVIOURS - SMOKING • Health-related behaviours – such as smoking and diet – are strongly influenced by the social environment in which people live. People do not have equal choicesabout how they live theirlives. (Shaw et al 1999). Surviving by Smoking, Hilary Graham, 1994. • ‘Smoking is one of the ways women handle and diffuse the contradictory pressures that structure their daily lives. It provides a way of keeping going when women have little going for them.’

21. SMOKING • ‘The habit identified as the major cause of premature death and childhood ill-health in Britain is – paradoxically- one which many women identify as essential to their survival and to the survival of their families’ • ‘Maternal smoking is a habit through which the welfare of children is simultaneously threatened and protected’ • Smoking can be ‘experienced as a preventive strategy for non-accidental injury’ • Smoking has a clear ‘mood management function’

22. SPENDING ON TOBACCO • ‘Like food and fuel, spending on tobacco is inversely related to income: more is spent proportionately on tobacco as household income falls’ • ‘Tobacco spending has the hallmark of necessity’ • ‘Women recognise the contradictory kind of support that smoking provides…smoking illuminates the toll that social divisions take on the welfare of women and their children’.

23. WOMEN, POVERTY AND HEALTH ‘Women bear the brunt of poverty, it is women who manage poverty on a daily basis and it is women who struggle to feed, clothe and house themselves and their children’. Hunt, 2004:23 The burden of ‘managing poverty’ has clear consequences for the health status of women.

24. WHY ARE WOMEN POOR? • Multifactoral • Women who are pregnant, women with small children, women from ethnic minority groups and those who have missed out on education are marginalised and excluded (Walby, 1997) • Lone parent families – approx 21% of all families; 90% are mother-headed lone parent families. • Women are more likely to be in low-paid work • Women are more likely to have responsibility for child and other care, reducing their capacity for employment, secure work and promotion.

25. CONCLUDING THOUGHTS Reducing health inequalities requires that the underlying causes of these inequalities are tackled (Shaw, et al. 1999)

26. SEMINAR GROUPWORK • Who is vulnerable to poverty, and why? • Why are poor people poor? • What are the implications of the effects of poverty on the role of the nurse?

27. RESOURCES Blackburn, C. (1992) Poverty and Health Shaw, M. et al (1999) The Widening Gap http://www.nottingham.ac.uk/~lqzweb/dlp/ poverty/index.html http:www.jrf.org.uk (Joseph Rowntree Foundation) http://www.poverty.org.uk/intro/ www.archive.official-documents.co.uk www.dh.gov.uk www.statistics.gov.uk