Saturday, October 20, 2018

Neoliberalism and Socio-structural violence against the poor in India "garibi hatao" to "acche din"

Socio-structural violence against the poor

Jane Jones

Cathy McCormack

Socio-structural violence against the poor in India "garibi hatao" to "acche din"

17.1 Introduction: The view from community activism

The two authors approach this chapter from the critical perspective of community activism and popular education, with which they have been involved at local, national, and international level. For over 30 years they have worked in community campaigns addressing the social, environmental, psychological, and political determinants of health inequalities. The chapter is also informed by their working relationships, both fruitful and contentious, with researchers, health professionals, politicians, policymakers, and voluntary sector organizations, at local and national levels.

What we have experienced and witnessed through our work is the misery consequent on what are referred to as ‘health inequalities’. We have come to understand how deeply these ‘inequalities’ are embedded in the way society functions: in economic policy, in health policy, and in the ways in which professionals understand and construe their roles.

Moreover, the ways in which language is used to describe and analyse these inequalities and the people who suffer them play a profound part in creating and maintaining them. While the language used in the media and in political discourse ranges from the sober to the virulent—the virulence being directed against those who suffer most—the language of research is nearly always dispassionate (see Chapters 6 and 20 for reflections on this tension from researchers’ perspectives). This tends to efface the reality of the lived experience (see also Chapter 16).

In this chapter, we try to communicate some of that experience. Much of the language we use, and the analysis we present, speaks explicitly of violence against the poor. By violence, we mean the knowing and deliberate inflicting of harm. It is beyond doubt that harm is being inflicted, and that it is consequent on economic and social policies pursued in the full knowledge that such harm will result. It may not be the primary purpose of the policies, but collateral damage is no less violent for those affected. Furthermore, the rhetoric used to justify (p.239) policy seeks to turn the victims into being responsible for their own injury, preparing the ground for further punitive policies; and the violence then becomes more explicitly targeted. This is a ‘war without bullets’ against working-class people (Fryer and McCormack 2012). The chapter will examine the concept of socio-structural violence, drawing from our experience in the 1980s as a tenant activist and as a community development worker involved in the housing and health campaigns in Easthall, Glasgow and Pilton, Edinburgh. We will conclude by discussing the implications of this for inequalities and health research. Specific personal contributions will be indicated in the text.

17.2 Socio-structural violence

The term ‘socio-structural violence’ captures the systematic ways in which social, political, economic, and cultural practices combine to cause early and avoidable death, harm, disadvantage, fear, insecurity, and marginality for particular groups of people. Some authors have broadened the concept to include that which violates basic needs, rights, and the individual’s intrinsic dignity as, for instance, enumerated in the United Nations Universal Declaration of Human Rights of 1948 (Fryer and McCormack 2012; Galtung 1990).

The more visible aspects of socio-structural violence are to be found embedded in the economic and social policies pursued by the UK government. The rejection of the Black Report recommendations in the 1980s, such as increasing the maternity grant and child benefit as a means to reduce inequalities in health, signalled the start of a harsher, uncompromising government who were determined to cut public expenditure (see Chapters 1 and 2). In a defining moment, seven years later, Margaret Thatcher deregulated the City of London in an enthusiastic embrace of neoliberalism: ‘it was, in every sense a revolution. It was messy and there was blood all over the place. Unlike most revolutions, it was imposed top down’ (Agius 2011).

The tsunami of neoliberalism that began to wreck working-class communities was even more messy and cruel (see also Chapter 9). It was clear that integral to the policies that began to flow from this government was a blatant disregard for the suffering of the poorest section of society. It was our first realization that in order to fulfil her government’s election pledges to reduce taxation, Thatcher was going to be snatching more than milk from children (the policy described as ‘the meanest and most unworthy thing he had seen in twenty years in parliament’, by Edward Short, the Labour education spokesman at the time).

Instead of examining the root causes of health inequality, the increasing emphasis on individual behaviour and personal responsibility shifted the public discourse around social and economic conditions.

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Health InequalitiesCritical Perspectives$

Health Inequalities: Critical Perspectives

Katherine E. Smith, Clare Bambra, and Sarah E. Hill

Print publication date: 2015

Print ISBN-13: 9780198703358

Published to Oxford Scholarship Online: January 2016

DOI: 10.1093/acprof:oso/9780198703358.001.0001

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Contents

FRONT MATTER

Chapter 1 Background and introduction: UK experiences of health inequalities

Chapter 2 Reflections on the legacy of British health inequalities research

Chapter 3 Nordic health inequalities: Patterns, trends, and policies

Chapter 4 Reflections on the UK’s legacy of health inequalities research and policy from a North American perspective

Chapter 5 Reflections on the UK legacy of health inequities research, from the perspective of low- and middle-income countries (LMICs)

Chapter 6 Contrasting views on ways forward for health inequalities research

Chapter 7 Axes of health inequalities and intersectionality

Chapter 8 Beyond ‘health’: Why don’t we tackle the cause of health inequalities?

Chapter 9 Neoliberalism and health inequalities

Chapter 10 Health inequalities in England’s changing public health system

Chapter 11 The equity implications of health system change in the UK

Chapter 12 All in it together? Health inequalities, austerity, and the ‘Great Recession’

Chapter 13 Industrial epidemics and inequalities: The commercial sector as a structural driver of inequalities in non-communicable diseases

Chapter 14 Place, space, and health inequalities

Chapter 15 The politics of tackling inequalities: The rise of psychological fundamentalism in public health and welfare reform

Chapter 16 Knowledge of the everyday: Confronting the causes of health inequalities

Chapter 17 Socio-structural violence against the poor

Chapter 18 For the good of the cause: Generating evidence to inform social policies that reduce health inequalities

Chapter 19 Influencing policy with research—public health advocacy and health inequalities

Chapter 20 The Spirit Level: A case study of the public dissemination of health inequalities research

Chapter 21 Conclusion—where next for advocates, researchers, and policymakers trying to tackle health inequalities?

END MATTER

SUBJECT(S) IN OXFORD SCHOLARSHIP ONLINE

Epidemiology

Public Health

Public Health and Epidemiology

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Socio-structural violence against the poor

Jane Jones

Cathy McCormack

DOI:10.1093/acprof:oso/9780198703358.003.0017

Abstract and Keywords

This chapter is approached from the critical perspective of community activism and popular education, with which the authors have been involved for over 30 years. It is informed by their working relationships (fruitful and contentious) with researchers, health professionals, politicians, policymakers, and voluntary-sector organizations, at local and national levels. Drawing on personal experiences of living and working in Scotland, the chapter reflects on the misery associated with what are referred to as ‘health inequalities’. It argues that the ways in which language is used to describe and analyse these inequalities, and the people who suffer them, play a profound part in creating and maintaining them. Challenging this, the chapter employs the concept of socio-structural violence to speak explicitly of violence against the poor. It concludes by arguing that the biggest challenge for those involved in health inequalities research, policy, and practice is how to begin reclaiming our humanity.

Keywords: community activism, health inequalities, Scotland, poor, popular education, socio-structural violence, structural violence, language

17.1 Introduction: The view from community activism

In this chapter, we try to communicate some of that experience. Much of the language we use, and the analysis we present, speaks explicitly of violence against the poor. By violence, we mean the knowing and deliberate inflicting of harm. It is beyond doubt that harm is being inflicted, and that it is consequent on economic and social policies pursued in the full knowledge that such harm will result. It may not be the primary purpose of the policies, but collateral damage is no less violent for those affected. Furthermore, the rhetoric used to justify (p.239) policy seeks to turn the victims into being responsible for their own injury, preparing the ground for further punitive policies; and the violence then becomes more explicitly targeted. This is a ‘war without bullets’ against working-class people (Fryer and McCormack 2012). The chapter will examine the concept of socio-structural violence, drawing from our experience in the 1980s as a tenant activist and as a community development worker involved in the housing and health campaigns in Easthall, Glasgow and Pilton, Edinburgh. We will conclude by discussing the implications of this for inequalities and health research. Specific personal contributions will be indicated in the text.

17.2 Socio-structural violence

(p.240) 17.3 Housing

In the 1970s, Greater Easterhouse in Glasgow, which included the community of Easthall, had a population of 70,000. It was the largest public post-war housing scheme in Europe, built as ‘houses for heroes’, ironically, to accommodate the massive slum clearance of the inner city, and thereby to address Glasgow’s appalling health record. By the 1980s this social housing was in a poor state. The substandard structures created massive issues of internal dampness and high heating costs for tenants.

Cathy: ‘I became really depressed because no matter how much I loved my children or tried to take care of them, I could neither keep the doctor at bay, or the fungus that was destroying everything that it came into contact with . . . I was continually having to throw out mouldy furniture, clothes, and toys and found myself having to choose between feeding my hungry children or hungry fuel meters which kept demanding more and more money. My doctor offered me a course of anti-depressants and it occurred to me that he was only employed to treat the symptoms of our health problems in the same way as our landlord . . . I asked him for a prescription for a warm, dry home and he laughed. I refused the tablets and I joined the city wide anti-dampness campaign instead.’

The same picture was evident in Pilton, Edinburgh. Tenants complaining to the housing department of the Council were told that the cause of the dampness was a result of boiling too many kettles and hanging up wet washing. The official view implied that their poor health was a result of eating too many fish suppers and not taking enough exercise.

We complained to the housing department and people would come down and say—well you’ve got to keep the house warm . . . but that was quite difficult because there wasn’t any heating in the rooms . . . and the cost of running a fire, if there had been space, [was too high]. You just felt caught in a trap and there was nothing you could do . . . my daughter was prone to coughs and colds and she ended up getting pneumonia.

Reproduced from J. Jones, Private Troubles and Public Issues—a community development approach to health © 1999 Community Learning Scotland. Used with permission under the Open Government Licence v3.0 (http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/)

17.4 Unemployment

Housing was not the only battleground. On the broader front, neoliberal orthodoxy became increasingly influential (see Chapter 9). Unemployment became acceptable as a deliberate tool of the market economy, breaking from the post-war consensus that it was ‘a scourge’ and should be minimized through government intervention. As unemployment rose to 3 million across the UK in the (p.241) 1990s, it became clear that there would be no intervention to soften the impact of this on people’s lives: ‘rising unemployment and the recession have been the price that we have had to pay to get inflation down. That price is well worth paying’ (Norman Lamont, Chancellor of the Exchequer (1991).

The ‘acceptable price’ that was, apparently, ‘well worth paying’ was the damaging health and social effects of unemployment on individuals, their families, and communities—well documented by research (Fryer 1995; Platt 1984, 1986). The thinking behind the government’s education and economic policies was exemplified by the Chancellor of the Exchequer, Nigel Lawson, in a speech to the IMF in Washington in 1984 when he warned Britain’s workforce that many of the jobs of the future would not be ‘high-tech’ or even ‘low-tech’, but ‘no-tech’. The move towards a low-wage, no-wage economy had begun—with deliberate policies to ensure that profits would rise faster than wages.

The last coalition and current Tory governments’ welfare cuts and ‘austerity’ programme is targeted at the poor, those who experience disabilities, and all their families, in preference to reducing the income/wealth of the richest groups. In England, people in poverty (21% of the population) have borne 39% of all cuts, disabled people (8% of the population) 29%, and people with the severest disabilities (2% of the whole population) 15% (Duffy 2013).

Work ‘capability assessments’, carried out on those on incapacity benefit by the multinational private corporation Atos on behalf of the Department for Work and Pensions, have been subject to allegations of harm and distress. Criticism has come from leading clergy, disability organizations, and claimants. Michael Meacher, Labour MP, opening a debate in the House of Commons asked how the insensitive rigour with which 1.6 million claimants on incapacity benefit were being assessed by Atos could be justified when ‘it has led, according to the Government’s own figures, to 1,300 persons dying after being put into the work-related activity group, 2,200 people dying before their assessment is complete, and 7,100 people dying after being put into the support group?’ (Meacher 2013).

Drawing from international and historical data, Stuckler and Basu (2013) conclude that the decisions governments make during financial crises have a critical impact on the poor when policy can become a matter of life and death. Examining case studies from the 1930s Depression in the USA, to Russia and Indonesia in the 1990s, to present-day Greece, Britain, Spain, and the USA, they show how different policies produce vastly different consequences for the population. For example, during the Great Depression in the 1930s, deaths actually plummeted in the USA due to interventions like the New Deal. In recent times, Iceland’s decision not to cripple their welfare state by bailing out private banks, but instead to put money into their social health care systems and increase social (p.242) welfare payments to its poorest citizens, has resulted in a healthy economy and healthy citizens. There has been no rise in suicides or depressive disorders, and today it is ranked as one of the happiest countries in the world. In contrast, the UK government’s programme is (literally) having deadly side effects, with Stuckler citing the UK as ‘one of the clearest expressions of how austerity kills’ (Henley 2013).

The authors comment that it was not only the dire impacts of the policies they found troubling, but also the heartlessness of the policymakers who have so vigorously endorsed them. They state that the impact of this financial crisis goes far beyond people losing their homes and jobs; rather it is a full-scale assault on people’s health. Worsening health is not an inevitable consequence of economic recessions, it is a political choice.

These are examples of socioeconomic policies being pursued in the full knowledge that harm will result. Some authors have described this as a new form of ‘barbarism’—a belief in the superiority of some people and a willingness to use cruel and vicious behaviours towards those who are considered inferior or undeserving (McCormack 2012; Thomas 2011).

17.5 Shifting values and the common determination of meaning

The less visible aspect of socio-structural violence is the corrosive influence which begins to shape and influence public support or acceptance of such policies and practices through misinformation and manipulation of the facts and through media, language, and images.

In the 1980s the term ‘inequalities in health’ was replaced in official contexts with the less emotive ‘variations in health’ (see Chapter 1). These shifts in language set the direction for research, for funding, and more importantly for public discourse. Inherent in the word ‘inequalities’ is the sense of injustice, which guides policy and research in directions to remedy this, in contrast to the idea of variations—‘normal’ individual differences—for which government has no responsibility (see Whitehead and Dahlgren 2007).

It is the introduction of this language into societal contexts, interwoven with mechanisms of power, which creates such a powerful and invidious force. ‘Cultural hegemony’ is a term that describes the way in which powerful groups manipulate the beliefs, perceptions, and values in a society so that their ideological stance becomes imposed and accepted as natural and inevitable. The UK trajectory since 1979 has been to wage war on the welfare state and the NHS through enforced privatization and the imposition of a business model. As citizens or patients, we were re-cast as consumers who should exercise our ‘freedom’ by (p.243) having more say in our public services and more ‘choice’ in this marketplace. It did not take long to taste the bitter pill of competitive relationships, the impossibility of providing choices within constrained budgets, or, most crucially, to realize that market values rely on inequalities, the antithesis of what public services are about (Jones 2002). The outcome is the deliberate destruction of our common bonds and a deadening effect on democracy.

17.6. Stigmatization

This form of cultural violence can be seen to move and harden public opinion against the welfare state by devaluing, stigmatizing, and blaming particular groups (see also Chapter 16). It ‘preaches, teaches, admonishes, eggs on and dulls us into seeing repression as normal and natural—or not seeing it at all’ (Galtung 1990).

Cathy: ‘The singer Frankie Vaughan and the media circus that followed him made my community in Easterhouse famous for its gang warfare in the 1960s. But there has never been any public recognition of the very deep political and spiritual violence that is constantly being inflicted on the hearts, minds and spirits of the unemployed, the poor and the most vulnerable people in our society.’

The emphasis on individual responsibility as a causal explanation for health inequalities moved to a different level in the UK when the financial crisis exploded in 2008. The drone attacks of the welfare ‘reforms’ and the ‘austerity’ cuts have not only been directed towards the most vulnerable groups in society (see Chapter 12), but have also been accompanied by a propaganda war that demonizes them. The manipulation and selective use of data has distorted public perceptions so successfully that the average public perception is that 27% of the welfare budget is claimed fraudulently. The reality, according to YouGov survey, is 0.7% (TUC/YouGov 2013). Vulnerable groups of people have been re-cast as ‘scroungers’ who constitute a drain on the country’s resources.

The rhetoric of ‘hard-working families’ (who are implicitly contrasted with welfare-state ‘scroungers’), which began under Blair’s and Brown’s premierships, is now deployed endlessly by government to separate those who are perceived to be ‘deserving’ of respect and support and those who are not. Speaking on welfare reform at the Centre for Social Justice, Ian Duncan Smith yet again refers to the ‘twilight world’ of Britain’s ‘ghettoised’ welfare recipients ‘where people are languishing on welfare’ with no incentive to aspire to a better life (Duncan Smith 2014).

The way in which areas of council housing or social housing have become stigmatized as urban hellholes where the ‘problem’ categories of society collect—‘benefits streets’—shows how stigma has become activated for political (p.244) purposes (Slater 2013). These examples offer a window into the psychological and cultural mind-set that creates categories of people who are seen as less valuable than others, as less human than others; as ‘disposable human waste’ (Bauman 2004; Tyler 2013): ‘A social, economic, psychological and propaganda war; a war fought with briefcases instead of guns against our own fellow citizens to try and safely dispose of all the people in our world who have become “surplus to market requirements”’ (McCormack 1993). This metaphorical description is now becoming a horrific reality. A recent survey found that 38% of waste companies had discovered homeless people in bins in the past 12 months as homelessness reached an all-time high (CIWM/StreetLink/Biffa 2014).

According to the Health and Safety Executive, people sleeping in bins are at risk of getting caught in the bin mechanism, being smothered by the bin contents, or being unable to escape before the bin is tipped into a waste collection vehicle. They state that there have been a number of occasions in recent years where a dead body has been discovered only after unloading at the waste depot. Subsequent investigations revealed that in some of these cases the person concerned was alive prior to being emptied into the waste truck (HSE 2010).

17.7 Shifting practices

Lastly, we want to draw attention to the subtlety of this dominant neoliberal hegemony—often invisible, spreading through the everyday, normal functioning and practices of institutions and professionals (see Chapters 8 and 9). The alliances and organizations that have traditionally formed a safety net and a voice for those who experience the excesses of the system also become deployed and enmeshed in the web of pressure, policies, and practices. Campaigners and community activists see, and live with, the consequences of the propaganda aimed at the working-class communities portrayed by politicians and the media as ‘lazy scroungers’ who want to live in a ‘dependency culture’ (see also Tyler 2013):

Cathy: ‘Communities became plagued with professional researchers, social workers, poverty management workers, child support workers, advocacy workers, CBT [cognitive behavioural therapy] specialists, Council-employed policymakers, programme makers, and health promotion workers all swarming in from their leafy suburbs to treat the symptoms of poverty and health inequalities. Once their dire warnings about the dangers of smoking and lack of exercise had been delivered, they then left in their cars, back to their ‘comfort zones’, further polluting us with their toxic car exhaust fumes. It became evident to the activist that our society was addicted to treating the symptoms of everything and tackling the cause of nothing. If there was a “dependency culture” it was the army of professionals who were employed to treat the symptoms.’

During the 1990s, the unemployed, poor, and oppressed were being pushed further and further to the edge of society. People in living in social housing (p.245) schemes began to realize that what they were being subjected to was social and economic apartheid. Opportunities for them to share their personal testimonies of the experience of living in poverty were provided by many of the charitable organizations that claimed to represent and advocate for them. However, rather than empowering people by analysing and focusing on the stigmatization and the political propaganda, people were more often displayed as ‘passive objects’ or victims. This activity has itself become a multi-million pound ‘poverty industry’ (Young 2007). Repeated exposure to distressing stories without any critical analysis of the causes can begin to normalize inequality and de-sensitize people to the reality.

Jane: ‘Attending a Church-led initiative in Westminster, to enable “the poor” throughout the UK to talk to a parliamentary committee, our group, Communities Against Poverty, from Scotland attended the pre-meeting to discuss what we were going to bring up. After a lunch of very thin soup, people broke into groups. On seeing “re-distribution” as our topic, the organizer swept across and made it very clear that this was not a topic to be discussed with politicians—we were here to talk about “poverty”.’

The alternative to being patronized is, in most cases, not to be visible at all. In 2007 a conference initiated by the Catholic Archbishop, a fellow of the Royal Society of Edinburgh, entitled ‘Transcending poverties—will the poor always be with us?’ involved 16 distinguished speakers from academia, civic life, and the churches. The cost of attending was (as conferences focusing on inequalities and poverty so often are) out of the reach for anyone on benefits. Alf Young of the Glasgow Herald wrote:

[T]o be brutally honest, six hours of learned discourse and debate produced very little fresh prescriptions for how to bring that resilient system of apartheid to an end. Around the victims of social and economic apartheid . . . a poverty industry has grown up that not only claims to represent their interest but also profits from that same advocacy. . . . It provides lots of well-meaning people with warm homes, cars in the drive, plasma TVs, meals out and two or three foreign holidays a year—the material aspirations that are now the norm for British citizens on average and above-average incomes . . . it was striking that the dispossessed, the real victims of social and economic apartheid, were nowhere to be seen’.

17.8 The new morality

The stigmatization of those on benefits, the misrepresentation of the causes of the financial crisis, the policies, and the practices operate to allow punitive sanctions and threats, such as taking disabled people off benefits, or forcing people into a cycle of low pay and unemployment, to become ‘the norm’. In (p.246) 2014, when 27 Anglican Bishops and other church leaders criticized his welfare reforms, David Cameron unravelled four centuries of progressive social welfare development by drawing from the Elizabethan Poor Laws and their imposed moral order on those who were to receive welfare support—a view which distinguished between the ‘worthy’ and unworthy or ‘feckless’ poor.

In his rebuttal of the concerns of the clergy (Cameron 2014), he insisted that the reforms were at the heart of his social and moral mission in politics—that it was ‘wrong’ to reward those who can work but do not. His statement completely ignores the fact that half of those on benefits are the working poor, who have to claim benefits because their employers do not provide a living wage. Shildrick’s research on Teeside (2010) showed no evidence that those who can work did not, or indeed that work is a route out of poverty. Many people were trapped in a low-pay, no-pay cycle moving in and out of casual, badly paid jobs, utterly at the mercy of today’s economic and welfare policies and powerless to change their situation (see Chapter 12). Her research also captured the fear of stigmatization that people now express when they are forced to claim benefits.

Cameron’s ‘moral mission’ is a perfect illustration of the way in which a new ‘morality’ is being forged, one that allows violence to be perpetrated on vulnerable people.

17.9 The role of research and dissemination

What does this mean for those researching health inequalities? Challenging the dominant discourse is difficult (see Chapter 8). Community activists and local campaigners spend years working to draw attention to the effects and causes of inequalities in health and build a body of knowledge and expertise drawn from their lived reality. This needs to be aligned with research within academia.

Jane: ‘The woman and health group in Pilton made a presentation “Home Sweet Home” to show the effects damp housing was having on their own health and their children’s health—the difficulty of getting their children immunised because they always had colds, their own stress, and the cost of replacing mouldy furniture and clothes. We tried to persuade the local GPs to monitor the extent of dampness amongst patients who reported respiratory problems, but they rejected this idea as being “too political”. We only managed to turn these private troubles into public issues when we developed a working relationship with the Research Unit for Health and Behavioural Change (RUHBC) at Edinburgh University and the senior researcher, Dr Sonja Hunt, arranged for a presentation to be made in the University.’

Significantly, around the same time, mothers in Easterhouse had also created a sophisticated exhibition board, ‘Housing Makes you Sick’, and together these initiatives triggered one of the biggest health and housing surveys ever carried (p.247) out in Britain into dampness, fuel poverty, and the associated health problems which at that time affected an estimated 10 million families in Britain.

The first study was completed in 1987, the second in 1989, taking in five housing estates (two in Edinburgh, two in Glasgow, and one in London) (Martin et al 1987, 1989). This research established that those residents living in homes with mould reported the most ill-health symptoms, even when adjusting for other variables such as smoking and low incomes. It has been cited as grounds for action, setting tolerable standards, compensation, statutory repair, rehousing tenants, and suing local authorities. This justified the long-held view of tenants in Easthall and Pilton that there was something wrong with the houses if residents could not boil a kettle or hang up washing.

While the researchers struggled to get their findings published in the British Medical Journal, tenant representatives struggled to get a press conference held in the House of Commons to bring these findings to a ‘nationwide’ audience, which they achieved. As a result, not only did their joint research receive ‘nationwide’ media coverage, but also the focus of a BBC2 documentary ‘Your Health is Your Wealth’. Apart from creating a ‘precedent’ that no landlord could ever again deny the link between damp housing and health, another result was that our findings were debated at the ‘Scottish Grand Committee’ in the House of Commons (HMSO 1989). This inspired the ‘Scottish House Condition Survey’, which through time has resulted in the right of people buying homes to request an energy audit (McCormack 2009).

17.10 Transforming private troubles into public issues

One of the effects of stigmatizing and blaming vulnerable and low-income groups, as we have already indicated, is that without a local group for support, people begin to absorb and internalize the dominant message promulgated by politicians and the media. Research which gives ‘voice’ to those experiencing the harsh realities of austerity policies which exacerbate inequality can expose those myths which inform the practices and policies inherent in socio-structural violence (see Chapter 6), for example Shildrick (2010) and Lambie-Munford et al (2014) on the use of food banks.

Framing research questions which build on the experience of communities, rather than those devised from the comfort zone of a university desk, can ensure that problems are interrogated more thoroughly and solutions better targeted.

The Easthall Residents’ Association (ERA) worked with a range of different agencies and researchers in order to find a solution to the issue of damp housing, which was not only affecting tenants’ health and well-being, but also reducing (p.248) their income, impoverishing their diet, and wasting energy. They invited in the Technical Services Agency (TSA), whose independent research showed that it would cost two-thirds of people’s benefits to maintain a healthy heat level in the home. The TSA estimated that, because of the poor insulation of the houses, people were wasting £10 million a year heating the skies above Easterhouse. The ERA not only took part in the housing and health study already mentioned, but also worked with architects, energy conservationists, public health practitioners, microbiologists, and tenants’ groups across Glasgow to initiate a £1.3 million passive solar-energy demonstration project.

Cathy: ‘The ERA in Glasgow had observed that older people seemed to die like flies in the winter from heart attacks and cold-related illnesses and they were confident that it was the inside of the houses, not outside conditions, that were to blame. During their own research, the ERA found an article by a public health doctor, Dr Evan Lloyd, who had been researching the role of environmental cold stress in ischaemic heart disease (IHD). The tenants were convinced that, as well as being subjected to extreme temperature changes outside, moving from the one warm room in a house to go into a cold one, to make a cup of tea, etc. meant being doubly exposed to this stress. Bedrooms were sometimes colder than outside.’

Making links with Lloyd led to an influential report which concluded that improving the thermal quality of housing to eliminate damp and mould and produce a comfortable temperature throughout the house has a major impact on the health of residents. It also referred to the financial benefits for the residents and, indirectly, for the NHS (Lloyd et al 2008).

17.11 Pressure on researchers

The researchers who worked on the issue of damp housing in the 1980s came under a lot of pressure. Questions were raised about their contracts, requests were made to see papers in advance of public seminars, and subtle pressure was exerted by the Chief Scientist’s Office (then part of the government’s Scottish Office). Attempts by the authors to get the research published by the British Medical Journal were met with an initial rejection before a successful appeal (Martin 1989). Lloyd’s research was also challenged, as was his decision to include three of the local residents who aided him in his research as co-authors.

Working with those who experience inequalities, researching causal explanations or directly interrogating the impact and experience of inequality is not for the fainthearted or those who fear career reprisal (see Chapter 20 for a personal account of such difficulties by Pickett and Wilkinson).

However, the positive and important outcome is that it can provide evidence for communities to utilize in their fight for social justice, turn ‘private troubles into public issues’, expose myths that can influence public opinion, and help to (p.249) challenge stigmatization. Therefore, there are good reasons for researchers to work with communities, despite all the difficulties (see Chapter 6).

Researchers require a keen understanding and awareness of the political context they are working in. Policymaking needs evidence, but evidence alone cannot replace political decision-making. Tackling inequalities in health will not be improved by more research alone; it will always depend on the political and philosophical standpoint of those in power and the strength of civic society to fight for justice. Disseminating research beyond academia is crucial in terms of its impact and relevance to the serious challenges facing us in the current political and ideological climate.

17.12 Conclusion: Moving health inequalities debates beyond the academic realm to reclaim our humanity

Inequalities research cannot remain within universities or in papers in academic journals if authors hope to have any significant impact on politics and policy. Integrity, objectivity, and rigour need not be compromised in forming alliances with those whose lives are blighted by the current orthodoxy. The plight of poor people is becoming more and more desperate as a result of the socio-structural violence being waged against them. Choices and focus, collaborations and dissemination, all matter. In these times of class war, it is important to know which side you are on.

The violence that has been waged against the poor has created huge inequalities that have broken our common bonds as a society. The biggest challenge facing both rich and poor is how to begin reclaiming our humanity. Perhaps this is where the real research into ‘inequalities in health’ needs to begin.

References

Bibliography references:

Agius, M. (2011) How the Big Bang created new life in the Square Mile, by Alistair Osborne, Daily Telegraph, 26 October 2011.

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Hari's Random Thoughts by Hariharan Ramamurthy

Saturday, October 20, 2018

Neoliberalism and Socio-structural violence against the poor in India "garibi hatao" to "acche din"

Socio-structural violence against the poor

Jane Jones

Cathy McCormack

Socio-structural violence against the poor in India "garibi hatao" to "acche din"

17.1 Introduction: The view from community activism

17.2 Socio-structural violence

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