“By harming one we all are harmed” William Morris (1834 – 1896)

In this blog Elspeth Gracey, Development Manager within the CHEX team shares some thoughts about how we organise ourselves in society and the impact that has on inequality and the relevance of long standing aspirations for improvement.

As a member of a community choir I was introduced to these words of William Morris, a 19th century social reformer, and I hope to explain why his words written then remain so relevant in the 21st century.

As a person employed in supporting communities to take collective action to improve health my thoughts were triggered by listening to a radio programme in which Michael Marmot , famous for his work on the impact that lacking a sense of control can have on the health of individuals. He spoke of continuing ‘health inequalities’ and eloquently described why health promotion messages would have little impact on people whose lives are too challenging to even listen to them.

In the same programme, another speaker spoke of the global impact of Tuberculosis and how those with fewest resources would find it most difficult to access treatment. Another speaker spoke of the impact of ‘natural disasters’ and how although an earthquake or hurricane may be generated ‘naturally’ those who suffer the greatest impact are always the poorest with fewest resources.

In trying to tackle the issues of ‘health inequalities’ we here at CHEX, within the Scottish Community Development Centre, promote the use of ‘community development approaches’ and describe what we call ‘community-led’ initiatives. However, it has occurred to me that sometimes the very language that we use can disguise the real issues.

In much the same way that we speak of our national health service – which is in many respects – our national sickness service. I wonder how clear is the phrase ‘health inequalities’ to those who are not involved in this work or indeed to those whose lives are so profoundly affected by them. I venture to suggest that a more accurate description would be the phrase ‘Unfairly and avoidably unwell and dying younger’. While it may not role off the tongue so easily I think most people would understand what we are talking about and may even realise that is the consequence of what our society generates in terms of what is recognised as the lottery of birth which keeps far too many of us so far from what many of the rest of us would take for granted as a basic human right, the right to health.

So, I am led to question why we continue to choose to organise ourselves in ways that not only generate but perpetuate and exacerbate such degrees of unfairness so that substantial portions of our fellow citizens die younger than needed and that in their foreshortened lives suffer a greater burden of ill health.

Having heard the radio programme I arrive at work within the Scottish Community Development Centre (SCDC) to find that a debate was underway by email amongst my colleagues about the merits of the word ‘empowerment’. This relates directly to Michael Marmot’s original research which showed that lack of control over our lives is a significant factor in the likelihood of dying younger and living for a greater percentage of our lives with life limiting illness.

So, where is community development in all of this and why should anybody be interested in a community development approach to tackling our societies’ ills? Working WITH communities, supporting them to organise and have their issues heard and acted upon is one route to positive change. People involved in those processes have an opportunity to take control, to be empowered and to implement radical change for their own communities leading ultimately to better health outcomes for those involved in the process and those who benefit from the improvements they generate.

Within the community development and associated battalions of professionals there are debates about where the term ‘asset based approaches’ lies in all of this. For me an asset based approach is integral to community development where those involved are recognised for the skills and knowledge they bring to identifying the issues of greatest importance to them and also to generating the solutions. However, in common with my colleagues I am wary that in some circumstances asset based approaches can be interpreted as a ‘just pull up your boot straps - you can do it yourselves’ version of working in communities without fully recognising that how society is organised cannot necessarily be fully overcome by individuals. It also needs to recognise that society as a whole shares responsibility for such inequality in terms of life circumstances and chances. Why then should it fall on the shoulders of those individuals alone to solve these issues?

We repeatedly see how communities can mobilise when institutions and agencies fail them. There is no disputing the power of community and of course here in the Scottish Community Development Centre we would never underestimate that.

However, all of this brings to mind one of my first encounters with a very successful community activist. Let’s call her Christine. Christine had spent much of her adult life in a peripheral housing estate organising, amongst other things, safe play areas for children, mobilising families to be involved with local councillors and other structures, fundraising, volunteering and generally giving over her life to her community and it’s betterment. She had most recently led a community initiative to provide affordable fruit and veg in the form of a local food co-op organised and run by local residents in a volunteer capacity. Having heard her present the difference this co-op had made to what her neighbours were able to access in terms of healthier eating and better use of their meagre incomes I went to congratulate her, telling her how impressed I was with the difference she was making. Dismissing my comments with a wave of her hand she reminded me of the unfairness of the situation she had found herself in for so many years. “I don’t like doing this, I do it because I have to – I might like to be on the golf course like anybody else. We do it because we have no choice”.

I long for the day when the majority of us make better choices about how we should organise ourselves so that Christine and the countless ranks of others like her can more readily choose how to spend their time.

In common with William Morris’ dreams of a fairer society we might finally be in a position where the following lines would relate to ALL of us.

“First I claim good health for all, and next good education
And then the right to leisure time, the joys of recreation
And then I claim the right to work, in work feel no resentment
And the right to share my labour’s fruits, and live in quiet contentment.”

Is that too much to ask? Surely we would all benefit if this is what we had?

 

Some links

The programme on BBC Radio 4 which I heard:

Start the Week Health Inequality TB Trauma and Technology

http://www.bbc.co.uk/programmes/b08tvj71

The Institute of Health Equity

http://www.instituteofhealthequity.org/

Michael Marmot’s Whitehall Studies https://en.wikipedia.org/wiki/Whitehall_Study

Associated sites

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NHS Scotland logo

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