It’s hidden; we don’t see it; but it’s real.
I recently went to a conference1 in London. I took my usual route to the capital had a smooth uneventful journey apart from being crushed into a tube at the other end. The latter was not surprising because it was the end of rush hour. As I watched people go by, I saw many important-looking people carrying lap tops, some talking on their mobiles and others minding their own business reading a newspaper. Like me, they were on their way to some work-based activity. On the way home I had a quick look at the recently renovated St. Pancras station and marvelled at the newly restored roof.
After the conference I spent a very enjoyable two hours with a friend I had not seen for over twenty years. We caught up and shared our life journey speaking about the highs and some of the lows, including our shared support for a certain struggling North East football club. My friend had had, and was still having, a very successful career. In this context success, I suspect, would not be defined economically; her success, in my view, could, however, be seen through the work she was doing with some very marginalised groups.
Poverty and Health
The conference I went to focused on the issue of health, in particular, social enterprises in health. The first major speaker was a very charismatic man from India called Stan Thekaekara2 who talked of some of the work he was doing in the South of India. The central part of his message was that if we are to make a difference we need to look at the issue of power, because at the core of any empowerment model is the need for one group to lose some of their power in order to ‘empower others’.
Another eloquent speaker 3talked about the need in health care to move away from a model of health that is dominated by technology and illness to a model that focuses on the issues of wellness. Within the latter model is the need to tackle the issues of health inequalities in society, poverty, regeneration and sustainability. If, as a society we really wanted to make a difference, we need to address the issue of inequalities in health, wealth and education, and not base everything on a misplaced trickle-down notion.
Beveridge and the Five Great Evils
If the Government’s Community empowerment action plan4 means anything it is the need to tackle the very issues that Beveridge highlighted in the 1940s and what he called the five great evils of:
- Squalor, and
Poverty and Family Hardship
Whilst travelling to the conference I read about a report published by the Frank Buttle Trust entitled Living with hardship 24/7: the diverse experiences of families living in poverty in England which is based on research undertaken by the trust, the NSPCC and York University’s Social Policy Department. This is a very significant report because it gets behind the facade of statistics and reports on people’s lived experience, clearly showing that the reality of poverty is multi-dimensional. It is not just about lack of money; it not only includes poor housing and lack of food but also impacts dramatically on people’s psyche - their emotional and psychological make up.
One of the report’s authors, Dr Carol-Ann Hooper, a Senior Lecturer in Social Policy at the University of York, said, “Children as young as five recognised that poverty was a key source of stress for their parents, and some tried to alleviate it by hiding their needs and wishes, and giving or lending money they had received from other family members. They were also often sad, angry, frustrated or upset by the impacts of poverty on their lives and hardship clearly impacted in a range of ways on all dimensions of children’s well-being.” 5
A related report also published by the NSPCC clearly shows that this lived experience varies from place to place and is not uniform throughout the country. Other reports from organisations like Unicef have shown how unsuccessful the United kingdom and the United States have been (in comparison with other industrialised countries) in tackling the issue of child poverty.
Poverty is Hidden
As I travelled on my journey to the conference, I did not see the squalor and problems that exist in many of our communities, and this is part of the problem. We are not tripping over the people affected by poverty, and we are getting on with our lives.
What this conference showed is that if we are going to address society’s health needs we need to address the need of poverty and inequality. I salute my friend, Stan and others for their tenacity, courage, commitment, passion, determination and vision. However, on occasions I despair that in a country that is so wealthy we still have so much poverty. You cannot rely on a trickle-down hypothesis in which, as the country gets wealthier, the poorest also get wealthier. As a policy it has never worked; it merely concentrates the wealth in the hands of the already wealthy.
[i] Social Enterprise - a world class solution? http://www.primarycarecontracting.nhs.uk/events/all/656
[iii] Professor David Colin -Thome - National Clinical Director of Primary Care
[v] See Dugan E (2007) Depth of child poverty in Britain exposed by report