Archive for the 'Health' Category

Repealing the 8th: how new legislation on abortion should be designed

Fiona de Londras

Fiona de Londras

Mairead Enright

Mairead Enright

Fiona de Londras and Mairead Enright – authors of ‘Repealing the 8th: Reforming Irish abortion law‘ – respond to the announcement of the Irish Cabinet of its intention to hold a referendum to repeal Article 40.3.3 in May 2018. The book, now publishing on Thursday this week, looks beyond the referendum to what might come next, presenting detailed proposals for new legislation.

Chapter 4 from the book – Accessing abortion care: principles for legislative design – is now available to download free on our website. 

In 1983 the Irish Constitution was amended by the insertion of Article 40.3.3, now known as ‘the 8th Amendment’. This provides that “the State acknowledges the right to life of the unborn and, with due regard to the equal right to life of the mother, guarantees in its laws to respect, and, as far as practicable, by its laws to defend and vindicate that right.

At first glance, the 8th Amendment may seem innocuous or merely aspirational. However, over time, this provision has led to a near-absolute prohibition on abortion in Irish law and serious infringement of pregnant people’s rights. Under the current law, abortion is only lawfully available in Ireland when a woman will almost certainly die without it, and even then multiple doctors usually have to agree that this is the case.

“More than three decades of activism have come together in a large, vocal, visible and highly effective campaign for political and legal reform.”

Now, though, there are signs of change. More than three decades of activism have come together in a large, vocal, visible and highly effective campaign for political and legal reform; for the removal of the 8th Amendment and introduction of a law that will enable women to exercise agency in pregnancy and ensure that, for those who want to avail of it, abortion care is available at home in Ireland.

On Monday, the Irish Cabinet announced its intention to hold a referendum to repeal Article 40.3.3 in May 2018. The People will be asked to delete this Article and to insert a provision that expressly says that provision may be made by law for the termination of pregnancy. The Taoiseach said that the referendum will present the People with a choice to enable the Irish parliament to legislate for abortion care at home, or to continue to export abortion to other jurisdictions and to put the lives of women in Ireland at risk.

The Cabinet will publish indicative legislation for a GP-led abortion service ‘on request’ up to 12 weeks, and more limited access to abortion in later pregnancy.

Hamill Aoife - 205kTravelled - Signs - London Irish Arc 2

After the referendum

In the book we look beyond the referendum, to what might come next once the 8th Amendment no longer absolves the Oireachtas of the responsibility to make law to provide for the needs of women in Ireland. We include detailed proposals for how new legislation on abortion might be designed, including draft legislation that gives effect to the proposals that appear to have received Cabinet support this week in a way that respects the rights of pregnant people in Ireland.

“…the rights of pregnant people can be developed in ways that truly respect and protect bodily integrity, privacy, and the right to be free from inhuman and degrading treatment.”

In doing this, we argue that repeal of the 8th Amendment would create opportunities for the progressive interpretation of the Constitution, so that the rights of pregnant people—for so long narrowed down to a bare right to life said to be equal in stature to that of an unborn foetus—can be developed in ways that truly respect and protect bodily integrity, privacy, and the right to be free from inhuman and degrading treatment. This, we argue, would compel the Irish state to provide for lawful abortion, but would allow it to pursue the socially valuable objective of preserving foetal life provided in doing so it respects the constitutional rights of pregnant people.

This can be done by introducing law that makes abortion available without restriction as to reason up to at least the twelfth week. After that such a law might make lawful abortion available on broadly drawn health grounds so that pregnant people can truly determine the course of their own reproductive lives, and so that victims of sexual violence or those who have received unexpected foetal diagnoses will be able to be supported through a decision to an end a pregnancy, rather than forced through a punitive ‘qualification’ processes. This is what we are calling for now that the Referendum has been announced.

Like the Citizens’ Assembly and Joint Oireachtas Committee on the 8th Amendment, we draw distinctions between the availability of abortion after 12 weeks and after 24 weeks, with later abortion (after 12 weeks) being truly exceptional in law, just as it is in life. Illustrating the feasibility of such an approach, we include in the book draft legislation that gives effect to this approach. This makes our book essential reading for anyone involved in the campaign.

Our objective in writing this book was threefold. First, we wanted to make the constitutional arguments about the 8th Amendment clear and accessible and, in so doing, to show that from a legal perspective there is nothing unusually difficult about legislating for abortion and no reason why, uniquely among medical procedures, it should be regulated within the text of the Constitution. Second, we wanted to show how the Constitution itself could develop after repeal to reinvigorate the personal rights of pregnant people and to strike a balance between protecting these legal rights and pursuing the social objective of preserving foetal life through voluntary, consensual, and well-supported pregnancy. Finally, we wanted to show that, by drawing on experience in other countries and on international human rights law, and by committing to ensuring that pregnant people have sufficient certainty and support to make decisions about their own reproductive lives, a workable, reasonable, and rights-based law on access to abortion can be imagined and designed for Ireland.

Now, with the announcement of the Referendum on the 36th Amendment to the Constitution, we are a step closer to achieving some of these goals, but there is still much work to do. Given this week’s developments, Policy Press has brought forward the publication of the book to 1 February: please circulate information about it to anyone who is involved in the debates around the referendum.

 

Repealing the 8th: Reforming Irish abortion law‘ by Fiona de Londras and Mairead Enright  is publishing on 1 February 2018 and is available with 20% discount on the Policy Press website. Pre-order here for just £10.39.

It will be available Open Access under CC-BY licence.

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The views and opinions expressed on this blog site are solely those of the original blog post authors and other contributors. These views and opinions do not necessarily represent those of the Policy Press and/or any/all contributors to this site.

The relationship between work & health in India

Martin Hyde, co-editor of  Work and health in India, discusses the relationship between work and health in a country with one of the fastest growing economies in the world and with a labour force of nearly half a billion people. 

Martin Hyde

Work stress and its effect on our health is something that we hear a lot about in the UK. Working longer and longer hours, having to do more and more in less and less time, increasing job insecurity are things that many of us experience. Newspapers and internet sites are full of stories about the damage that this can do to our overall sense of well-being as well as remedies to counter these negative effects. Many of these are supported by decades worth of academic research on the relationship between the working environment and health.

However, once we go beyond the high-income countries of Europe, North America and Japan we know very little about the nature of work and its impact on health in lower and middle-income countries. Given that these countries contain some of the world’s largest workforces and fastest growing economies this is a major oversight.

It was the desire to correct this oversight that motivated us to put together this book on the relationship between work and heath in India. Whilst there had been some research on this topic in India this book is one of the first to address the topic of work environment, stress and health in a rapidly developing country.

“The benefits of India’s tremendous economic growth have been unevenly distributed across society.”

India is one of the fastest growing economies in the world. The growth of the Indian economy has been matched by the steady increase in its labour force, which has risen from 330 million in 1990 to nearly half a billion people in 2014. This is roughly double the size of the labour force of the entire European Union.

Not only has the workforce grown but it has also changed from one dominated by agriculture to one with vibrant and growing service and manufacturing sectors. However, the benefits of India’s tremendous economic growth have been unevenly distributed across society.

The same is true of developments in the health of the Indian population. Life expectancy has risen steadily for both sexes and infectious diseases have declined over the past few decades. However, this fall in infectious diseases has been accompanied by a rise in non-communicable diseases (NCD), which now account for the top three causes of death in India.

“Chronic psychosocial stress at work is now becoming an important threat to the health of employees.”

So not only is the Indian economy and workforce beginning to more closely resemble those of the advanced industrial economies, so too are its disease and mortality profiles. As the labour market underwent a substantial transformation and while some traditional occupational hazards disappeared, chronic psychosocial stress at work is now becoming an important threat to the health of employees. For us, these twin developments called for more research to look at these issues.

To start to do so this book brings together a multidisciplinary and multinational authorship with researchers from all across India, from all careers stages, as well as researchers from the UK and Sweden. The range of topics covered, and methods and data used throughout the book reflect the diverse nature of the Indian economy.

Some chapters, such as those by Sanjay K. Mohanty and Anshul Kastor, and Harihar Sahoo, draw on large scale surveys to map the national picture of occupational inequalities in health. Other chapters focus on specific occupational groups such as tea pickers (Subrata K. Roy and Tanaya Kundu Chowdhury), police officers (Vaijayanthee Kumar and T.J. Kamalanabhan) and scavengers (Vimal Kumar).

What comes out in all of these chapters is a complex picture of the relationship between work and health. On the one hand we see many of the same issues in India that we see in other countries. Work stress is bad for your health wherever you live. On the other hand there are some findings that appear contradictory. For example, those in the highest occupations seem to have the highest rate of diagnosed illness. However, this is probably because only those in the top jobs can afford to go to a doctor. Finally, underlying all of this we see the intersections between gender, class and caste that impact on both work and health.

 

Work and health in India edited by Martin Hyde, Holendro Singh Chungkham and Laishram Ladusingh is available with 20% discount on the Policy Press website. Order here for just £60.00, or as an ebook for £21.59.

Find out more about impact, influence and engagement at Policy Press here.

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The views and opinions expressed on this blog site are solely those of the original blog post authors and other contributors. These views and opinions do not necessarily represent those of the Policy Press and/or any/all contributors to this site.

Siblings with and without disabilities think differently to each other about the comparison of their young adult experiences – and why it matters

This blog piece is based on the following article: Meltzer, A. (2017) Comparative life experiences: Young adult siblings with and without disabilities’ different understandings of their respective life experiences during young adulthood. Families, Relationships and Societies, early view.

Originally published by Sibling Leadership Network on 1st December 2017. 

 

It’s a familiar feeling. You are a sibling of a person with a disability in your late teens or early 20s. You are busy constructing your life around you – doing new things, making new relationships, learning to drive, moving out of home, finishing school, starting work. Your world is expanding. And yet there is something uncomfortable lingering in your mind. Maybe it is a feeling of guilt, maybe it is a feeling of inequity, maybe it is a feeling of being awkwardly advantaged. Whatever it is, it is a feeling that is there when you look over at the experience of your brother or sister with a disability and see that these life changes that you are making come with more hurdles when your brother or sister tries to do the same things – or perhaps they are things that you believe your brother or sister may never do at all. You value your own life and experiences, but that feeling is always there somewhere. It’s hard to think about and even harder to talk about, especially with your brother or sister themselves – because it feels unkind to point out the discrepancy between you to them – so you bury the feeling and forge ahead, valuing your own experiences, but carrying that sense of disquiet always with you too.

… But what if it did not have to be this way?

What if your brother or sister thought about the situation differently to you?

What if, by never asking them about it, you missed your opportunity to discover that perhaps they do not perceive the differences in the same way as you?

How might that new knowledge help you?

 

What does research say about how each sibling thinks about the comparison?

I conducted research about the relationships between young adult siblings with and without disabilities. I spoke to 25 young people with a disability and 21 of their brothers and sisters about what their sibling relationships are like and how they navigate their lives together during young adulthood. As a researcher, I had the opportunity to ask questions that might usually be too hard to ask directly within families… I had the opportunity to ask what each thought about their respective life experiences during young adulthood, especially the comparison between them.

 

What did siblings of people with disabilities say?

The story that siblings of people with disabilities told me was usually consistent with the scenario at the beginning of this post. Most siblings of people with disabilities generally perceived themselves as advantaged during young adulthood compared to their brothers and sisters. They perceived they had easier and more numerous opportunities – and that in the future they would be able to learn, work and live where and with whom they wanted, but they were unsure if their brother or sister would get to experience the same things as them. Often they appeared to feel that this was an awkward and inequitable difference between then. Often they felt bad about it, and sometimes they felt guilty about it.

 

What did young people with disabilities say?

However, when I spoke to young people with disabilities, they told me a different story – or actually, a range of different stories. Young people with disabilities had a variety of different views about the comparison between them and their brothers and sisters, of which feeling disadvantaged was only one possible option. Across my research, young people with disabilities told me other ways they felt:

  • The difference isn’t about disability.

Some young people with disabilities did not view the comparison between themselves and their brothers and sisters as about disability at all. Instead, they explained the differences between them to be because of other factors that affect all siblings – age differences, making different choices, having different preferences or enjoying different personalities. One sister with a disability said, for example, that she did not mind that all her younger sisters were married when she as the older sister was not, because she preferred the control that comes with being single. When the comparison between siblings’ experiences was not seen as about disability, the differences between them felt far less awkward.

  • I want that too, I just don’t focus on feeling bad about it.

Other young people with disabilities did see the differences between themselves and their brothers and sisters as about disability – and they did indeed want to share their siblings’ experiences – but they did not to focus on feeling too negatively about it. One brother, for example, just stated the differences in a matter of fact way and then moved on to talking about other things he cared about more. Another person noted that she did feel jealous and frustrated about her siblings doing things she could not do easily – such as travelling or moving out of home – but said she also felt genuinely happy for her siblings’ experiences and did not resent them taking up those opportunities, in fact, she wanted them to. Others spoke about advocating or fighting for their right to be able to take up those experiences themselves, but did not blame their siblings for gaining the experiences with greater ease.

  • Actually, there are benefits to the differences between us.

Finally, some young people with disabilities noted benefits to themselves of the differences between them and their brothers and sisters. Some felt that their own experience was better, such as two young women who felt that their disability made their academic achievements appear all the better compared to their siblings. Another person felt that her sister’s experiences acted as a reminder to her family of the level of choice and autonomy that she herself should also be recognised as having, and therefore that her sister’s different experiences actually helped to safeguard her own quality of life.

This range of views highlights that young people with disabilities commonly think differently to their brothers and sisters without disabilities about the comparison between their life experiences during young adulthood. It does not discount the possibility that some young people with disabilities may feel disadvantaged and may resent the inequality they experience compared to their siblings – but it highlights that this is one of a range of possible views. The research also does not suggest that young people with disabilities do not want to share their siblings’ experiences or that they are completely satisfied with their opportunities – many would indeed like more opportunities, the research just highlights that often they are able to see this in a broader perspective of the whole of their lives and relationships. Finally, the research does not represent all young people with disabilities – although people with a range of disabilities were included, including intellectual disability, there is still more to find out about what, for example, people with a high level of support and communication needs think. The research does however show a range of possible views.

 

Why does this matter? What can be gained from listening to what young people with disabilities say?

The findings of this research matter because they highlight that young people with disabilities have different views to their brothers and sisters, and that sometimes they may see their own experiences during young adulthood as more normalised, more empowered or in a different perspective than their siblings without disabilities do. Understanding young people with disabilities’ own views about their lives is important, not only for hearing what they have to say, but also because appreciating their perspectives may help sibling relationships.

Understanding young people with disabilities’ broad range of possible views means that the awkward sense of inequity that some young adult siblings of people with disabilities feel may not always reflect what their brother or sister is actually experiencing – it may reflect a more difficult or troubled view of what disability means in their brother or sister’s life than what that brother or sister actually feels themselves. Understanding the broad range of possible views should not stop siblings of people with disabilities acknowledging and challenging the inequities of their comparative opportunities – however, it does suggest that sibling relationships might improve, and feel less awkward, if young adult siblings of people with disabilities knew more about their brother or sister’s perspective. With this knowledge, young adult siblings with and without disabilities can perhaps together have relationships where they see their comparative experiences in a new light, building on each other’s understandings.

 

Ariella Meltzer is an adult sibling and a researcher at the University of New South Wales in Sydney, Australia.

The full article is available for free in the month of December 2017. You can download it here.

Carers Rights Day: International Perspectives

By Jo Moriarty, Social Media Editor, International Journal of Care and Caring

Every year Carers UK holds Carers Rights Day to help carers find out about their rights and how to access help and support. There is overwhelming evidence that many family carers often care for many years without knowing what support they are entitled to. However, carers’ rights need to be embedded within wider health, social, and employment policies, as two articles published in the journal this year reveal.

This year’s Carers Rights Day in the UK comes shortly after publication of the third issue of the International Journal of Care and Caring for 2017.

As the journal’s first year of publication draws to an end, it seems a good opportunity to think about carers’ rights in an international context by highlighting two articles that have appeared this year.

1. Collateral damage: Australian carers’ services caught between aged care and disability care reforms by Ara Cresswell FREE DOWNLOAD

The Australian Bureau of Statistics has shown that almost a third of Australian primary carers provide more than 40 hours of care per week. One third also live with some form of disability themselves. Almost three quarters rely on welfare benefits as their main source of income, meaning that their incomes are much lower than those who do not care.

Services for carers in Australia built up in a fragmented way and were often piecemeal, explains Ara Cresswell of Carers Australia. Set against this, flexible funding meant that support could be targeted on different types of carer and carers could access services as consumers in their own right. This changed in 2008 with the transfer of all funding for aged care to the national government, including grants such as the National Respite for Carers Program (NRCP). Carers Australia argues that the changes that have flowed from this have led to many carers receiving reduced support because help for them is so strongly linked to the entitlements of the person for whom they care.

A second factor was the introduction of the National Disability Insurance Scheme (NDIS) in 2012. It had been hoped that personal budgets for people with disabilities would help many carers return to paid employment. However, this has not proved to be the case, especially as these funds can only be used by carers themselves for training relating to caring and not to provide replacement care while they are at work.

Taken together, suggests Cresswell, an unintended consequence of these two reforms is that services for carers are ‘collateral damage, caught between aged care and disability care policies’.

2. ‘Enabling carers to care’: making the case for a European Union action plan on carers’ by Christine Marking FREE DOWNLOAD

Turning to Europe, Christine Marking, also highlights the problems when policies do not specifically consider the position of carers. She highlights the variability in support for carers across the European Union (EU). While recognising that most of the decisions that most affect carers occur at a national level, she argues that there is a place for EU wide legislation, such as the right to carers leave or help with training so carers can enter or re-enter the labour market. Another of her ideas is for a European Year of Carers, along the lines of previous years such as the European Year for Active Ageing in 2012 or the 2018 Year for Cultural Heritage. Ideas such as these could, Marking suggests, help promote a more integrated approach to support for carers and enable member states to learn from good practice in different countries. She concludes:

‘If carers are expected to continue providing care – and they are – meeting their needs should be an embedded dimension of health and social policy development.’

These are just two of the articles in the International Journal of Care and Caring (IJCC), which is a multidisciplinary journal designed to advance scholarship and debate about all forms of care and caring among researchers, policymakers, practitioners, family carers, and all those concerned with carers’ rights. The vision for the journal is set out here.

The IJCC welcomes research articles, debates and issues papers and book reviews which can be submitted here. Debates and Issues papers are free to access and every month a different research paper is available to read on temporary full text access.

You can recommend the journal to your librarian or take out a personal subscription here.

Read the latest issue of the International Journal of Care and Caring.

For all the latest Journal news and free articles:

Sign up to the International Journal of Care and Caring newsletter
•Follow @IJCCjournal on Twitter.

The articles featured in this blog post are free to read in the ‘Debates and Issues’ section of IJCC Vol.1 No.2

Am I a patient?

Alan Cribb unravels the transition from an epidemiological approach to a philosophical approach to healthcare he discusses in his new book – Healthcare in transition – by examining how his identification, or not, as a patient impacts on his research.

Whilst working as an academic I tend not to identify myself as a patient. 

In the last few years one of the themes of my work has been patient-centred or person-centred healthcare, and I have just completed Healthcare in transition, a book in which I tried to tease out some of the elements of, and tensions within, this idea. But I have never self-identified as a patient in my writing and I only occasionally do so in my face to face encounters with trusted colleagues and in what feel like safe spaces to me.

In some ways this is odd. I am not simply a patient in a notional sense – like very many people, I have regular interactions with medical consultants and other health professionals, I follow a regime of treatment and I have health-related conditions that challenge my identity and frame the way I organise my life. So why not self-identify as a patient in my academic work?

“Why not self-identity as a patient in my academic work?”

Partly it is probably just about privacy or for reasons of self-protection – not to invite threatening line of enquiry from others. But it feels as if it is about something more than that. First and foremost it seems presumptuous. It feels like I have been invited to the meeting with one ticket – as a researcher – but now I am claiming to have a further ticket and am expecting to vote twice!

This sense of cheating applies however I think about what counts as a patient, and I have to confess that I am confused about this. In health services research, for example, it is now a methodological and ethical norm to worry about the inclusion of either patient perspectives or patients in some fuller sense. But there is a spectrum of attitudes and practices in response to this norm.

In some cases – and this is to exaggerate for effect – ‘patients’ is treated as a kind of self-fulfilling marginal category, such that if people happen to have any other source of relevant expertise – they are health professionals, or researchers, or activists or even heavily engaged in a peer led patient group then they will to some extent be disqualified as ‘patients’.

This attitude stems from an understandable concern that the identity of patients isn’t colonised and misrepresented by powerful voices but, at the same time – certainly in this exaggerated sense – it risks reproducing a deficit view of patients.

“I feel either disqualified or under qualified.”

At the other end of the spectrum there are strong patient voices and groups who will not only lobby for involvement in research but will themselves lead research and will challenge prevailing orthodoxies – for example, questioning not only the practices of patient involvement but also the ways in which research agendas are set and research is conducted and so on. These kinds of patient voices play an important role and can be inspirational. But there is also a danger here – again at the extreme – that the identity of patient itself becomes professionalised and owned by a few well-organised people.

The first account coincides with my worry about being presumptuous. I need to be cautious about saying I am speaking as a patient, especially with any implication that it is on behalf of other patients, when I already have a hearing as an academic.

But I am equally ruled out on the second account. I have not taken any special steps to become an expert patient; nor do I have any particular credentials to claim a quasi-professional status in this regard. For me to act as if I had would be to cheat.

In short, I feel either disqualified or under qualified. But the issue of my patient identity will not go away completely. It seems unavoidable because even not mentioning it feels like a significant choice. In some contexts there are temptations to mention it – because for certain audiences it may add a sense of authenticity and credibility. In other contexts there are temptations not to mention it – because, for example, some clinicians or others may worry about what axe I have to grind and see it as a source of ‘bias’.

How far this issue is seen to be of importance, and in what respects, is arguably a function of the kind of research we are talking about and also of disciplinary assumptions and conventions. But for anyone who thinks ‘reflexivity’ matters it does seem to be a question worth asking.

If I am being reflexive as an academic then I can treat my identity as a source of problems or limitations that need to be acknowledged, or as a source of legitimacy or authority, or sometimes as a combination of both. This seems as relevant to patient identity as to other aspects of identity. On this account there seems to be something seriously lacking in my approach to date.

Healthcare in transition by Alan Cribb is available with 20% discount on the Policy Press website. Order here for just £17.59.

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The views and opinions expressed on this blog site are solely those of the original blog post authors and other contributors. These views and opinions do not necessarily represent those of the Policy Press and/or any/all contributors to this site.

Challenging the politics of early intervention

Nicola Horsley

Ros Edwards

Val Gillies

The past decade has seen a rash of early intervention programmes targeting mothers of young children.

Reports by the World Health Organisation and UNICEF, and early years policy and service provision in the UK and internationally, are now characterised by an emphasis on early intervention in the belief that pregnancy and the earliest years of life are most important for development. It has become the orthodoxy in a whole range of professional practice fields.

The idea of being able to intervene in parenting to ensure better life chances for children feels constructive and positive, but there is little evidence to suggest that it works. Moreover, early intervention doctrine ultimately holds mothers accountable for poverty and other social ills.

“…there is little evidence to suggest that it works.”

Pressure on mothers

Early intervention is directed at mothers as the core mediators of their children’s development. The significance of mother-child relationships in the early years often is underlined through reference to the developing brain. For example, the website of the influential Harvard Center on the Developing Child refers to mothers as ‘buffers’ between their children and adversity. As buffers, they are held personally responsible for inculcating what the Harvard Center terms ‘a biological resistance to adversity’ in their children.

The quality of mother-child relationships is posed as a decisive lever in building children’s brains, and is a core principle structuring the everyday work of many early years intervention programmes. In one UK early years intervention initiative that targets young and marginalised first time mothers, the Family Nurse Partnership programme, practitioners provide mothers with a sheet headed ‘How to build your baby’s brain’ featuring a list of activities claimed to enrich neural connectivity, such as reading books, singing rhymes, and playing on the floor.

“The deprivation facing poor working class families is posed as a result of poor mothering.”

The responsibility loaded onto mothers is especially pronounced in relation to low income, working class mothers and Black and minority ethnic mothers, as both cause of and solution to their children’s marginalisation and poverty.

The deprivation facing poor working class families is posed as a result of poor mothering and consequently the stunted brains of their offspring, at the same time as they are positioned as buffers who can mitigate against and overcome the effects of a harsh wider environment for their children. Early intervention programmes such as the UK’s Family Nurse Partnership, the Solihull Approach, and Parent-Infant Partnerships, overwhelmingly are delivered in areas of deprivation to poor mothers.

Ideas about brain science are used to legitimise interventions in the child rearing habits of working class families, protecting children brought up in poverty from any effects of their disadvantage and promote their social mobility. The social and structural causes of hardship and need that are being experienced by these families in the present are effectively masked, placing mothers as hidden buffers against the effects of privation on their children.

The developing world

Globally, UNICEF brings together early years development and parenting to offset children experiencing war and hunger on the basis of the speed of new neural connections formed in the brain in the early years, asserting that good parenting will help children overcome multiple adversities such as violence, disaster, and poverty. Despite the overall paucity of evidence that early years intervention works, initiatives are being rolled out across the developing world, in the belief that improved mothering will surely benefit the state of the nation.

For example, the ‘Fine Brains’ (Family-Inclusive Early Brain Stimulation) programme seeks to promote parental stimulation and interaction to improve children’s brain architecture in sub-Sahara. It asserts that mothers in these countries are ill-equipped to maximise the benefits of interaction, need to be trained, and then to train their husbands to parent properly. The complex and diverse historical, economic, political, social and religious contexts of sub-Saharan Africa are obscured in favour of a focus on individual mothers as able to overcome poverty, conflict and post-conflict, engrained gendered inequalities, and so on, through improving their knowledge of child development and home engagement practices.

“Despite the overall paucity of evidence that early years intervention works, initiatives are being rolled out across the developing world.”

 

A meritocratic construction

The policy and practice preoccupation with how poor mothers and deprived families bring up and nurture their children relies on a meritocratic construction of the wealthy and privileged as having better developed brains. This is a statement that many of us might find offensive. But within the confluence of brain science and early years intervention, success is naturalised and unproblematically correlated with brain structure and intelligence. From this perspective, the solution to poverty is to make people smarter. Working class mothers, black and minority ethnic mothers, and mothers in the global South can enable their children to think their way out of their predicament.

The idea that hardship and discrimination is to do with how much attention of the right sort that mothers give to their children, and the notion of countering global traumas and inequalities through parenting, is jaw-dropping. It demonstrates why early intervention policy and practice deserves more critical scrutiny.

 

Challenging the politics of early intervention by Val Gillies, Rosalind Edwards and Nicola Horsley is available with 20% discount on the Policy Press website.  Order here for just £18.39.

Find out more about impact, influence and engagement at Policy Press here.

Policy Press newsletter subscribers receive a 35% discount – sign up here.

The views and opinions expressed on this blog site are solely those of the original blog post authors and other contributors. These views and opinions do not necessarily represent those of the Policy Press and/or any/all contributors to this site.

What effect do sanctions & conditionality have on disabled people?

Guest editor Ben Baumberg Geiger introduces the new Journal of Poverty and Social Justice special issue, focusing on disability and conditional social security benefits.

 

Ben Baumberg Geiger

“There are times that policy runs ahead of academic knowledge.

Indeed, this is often the case, for policies must first be introduced before social scientists can study them – and if policy makers were restricted to policies that had been tried and tested, then policy innovation would be impossible.

Yet such innovation can come with considerable risks, as new policies can be introduced and widely imitated, only for social scientists – after some delay – to show that such policies are difficult to implement, can fail to achieve some of their aims, and may even have unforeseen and harmful consequences.

In a new special issue of the Journal of Poverty and Social Justice, we focus on one area where this might be happening: conditionality for sick and disabled social security claimants. While, historically, disabled benefit claimants were largely exempt from seeking work, high-income countries from Australia to Norway have increasingly required disabled claimants to take steps towards finding work, under the threat of financial penalties.

“…high-income countries from Australia to Norway have increasingly required disabled claimants to take steps towards finding work, under the threat of financial penalties.”

The conventional wisdom repeated by bodies such as the OECD is that this is a necessary step towards reducing high benefit claim rates, and, moreover, helps improve the finances, health, and social inclusion of disabled people themselves.

However, there are several challenges to this story. By any principle of justice, claimants cannot reasonably be required to perform actions that they are incapable of doing, but it is difficult for benefits agencies to know exactly what someone can or can’t do. If they get this wrong, conditionality for disabled people can create injustices, and inflict considerable stress on disabled people. Moreover, conditionality may move disabled people further away from work, by both undermining their relationship with their employment support caseworker, and making them less willing to take risks in performing tasks that they are not sure they are capable of doing.

 

Two conflicting stories – but what does the evidence say?

Until now, there has been very little published research trying to establish which of these accounts is correct. This is the aim of the special issue, which includes four research papers looking at experiences from around the world. In the UK, Aaron Reeves looks at on the impacts of conditionality for disabled people claiming unemployment benefit. In Denmark and Sweden, Sara Hultqvist & Iben Nørup look at the different forms of conditionality implemented for young disability benefit claimants. In Germany, Patrizia Aurich-Beerheide & Martin Brussig look at the (failed) implementation of conditionality for disabled people in Germany. And my own paper (see below) brings together these papers with a wider review of evidence and practice, to come to some initial conclusions about what we know so far.

“It is crucial for the wellbeing of disabled people around the world that deeper knowledge and more informed policy go hand-in-hand.”

The special issue also includes four further, slightly more unusual papers about the UK, perhaps the country where these issues have become most hotly contested. Indeed, conditionality for disabled people has been the subject of an award-winning film (I, Daniel Blake) and an award-winning play (Wish List), both of which are reviewed in the special issue (by Alison Wilde and Kim Allen respectively). Jed Meers covers a recent Supreme Court judgement about the ‘bedroom tax’ in the Supreme Court. And we felt it was important to convey the lived experience of conditionality, so a team from the Welfare Conditionality project describe two real-life stories of people who took part in their research.

So at the end of this, what do we know? In my (open access) review paper, I summarise the evidence into four ‘stylized facts’:

1. Requirements for disability benefit claimants are common, but sanctioning is rare (particularly outside of the UK and Australia).

2. Assessment and support are critical in making conditionality work on the ground, and can be combined into ‘passive’, ‘supportive’, ‘demanding’ or ‘compliance-based’ systems.

3. The limited but robust existing evidence suggests that sanctioning may have zero or even negative impacts on work-related outcomes for disabled people.

4. Individual case studies in ‘compliance-based’ systems suggest that sanctioning in the absence of other support can lead to destitution, and that conditionality can harm mental health.

While we need to know more, it is already clear that we cannot assume that conditionality for disabled benefit claimants is easy to implement, nor that it will have purely positive consequences. Policy may have run ahead, but research is now starting to catch up. It is crucial for the wellbeing of disabled people around the world that deeper knowledge and more informed policy go hand-in-hand from this point.

This is an edited version of the (free) introduction to the special issue, and is simultaneously being posted on the Policy Press blog and my own Rethinking Incapacity blog. The full special issue can be accessed here.

 

You can read the Disability and Conditional Social Security Benefits’ special issue of the Journal of Poverty and Social Justice here. 

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