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Commonwealth Health Partnerships 2015

Against isolation in old age: Towards a new view of social protection and rights Humans are social beings. We need to live near and with other people in order to survive and flourish (Baumeister et al., 1995). We need to have close connections when we’re very young, as we age and when we’re incapacitated. We also need to have meaningful opportunities to have close connections when we’re adults. The evidence from psychology and neuroscience is that social isolation is highly detrimental to our health. Psychology studies indicate that chronic acute loneliness, understood as perceived social isolation, generates the same threat response as pain, thirst, hunger or fear. It is an anxiety-inducing experience that triggers physiological reactions known as the ‘fight or flight’ response. Neurological studies associate chronic loneliness with numerous health risks including obesity, disturbed sleep, increased vascular resistance, elevated blood pressure, diminished immunity, reduction in independent living, alcoholism, depression, suicidal behaviour, the progression of Alzheimer’s disease and mortality in older adults (Harris et al., 2013; Ladd et al., 2013; Brownlee, 2013). This empirical evidence is corroborated by anecdotal evidence from people who’ve endured extended periods of isolation, and who report that it is one of the worst forms of suffering they’ve experienced (Bauer, 2012; Gawande, 2009). The health outcomes evidence is also complemented by philosophical traditions that value personal autonomy and relate it to family, community and national well-being. If we value personal autonomy, we must value the social connections that are indispensible to it. The reverse also holds: if we value collective life, we must value the preconditions for it in individual rights. Social connection is a need that applies throughout the course of our lives, but in this article I focus particularly on older people, who are often at greater risk of social isolation. From needs to rights Debates about human rights often downplay the social needs that we have independently of our economic conditions. It is true that some of the rights frameworks relevant to the elderly, such as the UN Convention on the Rights of Persons with Disabilities (UNCRPD), make provisions for ‘participation in social and cultural life’, ‘family life’ and so forth, and that this vision is latent in other protections, such as those against physical immobility or inappropriate institutionalisation, as well as in the positive aim of achieving the ‘highest attainable standard of health’. However, it remains the case that rights agreements and scholarly debates alike lack explicit reference to what is, perhaps, the most fundamental social human right: the human right against social deprivation (Brownlee, 2013). Here, social deprivation refers not to economic deprivation (poverty), but instead to genuine, interpersonal social deprivation understood as a persisting lack of minimally adequate access to decent human contact. This right is not just a right against being coercively denied social contact in solitary confinement or isolated medical quarantine – it’s also a right against being incidentally denied social contact when we’re unable to seek social contact without help. For healthy adults, the right against social deprivation secures only minimally adequate opportunities to access decent human contact. But, for people who are utterly dependent on others to meet their social needs, such as babies, young children (cf. Liao, 2006) and severely impaired people, including many elderly people, the right is richer; it secures positive access to decent human contact. The human right against social deprivation isn’t just a right to access the social contact we need, it’s also a right to contribute socially. We have a deep interest in being able to offer our care and company to other people in ways they need and value. We wish to spend time with our families. We wish to have a social circle that respects us. We wish to share our knowledge, to give and receive trust, to know other people’s stories and to share in their concerns. In general, we do not wish to contribute socially only indirectly by, for example, giving money to good social causes. Rather, we wish to contribute directly by being dependable and depended upon. In order to participate in the world of social connections, we need some basic social resources, including: the abilities to offer and receive social connections; enough decent social opportunities to forge and sustain social connections; and actual social connections that our society neither severs nor overlooks. We also need some recognition that we’re able, in principle, to contribute socially even when we’re physically dependent or cognitively impaired. If we are not taken seriously as social contributors and supported in our efforts to lead social lives, then we are victims of a distinctively social kind of wrong, which we can call social contribution injustice. I am proposing a technically new term here, but a range of rights instruments are concerned with participation by way of contribution, from the UN Convention on the Rights of the Child (to which all Commonwealth countries are signatories) to the broadest reaching ‘rights to development’. When, for example, Commonwealth health ministers tackle mental health as a sector and range of target populations needing to move ‘towards economic and social inclusion’, this contribution angle, as well as receipt of medical services, is at issue. The longstanding Commonwealth commitment to women in political and business leadership responds to related insights; as well as a loss of social capital, gender inequality is an affront to women’s rights both to consume and to contribute in an economy of goods and political ideas. Commonwealth Health Partnerships 2015 35 Kimberley Brownlee


Commonwealth Health Partnerships 2015
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