U n i v e r s a l h e a l t h c o v e r a g e a n d h e a l t h y a g e i n g Social injustice Social injustice not only wrongs its victims in the present moment, it also threatens their future prospects for social inclusion. A neglected person who is unable to form social ties without help not only lacks the chance to lead a social life right now, but also faces the risk that their social abilities will erode over time and render them less able to live socially. This denies them the chance to offer and receive reciprocal forms of social care, such as caring for those who raised them as they age, and caring for their own children and grandchildren. Concerns about these kinds of irreversible losses are reflected in UNCRPD provisions for early identification and medical intervention as well as for ‘services designed to minimise and prevent further disabilities, including among children and older persons’. When our society lets people suffer chronic, unwanted loneliness, it shows that it does not take these people seriously as social contributors; it does not regard them as able to contribute socially in ways that the society should seek to access. If it did value them as social contributors, then political and social efforts would be made to ensure that other people could benefit from their social resources. Elderly people are particularly vulnerable to social injustice since they face a high risk of experiencing periods of chronic, unwanted loneliness as well as the detrimental health effects that go with it. Further, people are often prejudiced about the elderly, not taking them seriously as social contributors, especially when they require physical care or are unable to communicate effectively with language. But, of course, the physical impairments that can prevent someone from accessing social settings without help do not invariably come with diminished cognitive and emotional ability. Moreover, even when physical, cognitive and emotional impairments go together, this need not eliminate a person’s social contribution potential. For instance, in allowing themselves to be cared for physically, an impaired person gives someone else a chance to show kindness, to cultivate empathy, to learn how to care and to be important to their well-being. These are substantial social contributions. To make them, a person needs some cognitive and emotional competence so that there can be mutual investment and a joint narrative between the person and physical caregiver, but the thresholds are often different from what we might imagine. An example of such social contribution might be elderly people allowing people with Asperger’s syndrome or autism to contribute to their physical care programme and thereby improve the carers’ skills in social relations. Public policy Public and private institutions can do a lot to meet or to deprive us of our social needs. Consider, for example, home visits to elderly people by nurses and health visitors. These visits are often the first things to be cut when budgets are tight and, when budgets aren’t tight, these services are often given insufficient resources, particularly in the private sector due to excessive profit extraction and mark-ups on home health visits. Moreover, even when social connection services are adequately funded, they can often be provided in ways that are not conducive to meeting people’s social needs. For instance, when a different person makes the home visit each week, the recipient of the visit has no continuity in their social interactions. They are forever starting over socially and share no collective memory, no joint narrative and no degree of mutual investment with the people who make these one-off visits. More generally, there is no acknowledgement here of the elderly person’s ability to offer reciprocal, interdependent social care to the visitors.1 Some of the operational realities of institutional programmes are unavoidable due to personnel changes and policy changes, amongst other things. Therefore, it’s necessary that much of our meaningful social contact comes through personal or private connections. Here too, however, the state can do a lot either to meet our social needs or to deprive us of them since it can enhance or hinder us in our efforts as individuals to forge and sustain social connections with each other. The state hinders us if it locates the local hospitals, prisons and retirement homes at a distance from the local community as well as when it routinely prioritises initiatives other than social connections. It hinders us if it disregards barriers to intimate association, such as long working hours, inadequate maternity and paternity leave, and inadequate childcare support. It hinders us if it makes public transportation difficult for the elderly to access, and if it requires people to pay out-of-pocket for services that, in theory, are covered under a free and universal system in the relevant respects. By contrast, the state serves us as social beings when it guarantees an adequate level of basic social welfare, attends to the social dimensions of city planning and sets up appropriate venues for ambient sociability, such as playgrounds, parks and public squares, thereby forging interpersonal associations. Venues for ambient sociability also offer one way to further integration among different groups of people, where integration is understood as the full participation of socially significant groups on terms of equality in all domains of life (Anderson, 2010). Universal health care is an expression of these same things – integration, participation, equality, rights-based thinking. Other ways to further integration include spatial integration of neighbourhoods, housing and schools. Additionally, the state can facilitate independent but integrated living. Some European programmes now assist elderly people to set up independent, apartment-style living arrangements with five or six roommates, supported by cleaning and nursing services. In these and other ways, our societies can remedy some of the wrongs of social injustice and give proper attention to our fundamental needs as creatures that must live in close proximity with other human beings in order to live well. Endnote 1 For a discussion of interdependency and post-dependency, see Dartington, 2012. References Anderson, E., 2010. The Imperative of Integration. Princeton: Princeton University Press. Bauer, S., 2012. Solitary in Iran Nearly Broke Me. Then I Went Inside America’s Prisons webpage Mother Jones. Available at: www.motherjones.com/politics/2012/10/solitary-confinementshane bauer Accessed 26 March 2015. 36 Commonwealth Health Partnerships 2015
Commonwealth Health Partnerships 2015
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