Portal de Periódicos da CAPES

Social justice for all: Are we there yet?

2019; Wiley; Volume: 28; Issue: 5 Linguagem: Inglês

10.1111/inm.12661

1447-0349

Debra Jackson, Kim Usher,

Employment and Welfare Studies

In nursing, we frequently espouse a commitment to social justice. This commitment is evident through curriculum documents, mission statements, and other artefacts of our profession. There are many definitions of social justice, and while in some ways definitions can be contested, a commitment to social justice is generally understood to refer to fairness in the provision of treatment, just and equitable distribution of resources, and reduction in social and economic factors which negatively affect the health of people and communities (Hellman et al. 2018). However, we live in a world that is far from just. Internationally, we are seeing a rise in neoliberalism and neoliberal policies, and the resultant impacts on health, particularly arising from increased individualism, financial deregulation, free market economies, and a move away from the provision of state-provided assistance in the form of social welfare – the latter often the result of austerity measures. Even in wealthy countries such as Australia, the United States, and the United Kingdom, large numbers of people live in poverty. In this world of individualism and free market economies, many people fall through the cracks for many reasons, and the move away from state welfare means there is less of a safety net to catch them. Thus, these powerful social changes mean we face increasing poverty and resultant social exclusion. Poverty is well recognized as a major health determinant (Wahlbeck et al. 2017) severely limiting the options people have to prevent future and manage existing health problems and challenges. those on the lowest incomes or who experience poverty and/or other multiple forms of deprivation and structural limits to their life opportunities over which they have no control, have been demonised and misrepresented and are frequently portrayed in both popular and political terms as being feckless and failing to aspire or work hard enough or to be willing to work at all. Thus, we see economically and socially disadvantaged people blamed for their own situations, likely leading to (even more) feelings of shame and despair, and to further social exclusion. Yet in reality, it can be extremely difficult to escape from poverty and the associated discrimination to effectively establish economic security because to be poor is to be denied opportunity and full participation in society. There are also intergenerational effects associated with poverty including substance use issues, antisocial behaviour, incomplete education, depression, and suicide (Lee et al 2018). We now have phrases in our common lexicon such as ‘the working poor’ (Bennett 2018), ‘pensioner poverty’ (Been et al 2017; Joseph Rowntree Foundation 2017), and ‘diseases of despair’ (Carryer, 2019). The ‘working poor’ captures people experiencing both absolute (whose income falls below the poverty line) and relative poverty (earns 50% less than average income), despite being in employment. Writing about the context in the United Kingdom, the Archbishop of York, John Sentamu (2014) noted that most of those living in poverty are working poor. ‘Pensioner poverty’ refers to increasing poverty amongst people dependent on welfare, resulting in frequent media reports of pension recipients unable to afford to meet basic needs of food, warmth, and shelter. Housing has become more expensive, while incomes, particularly for those dependent on benefits, have stalled or frozen. In a recent report, the Joseph Rowntree Foundation found that pensioner poverty is increasing in the United Kingdom, particularly for single people, people of minority (non-white) ethnicity, and those who are in rental accommodation (https://www.jrf.org.uk/data/pensioner-poverty). ‘Diseases of despair’ is a term to describe three groups of conditions: drug/alcohol overdose, suicide, and alcoholic liver disease, conditions that have been noted to increase in people who experience despair because of their bleak and hopeless long-term social and economic position (Meit et al 2017). Homelessness is associated with poverty and is a major social issue with dire, calamitous outcomes for health in both the shorter and longer terms. Compelling evidence tells us that homeless people experience greatly poorer health, including more communicable and non-communicable diseases, reduced capacity for self-care, greater morbidity and mortality, more comorbidities, more exposure to violence, more mental health issues, more substance use disorders, and significantly earlier death (Coohey, Easton, Kong, & Bockenstedt, 2015; Ellsworth, 2019; Grech & Raeburn, 2018; Lee et al., 2017; https://www.gov.uk/government/publications/homelessness-applying-all-our-health/homelessness-applying-all-our-health; Wilson et al., 2019). Wilson et al (2019) note that mental health issues can be both cause and result of homelessness. Clearly, the ability to secure meaningful employment and secure housing are two key variables strongly influencing health and health outcomes. In both Australia and the United Kingdom over the past 40 years, a neoliberal agenda has seen the selling off of public housing stock. Public housing is an important public asset and a powerful safety net for those unable to secure housing in the open housing market. Socially, we see less and less options available for people who may be poorly educated or unable (for a variety of reasons) to enter the workforce in meaningful and sustained ways. Even where people are able to do so, neoliberal free market policies have resulted in many thousands of people being trapped in long-term casual employment, with little opportunity to achieve sustained economic security, or to access once taken-for-granted employee benefits such as sick leave and annual holidays. For people with mental illness, the situation is complicated by stigma, which also influences access to both employment and housing. This stigma acts to deny social justice and prevent social inclusion and so powerfully maintains inequity and social exclusion. These issues go beyond the urban areas. Rural communities are also socioeconomically disadvantaged. We know that the further people live away from major cities the less healthy they are likely to be (AIHW, 2012). Many small rural communities lack access to appropriate health services, especially the services of specialists, and to education and employment. As a result, many rural Australians are trapped in an endless cycle of poverty, poor educational attainment, and poor health. As health professionals, we are only too aware of the effects of poverty, whatever its cause. As nurses, we walk alongside people facing sometimes the seemingly insurmountable challenges. We see them in all their hope and despair. How can we act to achieve a more just and fairer society for all? McKeown (2018) urges us to political activism and highlights the need for nurses to campaign against ideologies that harm people. It is important that we not only advocate to maintain and sustain services in a climate of reduced government spending, but also advocate for more just and fair societies that include elements basic to human flourishing – safe housing and meaningful employment. Without these being available to all, we are further than ever from achieving our goals of social justice for all.