The Global Commodification of Care: A Rant

This blog post is going to be about the elderly care system in the UK, already I bet a load of you will stop reading. "I'm not old" "I don't need care" or it is seen to be so far off in to the future that it simply is not of interest. Stop and read on as what I am talking about is a crisis for our society because in the UK and The West in general we have an increasingly aging society and how we care for our elderly should be as much interest to people as the "war" on terrorism or drugs, global warming or global diseases but it just isn't.  The aging population and the looming crisis in our elderly care sector is the Cinderella  of social issues ignored for being frumpy and unglamorous.

How the elderly and infirm are cared for is a very good indication of what any society believes is important. Even for the young and fit, who may consider elderly care as something they would prefer not to think about, the increasing ageing population means we’ll be forced to consider, in a lot more detail, how we fund and organise it.  Care is important throughout all our lifetimes – from the care given by parents during pregnancy and infancy, through to the often guilt-ridden process of finding appropriate care for those same parents when they become elderly and infirm. How care is delivered and the quality of that care will increasingly come to the forefront of social policy concerns in the UK and elsewhere.

In Wales, the demand for elderly care will be further compounded by the fact we have some of the sickest communities in the UK. In areas like north Merthyr Tydfil, where research has shown people often start to have significant care needs from the age of 59, it’s possible people will need more than a decade of elderly care before the end of their lives.

At the same time, working in the care sector is, for many, a less than glamorous or aspirational occupation – many care workers work long hours for wages at, or near, the national minimum. Even in those areas of Wales with some of the highest levels of unemployment people may prefer not to take jobs in this sector, which I’m sorry to say, has low status throughout UK society. Additionally, the care home sector in the UK is increasingly part of a global industry which is often financed by offshore capital and feels that to be competitive and cost-effective it needs to import warm-blooded goods in the form of care workers from poorer areas of the world. Often you will find people from the Philippines or Eastern Europe in local care homes working long and arduous hours to provide care for our elderly people so they can support themselves and their extended families back home. These workers are often highly skilled, highly motivated and committed to providing good quality care, but managing care teams with different languages and different cultures presents its own challenges and problems that need to be overcome.

Care in general and elderly care in particular are not things that are held in high esteem in our society which seems to me to be increasingly beholden to the cult of the self over anything else. As outlined in this piece we are increasingly "farming out" the care of our elderly to economic migrants who are dragged to this country through poverty in their own and while they are here caring for our elderly who is caring for theirs at home. This situation is exacerbated and compounded through the UK's government's dogma of austerity which dictates the freezing and reduction of public budgets which in turn results in there being less and less public money being available for the care of our elderly.  We live in the 7th richest country in the world but from  my experience the care that is on offer is not as one would expect from such a rich nation.  Don't blame the government, don't blame the care workers, indeed I remember one Filipino care worker saying to me once " Why do you British treat your elderly so appallingly?"  It is you and I to blame that we live in a society that worships at the alter of youth, celebrity, wealth and beauty and have only disdain rather than veneration for the old and the elderly.

I am not overstating the case when I say elderly care is a disgrace in this country, basically it is invisible and nobody cares until there is some scandal of neglect and then a previously disinterested public sanctimoniously wags its finger at care workers the vast majority of whom are trying to do the best job they can while being under resourced, underpaid, under valued and who are often immigrants trying to support a family back in the land of their birth. People passionately defend the NHS but social care is as important if not more so. The British public recently voted into power a Conservative government on a ticket of further austerity measures. Such austerity measures will further impact on the poor state of our elderly care system but hey who cares, that's democracy for you :-( 

Understanding Life, Death and Ill Health on Benefits Street

The health of the people in economically disadvantaged (poor) communities in south Wales as elsewhere is relatively poor, and inequalities in health between the most and least disadvantaged are wide and getting wider.  This issue has been the focus of considerable academic debate since the 1980s and inequality, including health inequality, is now regarded more widely as the issue that the UK is facing. Health inequalities are some of the most basic inequalities, there is probably no starker inequality than being alive or dead. The consequences of this poor health are, as I have said, premature death but also long-term disability, and exclusion from economy and society. An example of these health inequalities in South Wales can be seen in the example  of the Cwm Taf health board area, which includes the former iron town of Merthyr Tydfil and the former coal producing area of Rhondda Cynon Taf (RCT).  These two areas rank as worst overall in Wales for poor health, as measured by life expectancy, healthy life-expectancy and disability-free life expectancy. 

The term ‘deprivation’ disguises many different realities and conceals the strengths and assets which many of these communities contain.  Such communities therefore represent considerable and different challenges for social and economic development and health and welfare policy.  The greatest determinant of health is socio-economic inequalities which further contributes to the further widening of those inequalities. People find themselves unable to work, or able to work only at considerably reduced levels because of long-term ill-health and disability; and their wider participation in society is restricted.   In parts of the Cwm Taf area, situated within a classic well over 30 per cent of the population are living in poverty, on official definitions, and, as of 2009-10, 19 per cent of the population of RCT and almost 23 percent of the population of Merthyr Tydfil were claiming employment-related benefits.
   
A Message From Merthyr

As a case study of some of the issues faced by these communities on the northern outskirts of Merthyr Tydfil there is an area of known as the ‘Gurnos’.  The Gurnos was initially constructed during the late 1950s and early 1960s to re-house those displaced by ‘slum clearance’ of dwellings around the former iron works and was seen as a symbol of renewal and regeneration.  The estate continued to expand until the late 1970s but the loss of industrial production and rising levels of unemployment were followed by corresponding increases in social problems, such as crime, educational underachievement and substance misuse. Currently the estate comprises more than 2,500 council built properties.  Owner occupation is relatively low at 27.5 per cent and Gurnos is one of the most deprived electoral wards within an already deprived area of Wales.

Gurnos symbolises many of the issues facing communities where the traditional heavy industries that gave a sense of identity and pride have been replaced by low skilled, low wage often transient factory work. This has created a sense of inequality and injustice, exacerbated by the proximity of economically buoyant Cardiff, and other affluent areas along the M4 corridor. The social reality of the area is informed by a certain notoriety well beyond the immediate locality and residents are only too conscious of this as it can compound the difficulties many of them face.  This has engendered suspicion and cynicism, presenting difficulties for the development of research or health improvement projects led by people from outside the area.

While many of the big levers for health improvement lie outside Wales, in policies for the UK or Europe, at the level of locality, community cohesion can off-set some of the disadvantages created by inequalities in the wider economy and society . The complexity of problems in some of these communities is not easily understood and the problem with much community-targeted health initiatives is not that the communities are apathetic or worse seen as feckless but often community members are treated as if they are laboratory samples that need to have interventions done to them rather than conscious interpreters of their own situations who are rationally responding to the situations that they find themselves in.

It is important that any initiative which seeks to successfully address health inequalities in any poor areas understands and engages with the issues and barriers that people who belong to that community actually face.  As an example, a healthy eating initiative that simply tells community members that the need to eat five portions of fruit and vegetables a day has little chance of success unless it engages with an understanding of the barriers that may prevent community members achieving this, be they psychological, cultural or logistic.