Criticality and the welfare commons for health equity

Change

 

 

 

 

 

 

 

 

 

 

 

By Liz Such, Katie Powell and Julie Balen

Those looking for new ways to address contemporary social injustices might be heartened to read Fiona Williams’ recent think-piece in the Social Policy Association’s Social Policy Review (27). Her brief history lesson, on the origins of critique in social policy, reminds us how research can form an act of resistance to social injustices, of which health inequity is a part. Using inspiration from the feminist, disability and gay rights movements among others, Williams proposes a framework for critical social policy that might underpin wider contemporary resistance to injustices. The piece wasn’t an easy-read and it felt sometimes that the ideas were bouncing around but it certainly inspired deeper thinking about how health inequity can be challenged through research that harnesses contemporary forms of resistance. The piece raises some important questions about the sort of claims that can be made to support action to reduce health inequity

At the core of Williams’s framework are two concepts: ‘criticality’ and the ‘welfare commons’. Criticality refers to a view to the future that goes beyond criticism and critique: “While criticism is a mere descriptive identification of what an author disagrees with, critique attempts to deconstruct the underlying beliefs, claims and unexamined partiality in any given phenomenon, to point out omissions and injustices. Criticality, however, goes beyond this; it is forward-looking, it looks to political spaces for intimations of transformations” (p106). As such, criticality involves the creation of an imaginative space that enables practices of resistance through the articulation (rather than prescription) of alternatives to current practices and power configurations. For researchers and practitioners working in the field of health equity, this approach has the potential to shift the focus of action beyond mere description of established patterns of inequity towards a reimagined future. As Burowoy warns, academics need to be wary of the ways in which such practices can perpetuate their own privileges (Buroway 2005).

Williams’ call for criticality echoes Graham Scambler’s (2015) rallying cry to sociologists urging a search for alternatives to the current pattern of relations underpinning financial capitalism and growing social inequality in the UK. Criticality in social policy, Williams argues, has already contributed to a better understanding of the “multivalent forms of resistance” – recognising for example that resistance might involve redistribution of resources and recognition of the experiences of particular groups (which might be conceived as finding a ‘voice’ for marginalised groups). It has also, she argues, identified the “multi-layered nature of welfare settlements” (the different modes, practices and discourses for example that might be associated with welfare). Finally Williams draws attention to the work of criticality in social policy in uncovering the “multi-level nature of welfare” – recognising the interdependency between micro, meso and macro processes shaping injustices.

Welfare Commons refers to the reclaiming of public resources that have been subject to commodification over the last century: “land, water, space, time, creativity, public services, care” (p.95). The concept refers to a renewed democratic purpose that promotes communal and shared ownership of these resources. Recent examples of this in relation to health equity can be seen in organised campaigns that seek to resist neo-liberal pressures to shrink the welfare state, such as the “Save Our NHS” and anti-austerity campaigns.

The mobilisation of resistance however according to Williams, “stands on a knife edge” (p.95). The global expansion of neo-liberalism, disaffection with mainstream politics and the commodification of core resources such as care, education and health are superpowers in the struggle to claim resources for the common good. Williams draws on examples from her research into the organisation and implementation of care work to show how criticality and the welfare commons might be used to identify common issue areas – and sites for resistance – within a range of social justice areas. Investigating the ecological, financial and social reproductive systems affected by the issue of care among ageing populations, Williams identified three common themes: recognition, rights and redistribution.  Recognition of care as work, supports for the rights of carers as workers and redistribution of the resources needed for caring provide a framework for action that cuts across movements mobilised around the needs of workers, disabled people and migrants.  These concepts, she argues, help to unify the resistance across a range of causes – finding common ground and connections in the fight against injustice.

Health equity work and research with health equity at its core can be seen as allied with both criticality and the welfare commons. Equity is a future imagining of health locally, regionally, nationally and globally and resistance to inequity is evident in research and practice. Equitable health is a question of recognition, rights and redistribution that is articulated as an aspiration in local, national, regional (e.g. EU) and global (e.g. WHO) strategies. Knowing how to do it – to operationalise resistance –  is a more pressing challenge. While ‘everyday inhabitants’ and national and global pressure groups are voicing a challenge to the commodification of resources, it is beyond their gift to mobilise their mass reclamation. Researchers working in the field of the social determinants of health frequently scratch their heads as to how to effect change in the context of existing structural constraints. Williams framework would suggest that what is needed is to create conceptual coalitions “across progressive groups” (p.103) active in civil society to identify interdependencies between areas of resistance. This could include organisations that contest welfare cutbacks, health privatisation, environmental degradation, and racism and discrimination for example. An idea also supported by Scambler (2015) who has called for “a coming together of activists for change.” Any developing collective spaces of resistance, however, must include and empower the people who bear the brunt of the pervasive processes of exclusion. Equity in academic practice, as advocated by the Politics of Health Group(2015), seems likely to support the search for conceptual alliances.  For Williams, it seems this dialogue presents the prospect of alliances that can offer effective resistance to social injustice and can help to create transformative alternatives of the future. It seems crucial that these coalitions can present their claims with one – louder and more coordinated – voice.

References

Burawoy, M., 2005. For Public Sociology. American Sociological Review 70(1) 4-28. doi: 10.1177/000312240507000102

Politics of Health Group (2015). Health Politics as if People Mattered 2. Good Practice in Academia. Retrieved December 2, 2015 from http://www.pohg.org.uk/support/downloads/goodpractice_ac.pdf

Scambler, G., 2015. Triggers for social change. Retrieved December 2, 2015 from http://www.grahamscambler.com/triggers-for-social-change/

Williams, F., 2015.Towards the Welfare Commons: contestation, critique and criticality in social policy, in Z. Irving, M. Fenger and J. Hudson (eds) Social Policy Review 27 93—111.

 

Image by Steve Rhodes under a Creative Commons License