Justice Everywhere

a blog about justice in public affairs

Category: Health (Page 2 of 2)

‘Social’ Deprivation

To say that a citizen suffers social deprivation is typically thought to imply that the citizen suffers poverty, has poor education, and has a low socioeconomic status. In this blog post, I am not concerned with social deprivation conceived in this way. Rather, what I understand by ‘social’ deprivation is ‘a persisting lack of minimally adequate opportunities for decent human contact’*. According to this definition, citizens suffer social deprivation when they are denied minimally adequate opportunities for interpersonal interaction, associative inclusion, and interdependent care, for example.
 
Social deprivation is closely related to loneliness – defined as the perceivedlack of opportunities for valuable human contact. A 2010 survey by the Mental Health Foundation reported that, in the UK, only 22% of citizens never feel lonely, 11% feel lonely often, and 42% have felt depressed as a result of loneliness. More tellingly, the survey also found that 48% of citizens strongly agree or agree that people are getting lonelier in general. Strictly speaking, loneliness need not be caused by social deprivation; however, it seems reasonable to think that social deprivation will often play an important causal role.
 
Worryingly, the adverse affects of social deprivation and loneliness are manifold. For example, various empirical studies have revealed that both social deprivation and loneliness are associated with numerous adverse health outcomes and morbidity and mortality, in particular. Notably, loneliness is reported to be as much as a predictor of bad health as smoking! In addition to their adverse physiological effects, social deprivation and loneliness also have adverse psychological effects: in fact, in extreme cases, such as those involving long-term solitary confinement, social deprivation and loneliness are often reported to be as agonising an experience as torture.  
 
What is the significance of all of this? Clearly, this evidence suggests that, in addition to a concern for citizens’ material interests, we should also have a concern for citizens’ social interests. In other words, we have weighty reasons to care about, and to protect against, social deprivation and loneliness. In the remainder of this post, I outline and briefly defend two more specific proposals that aim at serving this end.
 
First, our concern for citizens’ social interests seems to suggest that we should prohibit use of institutionalised forms of social deprivation, such as long-term solitary confinement and medical isolation and quarantine. Instead, and even if it is more expensive, we should look to use alternative practices that serve the same function as the original institution, but in a way that protects citizens’ interest in decent human contact. The argument here is simple: evidence suggests that these practices cause considerable psychological and physiological harm, and this harm far outweighs the level of harm citizens – and even serious criminal offenders – are liable to bear.
Second, our concern for citizens’ social interests also suggests that we have weighty reasons to invest in infrastructure that is conducive to the protection of opportunities for decent human contact. This could take the form of mobility assistance for those, such as the elderly, who are most likely to suffer social deprivation, or subsidies for organisations, such as community pubs, that play an important role in meeting many citizens’ social needs. Failing to invest here amounts to risking neglect for citizens’ social interests and, for this reason, must be avoided. 

*I take this definition of ‘social deprivation’ from Kimberley Brownlee, ‘A Human Right Against Social Deprivation’, The Philosophical Quarterly, 63 (2013), 199-222. 

An Age Old Old Age Question

It is a truth universally acknowledged that the UK population is ageing. To be precise, by 2050 there will be 19million people aged over 65. What is more rarely acknowledged is the scale of the problem this poses. Old age is the price any society pays for improved health care; the trouble is our society simply cannot afford to pay it. In an ideal world of unlimited resources the just solution may be for the state to cover the costs of everyone’s social care. Alas we do not live in such a world. A years stay in an older people’s residential home can cost upwards of £30000. Multiply that by 950 000 (around 5% of older people currently require care) and the bill is staggering.

 

I intend outline three practically feasible alternative payment mechanisms and consider some of the potential injustices these systems may pose. There will be no 500 word dash to the most plausible/least objectionable/insert-political theory-phraseology here solution. I simply wish to generate some debate around one of the least fashionable, but most pressing, policy issues of our generation. Additionally, I would like to implore political theorists to consider justice through the lens of a real world policy problem. We do not only ourselves but our society a disservice if we are unwilling to be stirred from our ivory towers to get down and dirty in the dilemmas of real world policy making. And in any case, in 50 years time we will all be reaping the life that we sow now.

 

So, possible solution one: make individuals pay, but provide a safety net for those who cannot. This is pretty much how the system operates in the UK at present. There are two main problems with this. First, the safety net care paid for by the state is inadequate. State funded care is poor in quality and choice and, with the pressure on it increasing, is only likely to get worse. The NHS is based around the intuition that people should not receive inferior care because they cannot afford to pay – why should this be any different in older people’s care? Second, it is highly debateable whether it is fair to ask people to pay for their own care. Not everyone who gets old will need social care. Is it fair to ask an old person who is unlucky enough to need care to pay, often exhausting all their assets in the process, when their neighbour of good health will not part with a penny?

 

Solution two: up taxes such that all care can be funded. Putting to one side the usual questions that surround high taxes (will it destroy the UK economy, will the super rich move abroad and so on) this seems to be unfair because it places the bulk of the burden on the younger generation. Those who are already retired will avoid having to pay for their care without ever paying any form of punishing tax for it. Given the youth of the UK are already facing greater economic hardships and fewer opportunities than their parent’s generation, is it fair to disadvantage them further by levying a new tax? Or is this one off disadvantage one society must accept for a better care system for future generations? Further, is such a tax sustainable? The latter is an empirical question which depends on economic recovery and projections. In any case, any tax that would be sufficient to cover the scale of the problem would need to be substantial.

 

Solution three: people are left to insure themselves against the risk of expensive social care. There are already companies that provide services akin to this, but premiums are so high that few people choose to opt for them. This may be more palatable than high taxes because people choose whether or not to insure themselves against the risk of high costs, meaning it is less financially punishing and less paternalistic. Unfortunately, the flip side of an absence of paternalism if that people may fail to insure themselves altogether, meaning people could be forced to pay high costs for their bad decisions in later life. It is my opinion that some form of compulsory insurance system may be the least unpalatable option, not least because old people insuring themselves now would pay significantly more than young people, and pay this equally, thus baring the cost of their generation’s care themselves. However, additional to the problem of paternalism this measure would also be highly inconsistent. There are many things it may be beneficial for people to insure themselves against that are not compulsory. How could this inconsistency be justified? Ultimately, my answer to that is that consistency should be an aid to justice, and not an end in itself. I for one would rather live in an inconsistent society with more just outcomes than one where consistency is pursued above all else.

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