If we want to understand how austerity politics is affecting health inequality in the UK, this recent article in the British Medical Journal provides a useful starting point: the inequalities in life expectancy which had been narrowing between 1997 and 2010 have begun to widen again. These findings will come as little surprise to most people who have been personally affected by austerity. Poor health is something that politicians and media outlets of particular persuasions love to blame on individuals, when statistical data tends to suggest that the problem is societal. Even when an individual is in a position to make healthy choices in one area of their life, the complex, systemic webs of multiple deprivation can often succeed in pulling them back in other areas. However, if complex social forces are a key part of the problem of health inequality, they can surely also be employed to find solutions.
Over the last year, members of our community development trust in East Leeds have worked together to produce a report on the tools of resilience that can be found in our neighbourhood. Utilising a pragmatic, multi-layered form of Action Research, we have thematically analysed many hours of participant observation alongside other data drawn from interviews, focus groups and questionnaires, to learn about the systemic barriers and positive social interventions that most affect our community’s health. This was grounded, inductive, collaborative research which took place on a large, predominantly white-British housing estate on the outskirts of the city. Our findings, and some of the stories of people in our community, were written up into a report that is intended to assist funders and policy makers in re-aligning their priorities with the people who are experiencing the effects of austerity in their daily lives.
The community health context we find ourselves in is stark: our neighbourhood suffers from high levels of obesity, diabetes, coronary heart disease and lung disease. 12% of the population of our ward have health problems that “limit them a lot”, compared to a city-wide average of 8%. The link between this and our economic context is clear: 44% of households in our ward experience “multiple dimensions of deprivation”, compared to a 26% average across the city. However, statistics such as these don’t define this community.
One of the clearest themes to emerge from this study was that the people who live in this community want positive change, but few are content to be passive recipients of top-down interventions. The participants of this research regularly practice mutuality as one of their common tools of resilience, and the help they want from outside is on the same basis of dignity and respect: Solidarity, as opposed to charity.
This is the antithesis of many peoples’ experiences under austerity. Policies such as the bedroom tax and DWP targets for sanctioning benefits claimants are perceived as arbitrary and cruel, and have left many people in our community without enough money to pay for essentials such as heating and food. When faced with such dilemmas, people inevitably turn wherever they can for help. The first port of call is usually symbiotic social networks: family and friends who will help to plug gaps in the knowledge that roles could well be reversed in days to come. For those who lack such networks, churches and charities are now often seen as a fall-back option, especially in the form of foodbanks.
If any statistic has become symbolic of British welfare policy during this period of austerity, it is the ubiquitous rise of foodbanks. Many of the participants of this study have turned to foodbanks and appreciated the fact that they have been there to alleviate their hunger: without them, the situation in our communities would have looked significantly worse. Yet foodbanks are usually the very definition of charity, in which good, well-meaning individuals volunteer their time and resources to help those less fortunate in a controlled, boundaried, transactional way.
Whilst foodbanks have unfortunately been necessary in feeding over a million people in the UK over the past year (hundreds in our own neighbourhood), the Action Research we conducted sought to explore what food aid can look like when its characterised by solidarity, not charity. We therefore spent a year cooking together, eating together, learning together, asking each other what’s working for us as a community, and what isn’t.
We found many positive factors in our collective relationship with food: we are relatively well-served when it comes to accessing fresh food (many communities are less fortunate than us in this regard); we found that health education has improved significantly and most people have enough knowledge to live healthy lives; we also spoke with many local people who have a good level of experience of food preparation, either in a domestic or commercial setting. However, many people are still struggling with regards to both health education and experience of food preparation. This can lead to a reliance on poor quality processed foods from supermarkets, convenience stores and takeaways, a fact that clearly contributes significantly to our problem with obesity. Our questionnaire data found that this was a particular problem for families with children living at home, many of whom simply lack the resources to eat healthy meals. In such circumstances, food can tend to be seen as little more than a necessity – a way to avoid hunger as opposed to the more holistically fulfilling role it can play.
The systemic roots of these problems became increasingly clear to our research team throughout the year. Low paid employment forces people to work longer hours, leaving them time poor; fresh food is significantly more expensive than poor quality processed food; supermarkets are cheaper than convenience stores but are far less accessible for those without a car or internet access; our food distribution systems encourage waste before redistribution; rented accommodation is often unequipped with basic cooking equipment; food growing is not taught in schools. The list could go on.
Furthermore, it is also clear to us that there is a systemic problem with the stigmatisation of people who live in deprived communities. Coping mechanisms that are consistent across the socio-economic spectrum are characterised far more negatively when associated with people who experience poverty. Comfort eating, drinking to excess and spending more than we can afford on things we like may all be rightly classed as unhealthy habits, but they tend to be more readily excused as ‘self-care’ or such like when outworked in more affluent contexts.
We can see that food and drink facilitate the supposedly unhealthy coping strategies listed above, but this study found a wealth of evidence for the role of food in some of our most healthy, life-affirming tools of resilience. Central to this was the role of food in building and sustaining community. Through the simple process of cooking and eating together, we recorded instances of food being the catalyst for a wide range of community-based benefits, including:
- New opportunities to participate in collective endeavours
- A context to be vulnerable about personal problems
- Opportunities to achieve
- Skill recognition
- A sense of collective strength/power
- Opportunities to experience and explore new things
Such observations bring further clarity to our understanding of the link between social health and physical health. Reducing social isolation was one of the key recommendations of Marmot et al’s (2010) Fair Society, Healthy Lives report, because socially isolated people are up to five times more likely to die prematurely: “it is not so much that social networks stop you from getting ill, but that they help you to recover when you do get ill” (page 138).
The fact that food facilitates relationships, and relationships are good for our physical/social/emotional health is, on the one hand, rather obvious. However we have to be mindful of the distinct lack of public resources that go into the art of weaving physical places into well-networked communities, in which mutuality is able to thrive. Moreover, we must not forget the way that food aid tends to operate on a charitable model, entirely bypassing the solidarity that food could help to facilitate.
If we’re to build sustainable positive change in this area, it will require a combination of both DIY behavioural shifts, as well as deep-rooted systemic adjustments. As individuals in this community, we can all make healthier choices that benefit ourselves and those around us physically, socially and emotionally. We abdicate none of our own responsibility in this area, and will be using the resources available to us to create spaces of mutuality which allow everyone in our neighbourhood to access and prepare good food and to eat it in a socially healthy environment.
However, personal responsibility can only ever take you so far. The statistics at the start of this article will only properly shift when people with real resources, power and influence invest in our communities on the basis of respect and solidarity as opposed to stigma and charity. The aforementioned Marmot Review prominently features a quote from Nobel Prize-winning poet Pablo Neruda, compelling the reader to ‘rise up with me against the organisation of misery’. We look forward to playing our part in a movement of people who are doing just that.
Tim Jones is an independent researcher with a Social Research MA from the University of York. He has worked in the voluntary sector for the past 15 years, and has a particular interest in participative processes and bottom-up community development.