)
We know that poverty kills people early. And so too does the stigma that surrounds it.
Stigma is not simply something that makes an issue embarrassing or difficult for individuals to talk about. It is also built insidiously into the structures of our health and care systems. It frames narratives about who lives in poverty and why.
The stigma and shame that surrounds poverty stops people:
seeking the support they need and accessing services they are entitled to, for fear of being judged and made to feel unwelcome
being open about the reality of their lives and establishing trusted relationships – one of the key elements of high-quality care.
Stigma also stops services being designed and delivered in ways that meet people's needs and supports them to move out of poverty.
When it comes to poverty, the NHS tends to be seen as part of the solution, and not as a contributor to poverty stigma. The role the NHS plays in maintaining poverty and poverty stigma therefore is rarely discussed. But health care staff, services and structures are not immune to the framing of people living in poverty as having made bad lifestyle choices – and of there being people that are either deserving or underserving of support.
So how could the NHS go about dismantling the stigma and shame associated with poverty?
A good place to start is the recent JRF report on poverty and stigma. This report made me think that if the NHS is honest about wanting to tackle poverty, it needs to take the stigma that surrounds it much more seriously. The JRF report frames poverty as a structural, not a personal, issue. As such, combatting poverty stigma means understanding that people are not poor because of lifestyle choices; instead, people are living in poverty (and kept there) because of a failure to address wealth inequalities:
“People are not poor, rather millions are forced to live in poverty because they are being failed by the state, by government policies and by welfare systems.”
The report argues that that stigma holds poverty in place, and as a result, poverty and poverty stigma need to be tackled together.
Challenging stigma is difficult and uncomfortable –but necessary if we want to counter the inertia around the number of people living in poverty.
It can be hard to challenge something you might find hard to see or name. If, like many of us, you’re finding it difficult to understand how the NHS might be perpetuating poverty stigma, think how much more comfortable the NHS is talking about health inequalities, the cost of living, or deprivation rather than poverty or destitution. Think about how much easier it is to galvanise support and action around child poverty than adults living in poverty. I know there are sound reasons for focusing on children, but I also suspect that the narrative of deserving and undeserving is not far from the surface in these decisions. Finally, take a look at that JRF report – it’s got decades of learning and fresh thinking to challenge you.
Comments