Empowerment and President Obama

We were teaching about empowerment today on our Masters course in Public Health – Health Promotion here at Leeds Met. My colleague Dr. James Woodall was, as part of the session, asking students to critique a paper he and two other colleagues had written. The paper questions whether ‘empowerment’ has lost its radical roots and is now used too casually and without precise definition. (Woodall et al 2011)

Power is a key concept that we dissect when we discuss empowerment, and this inevitably leads to a discussion of powerlessness. Powerlessness, according to Solomon (1976) comes from three potential sources: firstly there are systems which systematically deny powerless groups opportunities to take action; secondly there are the negative images which oppressed people have of themselves, a form of self-oppression, and thirdly there are the negative experiences which oppressed people undergo in their everyday interactions with systems, institutions or the media.

In this week where Barack Obama has been re-elected (Hurrah!) it’s interesting to think about the effect of such an election on power structures and empowerment. When he was elected first time around, black people all over the world were delighted – what a message – to see a black man as the President of the world’s most powerful country, meaning that for the first time, a black man was the most powerful person in the world. (That depends, of course, on how much power you think a President can have, given the forces of capitalism and conservatism in the USA). In terms of the second of Solomon’s sources of powerlessness, Obama’s victories have had a huge impact on positive images and thus on dismantling self-oppression.

Marginalized people – and health promotion is principally concerned with those who are marginalized – have been able to use the election system to their advantage. This doesn’t happen often. In the election that took place this week, for once, the white, male majority did not get their candidate of choice. Exit polls show that 45% of men and 55% of women voted for Obama; of white men, 35% voted for him and 42% of white women. 87% of black men and 96% of black women and 65% of Latino men and 76% of Latino women voted for Obama. In terms of ‘race’ alone, 39% of white voters voted for Obama, 93% of African Americans, 71% of Latinos and 73% of Asians. Those earning less than $50,000 were more likely to vote for Obama – 60% as opposed to 44% of those earning over $100,000.

So all in all, poorer, female, black, Hispanic and Asian people were able to make their vote count and to elect someone who they felt would represent their interests. This is essential if one of the key outcomes of empowerment – systems change – is to happen. It also resonates with the first of Solomon’s points about sources of powerlessness, that systems operate to exclude certain groups in a systematic way. There is a good chance, with a second term, that Obama will be able to bring about permanent systems change. The implementation of the reform of health services must be a major plank of this systems change. One thing which seemed to make a difference this time around was persuading those who don’t normally vote, to get out and make sure they did.  They stopped Mitt Romney doing what he had pledged to do in cutting after school programmes, job training programmes, Head Start, Planned Parenthood and other social projects which primarily target the marginalized. Now, we have a President who has pledged to invest in education, tackle climate change, reform immigration policy; this means for example, that the eleven million undocumented immigrants might be able to gain a path to citizenship. I don’t agree with all aspects of America’s foreign policy but I’m certain it will be a lot more enlightened than it would have been if a Republican had got into the White House.

No doubt Obama will not be able to be as radical as he’d like, given the opposition of Republicans, but in terms of empowerment, it’s a great stride forward.

The change of leadership in China, also happening this week, gives hope that the two most influential countries in the world could take us into a different era of politics.

References:

Solomon, B.B. (1976) Black Empowerment: Social Work in Oppressed Communities, Columbia University Press, New York

Woodall, J., Warwick-Booth, L., Cross. R. (2012) Has empowerment lost its power? Health Education Research. 27 (4), 742-745.

Starting out on a health promotion course....

The start of the new academic year is always exciting, and we have been welcoming our new intake of students on the MSc Public Health- Health Promotion. Their initial module builds the Foundations of public health and health promotion and is an introduction to the Leeds Met philosophy. As we have written in our forthcoming book, Health Promotion: Global Principles and Practice (see reference below), we regard health promotion as a broad social movement centred on health justice. We adopt a social model of health, and this is a major challenge to some students, coming as they do, from a medical model mindset. Others are already in tune with a salutogenic as opposed to a pathogenic model. We pose this statement for discussion early on, though we broaden it to say that it could apply to any country: “The most confounding factor to health promotion development in Africa emanates from the fact that health promotion activities are in most cases, planned, managed and controlled exclusively by health staff, mostly from within the ministry of health. The main actors are health workers whose concept of health is based on the conventional public health model and whose focus is on interventions revolving around curative services. “(Nyamwaya and Amunyunzu-Nyamong, 2009:21). For some, it seems logical that health promotion is dominated by health staff, but for us, this is detrimental, as suggested by David Nyamwaya and Mary Amunyunzu-Nyamong.

Realising that health is created outside the health (or sickness) service, and that health care is but a small part of our thinking, is new to many students.  As such, we need to talk about key ‘threshold’ concepts. The threshold in many homes is the line you cross from the outside to the inside, or from one room to another, but in popular expression it’s a line that once crossed, you cannot go back. In educational terms, it means a concept that opens up a new world, a new way of thinking and often too, means an idea that you have to understand before you can progress to the next idea. Understanding what we mean by a ‘social model’ is such a concept, as too are ‘upstream thinking’ and ‘salutogenesis’.  At this stage in the course, many students have not crossed this threshold but the module guides them through the complexity of principles, theories, approaches and concepts that make up health promotion based on the Ottawa Charter.  Our first formative assignment is to ask students to consider whether the Ottawa Charter still provides a solid foundation for health promotion in the 21^st century – quite a difficult task!

The layers of health promotion are illustrated, for me, by the phrase ‘sugar in the blood’. To someone steeped in a medical model, sugar in the blood evokes the idea that we have high rates of diabetes in both developed and developing countries, and that this increasing trend needs to be addressed. Individuals need to address their diet and increase exercise, which will require top-down exhortation. At the other end of a political spectrum and of analytical complexity, we could see how the idea of sugar is infused throughout our lives.  The Tate galleries in London are famous for their role in cultural life, but the links with Tate and Lyle, the sugar manufacturers, is perhaps less prominent today.  The Tate family made their fortunes in the sugar planantions, which themselves were made possible by the slave trade. Many large stately homes, including our local Harewood House, near Leeds, are based on money derived from the plantations that used slaves.  Andrea Stuart, in her book, Sugar in the Blood: A Family's Story of Slavery and Empire, documents the history of her family. One of her ancestors went to the West Indies in the 1640s and made a fortune in sugar. This sweet stuff fuelled the industrial revolution in Europe as well as the Enlightenment, and created a new diet. It also of course, created the shamefully inhumane relationship between Africans and Europeans that still resonates today. Stuart’s book grapples with this legacy. 

So sugar is highly symbolic.

The health consequences of sugar have also become political issues. It was Professor John Yudkin in London who first questioned in the 1970s, whether sugar, rather than fat, was behind the problem of heart disease. His work was systematically discredited by lobbyists from the food industry, and especially the sugar industry. In an era when low fat items were being developed, the fat was replaced by sugar, to make the food palatable. The leading nutritional scientist Professor Phillip James began to question why people were getting fatter, even those who ate a ‘low fat’ diet. Simultaneously, researchers were looking at the effects of eating modern processed foods, and this showed that in both rats and people, the more sugar was eaten, the more hungrier those rats and people became, setting up a needy cycle. It seems that the stomach sends messages back to the brain asking for more sugar, as it becomes conditioned to want more. And in obese people, leptin, which is a hormone produced to tell you that you are full, becomes so depleted that it no longer serves its function. Eating lots of sugar is the mechanism causing this depletion. The food industry funds, and is involved in, much of the research looking at the links between diet and health. Moreover, the food industry is a powerful lobby, and is behind, for example, the failure of the WHO to recommend global limits on sugar intake in 1990.

I was once involved in developing healthy eating guidelines for schools across the then 15 members of the European Union. We held one of our meetings in the FAO offices in Rome. We were unexpectedly joined for this meeting by an organization called EUFIC who described themselves as an advisory body, and said they would fund publication of materials – with certain provisos. It turned out that they were a front group for the food industry. It amazed us that they knew about our work and also were prepared to fly people in for a meeting from all over the world, and were also prepared to fund nutrition related activities. A powerful lobby indeed.

The effects of sugar on the body are now well known, but governments do not appear to be tackling the food industry – it’s far too contentious,  jobs are at stake, and the food industry is lucrative and  entwined with other industries. The tobacco industry has been somewhat curbed but it looks like the food industry will not be, even if causes health damage.

The example of ‘sugar in the blood’ shows how a political issue is literally embodied in the individual. But tackling it at an individual level is not going to work. It would be a ‘downstream’ action to try to influence the diets of individuals who are already overweight or obese, and anyway it is not individuals who are putting the sugar or high fructose corn syrup into the foods we buy. As so obvious from the Ottawa Charter, policy action is needed from the highest levels to look at how our food is produced.

Some of our new students thought that their role would be to help these overweight and obese individuals to change their lifestyles – and maybe that is the case. What we also want them to do, however, is to think how they can effect change much further upstream.

Dixey, R, and others (2013) Health Promotion: Global Principles and Practice: Wallingford: CABI Press. Text book for postgraduates: http://bookshop.cabi.org/default.aspx?site=191&page=2633&pid=2454

London 2012 Olympics

I have to say that I loved every minute of the London 2012 Olympics. I cheered, whooped, shed tears and jumped up and down as much as everyone else. It was wonderful to see so many athletes doing amazing things and of course I was delighted at Team GB successes.  I’m a great sports fan anyway and this Games has been fantastic. For me though, the whole experience has thrown up contradictions, confusions and the need to analyse just what has happened over these momentous few weeks.  Sport is so commercialized, male, privileged, elitist, and nationalist – isn’t it? – so how is it that those of a feminist, leftist, peace-loving persuasion can find it so compelling? Well, I guess the fact that we can both critique it and find it compelling shows how complex humans are.  Half of me is astounded and fascinated by what humans can do with their bodies and part of me is saddened and puzzled that sane people can spend so much time, energy, money and make so many sacrifices just to shave 0.008 seconds off someone else’s time…..

But, back to the beginning - Danny Boyle’s opening ceremony was astonishing, dramatically showing how the opening says something implicit and explicit about the host nation. Before the perfectly honed bodies of the athletes were paraded, we were treated to human touches so different from the Beijing opening, with the experiences of everyday people, vulnerable, funny, brave, on show. Seemingly small touches spoke volumes – Doreen Lawrence, the mother of the murdered Stephen Lawrence holding the Olympic flag as it came into the stadium, for example, along with notaries like Ban Ki-Moon.  Another flag carrier was a human rights activist, a category of person, as many have pointed out, locked up before the Beijing Games.  The NHS had a starring role, the suffragettes made an appearance, and the 1993 Brookside first lesbian kiss popped up in a montage celebrating the film industry, a kind of snub to the 150 countries still banning openly gay athletes from competing.

These Olympics smashed the idea of sport existing in a separate bubble. The sport literally spilled out on to the streets, but it also raised key questions about diversity and equality. The opening ceremony was a celebration of the history and diversity of modern Britain.  The backgrounds and stories of the athletes showed they were connected to the real world, with all its messy complexity.

The Games have been good for women. For the first time, all 204 countries taking part sent women, with Saudi Arabia, Qatar and Burundi sending women for the first time. Team GB’s women had extraordinary success. This doesn’t mean that women are equal though. In the UK, the Women’s Sport and Fitness Foundation reports that women’s sport in general receives only 5% of total media coverage and only 0.5% of corporate sponsorship.  Some Olympic Sports were only open to one sex – synchronized swimming is female-only, but more sports are male-only, with canoeing a good example of discrimination, and overall there being 30 more medals available to men than women in the 2012 games.  In Saudi Arabia, girls and women are not allowed to do PE at school, join a sports club or even go to sporting events. The International Olympics Committee put pressure on the country to send women, and Wojdan Shaherkani made history by being their first woman from Saudi to compete, in the judo. She only knew three weeks before the games that she was to compete, and she didn’t meet the qualifying standard – but that wasn’t the point. She was one of 4,847 women competing in London, 44% of the total.  Not only was it great to see these women enjoying what they could achieve with their bodies, they have provided a set of role models for all the other girls and women out there. 

The achievements of athletes like Mo Farah highlight how Europe offers possibilities denied to many from poorer countries; Mo came to Britain aged 8, his parents hoping for a better life. His twin remained behind and although then a promising athlete, he has not gone on to develop this talent. Britain is a country of migrants, and Britain is happy to claim Mo, but it has also given a boost to Somalis and the Somalian diaspora – he is the first ethnic Somali to win gold. Sadly, a Somalian athlete at the Beijing Games was one of those who perished on a boat earlier this year trying to cross the Mediterranean to escape to a better life in Europe. The links with the colonial past are clearly seen in the multicultural, multiracial Team GB, and the BBC commentary team at one point, made up of the white commentator John Inverdale and three black athletes, all previous medal winners, had a sensitive and thoughtful discussion about why so many brilliant athletes are black, and why a white man hasn’t won the 100 metres since 1980. It’s easy to be flippant and say that black athletes are just better and we could offer all sorts of cultural and physiological explanations, but the fact that the discussion took place shows something of the confidence that Britain has in its multiculturalism. A poll in the last week showed that 68% of respondents agreed that Britain is stronger as a country of many cultures, rising to 79% in London and 81% among the 18-24 age group.

It’s noticeable that African athletes and those from the global South excelled in those sports that didn’t require expensive equipment. The sports involving horses, boats, bicycles, (and much of the winter Olympics) are the preserve of the global North, apart from a few exceptions such as a cyclist from Trinidad and I think I spotted a black rower from South Africa. This isn’t surprising, of course. To get up and run doesn’t need resources – though obviously it does to get up to international level, and that's where people like David Rudisha have been lucky to have been spotted and enabled to develop their talent. What is perhaps more surprising is how the athletes and medalists from the UK are still so over-represented by the privileged, and attended private schools. At the Beijing Games, 50% of GB’s gold medal winners were from fee-paying schools. One school, Millfield in Somerset taught seven of the competitors at London 2012, two of them gold medal winners.  An estimated quarter of the Team GB was educated at fee-paying schools (attended by 7% of the population).  (Incidentally, two thirds of England’s rugby team was educated in such schools too.) The facilities at these schools bear no relation to those at the schools most children attend; Tonbridge School in Kent for example, has a 25 metre indoor pool, 12 rugby pitches, 18 tennis courts and an Olympic standard athletics track. Well, I guess this is what the annual boarding fee of £32, 823 buys. Meanwhile, although there has been a scandal about the number of school playing fields that have been sold even since the Olympics, the number of children taking part in competitive sport is up from 58% in 2006/07 to 78% in 2009/10.  Yet the Tory Education Secretary, Michael Gove, on getting into government axed the £160 million budget for school sports partnerships. The debate about a lasting sporting legacy from London 2012 rumbles on, with contradictory policy moves.

The athletes exemplify a key idea in health promotion, that of deferred gratification – putting in hard work and making sacrifices now for the sake of a pay-off sometime in a distant future. Also it’s not just individual effort – all the athletes, winners or losers, thanked their teams – coaches, families, teammates – in interviews, showing how much of a group effort it all was.  They clearly felt a sense of belonging to something, which spurred them on.

An ICM poll showed that 55% of Britons felt the Games were worth the investment, as they are helping to cheer the country in hard economic times.

In terms of legacy, membership of clubs such as cycling clubs has already gone up and some of the top cyclists have spoken out for cyclists’ rights to a safer road environment. The fact that Team GB won so many medals wasn’t just due to home advantage – it showed what a sustained strategy of substantial investment in sport can achieve. The Games did attract a lot of corporate funding but also it really shows what public investment can do, including revitalizing one of the poorest parts of London, and hopefully, leaving behind an area with factories providing employment, houses and social amenities. The Games also enabled ordinary people to get involved, and volunteering is another of those ideas that is being talked about a lot in public health circles – it appears to help people develop a sense of wellbeing. 70,000 people were taken on as volunteers for these Games. This kind of community activity, and joining clubs, generates a sense of belonging and what we increasingly talk about as social capital; ‘Bowling Alone’ isn’t possible for many sports and for me it’s the sociability, team work, problem solving and having fun together that’s the real point of sport. It does concern me that young people get hooked up in the excessive competitiveness that leads to cheating, or can get obsessed with those hundredths of a second that make a difference. Making a difference is surely more about using sport to tackle social issues – racism, homophobia, HIV – or using some of the technology to solve practical problems. (We have bicycles that can shave seconds off a time by being more aerodynamic but a bike that can withstand the brutal paths in parts of the poorer world seems to elude us, for example). It’s a good move that under the new lottery deal with UK Sport, top athletes have to spend 5 days a year in schools motivating pupils to be more active.

Finally, what about all those amazing bodies? One man, watching a swimmer, exclaimed, “Look at this…what a beautiful boy”. That man was the father of the athlete in question, Chad Le Clos, and he had just beaten Michael Phelps, the so-called greatest Olympian of all time, in the 200 metres butterfly.  He, and all the other parents, were of course bursting with pride and overwhelmed at what extraordinary children they had produced. But it was ok for any of us to exclaim at the beauty of the bodies, as they were amazing: sport gives us permission to admire such beautiful bodies and what they can do, without being voyeuristic. The kit worn does seem to have become more body-revealing over the years, with the men’s diving kit and the women’s for the beach volley ball especially notable…… but the origin of the Greek games was centered on the beauty of the human form as much as it was about sporting prowess, with athletes expected to parade naked.  This of course is why some cultures disapprove of sport, with the link between nakedness, sexuality and the sporting body.  The Paralympics are about to start and it gives us a chance to appreciate different bodies, differently beautiful. I’m proud that the Paralympics originated in England, the inspiration of a German doctor given asylum here from Nazi Germany, Ludwig Guttmann. The Stoke Mandeville Games evolved into a challenge to prejudicial views about those who are differently abled, and fuelled the disability movement.

Lastly, just a note on Michael Phelps, who I mentioned as the “so-called” greatest Olympian. His achievement is fantastic of course, and he seems a very nice young man. No doubt he has had all the privileges though and my vote for greatest Olympian would go to his compatriot Jesse Owens, who defied the racism of the USA and of Nazi Germany to win four gold at the 1936 German Olympics in front of Hitler. He inspired so many generations of black American athletes and was a great role model – though maybe not in that he smoked a pack of cigarettes a day and died in 1980 from lung cancer.  He was perhaps in the minds of Tommie Smith and John Carlos from the USA on the day that they gave the black salute on the medal podium at the 1968 Games to highlight black poverty, together with the white Australian Peter Norman. All were supporting the Olympic Project for Human Rights. The opening and closing ceremonies too, at the London 2012 Games seemed to reflect some of the social context and politics within which sport takes place which helps me at least overcome some of those ambiguous feelings that elite sport creates.

Our health and The Arctic

I have just returned from the high Arctic, having done a circumnavigation of Spitsbergen, the largest of the islands making up Svalbard. We called at a number of the other islands, and saw stunning ice scenes, mountains, glaciers, and polar bears, walrus, reindeer…. Svalbard is about as far north as you can go, and is on a level with the top of Greenland. It was a huge privilege to have the money, time and ability to get there and to see it for myself. For me, wild places are essential to my ability to function in the modern world and the world of work; it’s what I want to do in my free time. I’m aware of course of what a luxury that is, and the danger of these areas being playgrounds for the rich. The paradox often, is that tourism destroys the wildness that we seek; I went with an environmentally-conscious and allegedly ‘responsible’ tour operator. The Association of Artic Expedition Cruise Operators (AECO) is an international association aiming to manage responsible and environmentally-friendly cruise operations in the Arctic and to educate those who visit about the issues facing this amazing part of the world. It undertakes studies to assess the impact on wildlife, the cultures and people and environment, in the hope of minimizing unwanted impacts.

Tourism however, is a complex area, and I’m not going into it here. (I do supervise a PhD student looking at pro-poor tourism in The Gambia, and that could be the subject of another blog…) Apart from being important to me, the Arctic is essential to the health of everyone in the world. Everyone on the planet depends on the health of the Arctic. It is what keeps the planet cool – the ice reflects the sun’s rays off its ice, thus acting like a giant air-conditioner. However, we know that the Arctic is heating up twice as fast as anywhere else.

Glaciologists have noted the seventh successive summer of a pattern of warm air circulating on the ice sheet of Greenland, and earlier this month, over only four days, a rapid melting took place over 97% of the surface of Greenland. NASA was so surprised at the findings that it first questioned the instrumentation, but the results have since been confirmed. Although conditions returned to normal by a couple of weeks later, it was highly unusual, as was the breaking off of a huge iceberg (about the size of Manhattan island) from the Petermann Glacier.  There are periods of natural rapid thawing occurring about every 150 years, but there is no doubt that some of the well-documented trends are due to human-made global warming. About a fifth of the annual sea level rise (at the moment about 3mm) is due to the Greenland ice sheet melting.  The National Centre for Atmospheric Science at Reading University in England has recently published studies carried out by Dr. Jonny Day, which concludes that more than 70% of the decline in sea ice is due to human activity, and could be up to 95%. They have compared the variability in the extent of ice over its natural cycle (a cycle of cooling and warming which occurs every 60 to 80 years), using computer simulations to see what would have happened without the input of greenhouse gases. The frightening thing is that as the ice melts, the effect accelerates (the ice-albedo feedback effect), with the sea absorbing even more radiation and therefore warming faster.  Prof. Peter Wadhams from the University of Cambridge predicts that all ice might be lost during the summer months from the Arctic Ocean by 2016. His views are mentioned in the newspaper article highlighted below.

The burning of fossil fuels, is of course one of key contributors to global warming, and the Arctic is now under threat itself from the scramble to find more fuel resources. The reduction in ice means the area is more opened up to exploration. This article of July 21^st explores the issues:

http://www.guardian.co.uk/world/2012/jul/22/arctic-ice-melting-oil-drilling

The rush to extract resources from the Arctic is being spearheaded by companies that already have poor records for environmental pollution. According to Greenpeace Russia, at least 300,000 to 500,000 tonnes of oil leaks into the Arctic Ocean every year from on-land drilling. The oil industry has polluted major water bodies such as Lake Baikal and its surrounding waterways, meaning that locals cannot catch fish or use water for drinking. The key Russian-owned company, Gazprom, is now expanding north into even more risky waters. It has established a second rig in the Pechora Sea off Siberia this year, in an area surrounded by wildlife sanctuaries and national parks. Greenpeace has been holding up icebreakers en route to the Arctic in advance of the drilling ships and have also started a campaign to establish a global sanctuary in the uninhabited area around the North Pole. The goal is to get the UN to designate it as a protected area for the sake of the health of the planet. Greenpeace also calls for a ban on offshore drilling and unsustainable fishing in the Arctic. The campaign is at:

www.SaveTheArctic.org

It seems clear that the Arctic is a huge part of the problem of global warming and therefore a major part of finding solutions. Greenpeace’s actions are therefore welcome in an age where governments and the UN seem to be taking action too slowly, and where they have conflicting agendas.

How the health promotion community responds to these issues is vital. Of course, people can take action in their personal lives, and as with any community, opinions will vary as to how seriously to take the threats of global warming. However, as health practitioners, our responsibilities to get involved are to me, very clear. Jenny Griffiths in the UK is perhaps the best-known advocate on the role of health practitioners on climate change. With three other editors, she has produced “The Health Practitioner’s Guide to Climate Change, Diagnosis and Cure”, a packed book of 350 pages on understanding climate change, but more importantly, on how to take steps to tackle it. It’s a practical book explaining how we can take action within the compass of our own work lives and practice. Health promotion is the professional area of practice that can persuade people to take action on something as important as climate change. Chapter 7 uses Mahatma Gandhi’s saying “Be the change you want to see in the world” to encourage us as health workers to make changes in our own lives, and then other chapters tackle organizational change, community change and so on.  It’s an essential book to help to start organizing your own response to these dire environmental challenges.

Meanwhile, who or what within the epistemic health promotion community is taking the lead on the threat to the health of the planet? Please use the 'comments' option in this blog to add your views. 

Reference:

Griffiths, J., Rao, M., Adshead, F., and Thorpe, A. (2009) The Health Practitioner’s Guide to Climate Change, Diagnosis and Cure. Earthscan.

Human Rights and Gay Rights

The European football championship was played in Poland and Ukraine a couple of weeks ago, inevitably focusing attention on those two countries.  Ukraine was in the news during the tournament, for failing to curb racist incidents directed at footballers, and it has remained in the news for further unfortunate reasons. Firstly there have been clashes between police and protesters angry at the “russification” of the language after the Parliament’s elevation of Russian to the status of a regional language, with the use of the Ukrainian language a statement of autonomy after years of Soviet rule. Secondly, the Ukrainian Parliament was, last week, debating draft law number 8711, that would make it an offence to talk about lesbian, gay, bisexual and transgender (LGBT) issues in the media. This threatens education and advice about sexuality, or sexually transmitted infections such as HIV; it threatens public gatherings where LGBT issues are discussed. There has been anti-gay violence in Ukraine, and the country is following the trend set by parts of Russia, which passed laws banning literature about homosexuality, making it illegal to hold film festivals, pride marches or exhibitions where LBGT people were expressing their identity and issues. 

Not so long ago, Britain had its own legislation, passed under Margaret Thatcher’s government and known as “Clause 28”, which made it an offence to ‘promote’ being gay as a ‘normal lifestyle’. Teachers and schools interpreted it as meaning that they could not talk about homosexuality. This law was finally repealed. The comparison is not an especially good one, as the laws currently being debated in Eastern Europe go further than this in terms of being much more punitive. The UN has come out to say that the laws proposed in the Ukraine would violate rights protected under treaties that the Ukraine has itself signed.

The Ukraine is not the only country currently to be debating gay rights. The Global Journal (theglobaljournal.net) featured the Ugandan gay rights activist Kasha Nabagesera in its May 2012 edition, with the headline, “Being gay in Uganda could soon attract the death penalty. Knowing and not reporting that your sister is a lesbian could soon be punishable with a prison sentence”. (p31) Kasha comments, “Uganda… (is)committed to uphold all human rights with no distinction, no exception…My government is proposing too kill me. What is the UN doing about it?” (p33). The ex-prime minister of the UK, Tony Blair, recently ran into a sticky moment in a meeting with the president of Liberia, Ellen Johnson Sirleaf, where gay rights were alluded to.  She stated, “We like ourselves just the way we are”, defending a law that criminalises homosexual acts (Ford and Allen 2011:19). Other African countries appear to be strengthening anti-gay legislation and homosexuality remains illegal in 37 African countries.

Despite this, there is a lot of LGBT rights activity in Africa, which often only comes into public view when a crisis occurs, such as the murder of the Ugandan gay rights activist, David Kato. The extent of this grassroots activity in Africa is shown by Epprecht’s (2011) useful paper (see reference below). He also suggests that possibly, men who have sex with men (msm) is one of the overlooked factors which might help to explain why sub-Saharan Africa has such high rates of HIV. He reports that in one study in Uganda, for example, 90% of the respondents (msm) had (female) wives as did over 60% in a Kenyan study. Homosexuality is clearly present, and the fact that it is not acknowledged means that health education and promotion are compromised. In Lusaka central prison in Zambia, for example, a well-conducted study found HIV rates of 42% among male inmates. (In the general popualtion it is 14%). Condoms are not distributed in prison as msm is not felt to exist by those who would have the authority to provide condoms. The whole issue is too political, and meanwhile men’s health, and that of the women they go on to have sex with on release, is fundamentally compromised.

Under international law, criminalising homosexuality is illegal, but in many countries, homosexuality is indeed illegal. Wilkipedia provides a useful overview of LGBT rights by country:

http://en.wikipedia.org/wiki/LGBT_rights_by_country_or_territory

The Human Dignity Trust has recently launched a campaign to combat homophobic legislation globally, and it includes activists from all over the world, including Africa:

http://www.humandignitytrust.org/

Homosexuality is illegal in 78 countries around the world. The maximum penalty in five of those countries is death. There is no clear reason for this extreme response; in Japan, homosexuality has been legal since 1880. What causes some countries to have no problems with respecting the rights of gay people and others to have major difficulties with it?  The Human Dignity Trust is campaigning on the single issue of decriminalising same-sex between consenting adults.

Even in a country such as the UK, where homosexuality is legal, and civil partnerships are available, there are effects on health due to the stigma still existing in some circles.  Stonewall, the gay rights campaigning organization posted this recently on its website:

“5 July 2012

Homophobic bullying ‘a daily nightmare’ for over half of Britain’s school pupils

Pioneering research reveals serious concerns about homophobic language
Nearly a quarter of gay young people attempt suicide

New research carried out by the University of Cambridge for Stonewall’s School Report 2012 has found that 55 per cent of lesbian, gay and bisexual pupils in Britain’s secondary schools experience homophobic bullying. The research, based on a national survey of 1,614 young people, also found that nearly a quarter (23 per cent) of gay young people have attempted to take their own life, and more than half (56 per cent) deliberately harm themselves.”

The report can be found at:

http://www.stonewall.org.uk/at_school/education_for_all/quick_links/education_resources/7956.asp

Gay people are humans like everyone else and thus should come under the same protection under international law, just like everyone else; gay rights are human rights and human rights are gay rights. An attack on gay people is an attack on human rights. And of course, human rights are fundamental to achieving health for all.

References:

Epprecht, M. (2011) Sexual Minorities, Human Rights and Public Health Strategies in Africa. African Affairs, 111/443, 223-243

Ford, T. & Allen, B. (2011) An awkward silence: Liberia’s President defends anti-gay laws – as Blair squirms. The Guardian, 20 March 2012.

"The Angel's Share"

Sometimes a piece of fiction captures exactly a situation that no academic research can accurately depict. Seeing ‘The Angel’s Share’ at the cinema recently brought home to me the background and lives of many of the offenders we meet through our work on healthy prisons. In a mirror of the film’s story, the lead actor is also an ex-offender; the film’s scriptwriter  (Paul Laverty) met him  (Paul Brannigan) at the Strathclyde police unit for violence reduction. Brannigan was jailed aged 16 for four years, after being involved in a gun battle involving family members. Both his parents were drug addicts and he was brought up in a tough part of Glasgow. That he has turned into an actor, and is now involved in another film, is a fantastic success story. He commented, “It probably saved my life. I’d nowhere to turn, got a kid; who knows what I’d have done for money”. That sense of having nowhere else to turn except to do something illegal is a feature of the film. A group of people meet by chance at the courts, all having escaped custodial sentences but being required to do community service.  What they contrive to do together does involve some illegal acts but it’s a really heartwarming story and also extremely funny. It has a happy ending and remains an uplifting film. Directed by Ken Loach, it is in his tradition of an honest, gritty, almost documentary style that captures the bleakness and brutality of life on some of the poorest estates in Britain. It really did seem that for the main characters, they would have been safer in prison than on the streets where they lived. This is also a sentiment echoed by some of the prisoners interviewed over the years by us, including those in a major study by my colleague James Woodall for his PhD.

That offenders come from these kinds of backgrounds is well known. Offenders are not typical of the general population - they are more likely to be drawn from sub-sections of the population regarded as marginalized and with a complex set of needs. 27% of offenders were taken into care as children (compared with 2% of non-offenders) and the statistics for other social problems run the same pattern: 49% of male and 33%  of female offenders were excluded from school (3% non-offenders); 52% of male and 71% female offenders have no qualification (15% non-offenders); 67% of offenders were unemployed before offending and 32% were homeless. Two thirds of male and just over a half of female offenders used drugs in the year before offending.

The low educational attainment and limited life chances are evident whenever you meet prisoners. This isn’t true of all offenders and it also isn’t the case that all those with poor life chances turn to crime. However, just as some environments are salutogenic or pathogenic, so too are some environments more or less criminogenic. Life can be toxic in parts of poor Britain; children too, simply learn whatever is around them, and up to a half of people in prison also had a father who went to prison. Paul Brannigan, who could play the lead role so convincingly because in essence it was his story, said, “In Glasgow, there’s no work. There’s no ships or houses getting built. No opportunities, no hope. And when you’ve no hope you can’t get your motivation up, your self-confidence goes down and you turn to drink and drugs. It’s a downwards spiral”.

So “The Angel’s Share” is a story about the social determinants of health, about what it means when someone takes you under their wing, shows faith in you and when someone offers you a chance to make a new start, with practical help – a job, a house. It’s also a story of how people can use their own imagination, ingenuity and talent to seize that opportunity once presented. And the angel’s share is that part of the whiskey that evaporates when it’s maturing inside the barrel……

Social mobility and 'jubilee'

Health promotion celebrates the possibility of change; it sees change as a force for good. People can change their lifestyle, their mindset, can get out of a health-harming situation – given the right kinds of social support. And societies can change – clearly history tells us this.  Thus the importance of people being able to change their social status is central to health promotion, given how much health inequalities are related to it. So the recently published report on social mobility in Britain makes depressing reading for anyone in health promotion.

Alan Milburn is the government’s Independent Reviewer on Social Mobility and Child Poverty, and in the report on social mobility and the professions, he suggests that social mobility has stagnated: http://www.cabinetoffice.gov.uk/sites/default/files/resources/IR_FairAccess_acc2.pdf

It appears that people in their 40s today are less socially mobile than people born in the 1950s (which includes me).  I benefitted from the greater access to education, including University, but that possibility has now ground to a halt, meaning that the biggest predictor of how well a child will do in life is the socioeconomic circumstances he or she is born into. The idea that birth determines life chances is of course, what a monarchy rests on. Having life chances determined by birth is seen as antithetical in a democracy, which is why the UK government has set out 17 indicators for social mobility or ‘life chances’ through childhood. Some of these indicators aim to decrease the huge gap in educational resources and attainment, with a stress on the early years, or pre-school interventions. Some of this may mean that the previous government’s measures will be continued, such as the Sure Start initiatives, many of which our Centre for Health Promotion Research evaluated. Now Children’s Centres, it will be interesting to see if they survive the ‘austerity cuts’ of the present regime. 

Milburn’s report highlights how educational attainment is so important to gaining professional employment – although only 7% of the population is privately educated, 70% of high court judges and 54% of FTSE 100 chief executives and top journalists, and 22% of medical and dental school students went to fee-paying schools. Our government and civil service are disproportionally run by the privately educated and privileged. In 2010, the Higher Education Funding Council for England reported some substantial increases in the number of youngsters from the poorest areas going into higher education from 2005 onwards, fueled by Labour’s investment. This appears to have ended with the switch to the coalition government; the class divide at the heart of our country, fueled by private education, has always been replicated in the tertiary sector, but this source of social mobility seems to have been shut off.

Birth as destiny is all around us this ‘jubilee’ week; that it is 'natural' to be born into one’s station in life appears to be a part of the British psyche. The royal family appears more popular than ever. Polls tell us that only 22% of the population wants the monarchy to be replaced by something more democratic. The monarchy, defending as it does class divisions, hierarchy, unearned wealth, militarism, and inherited privilege remains powerfully at the centre of ‘British’ life. To be born into fantastic privilege – and stay there - legitimates the fact that people can be born into deprivation – and stay there. It legitimates the 'naturalness' of social immobility. 

The ‘jubilee’ is heralded as a unifying pageant across all sectors of society; this version of ‘jubilee’, as a sharing of a popular culture, is far from the original meaning as set out in Judeo-Christian traditions, where it was meant as the cancellation of debts, freeing of slaves, sharing out of land, and equalization of resources. Biblically, it asked people to challenge the rights of the wealthy, to side with the poor and disadvantaged. This is the meaning adopted by the Jubilee Debt Campaign, which is still attempting to reduce the debts of the poorest countries whilst also highlighting the workings of the global finance system, tax evasions and lack of accountability of corporate capital. It has recently called for a new justice jubilee:

http://www.jubileedebtcampaign.org.uk/Launch3720of37203727Jubilee3720for3720Justice37273720call+7668.twl

The campaign asks us to remember the original meaning of jubilee, as, essentially, a call for economic and social justice.  Health justice, the key value at the heart of health promotion,  is contingent on these other forms of justice.