Social Inequality and Exclusion Knowledge in Social Care
How can a knowledge of social inequalities and social exclusion assist social workers in their practice?
In some respects the topic of this essay reflects both the heart and core of the philosophy behind social work. There are some who would argue that it is the recognition and appreciation of the inequalities of society that are the driving force behind most of the social legislation in this country today. (Powell, J et al 1996).
The definition of social inequality can be made on many different levels – philosophical, intellectual, socio-economic, cultural and health related, to cite but a few and a complete discussion is clearly beyond the scope of an essay such as this. In the same way social exclusion can be due to a myriad of causes – cultural, religious, behavioural, criminal, socio-economic, age, immobility and illness are a few of the more common factors. The fact of the matter is that in practical terms, both social inequality and social exclusion tend to overlap a great deal and in many cases, one is the cause of the other. (Lovelock, R et al 2004)
Because it is completely impractical to consider all of the possible causes of both social inequality and social exclusion we shall approach the issue by considering a number of different examples and discuss them in the context of the question.
In general terms, disability (both physical and mental) is a major cause of both these phenomena. We shall begin by considering the impact that disability has on both social inequality and social exclusion.
To it’s credit, the Government has recently taken a number of steps to try to combat the inequality and the exclusion elements that are inextricably linked with disability.
In order to be technically correct on the matter, we should note that the World Health Organisation actually subdivides the term “disability” into three different elements
Problems in bodily function or structure, which they used to call ‘impairment’; problems relating to activities, or ‘disability’; and problems related to social participation, which they called ‘handicap’. (Ramcharan P et al 1997)
For our purposes however, such a definition is hardly helpful in terms of examining the problems of the disabled. We would suggest that a definition in social terms is probably far more practical. Some commentators (Clasen J 1999), have observed that:
The treatment of disability as if it was a single problem may mean that disabled people receive insufficient or inappropriate assistance. The problems that disabled people have in common are not so much their physical capacities, which are often very different, but limitations on their life style.
In the context of this essay Goodin (et al 2000) adds the observation that:
Their income tends to be low, while disabled people may have special needs to be met which require increased expenditure. Socially, disabled people may well become isolated, particularly as their health declines and they struggle progressively to manage on the resources they have, and they may be socially excluded.
For our purposes in this essay we shall use the word “disability” in its English grammatical sense (a la Clasen and Goodin) rather than in the narrower WHO definition above.
Perhaps the first observation that we should make, is that disability, or the perception of disability, is very culturally dependent and to some extent is culturally determined. The cynic might suggest that the stereotype caucasian British white male might consider that a disabled person is the responsibility of the social services and the state, who can look after him, provide him with carers and organise a regular income in the form of some type of protected benefit. Equally, the stereotypical Asian family might consider the disabled family member to be the responsibility of the family itself and would only look to the state for advice and resources.
Clearly both of these stereotypes are cartoon exaggerations of the reality of the situation, but we use this to illustrate the cultural elements of the expectations of both the disabled person and their families or carers.
In the context of our considerations here, we need to consider how a knowledge of the social inequalities and social exclusion can assist the social worker in their practice. In order to do this in the specific area of disability, we should examine The Disability and Discrimination Act (1995). Many would argue that this has been a piece of legislation that was long overdue as it addressed a need that has been demonstrably present from time immemorial (Baldock J et al 1999). The fact of the matter is that the ability to discriminate on the sole grounds of race has been illegal in the UK for a considerable time.
As Spicker (P 1995) has observed:
The ability to discriminate on other, arguably more fundamental features of existence, still remained an option that did not have the sanction of the law.
In this respect, the Act has proved to be a valuable piece of legislation as it has helped to directly tackle many of the areas of social inequality and social exclusion. Many consider the Act to be simply aimed at the discrimination practices that were rife in the workplace, but the reality of the situation is that it is, in real terms, a far reaching piece of legislation which has implications for most areas of society and social interaction (Alcock P, 2003). The social worker will clearly need to have a working knowledge of the provisions of this Act if they are to be able to function effectively in this particular area.
The social worker, in their daily practice, may very well come across clients with disabilities of various types, and these clients may look to them for help, support and guidance if they have an appreciable element of social exclusion in their lives.
We can point to research which shows that the disabled have a substantial burden of discrimination when it comes to employment. (Chapman P et al 2004).
Jowell (R et al 1998) demonstrated a 7 fold increased incidence of unemployment when compared to their able bodied counterparts. It generally follows that greater levels of unemployment are associated with lower levels of income and this, in turn, is associated with greater levels of social exclusion (McKernan SM et al 2005),
The professional approach of the social worker will be to assess all of the possible factors that may contribute to their isolation and consider practical ways of breaking down the barriers to inclusion, whether they may be in the workplace, on the social front or even in terms of simple physical mobility. (Haralambos M et al 2000)
Another major area of social inequality, which again has repercussions on social exclusion, is the area of health in general. In this context the (then) Health Secretary, Frank Dobson, made the very pertinent comment :
Inequality in health is the worst inequality of all. There is no more serious inequality than knowing that you’ll die sooner because you’re badly off (Dobson 1997)
There is a direct and demonstrable link between social depravation and ill health. It follows from this that social inequalities have a direct effect on both morbidity and mortality. This is most marked in the children from deprived backgrounds. (Black 1980)
The Black report (cited above) was largely adopted and expanded in the publication of “The Health Divide” (Townsend & Davidson 1988), which further quantified the areas of social inequalities as manifested in morbidity rates in the population and correlated them to social stratification. The Report came to the conclusion that these social inequalities were not being adequately addressed either by the Health Authorities or the Social Services. These identified inequalities later emerged, further modified, in a document “Independent Inquiry into Inequalities in Health” ( IIIH 1998), and were associated with 39 separate recommendations. These were subsequently criticised for a lack of prioritisation, (McKernan SM et al 2005), where” the fundamental role of poverty was lost in a sea of (albeit worthy) recommendations ranging from traffic curbing to fluoridation of the water supply.”
Obviously, the findings of this succession of reports does not only impact upon the Social Services, it equally impacts upon other providers such as the Health Service and indeed the Government itself.
We have examined two specific areas of the whole picture of social inequality, and it is prudent to also consider an overview before leaving this area. The trend to socio-economic inequality can be considered to be either rising or falling depending on which criteria of assessment one takes. If we consider the number of people who are living in low income households, there has been a measurable downward trend in the last decade, this is partly due to the fact that there are progressively fewer people in workless households (Chapman P et al 2005)
Equally, if one considers the number of families on out-of-work benefits, this has risen by 30% in the last 6 years (JRF 2005)
If one considers the impact of the association of low income and increased morbidity, then we can cite studies that show that there has not been any significant reduction in these health related inequalities in the last 9 years.
(McKernan SM et al 2005).
There is also the geographical factor. We can show that virtually all the indicators of both social socio-economic inequality and social exclusion are more prevalent in the north-east of the UK and they tend to progressively reduce as one moves towards the south-west. The only notable geographical anomaly in this respect is London which has a peak of low income and unemployment problems and Scotland which has a peak in health-related issues. (JRF 2005)
In conclusion, although it is accepted that we have only examined a few small facets of the whole potential area related to both social inequalities and social exclusion, we would suggest that we have presented sufficient evidence to be able to suggest that the social worker cannot reasonably be expected to practice in the modern environment without a thorough knowledge and appreciation of these factors. It is not so much a case of “Does this knowledge assist the social worker in their practice?” but “This knowledge is essential to be able to practice effectively.”
References
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Chapman P, Euan Phimister, Mark Shucksmith, Richard Upward and Esperanza Vera-Toscano, 2004, Poverty and exclusion in rural Britain: The dynamics of low income and employment, Joseph Rowntree Foundation, Prentice Hall : ISBN1 899987 67 3,
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April 1998 – Ref 418 Poverty and exclusion in rural Britain: the dynamics of low income and employment
