JUDY YARWOOD, co-chair of the College of Nurses, reflects on the negative impacts of inequality on people’s health and wellbeing and calls on RNs to challenge inequality as election day looms.
None of you will need reminding that an election is nigh, a time when politicians step up their rhetoric, promising, if elected, much to many.
It’s a good time for us to evaluate politicians’ performance over the last three years, especially in matters that affect us all, such as the economy and healthcare. I was reminded how these two fields are inextricably linked, when I listened to the 2014 Robb lectures recently held at Auckland University.
The 2014 lecture series, “The human cost of inequality” (viewable at www.auckland.ac.nz/en/about/perspectives/public-lectures.html) was presented by two English epidemiologists, Professors Kate Pickett and Richard Wilkinson. The pair brought home the links between economics and health by showing how destructive inequality can be to health and the social fabric of a country.
An example they shared was the outrageous changes in income distribution internationally over the last decade. Whereas a ratio of 1:10 or perhaps 1:20 between the lowest and highest paid employees in a company was acceptable, we now have large corporations with ratios as high as 1:400. How is it possible that one person’s worth is 400 per cent higher than others?
The New Economics Foundation, described as UK’s ‘think tank’ to promote social, economic, and environmental justice, contends that many of the world’s economies are increasingly unsustainable, unfair, and unstable.
The two speakers highlighted New Zealand’s levels of inequality, which are frequently found high on the list alongside the ‘top unequal’ countries, the USA and Singapore, debunking the claim that
New Zealand society is relatively equal.
Kate Pickett finished on behalf of both speakers by saying they hoped that within 20 years, or perhaps fewer, it would be as embarrassing to be seen to be individualistic, greedy, and out for yourself as it was to be homophobic, racist or misogynistic – sentiments roundly applauded.
Time for RNs to take up the challenge
As Nicola Russell pointed out in her challenge in the Feb/March edition of Nursing Review, 47,000 RNs, the largest group of healthcare professionals, are a force to be reckoned with.
Increasing numbers of RNs working in primary healthcare see daily the impact on people’s and communities’ health and wellbeing of socioeconomic determinants like poor housing, income inequality, violence, neighbourhood contexts, and low levels of education. However, it’s one thing to identify the issues and another entirely to know how to make a difference. If, as Pickett and Wilkinson suggest in their acclaimed 2010 book The spirit level: Why equality is better for everyone, the institutions that employ many of us are a source of income inequality, what does that say about the focus of district health boards, primary health organisations, and health-related institutions?
You cannot find a place where these ideas resonate more strongly than in the care of the elderly, where many aged care workers, often unskilled, are paid less than the minimum wage. What this suggests is that our society places little value on caring for older people, who increasingly are seen as burdensome rather than beneficial. Baby boomers, currently a prime target, are constantly referred to as creating huge problems for our finite health resources. We seem to be caught in a time warp where ageing is seen as a disease rather than as a natural process. Our humanity for the elderly is perhaps converse to the country’s increasing emphasis on the GDP.
Over the past 50 years, enormous social change has occurred, transforming our society. But changes such as women’s position, gay rights, and civil unions, to name a few, came about, as Kate Pickett noted, through people’s action driving political will rather than vice versa. As members of society, RNs have the capacity to lead such action by drawing attention to the impact of social determinants and income inequality on people’s health and wellbeing.
Despite barriers, often economic and/or managerial, nursing leadership is alive and well, if unsung, in diverse urban, suburban, and rural PHC contexts. Visiting nursing students on clinical placement up and down the West Coast, I find expert, skilled, and enlightened RNs, often in sole charge of remote health clinics, working daily with the effects of poor housing, loneliness, violence, and unemployment. Without these RNs, many people would have little or no access to health care, a central tenet of primary health care.
So as RNs and nursing leaders, we not only have a personal choice on September 20 this year. We also have a professional responsibility to consider how inequalities can be challenged and addressed, social determinants recognised and tackled. All of which won’t happen overnight, but with people power and political will, it can happen. Don’t let September 20 pass without doing your part.
Judy Yarwood is co-chair of the College of Nurses and principal lecturer at Christchurch Polytechnic Institute of Technology nursing school.