Health inequalities, social justice and HIA

Professor Gareth WilliamsWales Health Impact Assessment Support Unit, Cardiff University

Cofion o Gymru!

Locating Wales

Crisis? What crisis?

Defining systemic crisis

It can be defined as:

‘financial system instability, potentially catastrophic, caused or exacerbated by idiosyncratic events or conditions in financial intermediaries’.(Tom Daula, former Chief Risk Officer, Morgan Stanley, circa 2006)

Source: Audit Commission (2009) When it comes to theCrunch…Responding to the economic downturn: the role andpotential of partnerships

Beyond financial crisis

Things fall apart; the centre cannot hold;Mere anarchy is loosed upon the world,The blood-dimmed tide is loosed, and everywhereThe ceremony of innocence is drowned;The best lack all conviction, while the worstAre full of passionate intensity.(Williams Butler Yeats, ‘The Second Coming’, 1919)

After

Recession for ever!‘We’ve always been in recession in Blaenau Gwent…’ (Health & Social Care).

‘I’d say that for a lot of the Welsh valleys they’ve never fully recovered from the closing down of the primary industries in the area, and Blaenau Gwent is no different, we had a huge steelworks site here, they were a big local employer, they’ve closed down’ (Housing)

‘a lot of companies come into this area, pick up some grants for coming in to the areas and within two to three years are gone’ (Debt/finance)

Injustice

‘While no-one would claim to be on the side of injustice, without the continued spread of beliefs in support of injustice it would not survive long in its present form. Now that we have enough resources for all, much that was previously seen as unfortunate has become unjust’Daniel Dorling (2011) Injustice: Why Social Inequality Persists, Bristol: Policy Press, p 1

Five tenets of injustice• Elitism is efficient• Exclusion is necessary• Prejudice is natural• Greed is good• Despair is inevitable

‘Because belief in the five tenets of injustice is so widespread among people in power, these beliefs are then propagated through what they control’Daniel Dorling (2011) Injustice: Why Social Inequality Persists, Bristol: Policy Press, pp 1,4)

Re-defining health impact assessment

‘Health impact assessment is a process through which evidence (of different kinds), interests and values are brought to dialogue between relevant stakeholders (politicians, professionals and citizens) in order better to understand and anticipate the effects of change on health and health inequalities in a given population’ Eva Elliott, Emily Harrop and Gareth Williams (2010)

Avoiding killing

‘The conflict between incompatible meanings cannot be resolved simply by producing evidence, not because evidence is irrelevant, but because its relevance can only be determined by the meanings themselves… Annihilating the meanings of others in the interests of truth is a form of killing.’ Peter Marris, The Politics of Uncertainty, 1996: 31

Last thoughts…‘How can we achieve a just society? Much of our political debate assumes that to answer this question is simply to maximise happiness or to respect each individual’s freedom of choice. But happiness and choice are not enough. To achieve a just society we have to reason together about the meaning of the good life, and create a public culture hospitable to the disagreements that will inevitably arise’. Michael Sandel, ‘We need a public life with purpose’, in: Citizen Ethics Network, Citizen Ethics in a Time of Crisis, 2010; www.citizenethics.org.uk