Tuesday, 27 February 2018

How changes to disability benefits harm claimants' well-being and sense of identity

Jessica Saffer, University of Hertfordshire
In a major undertaking, the government announced in late January that it will review all 1.6m claims for Personal Independence Payments (PIP) – one of the benefits that supports people with a disability.

There are serious issues with the benefits applications process, and many disabled people who claim Employment and Support Allowance (ESA) or PIP find the process very stressful. In just over two years, the British government has spent more than £100m managing reviews and appeals against their disability benefits decisions.


My new research found that people who receive disability benefits find changes to the system powerfully dehumanising. Changes since 2010 have included cuts to the financial support that people receive and the introduction of new types of benefits – the ESA and PIP – which have tighter eligibility criteria than the previous benefits. With the move to ESA, the work capability assessment was introduced, where some people with degenerative conditions faced regular reassessments for their eligibility to claim support, although this was overturned in late 2016.


More changes are coming, as the government gradually rolls out Universal Credit – which will eventually replace ESA – across the country.

Left feeling powerless

Many of the 15 claimants I spoke to from across the UK found the application process too complex and bureaucratic – and therefore unsuitable for people who are unwell, particularly those with fluctuating or degenerative conditions. They worried that the assessors were not qualified enough to understand specific conditions such as fibromyalgia or to consider the impact of having multiple disabilities, and that they neglected to consider medical evidence.


Claimants worried that assessments were politically and ideologically driven. One 48-year old woman who transferred across to ESA and PIP from the old benefits told me that the assessments were “deliberately slanted to remove people from social security”, leading to a sense of powerlessness.

Read more: We showed I, Daniel Blake to people living with the benefits system: here's how they reacted

The perpetual uncertainties in the benefit system had significant psychological implications for claimants. A 52-year-old woman with multiple disabilities told me: “I’ve been … excessively worrying … really fearful and anxious about it all.”
Claimants described how they had been stereotyped as “scroungers” and “benefit scum” by members of the public, and that they did not view themselves as equal citizens in society. They told me they thought the media and government perpetuated the perception of claiming benefits as a “lifestyle choice”, and were deeply affected by television programmes that portray benefit claimants in a negative light.


Those with non-visible disabilities, such as arthritis, felt that others judged them as undeserving of welfare support and felt they had to justify their needs. One 28-year-old man who had multiple sclerosis (MS) and had lost financial support in the transfer from Disability Living Allowance to PIP told me: “They are cynical or sceptical about my disability because I appear to be quite normal.”
Others described being treated unjustly and feeling humiliated by staff in the benefits system and by the general public. One 38-year-old woman with Myalgic Encephalomyelitis, known as ME, told me about her assessment:
I’ve got a bag full of tablets and (the assessor) managed to tip them all on the floor and then watched me for five minutes trying to pick them up before she bothered offering any help.

Impact on mental health

These experiences had a detrimental impact on claimants’ mental and physical health and well-being. Four out of my fifteen interviewees mentioned feeling suicidal – two said they had actually attempted suicide. Stress and feeling low exacerbated their physical health difficulties, such as chronic pain and fatigue – and physical health challenges exacerbated low moods, in what became a vicious cycle. The 28-year-old man with MS told me:
It is a two-way thing so I am unable to go out because I feel awful and then because I can’t go out I feel doubly awful.
I found that changes to the benefit system had a significant impact on people’s sense of themselves. Some claimants were required to present themselves as more disabled for benefits applications than for other social situations such as going to work or seeing friends, which led to a focus on their limitations. One 31-year-old woman who uses a wheelchair described her PIP application:
The focus has to be on all the things that you can’t do in life … that certainly wouldn’t be a way that would be helpful to live my life.
Some assessors focus on what people can’t do, rather than what they can. from www.shutterstock.com

Many described feeling less worthy than others and said they judged both themselves and other claimants. The stigma surrounding benefits was so potent that many claimants felt an intense sense of shame about receiving support, which led to them hiding it from others. This exacerbated the pressure of living with a physical health difficulty and the isolation associated with financial difficulties. Some were even deterred from claiming benefits to which they were entitled.


The ConversationFor the people that I interviewed, there were signs that changes to the benefit system had caused significant psychological distress and exclusion from full citizenship. The government’s review of all PIP claims is too little, too late – the damage has already been done. More support is needed for disabled people to afford a basic standard of living and to be full citizens within society.


Jessica Saffer, PhD Candidate, University of Hertfordshire
This article was originally published on The Conversation. Read the original article.

Thursday, 22 February 2018

It's poverty, not individual choice, that is driving extraordinary obesity levels

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Sharomka/Shutterstock.com
Martin Cohen, University of Hertfordshire
The “obesity epidemic” deserves much more serious attention than it is getting. It is, after all, thought to be killing nearly 3m people a year worldwide. It is putting huge pressure on health services, yet the public policy response in developed countries such as the US and UK is pitiful, largely confined to finger-wagging at children’s sugary treats.
The story that has not been getting out is that there is a clear and extraordinary correlation between obesity and social inequality. Obesity is invariably presented as a diet issue for nutritionists, whereas social inequality is deemed the domain of sociologists and economists. Put another way, even as the inequality gap becomes more and more obvious there’s been a medicalisation of a social problem. Yet obesity is not just a matter for nutritionists: rather, it is a product of social inequality and requires a collective social response.


This failure to face up to the underlying causes of obesity is all the more striking as issues of social inequality and justice are dominating the news agenda. Despite vast increases in total wealth in the world today, the health issue remains a marker for a general political problem about inequality in society, even in the most affluent societies.


The tragedy is that obesity is usually treated as a problem and responsibility of individuals or families – not as a social problem like, say, low-educational achievement or delinquency. And so the solutions are pitched at that individual or family level.

And yet the statistics point remorselessly towards obesity being a symptom with an underlying social cause. That should completely change the approach to dealing with it. But so far, it hasn’t.

Vital statistics

Take the US. Here, the most “obese” state, Arkansas, is also the fourth poorest state overall, whereas the poorest state, Mississippi, is also the third most overweight.


The picture in the nation’s second poorest state, New Mexico, is less clear because here it is complicated by another factor: ethnicity. New Mexico has “only” the 33rd highest adult obesity rate – apparently bucking the trend. Yet even in “The Land of Enchantment”, the correlation of wealth and health still leaves its unmistakable fingerprint. Here, the adult obesity rate is 34.4% among black adults, 31.3% among Latino adults and a comparatively sprightly 23.9% among white adults, again reflecting wealth distribution.


Recall that in terms of relative income, a 2017 study found that it would take 228 years for the average black family to reach the same level of wealth that white families have today, while for Latino families, it would take 84 years. Meanwhile, colour correlates to poor health and reduced life expectancy.


Recent studies in England also illustrate this link between obesity and income. As you can see in the interactive graph below (toggle the options to see how they compare), of the ten worst areas in terms of overweight or obese children, half are also in the worst ten for child poverty. England’s most obese council, Brent, is also its ninth poorest, whereas England’s wealthiest council, Richmond, despite being a neighbouring council in London, is one of the sprightliest, with a relatively low rate of obesity. And England’s poorest council? Another London borough, Newham, is also the eighth most affected by childhood obesity.



In its way, these figures are as disgraceful an indictment of social priorities and inequality as the 19th-century mortality levels due to epidemics of rickets or typhoid. And the solutions needed are every bit as collective rather than individual.

Victorian parallels

Imagine that the Victorians had tried to tackle typhoid by advising everyone to live in the countryside near clean wells, rather than by building sewers and water treatment plants. Today’s response to an epidemic that kills so many people around the world that it has become the fifth leading cause of early death, is just as unrealistic.


In the early years of the 19th century, the industrial towns of the West were characterised by overcrowding, poor housing, bad water and disease. Epidemics, even in the modern cities of New York and London, were – it was assumed – a part of life. The fact that they caused significantly greater suffering in the poorer, slum neighbourhoods only contributed to the blasé responses of city leaders. Epidemics were interpreted as punishments for moral turpitude – in much the same way that today’s illnesses linked to being overweight are. It was only very slowly that such attitudes – deeply rooted in religious notions of individual guilt – gave way to public health measures.


But then this was an era before the mechanisms for the transmission of diseases was understood, indeed in an era before even the idea of germs as tiny, invisible life-forms was fully accepted. And so it seemed only reasonable to middle-class New Yorkers that diseases like cholera would hit working-class neighbourhoods the hardest. It was seen as proof of their moral depravity.
Hand bill from the New York City Board of Health, 1832. Wikimedia Commons

Meanwhile, businesses fought against public sanitation proposals fearing increased costs – in much the same way that the food industry resists or subverts public health initiatives as the investigative journalist, Michael Moss, in particular has detailed. And like today, the business interest was often backed by politicians. The hazards back then were not ambiguous things such as sugary soda drinks or ready meals, but rotting animal carcasses and mountains of refuse. Yet the opposition to change was similar – every improvement had to be fought for.


So what are the factors that push poorer people towards unhealthy eating? Food and health policy expert Martin Caraher has explained that food choices are massively influenced by factors such as income, knowledge and skills. Others have highlighted the fact that eating well invariably involves more food preparation time. Yet such explanations don’t fit many cases, indeed seem dangerously retrospective. What is sure is that you cannot deal with the obesity epidemic by taxing popular snacks, anymore than you could deal with rocketing suicide rates by taxing sales of rope.
The ConversationThe point is that we need to collectively tackle the places where obesity germs breed – in stressed communities characterised by insecure and erratic employment, inadequate education, stress, depression and a lack of social cohesion. That this requires an enormous shift in public priorities is only to be expected – but the consequences of not acting are far worse.


Martin Cohen, Visiting Research Fellow in Philosophy, University of Hertfordshire
This article was originally published on The Conversation. Read the original article.

Thursday, 8 February 2018

Explainer: how Facebook has become the world's largest echo chamber

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Is there an echo here? Reuters/Benoit Tessier
Megan Knight, University of Hertfordshire
I began my research career in the last century with an analysis of how news organisations were adapting to this strange new thing called “the Internet”. Five years later I signed up for Twitter and, a year after that, for Facebook.


Now, as it celebrates its 14th birthday, Facebook is becoming ubiquitous, and its usage and impact is central to my (and many others’) research.


In 2017 the social network had 2 billion members, by its own count. Facebook’s relationship with news content is an important part of this ubiquity. Since 2008 the company has courted news organisations with features like “Connect”, “Share” and “Instant Articles”. As of 2017, 48% of Americans rely primarily on Facebook for news and current affairs information.


Social networks present news content in a way that’s integrated into the flow of personal and other communication. Media scholar Alfred Hermida calls this “ambient news”. It’s a trend that has been considered promising for the development of civil society. Social media – like the Internet before it – has being hailed as the new “public sphere”: a place for civic discourse and political engagement among the citizenry.


But, unlike the Internet, Facebook is not a public space in which all content is equal. It is a private company. It controls what content you see, according to algorithms and commercial interests. The new public sphere is, in fact, privately owned, and this has far-reaching implications for civic society worldwide.


When a single company is acting as the broker for news and current affairs content for a majority of the population, the possibility for abuse is rife. Facebook is not seen as a “news organisation”, so it falls outside of whatever regulations countries apply to “the news”. And its content is provided by myriad third parties, often with little oversight and tracking by countries’ authorities. So civic society’s ability to address concerns about Facebook’s content becomes even more constrained.

Getting to know all about you

Facebook’s primary goal is to sell advertising. It does so by knowing as much as possible about its users, then selling that information to advertisers. The provision of content to entice consumers to look at advertising is not new: it’s the entire basis of the commercial media.


But where newspapers can only target broad demographic groups based on language, location and, to an extent, education level and income, Facebook can narrow its target market down to individual level. How? Based on demographics – and everything your “likes”, posts and comments have told it.
This ability to fine tune content to subsets of the audience is not limited to advertising. Everything on your Facebook feed is curated and presented to you by an algorithm seeking to maximise your engagement by only showing you things that it thinks you will like and respond to. The more you engage and respond, the better the algorithm gets at predicting what you will like.


When it comes to news content and discussion of the news, this means you will increasingly only see material that’s in line with your stated interests. More and more, too, news items, advertisements and posts by friends are blurred in the interface. This all merges into a single stream of information.


And because of the way your network is structured, the nature of that information becomes ever more narrow. It is inherent in the ideals of democracy that people be exposed to a plurality of ideas; that the public sphere should be open to all. The loss of this plurality creates a society made up of extremes, with little hope for consensus or bridging of ideas.

An echo chamber

Most people’s “friends” on Facebook tend to be people with whom they have some real-life connection – actual friends, classmates, neighbours and family members. Functionally, this means that most of your network will consist largely of people who share your broad demographic profile: education level, income, location, ethnic and cultural background and age.


The algorithm knows who in this network you are most likely to engage with, which further narrows the field to people whose worldview aligns with your own. You may be Facebook friends with your Uncle Fred, whose political outbursts threaten the tranquillity of every family get-together. But if you ignore his conspiracy-themed posts and don’t engage, they will start to disappear from your feed.
Over time this means that your feed gets narrower and narrower. It shows less and less content that you might disagree with or find distasteful.


These two responses, engaging and ignoring are both driven by the invisible hand of the algorithm. And they have created an echo chamber. This isn’t dissimilar to what news organisations have been trying to do for some time: gatekeeping is the expression of the journalists’ idea of what the audience wants to read.


Traditional journalists had to rely on their instinct for what people would be interested in. Technology now makes it possible to know exactly what people read, responded to, or shared.
For Facebook, this process is now run by a computer; an algorithm which reacts instantly to provide the content it thinks you want. But this fine tuned and carefully managed algorithm is open to manipulation, especially by political and social interests.

Extreme views confirmed

In the last few years Facebook users have unwittingly become part of a massive social experiment – one which may have contributed to the equally surprising election of Donald Trump as president of the US and the UK electing to leave the European Union. We can’t be sure of this, since Facebook’s content algorithm is secret and most of the content is shown only to specific users.


It’s physically impossible for a researcher to see all of the content distributed on Facebook; the company explicitly prevents that kind of access. Researchers and journalists need to construct model accounts (fake ones, violating Facebook’s terms of use) and attempt to trick the algorithm into showing what the social network’s most extreme political users see.


What they’ve found is that the more extreme the views the user has already agreed with, the more extreme the content they saw was. People who liked or expressed support for leaving the EU were shown content that reflected this desire, but in a more extreme way.

The ConversationIf they liked that they’d be shown even more content, and so on, the group getting smaller and smaller and more and more insular. This is similar to how extremist groups would identify and court potential members, enticing them with more and more radical ideas and watching their reaction. That sort of personal interaction was a slow process. Facebook’s algorithm now works at lightning speed and the pace of radicalisation is exponentially increased.


Megan Knight, Associate Dean, University of Hertfordshire
This article was originally published on The Conversation. Read the original article.