Valuable, not vulnerable

vulnerable

This week (23 June 2020) I gave these remarks at an event organised by the London School of Economics, alongside Baroness Jane Campbell, Liz Sayce and Clenton Farquharson.

Acknowledging our vulnerability as human beings is not a bad thing. To be alive is to be vulnerable and hence acknowledging this is a foundation of empathy, which in turn is a foundation of building a ‘larger us’ and moving beyond the divisive ‘them and us’ that’s holding us back. Compare the inclusive approach of New Zealand’s Prime Minister Jacinda Aderne’s to President Trump being judged not by the content of his character but by his ability to walk down a ramp or how he drinks a glass of water….

It’s also crucial that inequalities in the risks we face are recognised. For example:

  • Children living in poverty more likely to be killed in road traffic accidents
  • Life expectancy of women with learning disabilities 17 years less than average life expectancy
  • BAME communities face profound structural disadvantage and discrimination
  • A third of all lives lost to Covid-19 in the UK have been those of disabled people.

Accepting that vulnerability as part of the human condition and acknowledging unequal risks is not the problem.

The problem stems from categorising a group of people as ‘the vulnerable’ or as ‘our most vulnerable citizens’.

The acid test of whether people profit from being labeled this way is: does it make us all safer and better able to lead lives we have reason to value?

My hypothesis is that it does not

It masks and amplifies stereotypes, prejudice, division and inequalities that make people more at risk or which diminish people’s freedom and opportunities

It overlooks the dynamic nature of risk, framing it all as inherent to the persons own characteristics rather than their context and circumstances.

In doing so, it precludes some people who are acutely at risk because of their circumstances but who not categorised as vulnerable, it misattributes causes, meaning solutions are missed and displaces accountability for action.

vulnerable peak

The word ‘vulnerable’ isn’t in common use. As this analysis of Google Trends shows, the word has not been in general use, but reached its peak along with the Covi19 pandemic in April 2020 and is now in retreat.

Now of course this was a period when the terms ‘clinically vulnerable’ and ‘clinically extremely vulnerable’ entered our language to denote people who were advised to take additional precautions. People were no doubt searching to understand who this applied to. But it was also a period where this specific terminology was coupled with increased references by politicians and others to ‘protecting the elderly and vulnerable’ or ‘protecting the most vulnerable’. And what a more detailed look at the trend shows is that it was the word ‘vulnerable’ alone that drove up the peak – not the specific terminology.

But while this graph suggests it’s not a word that has not been in common everyday us, we do know that it is a word that is strongly associated with disabled people, older people, with children labeled as having Special Educational Needs and with those who draw upon social care.

In 2018 the Frameworks Institute conducted a series of on the street interviews with members of the public asking them what came to mind when they heard the words social care and why we have a social care system. Almost all respondents spontaneously said social care existed to ‘look after vulnerable people who can’t look after themselves.’

While describing people as vulnerable implies extra concern and a will to protect, it is at once othering – fostering a sense of ‘them and us’ rather than ‘a larger us’. It was notable that in the on the street interviews no one talked about their own future selves or likened those requiring social care to themselves.

And that’s perhaps not surprising as the word is imbued with meaning that seems more likely to diminish the equal worth and status of those to whom the label is applied.

It conveys weakness, the lack of capacity and agency of a person to look after themselves, the increased likelihood that they might come in harms way or be taken advantage of. In the context of welfare reform debates it is used to demark a group of people who cannot be expected to assume the same responsibilities as other citizens.   It is employed to invoke compassion and to secure special ‘protection.’ It is also used instrumentally by people – particularly politicians – who wish to make their opponents appear unkind.

In doing so, it undermines status and opportunities by painting people as lacking agency or as not being in possession of any productive potential.   It promotes the idea that society’s primary responsibility should be to act as custodians, not to respect and promote disabled and older people’s freedoms. This in turn orientates public policy and services towards a culture of liability for disabled people, in which people’s freedom’s are curtailed rather than supported

300px-Mixed_stereotype_content_model_(Fiske_et_al.)

Prejudice towards older and disabled people has been described as ‘the soft bigotry of low expectations’. People are regarded not as a threat, but not as productive or with a valuable contribution to make. The word ‘vulnerability’ embodies and amplifies these ideas.

But prejudice also causes us to see others who are at risk as not vulnerable. For example, black teenage boys face the greatest risk of being a victim of knife crime but would rarely be described as vulnerable. Those deemed ‘not vulnerable enough’ to receive disability benefits also face so called ‘contemptuous prejudice’ because they are considered to have agency and hence be culpable, or criminal.

For many disabled people seeking support to lead their lives from the State this operates like the medieval ducking stool: too much agency and potential for self direction and they will be denied support; deemed sufficiently vulnerable to be worthy of support means not having much of a life.

It’s also important to say that the implied ‘warmth’ here does not always act as a shield against hostile acts. Low expectations underpin narratives of burden. Research for #socialcarefuture found that vulnerability is a word used alongside metaphors of a growing threat and burden from our ageing population such as ‘demographic timebomb’ and ‘silver tsunami’.

As history has shown, the consequences of such narratives can be deadly.

Today too, the language of vulnerability & the meaning it carries has made people more vulnerable.

We’ve seen ethical guidelines concerning access to acute care for treatment of Covid19 which include quality of life and social value judgments. We have heard announcements of individual deaths or the overall death toll accompanied by the qualification that people were either elderly or had an underlying health condition, while most of us should only expect a ‘mild’ illness. We’ve heard respected scientists openly wondering whether we should be counting deaths from Covid 19 of those who would die soon anyway. We’ve read opinion pieces in national newspapers freely discussing whether whether protecting the lives of vulnerable people is too high a price to pay, or those which have said the old should now have to pay for the costs of the recovery as the price of being protected.

carehomewindow

Does this perhaps holds clues as to the terrible death toll among people who were living in care homes? The government claims to have prioritised the safety and wellbeing of people in care homes from the outset. Not one person living in, working in or with a relative living in a care home agrees.   Their vulnerability saw them downgraded, not earning extra protection.

There is a flipside to this too. Because it is not considered a positive term it was clear when government first began referring to everyone over the age of 70 or with specific health conditions as ‘the elderly and vulnerable’ that lots of people to whom it applied disassociated themselves.

Language rooted in paternalistic benevolence (shielding the elderly and vulnerable) led initially both to othering (they must mean someone else), distancing (I’m going to argue they don’t mean me) and rejection of the advice (I don’t need protecting).  This may have changed in time, but in those early crucial days, how many became avoidably ill because the term vulnerable was used to describe the at risk group to which they belonged?

So, a term that is presumed to denote protected status in practice others and excludes, it diminishes people’s status, it obscures the causes and diverts us from the solutions and it excuses society for failing to uphold people’s human rights.   Where can we go from here?

As the UN Committee on the Rights of Persons with Disabilities advises, we must see risk as a dynamic question, not a fixed one, taking account of both intrinsic and extrinsic factors and their interaction with one another. And this must be set against an expectation that everyone should enjoy their human rights on an equal basis with others:

“Persons with disabilities are often wrongly perceived to be inherently vulnerable, when it is attitudinal, environmental and institutional barriers that result in situations of vulnerability.

While many persons with disabilities have health conditions that make them more susceptible to COVID-19, pre-existing discrimination and inequality means that persons with disabilities are one of the most excluded groups in terms of health prevention and response actions and economic and social support measures, and among the hardest hit in terms of transmission risk and actual fatalities.”

United Nations Committee on the Rights of Persons with Disabilities statement on Covid 19 and the human rights of persons with disabilities

To those ends, we need to describe differences in risk as inequalities, not vulnerabilities.

Moreover, in describing the risks people face, we must not add to them by using language that makes people less safe.

So I’m going to finish my remarks here by sharing a tweet by a school nurse that went viral back in April and which for me neatly sums up everything I’ve wanted to say:

@viki98015881 Met with a yr10 boy last week for socially distanced walk and talk. Wanted to make sure he wasn’t hungry. He explained to me that he could go into school if he wanted as was on the ‘valuable’ list. My heart swelled. I didn’t correct him @WeSchoolNurses

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