Living to a 150

Some politicians are making big claims about longevity to justify their health and social policies. Are our politicians on the far right simply fantasizing about living longer? Is this why they tell us good health investment should be directed towards curative research alone while everything else to do with health is lying under a precariously balanced metaphorical bread knife. How would you like that sliced – thin or sandwich?  From a cynic’s point of view this claim might simply be about appealing to the core of individualism and what’s in it for me? An old tactic repackaged.

Sure many scientists are making claims about future generations reaching incredible ages but I am sure they will agree at this point in time these are theories not proven fact, possible, even likely, but still theoretical.  Certainly our average life expectancy has risen as health care and living conditions have improved. Hans Rosling is very entertaining on this issue.

It is a fact that better access to health services and better living and working conditions improve the overall health of a population. One day some people might live to 150 but these results depend on future discoveries and advancements in biological interventions such as gene therapy. Such projections are speculative and assume scientific progress will continue uninterrupted and treatments will be equally affordable and available to everyone. Living longer, if indeed we do, might be the privilege of some people and not others depending on the social policies we choose to adopt.

My argument goes like this. In my opinion, human beings have always been a pretty arrogant lot. We really do believe we are superior – to other animals, climate etc etc.  We particularly hang on to the belief that we can tame nature and we do – to a point. How many examples of nature doing what it does, do we need to show us that although we might be on top for a while it won’t necessarily last – at least not without some counter reaction. A prime example is antibiotic use and the development of antibiotic resistance . When we triumph over one disease, a new one seems to emerge to take its place – smallpox, AIDS, Ebola, take your pick.  According to one recent study, although average life expectancy is higher, this generation has a different set of health issues – more metabolic disease.   The effect of this shift in disease on our future life expectancy is unknown but can be hypothesised. We already know the long term impact of these diseases on our health but on the other hand we don’t know the influence of future medical treatments yet to be discovered and made available.

There are other factors to consider when contemplating our longevity. We have known for some time health is more than biological and that social factors and social policies impact on our health.  We only need to look at work on inequality and studies on the health of particular, improverished populations such as the people who live in the Gorbals, south of the river Clyde in Glasgow.

Alarmingly social policies and where governments choose to invest does influence longevity and health. We only need to look at health outcomes for Indigenous peoples in places like Australia and Canada and recent findings that life expectancy has reduced in some areas of the UK. This backward shift is being linked to the reduction of services that maintain health and well-being. Even if some people manage to live to 150 it may not happen for everyone equally. Assuming good genes and discoveries in curative and genetic medicine, all people will still need access to good healthcare. The seeming dominance of far right ideologies that promote policies of user pays, a sole focus on individual responsibilities, privatisation and purely biological approaches to health combined with a failure to address inequalities will continue to negatively impact on the health of many people. It will mean only those who can afford access to services will reap health benefits.

Sure average life expectancy has improved but has the end point actually changed? We have always had centenarians and a very few sparky souls that live to extraordinary ages, a rare few reported to be a 120 or slightly more.

This is not new and I doubt if modern medicine has had too much to do with it. Perhaps someone can answer this for me – have we actually extended our lives beyond the upper limit of our bodies’ use-by date? To put this simply, has the oldest age anybody has ever lived actually changed? Is there an upward trend at that upper limit? Difficult question as many long lives are unverifiable. I don’t think so – it may come but it will depend on more than biology and must include the social. Perhaps also there is a certain truth in that when we cure one thing, something else emerges – whether this is disease, the impact of climate change or even the stuff people are pumping into their bodies to at least appear younger. For the moment, future generations living to a 150 remains predictive and speculative. We all need a better approach to health than one based on profit or policies that make it harder for people to access healthcare or improve their lives. And so if it does come true and we manage one-day to live past our current use-by date, I hope it comes true for everyone not just a few.

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Message to politicians- try living on disability support

Cutting welfare for people with disabilities is a vile and savage act.  Any crediting of intent would put our politicians on par with terrible people, so I shall stick with ignorance as the cause. I have worked with people with physical and other disabilities for much of my career and I know pensions and entitlements are more than just subsistence living – it is about survival. People with disabilities have to pay rent, eat and support dependents like anyone else but they also have to pay for much, much more than the rest of us.

Like everyone else, people with disabilities work if they can – but it takes more than personal will to get a job and maintain employment. Putting qualifications and education aside, employers need to provide flexibility, support and accessible environments. Tried getting around in a wheelchair lately? – even an electric one?  An electric chair (if you can afford one) can be worse – try turning around in a small office or corridor or even getting through a doorway. Some people need personal assistance in the workplace.  For example, a person might need help to empty a catheter bag, or be able to pay for a device that lets them empty a catheter bag onto a grassed area, or even to be repositioned in a wheelchair to avoid pressure sores that can kill you (remember superman?), or just eat lunch. Who is going to pay for assistive technology in the workplace? People when they do work often lose access to government subsidies for equipment and other items as a result of being employed.

People with disabilities already pay significant co-payments for equipment which can include wheelchairs, shower chairs, hoists, pressure cushions, home modifications, disposable needs such as bladder management disposables – then there’s medication and personal carers. There are subsidies but they are limited. Often people need more care because they can’t afford the modifications or equipment that would increase their independence.  There are even costs associated with an assistant animal if they can get one. People in rural and regional areas face higher expenses with the delivery of essential needs. Some people face costs associated with ventilators and need airconditioning because they don’t have temperature control – without it death is a real possibility.  Dare I state the obvious, power costs.  I have worked with people with all these needs and many of them are working and most would work if they could find a job. Too many people are still living inappropriately in nursing homes (some on the streets) because they can’t afford independence. People with all types of disabilities of all ages have hidden expenses that people without physical or mental disabilities don’t see.  It is more than just paying rent and eating. We should be going forward not backward.

Message to politicians: Try living for a year on a disability support pension with the same expenses and environmental limitations as a person with a disability and let’s see how well you fare.

Leave to the market what belongs in the market

I am not an economics expert by any definition but I do know that economies cannot be run like household budgets. Spending is a matter of priorities (including long term benefits) not necessarily cutting social services that cannot fund themselves.  money

It is very clear that some social responsibilities like education and health, if run for everybody in society do not make money. Consequently, when these services (that are basic universal human rights) are expected to pay for themselves, they will fail and poorer outcomes for society as a whole are the inevitable outcome. Instead of achieving what these services are intended to do, the goals become financial and ‘staying within budget” rather than say optimising health or providing the best possible education. If you don’t spend money on programs designed to help people with complex issues, find work or provide income support for people to survive, it is not just those people who will suffer. Social problems of all kinds will get worse. Increases in crime rates are inevitable not to mention poorer health outcomes and a less educated society. On one hand politicians blame and punish people who cannot find work, while on the other industries are closing down, robot technology is reducing the numbers of jobs, jobs are sent offshore, services for getting people into work are cut, and older people are forced to work longer. The health and well-being of society is closely linked to social inclusion, access to education, health and work, and feelings of security (and I don’t mean boarder security!) not to where the free-market is left to determine all things in society.

The federal treasurer, Jo Hockey, now pushing for privatisation and fee increases in higher education once protested for free education. How easily the worm turns.

Nor is everything black and white. It is not tax payers vs users of health services – they are not mutually exclusive. Nor are all the other dichotomies constructed by politicians. The reality is most social welfare spending benefits the highest income users in Australian society including our politicians. The ‘welfare’ demonised by some politicians is a very small proportion of social spending. In my view, access to education and health helps everyone in society. For these reasons, I think these services (and they are services not an optional extra) should be the same and free for all (yes I know a Utopian fantasy – but we did have it once). In my opinion, no public funding should go into any private health or education system (yes I can hear those screams). Society does need to pay for those things that make all of society better via a truly fair tax system. There some basics we should just expect. The rest of world is heading towards developing education and health for all while Australia, the UK and the US are going in the opposite direction increasingly limiting them to people who can pay. Who will be better off in the long run? Maybe none of us because the ideology-driven individuals who blindly believe the free market is the answer to absolutely everything, also don’t believe in climate change or science and probably support the teaching of creationism in schools too.

So in my view, it comes down to what we value in society and what sort of society we want to live in. An equal society has an unavoidable cost that can only be shared fairly in society. Leave to the market what belongs in the market – people deserve better.

What do social workers do in hospitals?

It was a pleasure to interview Shelley Craig and Barbara Muskat about hospital social work this week. Their research is published in an article called Bouncers, Brokers, and Glue: The Self-Described Roles of Social Workers in Urban Hospitals. What they have to say hospitalwill resonate with any social worker who has ever worked in an urban hospital. The findings of their research could pretty much describe hospital social work anywhere in Canada, the US or Australia. Social workers do great work and like the rest of the health workforce are under increasing pressure. Consequently, roles are changing and the profession must get better at articulating the high level of skills possessed by social workers to do what they do on a daily basis. It is important for social workers to take charge of defining their own roles rather than letting others do it for them. In brief, social workers in this study described 7 roles they regularly performed in hospitals in addition to therapeutic work with individuals, groups and families.

1. The Bouncer – Who gets called in to see the ‘difficult’ or distressed patients or families? Enter the social worker who uses assessment, diplomacy, arbitration, mediation, skilled communication and problem solving skills to calm volatile situations.

2. The Janitor – The role taken on when noone else knows what to do with it – filling the void and cleaning up. Finding clothes for a person so they can leave the hospital, housing a pet, or sorting out the car illegally parked outside. The list is endless.

3. The Glue – Social workers hold it all together – the people in hospital, their families and other important people in their lives, the team and the common purpose. Social workers are experts at systems, making linkages and ensuring the right people talk to each other.

4. The Broker – This role involves the active negotiation of service provision and ‘durable discharges’. Durable discharges are those most likely to last.  Discharge planning is often misunderstood. It is much more than completing a few tasks or making a few phone calls.  It is actually a complex,  in-depth process that must meet the unique, individual needs and circumstances of each person leaving hospital or it probably won’t last.

5. The Firefighter – puts out those fires, those urgent and immediate problems that are sometimes created by others.

6. The Juggler – self-explanatory! Multi-tasking at multiple levels.

7. The Challenger – or the advocate. Helping people understand biomedical approaches, making sure their wishes are heard, their needs understood and what is happening to them communicated to them in what can only be described as complicated and often confusing bureaucracies.

Shelley and Barbara talk in depth about social workers in hospitals with me on Podsocs. The podcast is due for release early in 2014 and is guaranteed good listening.