beating the odds book

Capability and Resilience:Beating the Odds

cap+res pages 22/8/06 4:43 pm Page C1

Capability and Resilience:Beating the Odds

Edited by Professor Mel Bartley

cap+res pages 22/8/06 4:43 pm Page 1

2 CAPABILITY AND RESILIENCE: BEATING THE ODDS

INEQUITIES in health across Europe remain persistent.Differential access to medical and health care services,though very important, cannot alone explain thepersistence (and in many instances increase) of healthinequities among different social classes or segments ofthe population.

Historically, approaches to the promotion ofpopulation health have been based on a deficit model.That is, they tend to focus on identifying the problemsand needs of populations that require professionalresources and high levels of dependence on hospital andwelfare services. The deficit models are very importantand indeed necessary to identify levels of needs andpriorities. But they have some drawbacks.

Deficit models tend to: define communities andindividuals in negative terms, disregarding what ispositive and works well in that particular population; seeidentified needs as requiring external actors to assess andsolve them; and also put pressure on disadvantagedcommunities to prove that they are worse off than othersto justify the expenditure of resources, thus decreasingcommunity self-esteem.

In contrast, asset models tend to accentuate positivecapability to identify problems and activate solutions, whichpromotes the self-esteem of individuals and communities,leading to less reliance on professional services.

Work carried out by the WHO has recognized that anassets-based approach to health promotion is crucial. Theinnovative programme of work described in this bookletmakes a valuable contribution to our furtherunderstanding of the processes for creating,strengthening and protecting assets in individuals,communities and organizations that protect and promotepopulation health. In doing so, it helps to redress thebalance between the amount of evidence of effectivenessthat comes from a pathogenic (biomedical) model ofdisease and the amount that encompasses an assets-based (people-centred) approach to health.

The cost-containment debates underway withinEuropean health systems will only be resolved by viewingthe population itself as the most significant healthresource a co-producer of health rather than simply aconsumer of healthcare services. Assets-basedinterventions, aimed at strengthening communitycapabilities and promoting independence and autonomy,can make a significant contribution to health protection.

Antony Morgan, Research Fellow, Karolinska Institute,Stockholm, SwedenErio Ziglio, Head, WHO European Office for Investment forHealth and Development

RESILIENCE always seems admirable. To have overcomeadversity, to have done it against the odds, is evidencethat someone has got what it takes the right stuff.

But what is the right stuff? In this booklet we get adistillation of the findings of research which has tried toidentify it. Usually adversity is taken to mean social andeconomic disadvantage being lower down the socialhierarchy. And often resilience turns out to involvesupportive families and communities, good educationalopportunities and services which are delivered withenough consideration and respect not to make theproblems worse. Positive social, emotional andeducational experiences can partially offset the effects ofmaterial deprivation.

But so often it is the material disadvantages anddivisions themselves which undermine supportivecommunity and family life. Material divisions are sociallycorrosive. Relative deprivation adds to the stresses offamily and community life, so removing the sources ofresilience.

Commendably, the authors of this booklet do notclaim to have found cheap effective shelters againstadversity. Although we may once have hoped thatincreasing resilience was a way of saving money by

proofing people against the difficulties they face, there islittle reason to think that health benefits bought this wayare any cheaper than those which would come fromreducing the underlying disadvantage itself. Nevertheless,society surely has a responsibility to provide services tominimise the harm which inequality does to peoples lifechances. Policies to increase resilience to the healtheffects of unemployment are no substitute for more jobs;nor is increasing resilience to the life-long effects of childpoverty a substitute for good family support.

We can perhaps see upward social mobility asevidence of one kind of resilience. Interestingly,internationally comparable measures of social mobilitysuggest that it is much greater in the relatively egalitarianNordic countries than it is in more unequal countries likethe USA and Britain. Where inequalities are smallerperhaps resilience is less at a premium.

Some societies seem to demand more resilience thanothers. But wherever the bar is set whether a society hastwo or twenty percent unemployed, or five or twenty-fivepercent of children growing up in poverty it is alwaysthe most vulnerable who suffer the consequences.

Professor Richard Wilkinson, Nottingham University

FOREWORD


CAPABILITY AND RESILIENCE: BEATING THE ODDS 3

INTRODUCTION CONTENTS

FOR MANY YEARS research has documented the harm tophysical and mental health and well-being that can be causedby poverty and by adverse life events. At the same time,however, other studies have shown that not everyone isaffected in the same way. There are some people who seemable to beat the odds and achieve a high level of well-being.Even more important, there are features of a persons past andpresent life that can support them against adversity. In achanging world, and one in which, increasingly no man (orwoman) is an island, who harms one harms us all, moreattention is being paid to more effective ways to help thosewho fall on hardship.

This booklet sets out the evidence we have at present onthe best ways to promote capability and resilience, two wordsthat are used to refer to the ability to react and adapt positivelywhen things go wrong. Each chapter deals with a differentaspect. Some of the challenges that people may face arepresented by situations that are pretty much a normal part oflife, such as education, getting a job and just growing older.Others are more unusual such as the kinds of crisis that facepeople when employment disappears from the area in whichthey live.

But what the research shows is that there are commonfactors that make resilience possible and increase peoplescapability. These mostly have to do with the quality of humanrelationships, and with the quality of public service responsesto people with problems. These two factors, in turn, are closelyrelated to each other. Good public services enable andencourage people to maintain social relationships, but badlyprovided ones can create social isolation. There are very greatimplications from this work, as we can also see from theevidence that it is social relationships that are most effective inmaintaining resilience in the face of adversity.

The research also reveals the enormous capabilities andresilience that people already show in their everyday lives andunder crisis conditions. This is by no means, however, to saythat poverty or conflict do not matter. Even the most resilientchild from a poverty-stricken area, for example, will never do aswell in life as a more ordinary child from a wealthy background.To see this has to make us ask, well, what would that resilientchild have been able to do, and to contribute to thecommunity and the economy, if he or she had never had toovercome disadvantage? A society that maximises thecapability for all citizens equally is also one that makes best useof the many assets for well-being and social and economicdevelopment that already exist in communities.

Professor Mel Bartley, UCL

Published by the UCL Department of Epidemiology and PublicHealth on behalf of the ESRC Priority Network on Capabilityand Resilience. (2003 2007)Project number RES-337-25-0001W: www.ucl.ac.uk/capabilityandresilience

ISBN 0-9527377-9-5 ISBN 978-0-9527377-9-7

Correspondence: c&[email protected]

Copyright 2006 UCL Department of Epidemiology andPublic Health.All rights reserved. The UCL Department of Epidemiologywelcomes requests for permission to reproduce or translatethis publication, in part or in full. The views expressed bycontributors or the editor do not necessarily represent theopinions of the UCL Department of Epidemiology and PublicHealth or the ESRC who funded the research on which thisbooklet is based.

Cover picture: Library photo posed by models. Assunta Del Buono/John Birdsall Photo Library www.johnbirdsall.co.uk

Foreword 2

Introduction 3

1. Resilience: Expect to fail 4 encourage to strive

2. Capability 6

3. Supporting children and 8adolescents: All you needis love?

4. Increasing life chances 10through education

5. Adult adjustment: live 12well, work well, love well

6. Beating poverty 14

7. Adult consequences of 16childhood adversity

8. Area deprivation 18

9. Social participation, 20social support and resilience in older people

10. Designing services that 22enhance resilience andwell-being

Conclusion 24

Contributors 24



THE NOTION of resilience refers to theprocess of withstanding the negative effectsof risk exposure, demonstrating positiveadjustment in the face of adversity or trauma,and beating the odds associated with risks(see Figure 1 opposite).

The table shows four possiblecombinations of risk and outcome. Peoplewho are exposed to low levels of risk andhave positive outcomes (square A) might bethought of as having the kind of favourablelife experience that more or less everyonewould prefer. The people in square D haveexperienced adversity which has resulted intheir mental or physical health taking a turn

for the worse. The people in square B haveexperiences of high risk and yet havemaintained good health. These are the peoplewho are demonstrating resilience: positiveadjustment in the face of adversity.

In our research we have concentrated onresilience in the face of socio-economicdisadvantage and poverty. We know frommany studies that people who experiencesocioeconomic disadvantage have muchpoorer prospects throughout their life course.It is harder for them to do well at school, toget good, secure, and well paid jobs, and toremain healthy and happy in later life.

There are, however, quite a few people

Resilience: Expected to fail encouraged to strive

People who have strong and supportive relationships at homeand at work are to some extent protected against the damagedone to health and well-being by poverty and socialdisadvantage. But major improvements in well-being requirethe abolition of poverty and reductions for all in economicand social inequality.

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a The key to giving young people a good start inlife is to help their parents. Uneven life chancesstart at birth, and peoples responses to adversesituations are shaped by their earlier experiences.

a Increasing the living standard of poor familieswith children, including improvement of socialhousing, schools and other public services, willhave the greatest impact in reducing the risk ofadjustment problems and poor health.

a Carefully designed preventive interventions canbe more cost effective than attempts to reducemaladjustment after it has become wellingrained.

a The living standards of the worst-off should bebrought closer to the average, bringing with it afairer distribution of resources.

POLICY IMPLICATIONS

who go through periods of poverty,unemployment, family breakdown and othersocial disadvantages and yet go on to leadhealthy and rewarding lives. The findings ofour research suggest the importance of socialrelationships, of ties to the community, andsocial interactive relationship skills as keysources of protection. Opportunities forindividuals to experience social andemotional support, recognition for theirstrengths and capabilities, and thedevelopment of social skills can increase theirfeelings of competence and self-belief, andencourage positive planning for the future.

As important as it is to enable people tobuild up strengths and capabilities throughsupporting family and communityrelationships, these resources do notextinguish the effects of risks such as povertywhich should be the main target forpreventive strategies. Living in adverseconditions of poverty and disadvantage givespeople less opportunity to build up and lesscapability to maintain good physical ormental health. Poorer neighbourhoods are farless likely to have good schools, pleasantparks and play areas for example. We cannotexpect individuals to develop resilience all bythemselves: this could put us in danger ofblaming the victim instead of investigatingunderlying obstacles and barriers to positivefunctioning. Throughout our whole lives weare influenced by our most importantrelationships and by the social circumstancesthat surround us such as the types of schoolingand training available, job opportunities, andsocial or legal barriers that limit choices on thebasis of ones sex, race or age.

Outcome

Positive

Negative

Low

A. Favourableexperience of life

C. Unexpectednegative outcome

High

B. Resilience: Unexpectedpositive outcome

D. Risk and vulnerability

Adversity

KEY SOURCES Luthar SS, Cicchetti D, Becker B. The construct ofresilience: A critical evaluation and guidelines for futurework. Child Development 2000; 71(3): 543-562.

Masten AS, Best KM, Garmezy N. Resilience anddevelopment: Contributions from the study of childrenwho overcome adversity. Development andPsychopathology 1990; 2: 425-444.

Rutter M. Psychosocial Resilience and ProtectiveMechanisms. In: Rolf J, Masten AS, Chichetti D,Nuechterlin KH, Weintraub S, eds. Risk and Protectivefactors in the Development of Psychopathology. NewYork: Cambridge University Press, 1990; 181-214.

Schoon I. Risk and Resilience. Adaptations in changingtimes. Cambridge: Cambridge University Press, 2006.

Werner EE, Smith RS. Overcoming the Odds: high riskchildren from birth to adulthood. Ithaca: CornellUniversity Press, 1992.

FIGURE 1: IDENTIFICATION OF RESILIENCE



THE BASIC notion of capability, introduced in1979 by Amartya Sen, has become one of themost influential theories of social policy andaction. According to Sen, Capability is thus akind of freedom: the substantive freedom toachieve alternative functioning combinations(or, less formally put, the freedom to achievevarious lifestyles).

The well-being of an individual or acommunity can be assessed on the basis ofthe opportunities they have or choices theycan exercise. Often these opportunities andchoices cannot be measured purely on thebasis of income, or of the material goods theypossess. Capability can often only beincreased by some kind of change in thephysical or social environment. We mightthink of an increase in capability assomething that increases the choices of

action available for the same amount ofmoney.

A good way to understand capability is totake an example, such as the introduction of atram service between Croydon and NewAddington, UK. The New Addington Estatewas developed to solve the housing needs ofthousands of people. But the estate hadrather few amenities such as shops orentertainment. So residents had to get tonearby Croydon to meet their needs. Did thepeople living on the estate enjoy a good life?If our concerns are with meeting a basicmaterial need for shelter, we would say yes.Good housing is vital to the people who livethere. However, there was widespreaddissatisfaction on the estate; people did notfeel that their quality of life was high.

In May of 2000, the Croydon Tramlink

Capability

Human well-being is determined by the substantive freedomof having opportunities and of exercising choices socialpolicy should enhance this freedom.

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43.5

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Capability (Human Development Index)Data: English Longitudinal Study of Ageing (ELSA) Wave 1

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started operating from New Addington. Whatdid the Tramlink add to the life of people ofNew Addington Estate to make it better? Itprovided greater choice in transport, as therewere now more frequent bus and tramservices. But perhaps most importantly, thetram is also easier for older people, those withmobility problems, and those with youngfamilies to get on and off. In this way, we cansay that the Tramlink has added to thecapabilities of the people on the estate. It hasopened up a whole new set of possibilities,and this is even more true for those withproblems of mobility, or with incomes that donot run to having a car, than for those withmore advantages.

Shifting the emphasis to capabilities hasenormous implications for social policy as it isa new way at looking at the world. One couldsee this in the United Nations DevelopmentProgrammes Human Development Index.The index measures three basic capabilities:living a long and healthy life, beingknowledgeable and enjoying a decentstandard of living. Many countries like CostaRica and Sri Lanka and states within countrieslike Kerala in India do surprisingly well interms of health and well-being, beating theodds stacked against them by their pooreconomic standards. We can draw up a leaguetable for areas of England and Wales, basedon the Human Development Index. If we dothis, we find that people in the areas withgreater human development regard theirquality of life to be higher (see Figure 2).

FIGURE 2: INDIVIDUAL QUALITY OF LIFE AT OLDER AGES ANDAREA CAPABILITY SCORE

KEY SOURCES Alkire S. Valuing Freedoms. Sens Capability Approachand Poverty Reduction. Oxford: Oxford UniversityPress, 2002.

Burchardt T. Identifying adaptive preferences usingpanel data: subjective and objective income trajectories.http://www.unipv.it/deontica/sen/papers/Burchardt.pdf Accessed March 31, 2005

Nussbaum MC. Women and Human Development: Thecapabilities approach. Cambridge: CambridgeUniversity Press, 2000.

Sen A. Development as Freedom. Oxford: OxfordUniversity Press, 1999.

Sen A. Capability and well-being. in M. Nussbaumand A. Sen (eds), The Quality of Life. Oxford: ClarendonPress, 1993.

a Policies can increase well-being by concentrating oncapability rather than merely on income and wealth.It is not just a question of the money or goodspeople have, but what these enable them to do.

a Improvements in public infrastructure such aseducation, training and transport can raise well-being without any change in individual income.

a Using measures based only on money, or onpossessions, does not give a good indication ofwell-being: some countries with lower per capitaincome have better levels of health and well-being than richer nations.

POLICY IMPLICATIONS



AS CHILDREN grow up, their environmentchanges, their competences develop, andthey continuously face new challenges. Howdo we know that a child is doing all right?Within most developed countries children areexpected to begin controlling their behaviourand obeying their parents at quite an earlyage. During the school years they areexpected to follow the rules of the school andto get along with peers. Academicachievement indicates adjustment duringadolescence. But at this stage of life, youngpeople also need to avoid problem behaviour,such as excessive violence and aggression, or

overindulgence in smoking, drinking, or drugtaking. This is also when a person begins toform close friendships, develop a sense ofself-confidence, and begin to feel able to planfor the future.

Adverse experiences in early life caninfluence the course of subsequentdevelopment, as well as the ways in whichindividuals respond to stressful eventsoccurring later in life. Yet, there are manypossible pathways, and early adversity doesnot necessarily lead to maladjustment. Youngpeople growing up in difficult materialcircumstances, being subjected to negative

Supporting children andadolescents: All you need is love?

The development of competence and skills in overcomingstressful situations is of great interest to parents and societyalike. Strong family relationships and structured activitiesenable young people to become independent adults,productive and responsive citizens.

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KEY SOURCESDuncan GJ, Brooks-Gunn J. Consequences of growing uppoor. New York: Russell Sage Foundation Press, 1997.

Haggerty RJ, Sherrod LR, Garmezy N, Rutter M, eds. Stress,Risk, and Resilience in Children and Adolescents: processes,mechanisms, and interventions. Cambridge: CambridgeUniversity Press, 1994.

Luthar SS. Poverty and Children's Adjustment.Developmental clinical psychology and psychiatry series; v.41. Thousand Oaks, CA: Sage Publications, 1999.

Schoon I, Parsons S, Sacker A. Socioeconomic adversity,educational resilience, and subsequent levels of adultadaptation. Journal of Adolescent Research 2004;19(4):383-404.


Ungar M. Nurturing Hidden Resilience in Troubled Youth.Toronto: University of Toronto Press, 2004.

1

Age 5Reading

Age 10Reading

Age 10Maths

Age 16Exams

Vulnerable (at risk) Resilient (despite risk)

Privileged low-achiever Multiple advantaged

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Children with good reading at age 5 and no economic problems in their family

Children with family economic disadvantage and low reading ability at age 5

Children with family economic problems but good reading at age 5

Children with low reading ability at age 5 but no family economic problems

attitudes and expectations may acquire ahard outlook that appears as problematic,when in fact these attitudes are protectivegiven the realities of their lives.

What are the important childhoodexperiences that help development andresilience in later life? Studies show thatchildren need their parents to providewarmth combined with structure. It is alsopositive if parents support children in theirschool work and have high, but reasonableexpectations. A stimulating and challengingschool environment is important, combinedwith well-organised out-of-school activities,such as sport, music, the arts, or practicalprojects.

However, a supportive family environmentmay not be sufficient to enable young peopleto cope with attending underfunded schools,or experiencing neighbourhood violence.Children showing initial positive adjustmentmay falter later, because support structuresare lacking (see Figure 3). Support is alsoneeded for crucial transitions such as schoolentry, move into secondary education,leaving school, and entry into the workforce.

This graph shows what happens tochildren with economically disadvantagedbackgrounds with above-average readingskills early in life (dark blue line). By the age of16, these clever but poorer children are doingworse in their exams than are theeconomically privileged children with lowerreading skills at age 5 (the green line). Highability in early life is not able to protectagainst the effects of childhood economicdisadvantage.

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FIGURE 3: EFFECT OF POVERTY ON EDUCATIONAL ATTAINMENT

a Support for emotional and social development isas important as help with school work for theformation of a fully rounded person able to copewith adversity in later life.

a The earlier intervention occurs, the moreopportunity there is to build up positive parent-child as well as home-school relationships.

a Development continues throughout andsupport for young people is vital throughout young peoples school careers as well as in thetransition from school to work.

a Interventions do not necessarily showimmediate benefits and longer periods ofintervention are more effective than shorterones. The aim should therefore be to fostersustainable programmes and services.

a Interventions should support community-ledactivities and integrated health and socialservice delivery, involving young people, as wellas their families, peers, and the widercommunity.

POLICY IMPLICATIONS



EDUCATION IS FUNDAMENTAL in breakingthe link between adversities in childhood andpoor health or reduced life chances inadulthood. Resources in the family, at schooland in the wider community can help youngpeople to achieve educational successdespite difficult circumstances. When we saythat education is a source of resiliencethroughout life, we mean that even if he orshe is born in poor circumstances, a personwho leaves school with some qualifications ismore likely to have good mental health, astable family life and a secure job withprospects. Even under conditions of social oreconomic disadvantage, the mental health ofadults who did well at school is protected (seeFigure 4).

Poverty during early life can have harmful

effects on the development of skills andknowledge. The longer a child remains livingin poverty, the greater the risk to educationalprogress. Even for children who do well inearly school years, growing up in a householdwhere there is no space for doing theirhomework, no books or other learningmaterials can mean that their progress isslowed down. However, studies have foundthat these negative effects of familydisadvantage can to some extent bedecreased. What is needed is a stimulatingand well-funded school with an encouragingwork ethos, that offers opportunities foractivities outside the normal schoolcurriculum. Where this is available, and wherefellow students have a positive attitudetowards education, it can make a lot of

Increasing life chancesthrough education

Promoting educational resilience is one of the most effectiveways to improve the health and social development of lessadvantaged children. Family problems can be overcome bywell-funded schools that provide a stimulating environment.

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Advantaged Disdvantaged

Poor exam results Good exam results

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Data from the National Child Development Study Policy implications

KEY SOURCESLuthar SS. Resilience and Vulnerability. Adaptations in the Context ofChildhood Adversities. Cambridge: Cambridge University Press, 2003.

Sacker, A. and I. Schoon Educational resilience in later life: resourcesand assets in adolescence and return to education after leavingschool at age 16. Social Science Research 2006 in press.

Schoon I. Risk and Resilience. Adaptations in Changing Times.Cambridge: Cambridge University Press, 2006.

Schoon I., Parsons, S., & Sacker, A. Socioeconomic adversity,educational resilience, and subsequent levels of adult adaptation.Journal of Adolescent Research, 2004, 19(4), 383404.

Wang MC, Gordon EW. Educational Resilience in Inner-City America:Challenges and Prospects. Hillsdale, NJ: Lawrence ErlbaumAssociates, 1994.

difference for a child who is at risk ofdropping out of school.

A stable community, where facilities suchas libraries and leisure centres provideopportunities for sports, hobbies and socialactivities, also has a positive influence on theability to learn. Teachers can support youngpeople and give them confidence in theirown abilities and higher aspirations forthemselves. Parents, even if their income islow, can help young people to stay in schooland gain some qualifications if they areinterested in their childs progress, show thatthey believe their child is capable ofsucceeding, and wish her/him to do so.

To increase the chances of educationalsuccess in children and young people whoface difficulties at home is to offer supportthat improves their psychological well-being.Self-confidence and self-esteem inspiregreater motivation to overcome difficultieswith school work that all children face. Ifparents and teachers of less advantagedchildren support their aspirations and feelingsof self-confidence and self-esteem, then thesechildren are more likely to turn things aroundafter initially dropping out of school. Childrenwho leave school with no qualifications oftengain academic and vocational qualificationsmany years later: it is never too late to learn.

The chances of developing into a healthy, happy andsuccessful adult despite growing up in poor socio-economic circumstances are greatly improved byencouraging educational achievement at school. Thiscan best be achieved by a multi-faceted approachaimed at increasing young peoples aspirations andtheir beliefs that they can fulfil these highereducational aspirations. Policies for increasingeducational resilience should aim to:

a Improve the quality of education for all, but forchildren living in poorer neighbourhoods inparticular

a Encourage better communication betweenparents and teachers by providing moreopportunities that build good parent-schoolrelationships

a Widen access to school facilities with all-agecommunity activities, after-school clubs, andfurther education courses run by other educationproviders

a Provide equal opportunities for further education especially for disadvantaged groups

a Facilitate life-long learning across the whole life-span by providing opportunities forapprenticeship schemes, day-release from work,evening and adult education classes that offer thechance to gain vocational and academicqualifications, and skills training for employmentin the 21st century.

POLICY IMPLICATIONS

FIGURE 4: PERCENTAGE WITH PSYCHOLOGICAL DISTRESS AT AGE42 BY EXAM RESULTS AND SOCIAL DISADVANTAGE AT AGE 16



MOST STUDIES on resilience have focused onchildren and adolescents, and there is lessunderstanding of how adults may overcomethe risks and adversities they face. Thetransition into adulthood is characterized bytaking on new social roles, such as entry intopaid employment, independent living,formation of intimate relationships, andparenthood.

Having paid work and having a family areboth known to be associated with lifesatisfaction, health and well-being. Work andfamily are places where people can enter intostrong supportive relationships of differentkinds, whereas social isolation associated withsingle parenthood, divorce, andunemployment has been linked to lowerlevels of health. A basic condition forimproving the lives of young parents is toprovide access to better employment

opportunities in combination with morefamily-friendly practices at work as well aseasier access to child and health care, whichwould enable parents to provide for thesocial, emotional, and economic needs oftheir family. Economic pressure, low income,poor housing conditions and overcrowdingare all associated with increased levels offamily distress, less effective parenting skills,and a higher risk of separation and divorce.

Work can be challenging and fulfilling, butcan also be stressful and demanding, boring,lacking in respect and recognition;undermining feelings of independence andcontrol. There is evidence that people withjobs with higher pay, prestige and whose jobsseem more meaningful to them have betterhealth and levels of psychological well-being.

Traditionally people have been thought ofas resilient if they overcome adversities and

Adult adjustment: live well,work well, and love well

Relationships at home and work can be as effective as moneyor status in promoting well-being.

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still manage to achieve a high income oroccupational status. What seems to be moreimportant, however, for life satisfaction isbeing happy at work and participating insocial relationships (see Figure 5). Thediagram shows that job satisfaction andbeing in a relationship are importantinfluences on life satisfaction. Income andoccupational status are far less important.

Is having a good job important enough tosacrifice family life? In fact, men and womenpursuing a career and delaying parenthoodare not more satisfied with their lives at age30 than men and women already living as atwo parent family. Although a relatively earlystep into parenthood is associated with a lackof career opportunities for both men andwomen, maybe different people havedifferent priorities. For some, a sense offulfillment and accomplishment may be justas well achieved through family life.

Putting too much stress on educatingyoung people in skills that will enable them tobecome more productive workers is notsufficient. We should rather be concerned tobuild up the kind of capabilities that will allowthem to lead the lives they have reason tovalue and to enhance the real choices theyhave (Sen, A., 1993, see Section 2). We shouldreconsider what makes a good life or whatdefines successful transitions by paying moreattention to the importance of socialrelationships and the way people relate toeach other, and how they care for theirfamilies, friends, and colleagues.


KEY SOURCESBrim OG, Ryff CD, Kessler RC, eds. How Healthy are We?A national study of well-being at midlife. Chicago: theUniversity of Chicago Press, 2004.

Huppert FA, Baylis N, Keverne B. The Science of Well-being. Oxford: Oxford University Press, 2005.


Schoon I, Hansson L, Salmela-Aro K. Combining workand family life. Life satisfaction among married anddivorced men and women in Estonia, Finland, and theUK. European Psychologist 2005;10(4):309-319.

Sen A. Capability and well-being. In M.Nussbaum &A. Sen (Eds.), The Quality of Life. Oxford: ClarendonPress, 1993 (pp. 3053).

Werner EE, Smith RS. Journeys from Childhood toMidlife: risk, resilience, and recovery. Ithaca, N.Y: CornellUniversity Press, 2001

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What is most important for life satisfaction among employed men and women at 30 years of age?Job satisfaction, relationship status and general health are the most important predictors of lifesatisfaction.

Figures on the left hand axis are standardised betas and can be squared to obtain unique percentagesof variance accounted for in overall life satisfaction. All coefficients are significant at the p


PEOPLE LIVING in poverty face formidableodds. Poverty usually wrecks the chances ofgood health and well-being. Poorer peopleare much more likely to face living in placeswhere the facilities and services have beenstripped away or overloaded; to have multipleproblems and contact with many different

support agencies; to be unable to accessessential services, lacking access even tohealth care and education services in somecases; to have to rely on the state for incomeand to have poor health and poor lifechances.

Poverty is not simply not having enough

Beating poverty

Whilst most people are crushed by poverty, a few seem to have beaten theodds, from whom, positive lessons for public policy and practice can be learnt.

Surviving despite poverty

(Q6.1) I thought, right ok, we live in agood community, up to the pub, noticeon the notice board: If anybody has gotany spare furniture that they want to getrid of please ring Valerie and Pete on thisnumber. We completely furnished herhome within a week, including carpets.And people were coming for monthsafter with microwaves, toys, all sorts,honestly you would never believe thegenerosity of people on this estate. Itwas fantastic. I got more help from thepeople off this estate than I got from myown family and the statutory agenciesthat were supposed to be there for thatsort of thing. Grandmother living in aninner city area, North West

(Q6.2) The estate has come on leapsand bounds, but that there wasn't reallyanything wrong with the estate butthere was something wrong with thecouncil and the local housing office.They needed training.Father living on a deprived estate, Wales

(Q6.3) Its easy to personalise theproblem when it's actually a widerproblem and not just your fault.Mother living in poverty, North West

(Q6.4) And theyve started these co-operatives now and theyre selling freshfruit and veg in some of theCommunities First areas where they

deliver to local people and things as wellnow. They buy in fresh fruit and packageit up and they were saying that over fiftypercent now of the households in mycatchment area are taking that up,which is amazing.Welsh community worker

(Q6.5) We have talked about a hugeblack economy in a way round here Ithink its like odd jobs And I thinktheres quite a lot of that really that goeson they might not even be trained init, but are pretty handy, so theyll go anddo a job for someone for a couple ofhundred quid because if they pay abuilder its just too expensive Welsh community worker

Escaping poverty

(Q6.6) One of the ladies works for us sheactually started off as a volunteer beforeI came, she's come into this office, doingfranking letters and posting letters andthen she's done the Business Admin.,and she's done her English course, andshe actually applied for one of the postslast year and got one of the posts. Andthere's lots of little success stories likethat about.Sure Start professional, North West

Tackling the widerconsequences of poverty andits impact on a neighbourhood

(Q6.7) Well I think it was mainly withinthe Pakistani community that peoplejust got fed up of prostitutes sort ofplying their sort of trade around sort ofstreet corners, women being hassled bypeople from outside the area. And just ageneral disintegration of the area as asort of centre for drugs and prostitution.But people just said Enough is enough,and they had street patrols, they used tosit twenty-four hours a day on thecorner, monitoring people, monitoringcars that came into the area So it wasreally direct tactics. Researcher talkingabout a community in the West Midlands

Sources: Canvin et al, 2006;Mitchell et al, 2006.

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money. It is also about being excluded fromthe normal social interactions in society, withprofound implications both for those inpoverty and for those frontline workers whoengage with the poor. Policy-makers in Britainhave tended to view some sections of thepoor population as somehow deficient. Theysuggest, sometimes quite openly, that thecauses of poverty are the inadequacies of thepoor. Although this victim blaming hasreduced over time, poor parenting has inparticular been an enduring theme inexplaining how poverty continues into thenext generation.

Whats new in this research?Rather than focus on how poverty grindspeople down, our research has attempted toidentify factors and capabilities withinfamilies and hard-pressed communities thathelp them beat poverty that is, to copewith, or to get by despite living in, poorcircumstances. Beating poverty may beapproached from two perspectives. First, it isbecoming clear that poverty anddisadvantage can have different impacts,depending on the presence or absence ofprotective factors. One line of enquiry,therefore, seeks to understand more aboutthe factors that protect the health and well-being of people who continue to live inpoverty or in disadvantaged areas, enablingthem to survive the experience. Second,beating poverty could entail escaping thestate of poverty. This then involves exploringthe main escape routes out of poverty andhow these could be opened up.

The quotes opposite give examples of howpeople living in poverty have beaten the odds how they manage, how they have turned theirlives around and the factors that are key inthis respect. Not everyone overcomes thisadversity; many are crushed by poverty, butthere are positive lessons for public policy andpractice from those who have beaten the odds.

a As a matter of priority, regeneration of poor areasshould include replacing hollowed outservices andproviding social facilities that allow a neighbour-hood to become a community. Services need to bebased on trust and respect, as detailed in Chapter10 (Designing resilience-enhancing services).

a Housing policies that have helped createghettoisation, with the resulting overwhelming ofthe local infrastructure, should be re-designed tohalt (and start to reverse) the process.

a Provision of adequate social security benefits thatallow people living in hardship to participate in thelife of their community is critical to their well-being.Continued shortcomings in benefits, coupled withlow take-up of some, need to be addressed.

a Intensified efforts are needed to provide non-judgemental preventive health services in poorareas that allow residents to maintain or regainhealth.

a Provision of educational opportunities, from pre-school daycare to life-long learning, is one of themost effective ways of helping people escapepoverty. High quality, affordable childcare is key toboth childrens early development and to releasingparents time to participate in learning andemployment opportunities.

a Paid employment and entry to the labour markethave been seen in recent years as the principalpathway out of poverty and welfare dependency. Itis undoubtedly important to provide increasedopportunities to gain skills to improve chances ofemployment. Our research, however, cautionsagainst concentrating efforts solely on employmentat the expense of activities that help people buildself-esteem and the social interactions that willhelp them release their capabilities.

POLICY IMPLICATIONS

KEY SOURCESTownsend P and Gordon D (eds). World Poverty: new policies to defeat an old enemy.Bristol: Policy Press, 2002.

Acheson D (Chair). Report of the Independent Inquiry into Inequalities in Health.London: The Stationery Office, 1998.

Jones C, Burstrm B, Marttila A, Canvin K, Whitehead M. Studying social policy andresilience in families facing adversity in different welfare state contexts the case ofBritain and Sweden. International Journal of Health Services, 2006, 36 (3): 425442.

Kemp P et al. Routes out of Poverty: A research review. York: Joseph RowntreeFoundation, 2005.



A POSITIVE childhood environment may actas a resilience or protective factor in twoways. First, people who had a warm andsecure relationship with their parents inchildhood may have better mental healthregardless of later life. Secondly, a positivechildhood environment may lead to thedevelopment of a resilient personality. Thischapter reports on some new research usingthe Whitehall II study, a longitudinal study ofmore than 10,000 people working in the civilservice in London. Participants in the studywere asked about their experiences inchildhood, and these were related to careerattainment and mental health when theywere aged 4565.

The ways in which parents and othercaring people relate to children may have aneffect on how resilient they are if they meet

with problems in later life. One way in whichthis may happen is that a childs earlyrelationships to the people who care for heror him can influence what is calledattachment style in adulthood. A personsattachment style is the way in which she or hefeels about relationships. Some people feelquite safe and trusting towards others whileat the other extreme some people are veryanxious or may avoid closeness for fear ofbeing let down. Styles of attachment developfrom early relationships with parents andcarers and are maintained into adult life. Wefound that a warm parental style was themost important predictor of adult attachmentstyle. Because poverty and disadvantageinfluence the ways parents behave with theirchildren, they can also have an indirectinfluence on the attachment style a person

Adult consequences of childhood adversity

The consequences of adversity in childhood persist into lateradult life

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The figure shows the increased risk of poor mental health in adulthood by childhood experience andadult attachment style (secure, anxious, avoidant, dismissing) after taking account of differences inrisk of poor mental health by age, sex and employment grade.

develops as they grow to adulthood. Men and women in our study with less

anxious and more secure attachment styleshad better mental health. Positive childhoodemotional experiences and lack of materialdeprivation in childhood were also associatedwith good mental health in later adulthood.

But did an emotionally warm childhoodmake people more resilient when things wentwrong for them later in life? There was someevidence that people who did not experienceemotional deprivation in childhood were lesslikely to experience mental health problemswhen they lost their jobs. However, this wasnot because of their personality type:attachment style by itself did not protectpeoples mental health if they lost their jobs,or if they experienced high job strain orphysical illness.

We did find that attachment style acts as asource of resilience in peoples work careers.In study members who had not had higherlevels of full-time education, those with asecure attachment style were more likely toprogress to the higher grades with more payand status. The people who did have highereducation levels could get to the topregardless of this aspect of their personality;they did not seem to need the extra resiliencein order to succeed in their careers.

KEY SOURCESStevenson, F, Zimmerman MA. Adolescent resilience:a framework for understanding healthy developmentin the face of risk, Annual Review of Public Health 2005,26, 1311321

Gittelman, M G et al. Recollections of parentalbehaviour, adult attachment and mental health:mediating and moderating effects. PsychologicalMedicine 1998, 6, 1443-55.1998

Gilman SE, Kawachi I., Fitzmaurice GM, Buka SL. Socio-economic status, family disruption and residentialstability in childhood: Relation to onset, recurrenceand remission of major depression. PsychologicalMedicine 2003, 33, 1341-55.

Stansfeld SA, Head J, Bartley M, Fonagy P.(forthcoming). Social position, early deprivation andthe development of attachment.

Stein H, Fonagy P, Ferguson KS, Wisman M, Livesthrough time: An ideographic approach to the studyof resilience. Bulletin of the Menninger Clinic 2000, 64,281305

a Adversity during childhood persists into adultlife and is manifest in poorer adult mental healthand lower resilience in the face of later problems.

a Reducing material and emotional deprivation inchildhood encourages development of moresecure relationships in childhood and adulthood.

a Both economic and social interventions areneeded to move families out of materialdeprivation and to support those parentsexperiencing difficult circumstances.

POLICY IMPLICATIONS

FIGURE 7: CHILDHOOD FACTORS AND ADULT ATTACHMENTSTYLE AS RISK FACTORS FOR POOR MENTAL HEALTH



IN VERY DEPRIVED areas we expect to findpoor health and higher rates of death. This ispartly because deprived areas containresidents whose experiences of a life inpoverty have made them ill, and partlybecause the harsh social and physicalenvironment in deprived areas can alsodamage health. However, the connectionbetween deprivation and poor health in anarea can sometimes be weakened. In Britain,there are a small number of very deprivedareas that show strong evidence of resilience the risk of death is lower than in othersimilarly disadvantaged places. There are onlya few of these areas, some found in London,others in the Midlands, North West Englandand in South Wales. And although people inresilient poor areas live longer, they do not

live as long as people in wealthier parts ofthe country.

How does resilience happen?There does not seem to be any single reasonwhy some economically deprived areas havebetter health. Yet, they do seem to have somecharacteristics in common which may help. Ingeneral, when an area suffers economicdecline and jobs are lost, sick people are lesswell able to move away. Local servicesbecome overloaded and there are not evenenough healthy people to take up new jobsthat may open up. But in some areas,measures were taken which helped to keephealthier people from moving away when theeconomy turned down, and even to attractnew people. One successful strategy was

Area deprivation

There are some deprived areas in Britain where characteristicsof the communities, and local policies, seem to have helpedkeep residents healthier than we might expect.

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action to maintain and renew the housingstock in an area. Where this happened, moreof the resident population stayed put andnew people came to live in the area. Strongcommunities with good networks of socialrelationships also appear to have helpedthese areas cope in the face of economicproblems. It does not appear to matter whatthe glue is which holds a communitytogether: there are examples of a commonethnic or religious identity, and of a sharedindustrial history, such as being a mining orcar-building area. Having something incommon helps communities work together totackle social and economic problems, and tocope with difficult circumstances. All theresilient areas studied both had protectivesocial networks and benefited from newinitiatives designed to help in the face ofeconomic decline.

What more work needs to be done?Whilst we can identify resilient areas, thecharacteristics of their communities and the

more successful new policies, an importantquestion remains. Why do these polices,characteristics and practices lead to betterhealth in some deprived areas, but not inothers? At present we have no answer to this.

KEY SOURCESStewart M, Reid G, Buckles L, Edgar W, Mangham C etal. A Study of Resiliency in Communities. Ottawa, Officeof Alcohol, Drug and Dependency Issues, HealthCanada, 1999.

Davey Smith G, Shaw M, Dorling D. Shrinking areasand mortality. Lancet 998; 352(9138):1439-1440

Mitchell R, Backett-Millburn K. Health and Resilience:What does a resilience approach offer health researchand policy? RUHBC Findings series 11, University ofEdinburgh, 2006.

Mitchell R. Greater Expectations: The parts of Britainwhere people live longer than they should. RUHBCFindings series 4, University of Edinburgh, 2003.

Shaw M, Dorling D, Gordon D, Davey Smith G. TheWidening Gap: health inequalities and policy in Britain.Bristol: Policy Press, 1999.

40%

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The graph shows the differencein mortality rates betweendeprived areas which areresilient and not resilient, andbetween resilient areas and theBritish average. For example,the mortality rate for 30-44year olds in resilient deprivedareas is about 25% lower thanit is in non-resilient deprivedareas, but still about 25%higher than the British average.

Compared with British average

a Local housing policies to assist in retaining andattracting population are important forprotecting the health of an area followingeconomic downturn. These must cover the socialand private housing sectors.

a Strong social bonds are important. The provisionof places where communities can meet andinteract will help to foster these.

a Informal labour markets where residents workfor each other in the black economy can be auseful source of services and income in deprivedareas both of which may protect health.

a Most deprived areas do not beat the odds.Tackling deprivation itself remains the mostimportant means to prevent poor health andhealth inequality.

POLICY IMPLICATIONS

FIGURE 8: THE DIFFERENCE IN MORTALITY RATES BETWEEN RESILIENT AND NON-RESILIENT AREAS



Social participation, social supportand resilience in older people

OLDER PEOPLE in Western industrialisedsocieties are remaining healthier andwealthier through early old age than everbefore. The notion of living to one hundredthese days smacks less of science-fiction andmore of continued productivity, planning andlong-term provision.

For many people, higher pensions nowmake retirement a time of greater freedomand the opportunity for creative pursuits. Thishas been called the Third Age, a new phase inthe life course dedicated to self-realisationand continued personal development. It isequally important to recognise older peoplessocial contributions, i.e. recognising theirroles in the care and education of their

grandchildren, and as supporters ofcommunity maintenance and development.The majority of older people participate involuntary work, or some form of communityinvolvement and many play a major role inlooking after their grandchildren.

Having paid work beyond the normalretirement age (as long as it is donevoluntarily rather than because of financialhardship) seems to improve quality of life, asdoes volunteering and being involved withgrandchildren. What these activities have incommon is that they all help to maintain apersons involvement with a social network ofworkmates, friends and family.

People who have plenty of contact with a

Exploring the contributions older people make to thecommunities in which we live shows us the ways that olderpeople support others and how this support has benefits forhealth and well-being of all.

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social network of this kind tend also to receivehigher levels of social support. Contact withothers means that they have someone to talkto when they are feeling worried or low,someone to ask for practical help, and thatthey feel that they are valued and importantin the lives of others. One reason we thinkthat good, accessible and affordable publictransport is important (see Chapter 2) is that itmakes social contact easier for a wide rangeof people regardless of their income, age ordisabilities.

Figure 9 shows how social support of thiskind helps older people to maintain theirquality of life if they develop an illness. In thisway, we can say that involvement in familyand community is a source of resilienceduring older age.

Like younger people, older people are a lotless likely to have a high quality of life in thepresence of a limiting long-standing illness.Only 45% have a good quality of life if theyalso have a weak social network. However66% of older people with a long term illnesshave a high quality of life if their socialnetwork is good. This is why we can say thathaving a social network is a source ofresilience in the later years of life.


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Policies that improve quality of life in people as theygrow older will aim to:

a Make sure that older people know their rightsunder the age and disability discriminationregimes.

a Reform tax credits for disabled people to enableolder people to continue working even if theirhealth is no longer perfect.

a Provide flexible retirement schemes whichensure that people do not lose out on either

pensions or tax credits if they withdraw fromwork gradually.

a Encourage older people to continue withvocational learning; abolish the age limit tostudent loans, to open the way for greaterequality of opportunity in education.

a Family doctors could use a simple checklistabout quality of relationships with family, friendsand neighbours to identify those most at risk.

a Offer greater support for carers.

POLICY IMPLICATIONS

FIGURE 9: PROBABILITY OF HAVING AHIGH QUALITY OF LIFE WITH LIMITINGLONGSTANDING ILLNESS: INFLUENCEOF SOCIAL NETWORK

KEY SOURCESBaltes P, Mayer K. The Berlin Aging Study. Cambridge:Cambridge University Press, 1999.

Laslett P. A Fresh Map of Life. London: Macmillan Press,1996.

Row J, Kahn R. Successful aging and diseaseprevention. Advances in Renal Replacement Therapy2000;7:707.

Ryff C. Beyond Ponce de Leon and life satisfaction:new directions in quest for successful ageing.International Journal of Behavioral Development1989;12:3555.

Wagnild G, Young HM. Resilience among olderwomen. Image: Journal of Nursing Scholarships 1990;22:2525.

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WE LISTENED to people living in financialhardship and to social welfare workers talkingabout what helped or hindered them in theirday-to-day lives (see Canvin et al, KeySources). These are some of the points theymade about designing better services.

Living in hardshipOne critical aspect of living in hardship is highlevels of isolation and anxiety. Lack ofresources plays a part, but so too does lack oftime. It takes enormous reserves of time andenergy just to get by. People are too busy justcoping with day-to-day struggles toparticipate in extra activities. The growingsurveillance culture, inducing a feeling ofbeing judged when going out or contactingservices, means that people excludethemselves even further from potentialsources of help and social contact.

Despite the odds against them, peopleshow great resourcefulness in coping withsuch adversity. This includes advanced riskassessment capabilities in making decisionsabout which services helped and whichhindered. Adequate material benefits andsupport services could be critical to their well-being, but all too often those in greatest needget the least support. The message that usersare not valued, and indeed mistrusted,permeates many facilities in hard-pressed areas.

Disrespectful servicesIt is not just the degraded physicalenvironment; too often the way the servicesare provided is patronising and disrespectfulof peoples lives and experiences. This is mostoften felt as not being listened to and beingon the receiving end of highly prejudicialjudgements. Hence, the capacities of the poor

Designing services that enhanceresilience and well-being

Non-judgemental spaces(Q10.1) I started going to the toddlergroups and all the staff are brilliant, itsdead friendly and I can approach themand theyre never off with you. They justcome over to see if youre all right andjust have a chat and that to them. Itsjust normal conversation, its not nosyand they dont care what your house islike when they walk in. None of themjudge you. Its brilliant.

Building self-esteem(Q10.2) Parentline Plus raised my self-esteem, my confidence. Theyacknowledged what I did know andwhat I could do and built on that, and Ithink thats what made the difference.

Listening and responding toneeds(Q10.3) They come to do the businesscourse, and then they said yeah we wantto do floristry and then after the floristrytheyll be doing another one, whateverthe majority want theyll try andorganise. Theyve got a minibus goingon a Wednesday to take people toCollege. It is really good living aroundhere, they do a lot for you.

Recognising and releasingcapability(Q10.4) Ive been able to do courses andthings I wouldnt be able to do. I workwith young mums and kids out ofschool. A lot now go to college, wherethey never went to college before.

Theyve all got a better outlook on lifenow. I think there were certain peopletelling them that they couldnt do thingsand weve had a more positive approachand telling them that they can dothings. I think its made a difference.

Friendliness(Q10.5) Social Workers should havefewer cases theyre run into theground. They dont have enough timewith the client. How can you passcomment or have a hand in someoneslife when you dont know them? Peopledo things for themselves if they have afriend someone who cares and looksout for you.

Source: Canvin et al.2006

The way that the services are given is as important as what is provided: thosethat show respect and earn the trust of the community help to enhanceresilience for people living in adversity.



and the disadvantaged are often overlookedand the approach is highly problem-focusedand negative. These attitudes and associatedassessment processes now embedded inwelfare provision are major factors inundermining welfare service recipients andhave many consequences. In some instancesthey lead those who are in need of assistanceto refuse to engage with welfare agenciessuch as Sure Start, social servicesdepartments, and community nurses.Combined with their low expectations ofpublic welfare provision, this leads some ofthe poorest to lean exclusively on a networkof friends and family, who themselves may bein a similar position and command fewmaterial and social resources.

Resilience-enhancing servicesSome welfare interventions have beenexperienced as helpful and enhancedresilience. A key factor is when individualwelfare professionals, either in the statutoryor voluntary sector, have acted more akin tofriends rather than as distant bureaucrats orprofessionals. Time and again, our researchrevealed that those welfare professionals wholistened, who were not judgemental, gavetheir clients time, who were prepared toadvocate for their clients and seek solutionswhich were appropriate to their needs, were

highly valued and made a positive differenceto their lives (see box left). These were theexception, however, and when interviewed itwas often the case that state welfare workersfelt that their approach was despite theiremploying agency, rather than positivelyendorsed by the agency. Social workers inparticular felt that local authority socialservice departments were so overwhelmedby their inadequate budgets and thedemands from central government (endlessperformance targets and indicators) that theircapacity to act as enhancers of resilience wasseverely curtailed.

KEY SOURCESCanvin K, Jones C, Whitehead M. Avoiding socialwelfare services in Britain: causes and consequencesfor health and well-being. Working Paper 3, Universityof Liverpool, 2006.

Jones C, Burstrm B, Marttila A, Canvin K, WhiteheadM. Studying social policy and resilience to adversity indifferent welfare state contexts: Britain and Sweden.International Journal of Health Services, 2006, 36 (3):425442.

Jones C. Voices From the Front Line: Social Workersand New Labour. British Journal of Social Work, 2001;31:547562.

Jones C, Novak T. Poverty, Welfare and the DisciplinaryState. London, Routledge: 1999.

Talk With Us, Not At Us. How to develop partnershipsbetween families in poverty and professionals. ATDFourth World. Paris: Fourth World Publications, 1996.

Several principles for designing more resilience-enhancing services emerge from these findings:

a Trust and respect: provision of non-judgementalspace, where people in hard-pressed neighbour-hoods feel they are welcome, is crucial. Thisinvolves building up trust and creating socialspaces for participation in activities with peoplewho share similar experiences (see Quotes10.110.5). Provision must also be on the basis ofrespect in deed as well as in word.

a Recognising and releasing capabilities: servicesmust rid themselves of the legacy which seesthose in hardship and poverty as being in deficit,and of less moral and social worth. Services thatprovide opportunities for clients to build self-esteem and confidence, and identify skills andaptitudes that would otherwise have gone

unrecognised, are essential for improving lifechances and individual well-being.

a Listening to and involving people: the needs andperspectives of clients and front-line staff shouldbe at the core of service provision and design.Treating user groups and individual clients as alegitimate source of welfare wisdom andincorporating their views is essential. Userinvolvement plays a key role in acknowledgingand releasing the often hidden capabilities ofusers, sometimes leading to employment, as wellas enhancing the responsiveness and sustain-ability of services. Front-line welfare workers tooare acutely aware of what should be providedand the deficiencies in existing provision. Toooften they are not consulted, but should bebrought into the policy-making processes.

POLICY IMPLICATIONS



EDITOR

Professor Mel Bartley

CONTRIBUTORS

Ms Muna Arephin, QMUL

Professor Mel Bartley, UCL

Professor David Blane, Imperial College London

Dr Noriko Cable, UCL

Dr Krysia Canvin, University of Liverpool

Dr Vicky Cattell, QMUL

Professor Peter Congdon, QMUL

Professor Sarah Curtis, QMUL

Professor Danny Dorling, University of Sheffield

Mr Jamie Fagg, QMUL

Ms Julia Gibbs, University of Edinburgh

Ms Jenny Head, QMUL & UCL

Ms Ze Hildon, Imperial College London

Mr Steven Hope, City University London

Professor Chris Jones, University of Liverpool

Mr Peter Martin, City University London

Dr Richard Mitchell, University of Edinburgh

Dr Scott M Montgomery, Karolinska Institute

Dr Gopalakrishnan Netuveli, Imperial CollegeLondon

Ms Claire ORegan, Imperial College London

Professor Stephen Platt, University of Edinburgh

Dr Catherine Rothon, QMUL

Mr Andy Ross, City University London

Dr Amanda Sacker, UCL

Professor Ingrid Schoon, City University London

Professor Stephen Stansfeld, QMUL

Ms Juliet Stone, Imperial College London

Dr Helena Tunstall, University of Edinburgh

Dr Anne-Marie Tupuola, QMUL

Professor Margaret Whitehead, University ofLiverpool

Professor Richard D Wiggins, City UniversityLondon

Professor Dieter Wolke, Universtitat Zurich

ADMINISTRATION

Jane Johnson, UCL

Patricia Crowley, UCL

DESIGNER

Richard Reeve Designwww.richardreevedesign.co.uk

CONCLUSIONS

This booklet represents a summaryof three years work of a research networkfunded by the UK Economic and SocialResearch Council (ESRC). There weresix projects: three dealt with thedifferent phases of the life coursefrom childhood to old age, two otherslooked at resilience and capability indifferent geographical areas, and oneproject concentrated on the ways inwhich social services may best act tosupport resilience.

A lot of the literature that inspiredour work is included in the Key Sourcessections of each chapter. But anothermajor source of inspiration has been aprogramme of research on Health Assetsbeing conducted by the World HealthOrganisation s European Office forInvestment in Health and Development,a platform created specifically for policy-makers to enable them to draw from thelatest evidence and know-how to addressthe social determinants of health. Wehope that our work has contributed tothis initiative, alongside , the WHOCommission on Social Determinants ofHealth, chaired by Professor Sir MichaelMarmot, which is gathering evidenceworldwide on this theme (seewww.who.int/social_determinants/en).

The findings we present here are onlysteps in what will no doubt be a longprocess of discussion and debate. Wewould encourage anyone reading thebooklet to contribute on our websitewww.ucl.ac.uk/capabilityandresilience oremail c&[email protected] papers and book chapters basedon the work will continue to appear forsome time and will be listed. The websitealso contains full details of the work of allthe projects and how to contact projectleaders and staff.


CAPABILITY AND RESILIENCE: BEATING THE ODDSISBN 0-9527377-9-5 ISBN 978-0-9527377-9-7W: www.ucl.ac.uk/capabilityandresilienceE: c&[email protected]

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