Infrastructures MatterClimate Change, Social Capital and Interdisciplinary Approaches to Health and Social Care Provisions

Lena Dominelli*Durham University

Email: Lena.Dominelli@durham.ac.uk

*presenting on behalf of BIOPICCC Team from Durham University and Heriot-Watt

City of Durham, UK

BIOPICCC

• Built Infrastructure for Older People’s Care in Conditions of Climate Change

• Collaborative venture involving 2 universities – Durham and Heriot Watt

• Research team consists of experts in engineering and the physical sciences, social and geographical sciences and health and social care.

Flooding in Northern England in 2007

Research to date• Ethical approvals (social services, NHS and universities)• Pilot study to test out research instruments and

questions and identify issues that might crop up in the research.

• Identification of two case study areas for in-depth research.

• Establishment of a multi-stakeholder network interested in supplementing the research being conducted in the 2 in-depth case study areas.

• Focus groups.• Interviews.• Meetings with key informants including older people and

carers, local authority personnel, emergency response teams, utilities companies and civil society organisations.

Focus of the research• Extreme weather events – heatwaves and

cold snaps, flooding including coastal erosion.

• Older people over 65

• Health and social care provisions

• Built infrastructures

• 2 case studies, 1 in Northern and 1 in Southern England, covering both rural and urban areas

• Pilot study at 2 rural sites

Social capital

Social capital (Putnam, 2000) consists of:• Bonding (family and close neighbours)• Bridging (people who are in the same geographic

location, but not related)• Linking (wider than the local community and can range

spatially from the national to the international).• Connectivity and accessing resources are crucial

aspects of social capital, as is the creation of social networks of support.

What happens when the built infrastructure fails?

• Power failures, especially electricity

• Inaccessible roads

• Disrupted communication systems

• Insufficient/inadequate emergency equipment

• Compromised housing or buildings

• Blocked drains/damaged sewers

• Failed water supply

The Pilot Study

• Two rural former mining villages, both affected by floods, recent heatwaves and cold snaps in northern England.

• To preserve anonymity we have called them Hill village (population about 4000) and Valley village (population about 2000).

• 6 semi-structured interviews with older people of ages varying between 66 and 81 with different vulnerabilities including mild dementia and mobility problems.

• 2 focus groups involving managers and front-line workers.

• Telephone interviews with formal service providers.• Thematic analysis.

The villages• Both were former mining villages with a strong sense of

community, social capital and social networks.• Flooding had occurred in 2000 and 2008• Cold snaps had occurred as recently as the winter of

2010-11 (and the previous year, but less prolonged) and this weighed on the minds of older people most.

• Heatwaves had occurred in 2003 but were not considered that important.

• Roads had become impassable during both floods (blocked by cars) and cold snap (icy, ungritted roads).

• The power supplies held up generally and back-up provisions were available, e.g., to refrigerate medicines.

• Some agencies had ‘risk registers’ but sharing them was problematic (confidentiality) and could impede the coordination of help, provision of services.

Pumping flood waters off the streets, Northern England

Gendered division of labour• Many carers lived locally and were able to step into the

breach (walking) when formal services were unable to attend to those in need.

• Public services, especially the domicillary care workers replaced independent sector ones.

• Most of those doing the caring were women, while the first response emergency teams were mainly men.

• Women were also particularly active in community organisations and community centre that provided a place of safety during the floods.

• ‘…we were able to continue to deliver the service on foot. That’s the only reason we’ve been successful….we were relying on good will because people had to come out when it wasn’t their day to work’

• Altruism is an important part of civic duty that forms part of social capital.

Key findings• Older people were more worried about the recent cold

snap than the flooding several years earlier.• Older people were generally satisfied with the level of

services they had during both floods and the cold snap.• Older people relied on friends and neighbours to help

when the formal services fail.• Social capital at the community level exposed the

gendered nature of informal care and how women came to the rescue when other systems failed. Interestingly, this was seen as ‘natural’ and was expected:

‘I don’t get any help, nor meals-on-wheels. But I’ve got a daughter you see and she does everything’. (The son also lived nearby).

• Women are drawn in through bonding social capital.

Key findings continued• Older people were worried about the impact of failures in the

built infrastructure on their everyday life routines:

• Being warm and comfortable

• Being safe in their own homes

• Having their medicines and medical equipment available when needed

• Having a ‘centre’ to village life and not seeing its destruction as part of economic decline in the area, e.g., the loss of the Post Office as the hub of the village.

‘The Post Office was the centre of village life. If I hadn’t been in for a week they’d phone up to see that everything was alright. Now that’s gone’

• This epitomises the loss of social capital as connectivity.

• Those on the spot determined priorities in responses.

• Lessons learnt included focusing on how preventative measures could have been better.

Red Cross Ambulance to the rescue in snowbound Britain 2010

Risk mitigation and citizen engagement

• Extreme weather events engage experts, practitioners, politicians and local residents in managing risks and the uncertainties associated with these.

• One danger is sidelining citizen-based knowledge and participation with experts taking over as suggested by Dupuy’s (2005) ‘enlightened’ catastrophism.

• The pilot study BIOPICCC conducted indicated the reverse was the case. When formal carers were unable to fulfil their functions during a cold weather snap that curtailed transportation in a rural area, informal caring amongst the local citizenry, particularly family members and neighbours living nearby came to the rescue and ensured that older people took their medicines, had food and warm homes to go to.

Consciousness Raising? During a cold snap, a few older people did not mind the idea of global warming.

State failure or social failure?

• The 2003 heat wave caused more than 50,000 Europeans to die, mainly in the Mediterranean basin. The UK had 2,000 deaths, but 17,000 occurred in Italy, 15,630 in France, 5,290 in Spain and 2,310 in Portugal (Robine et al., 2007).

• These deaths came to epitomise the failure of European states to deliver care for their citizens, with a dire turn of events in France that contrasted to American responses to the 1995 heat wave in Chicago (Klineberg, 2001).

• Linking social capital might have helped here.

The state’s role in the 2003 heat waves• Older people’s citizenship rights became invisible and

were played out at the interstices of politics and sociotechnical performances.

• The French state expected the market to provide solutions while it managed people’s emotions embedded in bodies that symbolised personal and collective suffering.

• The state’s emphasis on normalisation or getting things back to normal succeeded in retaining the status quo without reconfiguring citizenship rights and environmental justice for older people.

• Meanwhile, older people’s collective and personal memories were being reconfigured and incorporated in new state narratives that enable older people to become new political subjects; neither did it affirm their environmental rights nor develop their future resilience. Instead, it used communitarian sentiments to offload its duty to care for these residents onto the family and community (mainly its women members).

Controversy undermines expressions of social capital

• Controversy about what should have been done in the heat wave of 2003 in France remained confined to local places as community groups could not mobilize independent expertise or a (inter)national social movement.

• Their complaints focused on emotions, suffering, death, and resentment as the numbers rose and older peoples’ bodies became temporarily visible in the public domain.

• Official narratives and expertise dominated the scene and curtailed controversy by engaging in a socio-technical, bureaucratic restructuring of events while local protests were incapable of shifting the state’s technical fixes in more moral and ethical directions.

• How far can informal care provided through bonding social capital replace public provisions? BIOPICCC’s pilot study suggests it is limited in what it can do.

Local contexts matter

• In the UK, neither heat waves nor cold spells have become politicised in ways that mobilize political representatives and public opinion around the unacceptability of preventable deaths as they did in France where the press orchestrated a campaign based on a moral panic that concentrated on rising numbers of older people’s bodies lying in morgues across the country.

Citizenship matters• Citizenship becomes an important concept for understanding

resident involvement in decisions made about the mitigation of risk and the building of resilience in such situations.

• Citizenship control demands transparency and accountability from those who hold power, manage resources and mediate relationships between individual residents and the state.

• Arendt defines citizenship as the ‘right to have rights’ and emphasizes the right to inclusion, recognition, and belonging in both political space and civil society.

• Her definition demands: – The absence of a coercive state– Control over the tyranny of the market– A biopolitics that suggests that change is possible– Control over the management of people – Acknowledgement of people’s suffering and victimization

by forces beyond a citizen’s control.How far do climate change debates allow for full engagement

by the citizens of any state to determine strategies of mitigation and adaptation, especially at the local level?

The state’s role in disasters

• The state has a key role in:– Managing and coordinating disaster responses– Regulating those who provide services in disaster

situations.– Monitoring service providers to ensure residents’

safety and enforcing the principle of ‘do no harm’, which is central to any humanitarian intervention.

– Developing preventative services before disaster strikes, in the reconstruction processes afterwards and in ensuring that these are maintained.

– Ensuring that all individuals receive the goods and services to which they are entitled as victim-survivors of a disaster like an extreme weather-event.

• Most states lack a comprehensive and holistic community-based approach to disasters.

Lowered expectations• Individuals contest the state’s attempts to

normalize hazards and make them responsible for meeting all the risks they pose.

• Having the capacity to respond to such shocks is seen as resilience, an attribute that the state expects all individuals and communities to acquire and promote through collective local action, as is currently being endorsed through the New Localism Bill and the ‘Big Society’ in the UK.

• Many community groups see this as the government finding ways to offload its responsibility of caring for its citizens.

• BIOPICC’s study showed that older people did not sit back and wait for the state to deliver, but drew on local social capital to see them through.

Civil society organisations

• Trigger events generally produce controversies that civil society organisations use to mobilise residents. Only a few have done this for older people’s plight during climate change scenarios, e.g., Help the Aged International.

• Climate change expertise becomes available to local communities largely during litigation when environmental activism shapes the narratives and plans for action. Infrastructural collapse becomes very relevant at such points.

The state’s formal involvement• The state is more likely to favour reactive socio-

technical bureaucratic forms of restructuring to solve problems, e.g., creating Expert Groups, setting strict codes of behaviour, changing regulatory regimes and surveilling citizens’ activities.

• Its formal responses are often circumscribed by limited ideas about environmental citizenship and environmental justice, and so it focuses policies on avoiding the formation of environmental victims. However, they continue to be produced as long as additional resources are not forthcoming, e.g., the shortage of water pumps for flood waters found in the BIOPICCC study where one group’s need for pumps could only be met at the expense of another.

Invisible older people and carers

• Extreme weather events expose the state’s political work in framing disposable groups like older people as existing outside social networks and the national imagined community by leaving them to fend for themselves.

• Moreover, BIOPICCC’s pilot study reveals that as long as informal carers step into the breach, they simply get on with their lives as best they can and their needs remain invisible. And so do they, as a group.

• That this caring is also provided primarily by women also remains invisible.

Invisible citizens• The state has to find ways of incorporating and

encompassing all citizens in a national polity that enacts an ethics of care that addresses the vulnerability of all (Paperman, 2003) and transcends the ‘ecology of fear’ (Davis, 1998), if it is to prevent the exclusion of large segments of the population from citizenship expressed as ‘the right to have rights’

• Vulnerability will increase if informal carers cannot meet the needs that the state does not.

• There is a limit to the extent to which social capital can be stretched to cover the gap in care left by the social state.

A decline in democracy?• During the 2003 heat wave, the French state

acted like a steward that engaged in a form of politics that reinforced its power when facing challenges to its authority.

• The British state acted as a political self-sustaining microcosm that became legitimated through a techno-bureaucratic rationality that configured it as controlling and indifferent to people’s plight.

• These reactions produce a citizenship that survives in the state’s shadow as its government attempts to increase its power over the citizens. This development is central to a state that is removing itself from the formal caring arena and is a worrying outcome for democratic states.

Constructing older people as vulnerable• Lower levels of social vulnerability expose unequal

patterns in access to and the distribution of economic resources and infrastructures.

• Social vulnerability suggests a need to transcend standard measurements and analyses of exposure to biophysical vulnerability and natural hazards by taking account of social resilience and infrastructural support capabilities.

• Integrating social science research on social vulnerability with emergency planning and risk decision management is needed more than ever (Schmidtlein et al., 2008).

• Factors to be considered in developing responses to disasters vary according to context, place and levels, making an interdisciplinary approach that coproduces knowledge and responses to extreme weather events with local people more likely to succeed.

• Interdisciplinarity and the coproduction of solutions enhance preparedness, immediate responses, mitigation strategies and long-term reconstruction and preventative endeavours.

Conclusion• By affirming science and technology as essential for the

construction of citizenship ‘spaces’, state responses distort the principles and pressupositions of citizenship based on ‘the right to have rights’ and fully to participate in the national life of society, including in the local community.

• An inclusive citizenship relocates persons and groups living invisibly in the interstices of sociotechnical and bureaucratic responses by promoting their agency (capacity to act), making them visible, facilitating their participation in collective work, and constructing a common world that transcends the politics of survival and fear.

• Interdisciplinary approaches can result in innovative responses based on the coproduction of knowledge and responses that are used to inform democratic and collective action that promotes active citizenship in mitigating risk and preparing people to thrive once they survive natural disasters.

• Moving from mere survival to thriving without costing the earth is an important aim for resilient and sustainable responses to climate change.

Shaped by the past, creating the future

References

• Davis, M (1998) Ecology of fear: Los Angeles and the Imagination of Disaster. New York: Metropolitan Books.

• Dupuy’s (2005) Enlightened catastrophism• Klinenberg, (2001) Chicago heatwaves.• Paperman (2003) ethics of care• Robine et al (2007) 2003 Heatwave • Schmidtlein, M., Deutsch, R., Piegorsch, W., Cutter, S.

(2008) ‘A sensitivity analysis of the social vulnerability index’, Risk Analysis, 28(4): 1099-1114.

• Wisner, B. et al. (2004) At Risk: Natural Hazards, People’s Vulnerability, and Disaster. London: Routledge.