Peter McKenzie examines the idea that feeling socially inferior can have real-life health impacts, arguing for a welfare system that doesn’t shame the people who need it
New Zealand politics is currently dominated by big ideas. Think fees-free university, KiwiBuild, the Pacific reset or the ban on offshore oil and gas exploration. Regardless of the merits of those policies, it’s a refreshing change from the risk-averse governance of recent decades.
But of all the coalition’s reforms, the most transformational is perhaps the least grandiose: the creation of a kinder and more supportive welfare system.
In the words of Carmel Sepuloni, the Minister for Social Development, “We don’t want to be pushing people into further hardship or causing unnecessary stress and anxiety in people’s lives because we’re making it difficult for them to access something that they are actually eligible for.”
To accomplish this goal, partway through 2018 Sepuloni directed Work and Income’s staff to explore every option before suspending or penalising a welfare recipient. Later in the year, Sepuloni announced that Work and Income’s 126 service centres would be renovated into more welcoming and family-friendly environments.
These changes will make it possible to reschedule an appointment that clashes with work, or to bring your kids along because there’s child-friendly zones with iPads and activity packs. Very simply, it takes a lot of unnecessary psychosocial stress (stress caused by interactions with other people) out of dealing with the welfare system.
That’s crucial, because a wave of research has consistently demonstrated the negative consequences of psychosocial stress. It is a leading cause of every type of physical or mental illness, from depression to diabetes. It leads to chronic inflammation of the body, degrading chromosomes and causing premature ageing. Chronic stress atrophies our brain’s prefrontal cortex, reducing impulse control and making people more likely to choose short-term pleasure over long-term health and success. Importantly, all these negative consequences are likely to plunge welfare recipients further into turmoil and poverty.
The worse we treat welfare recipients, the less likely they are to escape their situations.
Psychosocial stress is experienced by everyone. But psychosocial stressors can be exacerbated by a few factors, mainly feeling unable to control stressors or feeling unable to predict the duration or intensity of stressors. These are precisely the factors present in a punitive welfare system, the inflexibility of which makes it impossible to predict or control the nature of the psychosocial stressors which the system inflicts. In other words, a punitive and uncompromising welfare system exacerbates negative health outcomes for the very people it is meant to help.
By contrast, a flexible and welcoming welfare system gives recipients a greater sense of control and makes it easier to predict the nature of any stressors, lessening the impact of any psychosocial stress incurred.
But the coalition’s reforms are even more profound because they also reduce stress arising from social status, an even more pernicious psychosocial stressor.
Stanford University Professor Robert Sapolsky is one of the world’s leading experts on psychosocial stress. Sapolsky explains that “having your nose rubbed in your poverty is likely to lessen your sense of control in life, to aggravate the frustrations of poverty and to intensify the sense of life worsening… the surest way to feel poor is to be made to feel poor – to be endlessly made aware of the haves when you are a have-not.”
Sapolsky’s research demonstrates that the poor have consistently and dramatically worse health than the middle and upper classes. He calls this the socioeconomic status (SES) gradient. Those at the lower end of the SES gradient have truly abysmal health outcomes. In some countries, those at the gradient’s lower end die up to ten years earlier than those at the upper end and the risk of many diseases can rise five or tenfold. Most worryingly, these are long term consequences. One American study which tracked the lives of elderly nuns showed that even after a half-century of sharing the same food, healthcare, housing and other lifestyle factors, the best predictor of disease, dementia and death was the socioeconomic status the nuns had before they took their vows.
As the nun example indicates, worse health outcomes for those who are lower on the SES gradient cannot be explained simply by unequal access to healthcare and material comforts. There is a steep SES gradient even in countries with universal healthcare and easily accessible welfare systems. Similarly, researchers who studied the British bureaucracy (a highly hierarchical system) found that lifestyle factors like smoking or poor diets explained just a third of the bad health outcomes experienced by lower-ranking bureaucrats.
When the system treats welfare recipients with hostility or indifference, when identification is demanded at the door to a service centre, when it is impossible to reschedule appointments or react to problems with flexibility, then the system is repeatedly signalling to welfare recipients that they don’t matter – that they are inferior.
Since healthcare, material comforts and lifestyle factors can’t explain the persistence of a steep SES gradient, we require another explanation. Sapolsky and others hypothesise that merely believing you are socially inferior to others can have major negative consequences.
For example, Nancy Adler at the University of California conducted a study where people were shown a 10-rung ladder and asked “In society, where on this ladder would you rank yourself in terms of how well you’re doing?”. Adler showed that the subjects’ subjective view of their social status was at least as good as their objective socioeconomic position in predicting their health.
All Westernised societies are intensely hierarchical, with poorer people and richer people. And any such society will have a SES gradient of health outcomes. But a punitive welfare system compounds the problem. When the system treats welfare recipients with hostility or indifference, when identification is demanded at the door to a service centre, when it is impossible to reschedule appointments or react to problems with flexibility, then the system is repeatedly signalling to welfare recipients that they don’t matter – that they are inferior.
Reforming the welfare system so that recipients aren’t forced to wait in inhospitable waiting areas, watched by uniformed guards and refused the help they need unless their performance is perfect will eliminate that message of social inferiority, and reduce the negative outcomes that come with it.
Our welfare system was designed to alleviate the material hardships experienced by the poor; to ensure that the ill had food on the table, that single parents could afford rent and that the unemployed could pay for heating. It also evolved into a system that shamed those people and indicated society’s disapproval of them.
That has always been a morally problematic approach. It is becoming increasingly obvious that it is counterproductive as well; the worse we treat welfare recipients, the less likely they are to escape their situations. A kinder and more supportive welfare system empowers welfare recipients and prevents catastrophic health outcomes. That’s truly transformational.