2014 Shaping the Future of New York Fridays: 11:00-1:45 Boylan Hall, 2231

While reading about CCTs (conditional cash transfers) in this weeks’ material, I was reminded of the first paper I wrote for this class about the different approaches taken to combat homelessness in America. I found the success of CCTs in several Latin American countries pleasantly surprising, because similar programs implemented in the United States were not as successful; a radically different approach has been shown to work instead.

CCTs force the people they help to begin helping themselves before gaining access to funds they need. Parents have to send their kids to school, and if attendance goes down, social workers are sent to check in. This has increased the rates of school attendance, says the article, and kids are learning instead of working in “degrading or hazardous conditions.” The article makes an important point, however, when describing the visits of these social workers when they do have to happen: “the programme emphasizes opportunities for greater well-being, rather than punitive measures for poor performance.”

This is an important distinction to make, because it is precisely the idea of “punitive measures” that has made similar condition-based approaches ineffective when it came to the homeless of America. The 100,000 Homes Campaign is a radical program based on the idea of housing first, a concept that gives homes to the most vulnerable (based on medical history, emergency room visits, etc) with no terms or conditions. In their manifesto, the Campaign says,

“Most homeless people were told they had to earn their way to permanent housing by checking these supplementary boxes [that they were attending job training, addiction counseling, etc].While the intentions behind this approach were good, the unfortunate result was that very few people ever escaped the streets.100,000 Homes communities believe this traditional approach is backwards, and the data agrees with them. Countless studies have now shown that we must offer housing first, not last, if we want to help people out of homelessness.”

Housing first argues that creating a system where recipients must fulfill certain requirements before getting help is “imposing”, and discourages autonomy, which is a key factor in mental health and self esteem. People need the freedom to make their own choices, and when given that freedom, the program argues, those people are more likely to make the right decisions.

So why have conditional-help programs worked for Brazil’s poor families, but not for America’s homeless? Perhaps the data for each must be studied in greater detail- cultural differences could be to blame; or perhaps familial poverty and individual homelessness are different beasts that must be attacked in different ways. Regardless, it is clearly important to have an open conversation about the pros and cons of each approach and how they would help when thinking about implementing social policy and wellness programs.

I found Part 3 of Stuckler and Basu’s The Body Economic illuminating in light of the conversations and discussions we had in last week’s class. One of the ideas we had discussed was the ideology behind austerity, why people would believe in this system that so clearly has painful health as well as economic ramifications. We spoke about the perception of America as a society in which every man is for himself, the great American dream of a man pulling himself up by his bootstraps and attaining economic success. In thinking about austerity, this idea is a very important one because it can explain why people would be opposed to austerity in theory. The great American man doesn’t need Big Government to get involved in his health affairs, which is his personal business. The great American man can, and should, take care of himself. Part 3 of The Body Economic echoed this sentiment, that this great-American-man ideal was a key factor that contributed to austerity’s success- but, interestingly enough, Part 3 related this idea to austerity’s success in the U.K. “…The previous Tory government of John Major called the NHS a ‘bureaucratic monster that cannot be tamed’… Ultimately, the Tories’ position was not based on evidence but ideology- the idea that markets, competition, and profits would always be better than government ideology.'” (page 105). Could it be that the media in America, to whom we attributed in large part the circulation of the great-American-man ideal, was so successful that its ideas permeated the culture of the U.K. as well? Or was this ideal never exclusively American to begin with?

In the next chapter, Stuckler and Basu provide more examples of the less-government-is-better-government idea championed by U.K. politicians: “In 2010, Chancellor of the Exchequer George Osbourne announced an austerity package… This plan was what the Tories called Big Society, which shrank the role of the state in the hope that local communities would fill the gap. As their pamphlet explained, the plan was ‘underpinned by radical reform of public services to build the Big Society where everyone plays their part, shifting power away from central government to the local level…'” (page 132). Here, the idea we discussed takes on a more frightening yet familiar form: the most vulnerable in society, people who need help (sometimes in large part because of the failures and irresponsibilities of the more well-to-do) are lazy, freeloading off of the economically stable. It is interesting to think further about where this idea came from- is it an offshoot of the great-American-man? Regardless, it is a very dangerous way to think if the end goal is producing a healthy, stable and thriving society.

Part 2 of Stuckler and Basu’s The Body Economic stood out to me in part because of its emphasis on emotional themes like morality and unity. In discussing economics, politics and the affairs of countries, ideas like right and wrong are often ignored or treated as unimportant and idealistic. In a perfect world, or on an individual level, people should always behave morally. But must we, and do we, demand that same moral standard when it comes to the actions of countries as units? Stuckler and Basu would say yes, that holding countries to a high moral standard, demanding that they respect and serve their people, is an essential component to their success in all areas- economics, politics and public health. The authors’ discussions in Part 2 about the reactions of Iceland and Greece to their respective fiscal crises focus very much on the emotions of the people and the morality of their countries’ solutions. “Icelanders were now faced with a profound moral question,” Stuckler and Basu write on page 62. “To what degree if any were they as a people and as a country responsible for the malfeasance of their business class?” Thinking about their economic crisis on a moral level, it can be argued from the reading, is what saved the Icelanders from complete chaos. The people of Iceland, over ten thousand of them to be exact, understood that it was not right for them to have to shoulder the burden of austerity to bail out a tiny, reckless upper class. Their peaceful protest then encouraged the leaders of Iceland to also look at the issue in a moral fashion, and a democratic solution was reached: hold a public forum. Austerity was voted against, and the people of Iceland enjoyed a slow yet progressive move towards recovery without the pain of a health crisis.

This sense of morality and democracy among the Icelandic people came, in part, from their strong sense of unity. As the authors point out on page 72, “The people of Iceland felt that they were all experiencing the crisis together…Building a sense of community and togetherness…may have contributed to a heightened spirit of democracy in a time of crisis.” I find it fascinating that Stuckler and Basu chose to note and record the emotional and moral aspects of the fiscal crises- it really speaks to the idea that countries are made up, ultimately, of individuals.