Why do posh people ignore poverty on their own doorstep?
BMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39378.486794.94 (Published 25 October 2007) Cite this as: BMJ 2007;335:888
All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
Ben Dean states: "Choice does indeed require insight, and there have
been many thousands of teenage girls in the UK who has had enough insight
to deliberately get pregnant in order to gain their own flat and
benefits".
I wonder how many teenage girls actively scheme to get pregnant in
order to get a flat and benefits? Might it be the case that most get
pregnant because they lack role models and are not mature enough to
consider the consequences?
It comes back to education again. This responsibility lies with
parents, teachers and community mentors. It also indirectly lies with the
media who seem to get dumber and dumber each year that passes.
Competing interests:
None declared
Competing interests: No competing interests
When I joined medicine as a medical student, I had noble thoughts of
helping the world and the poor in my neighbourhood. We used to run a
charity clinic and distribute vitamins and protein rich food supplements
in an area around a local temple. I used to enjoy the scenes of poor
people standing in queues out side our one room charity clinic.
As I matured in knowledge, experience and influence the juvenile
thoughts of charity and sharing went out of the window and I have
transformed into a posh NHS consultant in Cambridge working for more and
more of private practice.
There is something wrong with you if you are not a socialist when
young and a Capitalist as you grow old.
I seem to be heading the wrong way.
We have hundreds of thousands of paramedical NHS employees, such as
nurses, midwives etc who find it difficult to balance their books. In
Cambridge they find it difficult to buy houses, can't afford the parking
fee etc. (Iam sure this is true of many NHS hospitals up and down the
country.)
I don't really want to know about them as I have a large house right
in front of the hospital.
I enjoy their suffering as it is a great source of joy to me and I
can pat on my back for being so better off than most of them.
On a serious note I think NHS as a great organization should take a
lead in looking after the majority of its staff. Staff should be
encouraged to have car share by alloting dedicated parking slots for car
sharers. NHS should have co-operative stores for its employees on site.
The problems in NHS are not entirely due to lack of resources or
incompetence. The major problem is the elitist approach of those at the
top, and the total lack of commitment to NHS from those that matter.
Competing interests:
None declared
Competing interests: No competing interests
I just wanted to say that I thought Alison Munns has hit the nail
firmly on the head with her excellent comments.
There is such a tendency in today's society for people to take
absolutely no responsibility for their own actions and choices, instead
they prefer to blame everyone but themselves for things which they could
individually do much more to change.
This leads to a bizarre situation where an all too significant number
of self-made victims are not encouraged to do anything about their sorry
predicament. They expect other people and the state to spoon feed them
the answers and the solution.
The role of the state should be to create an environment that
encourages the poor to lift themselves out of poverty, unfortunately this
state is more keen on spoon feeding and reinforcing peoples' self-
defeating tendencies.
Choice does indeed require insight, and there have been many
thousands of teenage girls in the UK who has had enough insight to
deliberately get pregnant in order to gain their own flat and benefits.
The naive socialist's approach of handing out generous rewards for
failure is wrong. While the individualist's approach of not intervening
at all is also wrong. There is a happy medium of sensible and intelligent
intervention. The state must act as a catalyst that allows people to drag
themselves out of poverty by making better choices; better choices which
are encouraged over bad choices.
At the moment we are using the wrong approach, reinforcing the
culture of the helpless victim will only make this cycle worse. People
can do much more to help themselves and the state could do a hell of a lot
more to encourage it.
Competing interests:
None declared
Competing interests: No competing interests
Dear Dr Lewis
To reply to your 2 queries to the points i was trying to make:
(1) the karate club my child attends is in no way posh. I know the
familes of the children there and I know the families of the children
outside. I know that some in the club have very very little in terms of
material possessions. I know that some of the children outside have more
in the way of material possessions than my child. They or their famillies
made the choice to spend that which they have (time and money) in the way
that they do. We will get nowhere in understanding or changing our world
by saying that those families who choose to let their children damage
property and insult adults have no choice when other families (who
objectively have less recource) do not behave in that way.
(2) I see very clearly from my work as a GP with patients who do not
wish to engage in the world of work that they are often not tragic victims
who are cast on the scrapheap by an uncaring society but individuals that
are making an active choice. Often they are very intelligent, numerate and
literate and thus capable of calculating that the "effort required" /
"income generated" ratio falls, for them, in favour of benefits (if they
can obtain the holy grail of the "doctors note") rather than work. An
example "well i could work but i would only be about £20 a
week better off so what's the point?".
Of course for me with the experience on which i make my choices there
is huge point: contribution to society, a feeling of a job well done, the
camaraderie of collegues, knowing that i have worked hard for what i have
and the satisfaction that feeling brings.
I know why i make the choices i do. Other people know why they make
the choices that they do. But we shy away from asking about them. Much
easier to say they have no choice or that they do not have the capacity to
make a true choice as they lack insight. I don't think as a society we
want to hear the answers that we would get if we did ask. But if we don't
the elephant stays in the room.
Competing interests:
response to previous comments
Competing interests: No competing interests
In writing about Britain's class inequalities, Deborah Cohen does her
cause no favours by comparing Britain's poor to Africa's.
If the Joseph Rowntree definition of poverty is to be excluded from
participating in the norms of society, then for British children this is
likely to mean no foreign holidays, no takeaway meals, no internet access,
no cable television.
For a child born in many parts of the developing world, death before
the age of 5 is a societal norm. Those that survive those dangerous first
few years face the societal norms of hunger, lack of access to basic
healthcare, illiteracy, loss of their mother in childbirth, loss of 1 or
both parents to AIDS, and child labour.
It should come as no surprise then, if rich (or "posh", as Dr Cohen
describes us) Britons concentrate their charitable efforts on poverty in
the developing world rather than at home. It is not a matter of whether or
not our fellow Britons are poor through their own choices; it is just that
in worldwide terms, they are rich.
Competing interests:
RW considers herself rich, and aspires to posh-ness. She is a regular supporter of various developing world charities, and recently requested goats and chickens instead of birthday presents.
Competing interests: No competing interests
Ruskin said that education is not that one knows more, but that one
behaves differently.
I am blessed with sufficient insight to make a sensible choice
between being a slob who snorts coke all day or putting my time and income
into my children's future.
Many of our dysfunctional neighbours lack insight in to the true
crumminess of their lives.
I believe this is partly due a childish media and an ingrained class
system, which sadly benefits no-one.
Competing interests:
None declared
Competing interests: No competing interests
Dear Alison,
" waiting for my son to finish karate training: a community hall full
of children who are courteous, respectful and working hard. In sharp
contrast outside are chidren of the same age trampling on the flower beds
and hurling stones and abuse at the shop windows. It is not cash,
connections or class that separate them."
In put it to you that it IS cash, connections or class that separate
them !! Examine the evidence of your own eyes
"Someone made a choice" - you did.
"To claim "victim" status, to say that people have no choice is to
deny us the opportunity to change things."
How else do you explain your observation "of the gentic inheritance
of incapacity benefit (families where no adult has worked in 2
generations)"
Competing interests:
None declared
Competing interests: No competing interests
Deborah Cohen writes that it is not easy to break the cycle of
inequality and lays the blame at the door of our "class ridden society".
This cycle is real and it would be folly to disagree with the premise
that parents with more recourses (be these financial, intellectual,
spiritual or simply time)are more likely to produce "sucessful" children.
But it is misleading to say that people do not have choice. We, who
do not live their lives may not understand WHY people make the choices
that they do. Our choices are based on our individual experiences and
values and attitudes. It is our choices that define us and divide us.
It is not a lack of opportunity that makes people watch reality TV
rather than read a book from the Library.
It is not a lack of opportunity that makes people walk past the
theatre to spend more at the bingo hall.
It is not a lack of opportunity that makes people spend limmited
income on mobile phone ring tones, nail extensions and fruit machines
rather than good quality food.
And it is not a lack of opportunity to work that leads some of my
patients to demand that i certify that a diagnostic label that they have
collected (that requires no follow up, no treatment and appears to cause
no disability) makes them incapable of any work. The hard working
immigrant patients that i see are proof.
It is a choice.
I write this waiting for my son to finish karate training: a
community hall full of children who are courteous, respectful and working
hard. In sharp contrast outside are chidren of the same age trampling on
the flower beds and hurling stones and abuse at the shop windows.
It is not cash, connections or class that separate them.
Someone made a choice.
To claim "victim" status, to say that people have no choice is to
deny us the opportunity to change things. Instead we need to focus on why
people make the choices they do. Only then do we have a chance to help
them make different ones.
Competing interests:
inner "new town" GP,
socialist,
mother,
observer of the gentic inheritance of incapacity benefit (families where no adult has worked in 2 generations),
sponsor of an African child and supporter of local charities
Competing interests: No competing interests
The answers to this question lie within an understanding of the human nervous system.
Most readers will be capable of a simple thought experiment.
I invite them to choose on any given day whether to be happy or sad.
Alternatively to immediately prefer coffee to tea or vice versa.
These apparent "choices" are of course a chimera
The extreme manifestation of such "choices" fall into the realms of psychiatry.
The point I am making is that it is very difficult for any human being to understand the experience of another unless it is part of their own life experience.
I never understood the difficulties of being a doctor until I became one. I never understood being a businessman (horticulture) unitl I became one. I never understood the difficulties of raising four children until we had four children.
To return to the point - I am still arrogant but less so.
Life is a gift.
The gift is unfairly distributed - but blesses those who do not expect fairness but can accept with peace what they have
Sociological research supports this conclusion.
Competing interests:
Posh Person
Competing interests: No competing interests
Poverty in Africa
I wish I was writing this with twenty years of experience working in
Africa. I wish I was writing this as a consultant. Maybe someone would
listen then. But i'm an FY1 with five months in Mozambique, Zambia and
Malawi.
Please don't try to compare the "poverty" of Britain which is
relative with the absolute poverty of Africa. I've seen far too many
babies and children die of malnutrition or simple pneumonia or diarrhoea.
I've seen a woman die from lack of a 90p anticonvulsant and children die
from the shortage of penicillin. I've seen men in their twenties and
thirties die of HIV related illnesses.
They die in the worst kind of way, stigmatised by society, in pain,
with limited or no access to adequate analgesia. Isolated socially,
leaving little or no hope for their dependants. And the greatest insult?
Effective, cheap treatments exist to extend their lives or relieve their
suffering.
Our world is ridiculously unfair. A child could spot the problem. But
us grown ups couldn't. We are intelligent enough to work out why it is
acceptable. They are "over there" and there is "poverty" on our doorstep.
Competing interests:
None declared
Competing interests: No competing interests