Some notes on homelessness, marginalisation, and social policy.
Yesterday I was in Leeds visiting some colleagues. On the way to the campus, I was stopped by a homeless man who needed help. They showed me an open wound on their leg and explained that they have diabetes, and that this can flare up and cause ulcers, which is what had happened.
They told me they had been to the hospital previously, where I think their leg had been bandaged, and they were then given a prescription for additional bandages which they could collect from a pharmacy. Prescriptions on the NHS are paid for on collection, but if you are receiving Job Seeker’s Allowance then you can get your prescriptions for free. In order to apply for Job Seeker’s Allowance, you need a bank account, previous employment, and an address of residence.
In this case I think the man had taken his old bandages off before getting new ones. Because he now had an open wound on his leg, his shelter had to kick him out, because it was not sanitary for him to be there, and presumably they could not bandage his leg for him. Because he was no longer at the shelter, he could no longer claim Job Seeker’s – arguably he was in no fit state to work anyway – and therefore he could no longer get his prescribed bandages, without paying for them. As a result, he told me he’d been sleeping behind a church for the last two days, asking passers-by for some money so he can get his leg bandaged.
This man’s ordeal is a terrifying demonstration of how our social safety nets can fail, and how problems and marginalisations can reinforce each other.
First, the gaps in our safety nets. Why some someone need to be able to work in order to receive free prescriptions? Surely those people who are unable to work because of medical conditions are most in need of free prescriptions?! Good social policy design requires co-production with a wide range of people and communities, in order to ensure everyone who needs support can access it. And if we are choosing to exclude some group from a safety net, we need to document why, decide if that is ethical, and seek to implement additional or alternative protections.
Second, complex problems. If this person wasn’t homeless or unemployed, they could probably have handled their diabetes. If they were homeless or unemployed but didn’t have diabetes, they would probably find it easier to stay in a shelter, keep looking for work, and maintain their Job Seeker’s. Instead when their diabetes and their homeless are combined, the outcome is a multiplicative burden, much worse than either issue in isolation.
He also told me a bit of his life journey, how he wanted to become a vet with the RSPCA, how he didn’t do well in college and dropped out.
I gave the man some money for his prescriptions and to get a day rider bus ticket. While we walked to the bus stop we walked past another homeless man who he described as “a bully”, and he said this person would take money off of him and other homeless people. This is part of homeless life I had not considered before, but it is something we see in many situations: when people are trapped in a vulnerable position, sometimes their response is to look out for themselves at all costs, rather than to build solidarity and mutual aid. It is truly terrible.
On my train back home at the end of my day, I wondered if the situation had just been an elaborate ruse. Perhaps he already had clean bandages and he had just taken them off to try and elicit some sympathy from me, so I would give him money? This is an example of what Miranda Fricker calls ‘testimonial injustice’, where the accounts of marginalised people are doubted or discredited by those in greater social standing. You might recognise testimonial injustice in other context such as when women’s accounts of sexual assault are minimised. Unfortunately it is quite pervasive. I felt ashamed to have the thought cross my mind, but I’m glad I noticed it for what it is and that I did try and help the man. I determined that I did the right thing regardless of if his testimony was truthful or not: if he was truthful, then he really needed the help; and if he was lying, then I have lost some money, but that is no great harm to myself, and he would benefit from that anyway because he needs money to buy food and transport and survive. That said, this game-theoretic approach is not really a solution to testimonial injustice: it moves us from disbelief to doubt, but it doesn’t move us to trust.