Common sense tells us that poor health can lead to social exclusion and that increased social exclusion can in turn lead to poorer health and quality of life. People working in the field of advocacy for older people know that timely intervention by an advocacy service can be preventative and break a vicious circle. It’s not always easy to explain this in a concise way and I was heartened to read the proof in a report that coherently argues that social exclusion is not inevitable or irreversible with age.
‘Policy makers should encourage greater development of outreach provision to reach the hardest to reach before crises occur’ suggests a report from the International Longevity Centre and AgeUK: Is Social Exclusion Still Important for Older People argues that ‘outreach programmes could encourage more targeted volunteering and advocacy to ensure those with fewer resources receive the services and support that they may need’.
Working in partnership to deliver the Dorset Cancer Advocacy service voluntary organisations Help and Care and Dorset Advocacy are well placed to reach the ‘hardest to reach’ with their established networks across the county and the service complements the range of other support services they offer.
Getting back to the report I found it useful in trying to understand the notion of social exclusion that ‘for older people the notion of social exclusion is grounded in the preservation of independence and autonomy.’ While I have been reading recently about the social determinants of health this report shows that, conversely, health (as well as demographic and socio-economic) characteristics are associated with older people’s levels of social exclusion.
‘Poor mental and physical health’ is ‘associated with higher levels of social exclusion…people whose self-rated health changed from good to bad/poor were five times more likely to become excluded from local amenities compared to people whose health remained very good’. The amenities which the report demonstrates to be increasingly difficult for older people to access include local shopping facilities and hospitals.
I already knew that the work we are doing through peer advocacy support to help older people get the best out of their cancer treatment and care was important to those people both when having treatment and in coping with the after effects. What I now understand more clearly is that our work can be instrumental in preventing a downwards spiral: The poorer your health the more likely you are to become socially excluded, the more socially excluded you are the less likely you are to get the support you need.
In making the case for outreach and advocacy the authors state: ‘Our analyses highlight the precarious position occupied by those who are socially excluded in accessing the necessary services and support that they need. Socially excluded people… are (i) those who are likley to be less engaged with civic structures and have access to information; (ii) are those who have difficulties in physically and economically accessing social, financial, cultural and civic structures and institutions: and (iii) are also likely to have lower levels of negotiation and fewer avenues of social support to help in accessing services and support.’
The financial case for reaching the hardest to reach is also made clear ‘Loneliness, cutting meals, and not receiving care to help with the activities of daily living are negative outcomes in themselves, but can also be viewed as precursors of much more serious, and costly events.’
Older People Living with Cancer 