#5 The Politics of Vulnerability

Throughout the COVID-19 pandemic, the concept of vulnerability has played an increasing role in our discourse. Phrases like ‘the vulnerable’, ‘vulnerable groups’, and ‘the most vulnerable in society’ capture our attention in many a headline and daily briefing. But what impact does this vague use of the word have on our ideas about vulnerability?

As a word, vulnerability undoubtedly mobilises compassion among the public and commands financial resources in the political sphere, but what actually is vulnerability? Who are the vulnerable? Do these individuals always accept being labelled as such?

This post will explore vulnerability in two parts. First, we’ll discuss the basic theory behind vulnerability in disaster studies. Then, we’ll apply this lens and expand into the interesting debate around the politics of vulnerability.

An Introduction to Vulnerability in Disaster Studies:

Vulnerability can hold a different meaning for different people, depending on their worldview, experiences and areas of interest. In this section, I attempt to explain what it means in the context of disaster academia, but this isn’t to say that other definitions of ‘vulnerability’ are any less valid or useful.

In disaster studies, vulnerability is defined as “the characteristics determined by physical, social, economic and environmental factors or processes which increase susceptibility […] to the impacts of hazards” (UNDRR, 2015). Put simply, it can be thought of as the human dimension of a disaster.

When the concept of vulnerability emerged in disaster literature, it marked a fundamental turning point in our perspective of disasters. Disasters were previously thought of as uncontrollable external forces that disrupted linear societal progress (Frerks, et al., 2011). As vulnerability was assimilated into the literature, we came to understand disasters as a more complex and dynamic interaction, which not only disrupt society but that are fundamentally shaped by it (Frerks, et al., 2011).

This shift in thinking facilitated our recognition that disasters are actively constructed through poor governance, political processes and harmful development strategies (Frerks, et al., 2011). The nutcracker analogy is often used to help understand how vulnerabilities contribute to disaster. Let’s think of one arm of this nutcracker as the hazard (e.g. a flood, an earthquake, a virus). The other arm of this nutcracker represents the social conditions that foster vulnerability. Each of these arms places pressure on the nut (i.e. our individual or population of interest). At a certain point, this nut will crack, resulting in or ‘releasing’ a disaster. The interaction between these different pressures is essentially Wisner’s et al.’s (2004) ‘pressure and release’ model of disaster (see figure 1 below).

All of this said, we must recognise that it is impossible to eliminate vulnerability entirely, as the sociopolitical environment and the perspectives of individuals and institutions are continuously evolving (Frerks, et al., 2011). Nevertheless, analysing vulnerabilities in this way can expose overarching social and structural causes of disaster.

Figure 1. The Pressure and Release Model. Adapted from Wisner, et al. (2004).

Hopefully this crash course in vulnerability and disasters has given you an insight into how we can understand the pandemic from a different viewpoint. Now let’s use this lens to think critically about how the notion of vulnerability is used in the political sphere.

Vulnerability in Public Health and Politics:

The language of vulnerability has become a motif of this pandemic. Narratives about ‘vulnerability’ and ‘the vulnerable’ are frequently used in COVID-19 daily briefings, political interviews, and policy papers. The Chief Medical Officer also commissioned the ‘vulnerable list’ – now renamed the ‘shielded patients list’ – to identify individuals who are more susceptible to the negative impacts of COVID-19 (NHS Digital, 2020).

Recognising vulnerability of all kinds is vital in disasters, as we have established. In times of crisis, identifying those who are more vulnerable is instrumental in making decisions that reduce risk (Crowther, 2020; Wisner, et al., 2004). The discourse of vulnerability has the power to emote compassion and mobilise our moral obligation to enact social justice (Brown, 2011; Clark & Preto, 2018). Applying the label of vulnerable acknowledges the struggles of many people who experience inequities. However, discourses around vulnerability can be problematic.

With the rise of vulnerability in our everyday lives, its meaning has become somewhat nebulous. This ambiguity extends into policy spaces, as well as scientific literature (Brown, 2011; Clark & Preto, 2018; Katz, et al., 2019). The terms ‘vulnerable groups’ or ‘the vulnerable’ were found to be left largely undefined in a critical discourse analysis of several prominent public health journals (Katz, et al., 2019). This paper found that leaving the who, what and why of vulnerability to be assumed, allows us to turn to prejudiced or detrimental ideas about the ‘typical’ vulnerable person. Similarly, Brown (2011) notes how the term is now more often used in policy as a standalone device – ‘the vulnerable’ – rather than a relational one – ‘vulnerable to’. We must ask what impact the vagueness in vulnerability discourse has on our perspective and on social inequities.

Inappropriate use of vulnerability can create divisive narratives despite superficially unifying messages. Shannon (2020) comments on the dichotomies emerging during the pandemic from a social care viewpoint, criticising the juxtaposition of the heroes (e.g. key workers, Captain Tom) with ‘the vulnerable’. We are divided into the protectors and the protected; us and them. These oversimplified tropes fail to recognise that we can all be heroic and we can all we vulnerable; the boundaries are blurred.

This ‘us and them’ discourse works to facilitate disempowerment. ‘The vulnerable’ are reduced to preconceived ideas about their passivity, and the focus becomes their deficits rather than their achievements and value (Fawcett, 2009; Shannon, 2020). For this reason, some individuals may reject being labelled one of ‘the vulnerable’. There are also many people vulnerable in ways that do not fit into our conventional understanding of vulnerability, who this divisive discourse works to exclude (Shannon, 2020).

Poor consideration of how the notion of vulnerability is used can entrench the damaging belief that vulnerability is somehow inherent. The idea of intrinsic vulnerability ignores that vulnerability is continuously being shaped by sociopolitical and economic realities (Katz, et al., 2019). Certainly, there are those with health conditions who, in the context of this pandemic, are appropriately described as more vulnerable. Although, we must reject the way that vulnerability is framed in political discourse: the homeless people struggling to socially distance themselves; the families relying on school-issued food vouchers to survive, and the people living in chronically underfunded care homes, being cared for by staff with inadequate personal protective equipment, are NOT inherently vulnerable. These vulnerabilities are reproduced by political decisions.

Relocating culpability for vulnerabilities entirely within individuals does not acknowledge the progressive construction of vulnerability through social conditions and structural processes, as highlighted by the pressure and release model. Through the systematic reframing of vulnerability in political discourse, political accountability is strategically removed (Crowther, 2015; Katz, et al., 2019; Stranges, 2019). Accepting the politically-endorsed understanding of vulnerability as inherent, conceals the damaging power dynamics that facilitate these vulnerabilities.

We must continue to challenge the free-floating use of vulnerability in political spaces. But more than this, we must continue to reject divisive narratives, and remember that we can all be vulnerable and that we are all valuable.


Thank you for making it to the end of this very long post! I hope you are all managing to stay safe and well x

Next time: Reflecting on my Time as an Interim Foundation Doctor


If you read one (other) thing today:

‘Them, Us & COVID-19’ by Bryony Shannon:

This blog article summarises some of the key ideas that I’ve tried to talk about here (a lot better than I could ever articulate them!). I think that it’s a refreshing perspective on how language has the power to shape the narratives we hold about others.

Click the button below to read the article:


Sources:

Brown, K. (2011). ‘Vulnerability’: Handle with Care. Ethics and Social Welfare, 313-321.

Clark, B., & Preto, N. (2018). Exploring the concept of vulnerability in health care. CMAJ, E308-9.

Coppola, D. (2015). Chapter 3 – Risk and Vulnerability. In D. Coppola, Introduction to International Disaster Management (3rd ed., pp. 150-223). Oxford: Elsevier.

Crowther, N. (2015, August 5th). It’s high time we abandoned the language of vulnerability. Retrieved from Making Rights Make Sense: https://makingrightsmakesense.wordpress.com/2015/08/05/its-high-time-we-abandoned-the-language-of-vulnerability-2/

Frerks, G., Warner, J., & Weijs, B. (2011). The Politics of Vulnerability and Resilience. Ambiente & Sociedade, 105-122.

Katz, A., Hardy, B.-J., Firestone, M., & Lofters, A. (2019). Vagueness, power and public health: use of ‘vulnerable‘ in public health literature. Critical Public Health.

NHS Digital. (2020, April 10th). COVID-19 – high risk shielded patient list identification methodology: Overview. Retrieved from NHS Digital: https://digital.nhs.uk/coronavirus/shielded-patient-list/methodology/background

Shannon, B. (2020, April 28th). Them, us and COVID-19. Retrieved from Rewriting Social Care: https://rewritingsocialcare.blog/2020/04/28/them-us-and-covid-19/

Siegler, E. (2020). Letter to the Editor: Challenges and Responsibilities in Caring for the Most Vulnerable during the COVID-19 Pandemic. Journal of the American Geriatrics Society, 1-2.

Stranges, J. (2019, August 30th). Words matter: The use of ‘vulnerable’ in health care and public health. Retrieved from St. Michael’s Hospital: http://www.stmichaelshospital.com/media/detail.php?source=hospital_news/2019/0830

UNDRR. (2015, November 12th). Vulnerability. Retrieved from Prevention Web: https://www.preventionweb.net/risk/vulnerability

Wisner, B., Blaikie, P., Cannon, T., & Davis, I. (2004). At Risk: Natural hazards, people’s vulnerability and disasters (2nd ed.). Routledge.


disaster-medic.com

Published by Becca Anderson

Junior doctor with an interest in disaster management 💊👩🏻‍⚕️💉 ~ 🌋🌪🦠

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: