Injustice: Why social inequality persists by Daniel Dorling

I first came across the work of (Prof.) Danny Dorling in the 1990's in connection with workshops on visualization in the social sciences and Geographic Information Systems (GIS). The other week I read a feature on his (very timely) book in the Society section of The Guardian (O'Hara, 2010).

You do wonder exactly where we are in policy terms given the interval since the Black Report. Dorling's book then sounds like a must-read, with the information posted below from the publishers.

In addition in Waterstones at the weekend I found The Spirit Level, available on their 3 for 2 offer. The links also posted below with an insightful 2009 review of The Spirit Level by Daniel Ben-Ami on sp!ked; plus a related LGC & HSJ event:

Implementing the Recommendations of the Marmot Review:
Reducing Health Inequalities

Injustice: Why social inequality persists

About This Book
Few would dispute that we live in an unequal and unjust world, but what causes this inequality to persist? Leading social commentator and academic Danny Dorling claims in this timely book that, as the five social evils identified by Beveridge are gradually being eradicated, they are being replaced by five new tenets of injustice, viz:

• elitism is efficient;
• exclusion is necessary;
• prejudice is natural;
• greed is good; and
• despair is inevitable.

In an informal yet authoritative style, Dorling examines who is most harmed by these injustices and why, and what happens to those who most benefit. Hard-hitting and uncompromising in its call to action, this is essential reading for everyone concerned with social justice.

"His attack on elitism and despair is impressive, his factual evidence undeniable." Rt Hon David Blunkett MP

Additional resources for Injustice: http://www.policypress.co.uk/injustice_appendix.asp

Dorling, D., Orford, S. and Harris, R. (1998) Visualization in the Social Sciences, A Report for the ESRC/JISC Advisory Group on Computer Graphics, AGOCG Technical Report No 41 (ISSN 1356-9066).

O'Hara, M. (2010). Why Britain's battle to bring down social inequality has failed, p.1 of the SocietyGuardian section of the Guardian on Wednesday 21 April 2010.
The Equality Trust, established by the authors.

World Justice Report: a Plan for Equality and Prosperity Within Planetary Boundaries

Box 1: Combining Global Equality and Planetary Habitability

The Global Justice Report describes desirable future scenarios combining two key goals: socioeconomic equality (including full equality between countries, full gender equality in labour hours and pay, sharp compression of within country income and wealth scales, combined with fair access to education, health and political voice), and planetary habitability (aligning global resource use within ecological boundaries, including a limitation of global temperature rise below 2°C). 

To avoid climate catastrophes, we show that sufficiency is required: a structural transformation of the economy involving shorter working hours, a lower material footprint, a shift from material-intensive sectors toward relatively immaterial sectors such as education and health, and major changes in food systems and land use. Rapid decarbonization of energy systems is also necessary, as is the sharp compression of income and wealth inequality. This compression is both a social justice objective and a condition for financing necessary climate investment and human capital expenditure and for sustaining political support from bottom- and middle-income classes in both the North and the South. 

Box 2: Material and Monetary Accounting for Democratic Debate

Economy and ecology cannot be debated apart: every economic activity has a material footprint, every ecological policy shapes incomes and wealth. To make these links visible, the Global Justice Report uses multidimensional social progress indicators. We set quantitative targets for global socioeconomic justice by combining two complementary languages: material accounting (work hours, sectoral shares, education and health, energy systems, GHG emissions, land use, forest cover, temperature levels) and monetary accounting (income and wealth scales between and within countries, progressive tax rates). The report draws on two centuries of historical data on global inequality and resource use, and on the recent literature on social progress, climate and colonial reparations. 

The Global Justice Report proposes a quantitatively and institutionally grounded step toward global justice. It does not seek to close the debate: it offers a transparent basis on which citizens, unions, parliaments, and international bodies can debate, contest, and decide the course of the coming decades.

...

Chancel, L., Dietrich, J., Mohren, C., Moshrif, R., Odersky, M., Piketty, T., Somanchi, A., et al. (2026), The Global Justice Report: A Plan for Equality & Prosperity Within Planetary Boundaries, World Inequality Lab (gjp.wid.world).

individual

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INTERPERSONAL : SCIENCES             

humanistic ------------------------------- mechanistic

SOCIOLOGY : POLITICAL   

|

group 

SOCIAL JUSTICE

Previously: 'wealth' : 'poverty' : 'social justice'

 My source: BBC Radio 4 World at One.

 

 

Health Inequality: TB, Trauma and Technology - c/o BBC Radio 4

One of the joys of working in the community is that while travelling I can often catch the radio. Being on a 10-6 today I was even better placed to listen to 'Start the Week'. Even though there's the web iPlayer ... sometimes maybe it's a case of real time - real thinking...

It is a very engaging conversation that - as I listened - spoke directly to Hodges' model: but I would say that (not sure about the real thinking though..!).

BBC Radio 4 Start the Week (19 June 2017) Health Inequality: TB, Trauma and Technology

BBC Radio 4 Start the Week:

Health Inequality: TB, Trauma and Technology

In reference to a book there is mention of organisational justice, which I will add to the post on the Grenfell Tower disaster.

I've a related post to follow after midnight UK on social determinants of health. Thank you for your ongoing interest.

Additional tags:

#psychiatry #information #basic needs #shelter #authority #uncertainty #friends #community #location #crisis #war #globalhealth #book #resilience #care #stigma #neglect #institution #community #technology #outcomes #research #services #internet

Julian Tudor-Hart 'The Inverse Care Law' - c/o The Lancet

On the bottom of my notes re. Giarchi and 'distance decay' I'd written:

'Inverse Care law - p.60. - Giarchi. "those who suffer more ill health are less likely to be assisted."

It made me wonder about the origin of this law having posted about it in 2020.

The Lancet has an editorial and an associated podcast:

50 years of the inverse care law. The Lancet, Volume 397, Issue 10276, 767. February 27, 2021.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00505-5/fulltext

'“The availability of good medical care tends to vary with the need for it in the population served. This inverse care law operates more completely where medical care is most exposed to market forces, and less so where such exposure is reduced.”

These understated opening lines of Julian Tudor Hart's paper, The Inverse Care Law, are as relevant now (50 years to the day since publication) as in 1971. The paper is one of the landmark publications in The Lancet's near 200-year history, and the resonance of Tudor Hart's definition of the inverse care law has global and timeless importance. Simply expressed, Tudor Hart observed that disadvantaged populations need more health care than advantaged populations, but receive less.

Tudor Hart's life and career took him from highly privileged beginnings in London and Cambridge to decades spent in the deprived and deeply socialist Welsh valleys. His experience and work has inspired a generation of influential health-care leaders including Andrew Haines, Allyson Pollock, Cesar Victora, and Graham Watt. Today's anniversary issue of The Lancet explores both the global reach of the inverse care law and primary care initiatives in deprived areas around the UK.

Although inequality in health and its many causes are widely understood, inequity in health-care service provision is enduring and fundamental: an intractable concept that lies at the heart of the inverse care law. The inverse care law is primarily about inequity (injustice) in health care that results in unfair social inequalities (imbalances) in health. Since the inverse care law was published, the UK's National Health Service (NHS) has strived to reduce inequity with mixed success. Notably, long-lasting progress was achieved through the 1970s resource allocation formula, which reduced geographical inequality in hospital and institutional expenditure. In the early 2000s, the NHS strengthened primary care provision in disadvantaged areas, leading to a temporary reduction in social inequality, although this progress has reversed following shifts in funding, a slowing of spending, and years of living with austerity.'

See also: 

https://en.wikipedia.org/wiki/Julian_Tudor-Hart

https://www.chpi.org.uk/blog/julian-tudor-hart-and-the-essence-of-primary-care/

Does “#AI” stand for Augmenting Inequality in the era of Covid-19 healthcare? c/o BMJ

Fig 1 Cascading effects of health inequality and discrimination manifest in the design and use of artificial intelligence (AI) systems [BMJ]

Original graphic surgically re-rendered as per the knowledge (care) domains of Hodges' model:

individual

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INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

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group

My source:

Does “#AI” stand for Augmenting Inequality in the era of Covid-19 healthcare? | via @bmj_latest https://t.co/P3zgVBeI4p

— Rob McCargow #MoveForJack (@RobMcCargow) March 16, 2021

c/o SDOH list "Liberal/Individualized Versus Materialist/Structuralist Approaches"

Abstract

Background: While consensus exists that the sources of health inequalities are social inequalities brought on by the experience of qualitatively different living and working conditions, means of addressing these conditions continue to be the subject of dispute. Whether to emphasis education or income as a social determinant of health is one such example of differing views on the sources of these inequalities and the means of addressing them. These different emphases are often justified through the narrow examination of the magnitude of statistical relationships between educational attainment and income with health outcomes.

Purpose: We offer a broader view, seeing these differing emphases as indicative of contrasting views of the nature of society and means of responding to these inequalities with emphasis on education representing a liberal reformist view of the issue while an emphasis on income representing a materialist structuralist view.

Research design and study sample: We examine, the validity of this hypothesis through an analysis of content of five representative publications that consider educational attainment as a social determinant of health and five that do so for income.

Analysis and results: We find that the emphasis on education as a social determinant of health focuses on the attributes of the individual and is generally accepting of the structures and processes of the existing economic and political order. In contrast, an emphasis on income – when placed within a materialist analysis – views existing systems as inequitably distributing income and other resources thereby requiring their reform or transformation.

Conclusion: Considering evidence of deteriorating living and working conditions for many in Canada and elsewhere, we see the latter emphasis as more useful for understanding and addressing these disturbing developments.

Ervin A, Raphael D. Liberal/Individualized Versus Materialist/Structuralist Approaches to Addressing Social and Health Inequalities: Education and Income as Social Determinants of Health. Community Health Equity Research & Policy. 2025;0(0). doi:10.1177/2752535X251316086

At present differentiating and conceptualising the individual and the collective (society) is ongoing. Ervin and Raphael's paper is helpful then:

'Grabb’s definition of social inequality leaves room for the importance of individuals’ attributes such as educational attainment and income – while Crossman’s definition directs explicit attention to the structures and processes of society9,10:'

Individual

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      INTERPERSONAL    :     SCIENCES               

HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

|

Group

'Social inequality can refer to any of the differences between people (or the socially defined positions they occupy) that are consequential for the lives they lead, most particularly for the rights or opportunities they exercise and the rewards or privileges they enjoy.9, p.1'	Physical processes Physical structures Infrastructures
'Social inequality is characterized by the existence of unequal opportunities and rewards for different social positions or statuses within a group or society. It contains structured and recurrent patterns of unequal distributions of goods, wealth, opportunities, rewards, and punishments.10'	Political processes  (bureaucracy) Political structures (inc. Institutional) Power

In Ervin and Rapahael (2025) there are also two tables:

Table 1. Four Primary Aspects of How Educational Attainment Comes to be a Social Determinant of Health.

Table 2. Five Primary Means of Conceptualizing How Income Comes to be a Social Determinant of Health.

- the main headings of which I have mapped to Hodges' model below.

Individual

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      INTERPERSONAL    :     SCIENCES               

HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

|

Group

Personal cognitive and decision-making skills (Cognitive) Access - Literacies	(Physical) Access to healthcare
Behavioural risk factors SOCIO-	Life Chances - Health Career -ECONOMIC status

To leave, manage or join list: https://listserv.yorku.ca/cgi-bin/wa?SUBED1=sdoh&A=1

Kantian Justice: A Desert-sensitive Responsibility-enhancing Theory

On Nov 3rd & 4th last year, I was able to attend a launch event in Liverpool, UK - which I intended to post:

KantianDESERT* is designed to formulate a new model of distributive justice in response to growing economic disparities globally, by offering a distinctive position within dominant egalitarianisms in current political theory/philosophy. Through several original contributions, the project builds an innovative case for a theory sensitive to individual just deserts.

This 5-year, €2 million Advanced Research Project, selected by the European Research Council and funded by the UK Research and Innovation, is led by Professor Sorin Baiasu (Liverpool). With this conference, the project will be officially launched.

The launch has been followed  by a reading group working through (now chapter 4) of Shelly Kagan's -

The Geometry of Desert

Chapter 3 on Desert Graphs - seemed somehow familar, at least in the structures first presented:

Abstract

This chapter is concerned with desert graphs, which help clarify and demonstrate the complexity of the topic of desert. The first section includes graphs that explain the fault forfeits first view and its two extensions. It then studies varying slopes, graphs that depict the desert line of two different individuals, and rotation. The next section discusses the concept of peak, which represents the exact level of suffering or happiness a person actually deserves. It also includes a comparison of the eastern and western slopes of one and two individuals, as well as a section on the Sym Mountain. This chapter also introduces the mountain as the characteristic shape of an individual desert line.

Kagan, Shelly, The Geometry of Desert (New York, 2012; online edn, Oxford Academic, 24 Jan. 2013), https://doi.org/10.1093/acprof:oso/9780199895595.001.0001, accessed 16 Mar. 2026. 

The main launch programme is copied below for reference:

Day 1

9.00-9.15: Coffee/tea. Welcome addresses from Professor Peter Buse (Liverpool, Dean of the School of the Arts) and Professor Michael Hauskeller (Liverpool, Head of the Philosophy Department)

9:15-10:15 Introduction; about the project. Sorin Baiasu (Liverpool): Kantian Justice: A Desert-sensitive Responsibility-enhancing Theory; Tom Bunyard (Liverpool): 'Is Desert a Viable Concept?'; Tom Whyman (Liverpool): 'Food Justice and Desert'

10.20-11.20: Sebastian Orlander (Independent): ‘Kant, Freedom, Desert and Practical Faith’
...
11.30-12.30: Tommaso Mauri (Perugia): ‘Desert and Inequality in Kant: A Theologico-Political Approach’
...
1.15-2.15: Elisabeth Widmer (LSE): ‘What’s the point of Kantian Inequality?’
2.20-3.20: Huub Brouwer (Tillburg): ‘Defending Asymmetries of Desert’
...
3.30-4.30: Tom Mulligan (Georgetown): ‘Who deserves what AI produces?

4.35-5.20: Roundtable

7.00: conference dinner ...

Day 2

9:30-9.45: Welcome; coffee

9.45-10.45: Seniye Tilev (Kadir Has University): ‘Kant on Well-Being and Virtue: A Framework for Desert Without Consequentialism’

10.50-11.50: Krishna Pathak (Delhi): ‘Institutional Desert, Injustice, and Adaptive Preference for Suicide: A Kantian Perspective’
...
12:10-1.10: Jochen Bojanowski (Illionois): ‘Luck Egalitarianism and the Limits of Desert’
...
2.10-3.10: Gabriel Maruchi (Campinas): ‘Denotational Revisionism Cannot Escape Basic Desert’

3.15-4.15: Marius Baumann (LMU): ‘Desert, Responsibility and Skepticism’
..
4.30-5.15: Roundtable & close

Commentators: Tom Whyman (Liverpool), Sorin Baiasu (Liverpool), Bertjan Wolthuis (VU Amsterdam), Christian Españo (University of the Philippines Diliman), Sung-Yeop Jo (LMU), Tom Bunyard (Liverpool), Robin Eliath Joy (Calicut), Beşir Özgür Nayır (Boğaziçi).

https://www.liverpool.ac.uk/philosophy/research/research-projects/kantian-justice/

My source: *Philos-L https://www.liverpool.ac.uk/philosophy/philos-l/ 

Universal Basic [Income and Capital] c/o N. Berggruen

Individual

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     INTERPERSONAL    :     SCIENCES               

HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

|

Group

AI .. Pope Leo XIV - 'Distributional justice' Pope Leo XIII "Rerum Novarum" 1891?^    *Ethics - see below.	Baby bond schemes - Australia Superannuation programme USA MAGA accounts Proposed European Sovereignty Fund? UK? Globally? "We're in this together, remember"
UNIVERSAL BASIC INCOME UNIVERSAL BASIC CAPITAL    PREDISTRIBUTION not REDISTRIBUTION ^History: Impact of the industrial revolution	.. ECONOMY   Diminishing value of labour  Global wealth inequality  US: top 10% own 93% of all equities Europe: .. nearly 60% of all wealth. Bottom 50% owns just 5%

*The ecological and ethical impacts from the energy demands of AI still need to be addressed. Financial 'rewards' for the masses, must not become the 'cake' - the bribe for the public to enter into a conspiratorial dyad with technology. PJ

Source: N. Berggruen, Universal basic capital would create a fair AI economy, Opinion, FTWeekend, 1-2 November. 2025, p.13. https://berggruen.org/eu

https://www.ft.com/content/9b93e02a-c693-4070-9094-a2f532dfa929

See also: 'economics' : 'poverty' : 'AI' : 'inequality' : 'universal'

"The problem that the concept of ‘x’ describes is 'y'."

"The problem that the concept of ‘class’ describes is inequality."
Tyler (2015) p.493.

Tyler, I. (2015), Classificatory struggles: class, culture and inequality in neoliberal times. 

The Sociological Review, 63: 493–511. doi: 10.1111/1467-954X.12296

The problem that the 
concept of ‘care’ describes is 
.....?

individual

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INTERPERSONAL : SCIENCES

humanistic ---------------------------------------  mechanistic

SOCIOLOGY : POLITICAL

|

group

dependency	evidence
demand	supply

signs and symptoms	assessment
roles	funding

self-knowledge	research
family carers	work-force

beliefs - education	systems
expectations	organisations

counselling	treatments
community care	appointments

care	care
care	care

?	?
?	?

person	person
person	person

Pointing to the gap: Social Determinants of Health in Hodges' model

Recent discussion on a HIFA forum included mention of the Social Determinants of Health SDH and inequality. Revising the draft paper on h2cm and threshold concepts (abstract to follow soon) social determinants arose in references there also (Aronsson, 2016).

I realised that I have not stressed enough how readily (and obviously) Hodges' model facilitates reflection and critical thinking about SDH. Hodges' model can really come into its own in this particular application.

So, just in case I take Hodges' model for granted in its potential utility, below I have drawn on the following figure (the findings within will no doubt vary over time and with further research).

By Jsonin - Created this open source diagram for our research into standard human data elements Previously published: http://determinantsofhealth.org, CC BY 4.0, Link

I have mapped the main percentage items to Hodges' model below. Clearly there is great deal of overlap; what for example, is the effect of the physical environment upon individual behaviours? Medicine and medical care does not just rest upon several sciences, but it is inherently political and about power.

Throughout my career and many others I am sure, there is an accompanying gap. It follows us around from the initial educational encounters through to our very latest mandatory training and CPD exercises. Whilst educational in being the theory-practice gap, applying SDH to Hodges' model reveals a much greater gap that politically is still being fought over...

individual

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INTERPERSONAL : SCIENCES

humanistic ----------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

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group - population

38% individual behaviour	7%  physical environment 11% medical care 21%  genetics and biology
SOCIAL DETERMINANTS OF HEALTH 23% social circumstances	As if we needed to be 'told': This space suggests that there really is  still much more to do. To those who would say:  "We have done so much!"  I would say:  "But, we have only  scratched the surface of  the three 'easiest' care domains."

The 38% attributed to an individual's behaviour is a further source of evidence for Hodges' model as a resource for education and personal change.

Aronsson, J. (2016). Transformative sustainability learning within the undergraduate nursing curriculum. Community Practitioner, 89(1), 20-21.

Self-care in e-space and the need to Impress

Working with older adults you realise how unselfish a group they are with regards to their care needs: "spend the money on the children who need it, they are the future."

You also realise that although there are growing numbers of 'silver surfers' (sorry) and their number will swell - the use of digital technology by the general public remains yet another potential source of inequality.

Many years ago I came across HealthSpace (UK) as a fledgling approach and application. I was really impressed as it underlined the need for a generic conceptual framework for health and social care - from senior school through to older age.

It is often said that effective communication needs a channel that is noise free - well here in Hodges' model is a resource to reduce noise for health information across many contexts:

• education
• prevention
• consultation
• social marketing
• self-care
• care planning, evaluation and management
• carer support
• supervision

Demographics also underlines the opening remark in this post and for older adults and many younger that matter of choice arises when it comes to the deployment of digital technology. Yes, many forward thinking people will readily jump on board and use ICT to study, learn, commission, record and co-ordinate their own care - or that of a relative. But what about those who will not use HealthSpace or another personal health records [PHRs]?

For those who do not want to engage - are they to be literally pressed into service? Obviously not - and besides recruitment to the UK services is growing. Jokes aside though the pressure to get the public to add value to their own care is critical to the future sustainability of the health and social care system.

Which brings me back to HealthSpace and the following news on e-Health Insider:

'HealthSpace expansion plans shelved'

Last year’s Health Informatics Review outlined a wide-ranging role for HealthSpace, but the DH has now done a U-turn and demanded more evidence of the site’s value to patients before pushing ahead with further expansion.
...
An outline business case worth £80m to £90m – one source puts the figure at £98m - had been developed by CfH, which was to have been submitted to the Treasury earlier this year.

However, the DH is understood to have spiked the business case, seeking more evidence for the value of HealthSpace, which has not received the backing of Christine Connelly, director general of informatics.

Dr Neil Bacon, founder of the doctors’ website doctors.net and the patient website iwantgreatcare.org, said he was unsurprised that the DH had shelved its plans.

“I think this is their way of quietly getting rid of it,” he told EHI Primary Care. “In the commercial world, if a solution with more than 250,000 potential users had only been used by 400 people it would already have been put out of its misery.”

Dr Bacon said he believed there was a clear and growing demand for patients to manage their own health records but that innovative, entrepreneurial solutions rather than government-led solutions would meet that demand.

More to follow no doubt - but do take care even now if you live by the coast ....

Additional links:

Google Health
 
Microsoft - Health

Digital Britain

The Impress Service

The Royal Navy

Image source: Press Gang stamp

DATA POWER 2024

"Exciting news: 

The fifth #DataPower Conference will take place from 4th to 6th September '24 - in Bangalore (India), Graz (Austria) and online.

Conference theme: Situating Data Practices Beyond Data Universalism.
Deadline: 19th Jan '24"

https://datapowerconference.org/data-power-2024/about-2024

INDIVIDUAL

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     INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

data, AI anxiety psychological security my privacy knowledge what, how we know emotional well-being literacies	DATA numeric - quantified physical access/security surveillance freedomS machine algorithmic
humanity social - society cultural life civil society wisdom data-related PRACTICES how to envisage a just data society? inequality - discrimination	control governments security agencies economics - politics citizenship rights - injustices private corporations political security POWER

  My source:
https://x.com/juliane_jarke/status/1720118890234106296?s=20

Leurs (2023) Data as Boundary Objects, Datafication as Boundary Work

individual

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INTERPERSONAL : SCIENCES

humanistic -------------------------------------------  mechanistic

SOCIOLOGY : POLITICAL

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group-population

PERSON SUBJECT	person [DATA] OBJECT
'Situating data' inequality 'Conceptual Stepping Stones' - Social (and Political)  choreography?	SLAVERY REGISTERS - PASSPORTS RACISM COLONIALISM FEMINISM Star .. feminist slogan “the personal is political.”

Leurs, K. (2023). Data as Boundary Objects, Datafication as Boundary Work. In K. van Es & N. Verhoeff (Eds.), Situating Data: Inquiries in Algorithmic Culture (pp. 123–140). Amsterdam University Press.

https://www.researchgate.net/publication/376113967_6_Data_as_Boundary_Objects_Datafication_as_Boundary_Work

See also: https://en.wikipedia.org/wiki/The_personal_is_political

Situated: Does the 'work' that can be done by a concept vary by definition, according to the (care / knowledge) domain it is found / placed in? Does this is turn influence the 'objects' that are found in the act of crossing(s)?

Thank you – on International Nurses Day (my emphasis)

Dear Peter*

On International Nurses Day, we want to recognise the vital role that nursing professionals play in delivering safe and equitable care. ...

This year’s theme, ‘Our Nurses. Our Future. Empowered Nurses Save Lives’, reflects the importance of supporting you to uphold high standards in a rapidly evolving health and care landscape, with rising demand for care. There are new models of care^ and rapid growth in the use of AI. There are also changing demographics – a more diverse nursing population, with a third of nursing professionals being Black, Asian and minority ethnic. There is also a more diverse patient community to care for, with a greater mix of complex mental, physical, cognitive, and behavioral care needs. To make matters even more challenging, there are sadly rising levels of racism and intolerance across our society, which is affecting health and care – with some Black, Asian and minority ethnic nursing professionals now being subjected to 1970s and 1980s style racism. This is unacceptable. That’s why we’re working to modernise practice learning the Code and the revalidation process, to support you, and students, to uphold high standards in the modern and changing world. We’re consulting on our proposals to strengthen practice learning, so that the next generation of professionals is equipped with the right knowledge, skills and experience to meet society’s future health and care needs. We encourage you to take part in the consultation and share your views, so that the changes we make are informed by your lived experience and professional insight. At the end of this month, we will be publishing anti-racist principles for nursing and midwifery education and practice, to help tackle health inequalities for patients who are Black, Asian and minority ethnic. Our work on the anti-racism principles reflects our responsibility to set clear standards that support equity, safety and public confidence – this has also been central to the ongoing reviews of the Code and Revalidation process. We know there is more to do, and we are listening – to your experiences, your insights and your ideas, as we shape the changes. International Nurses Day is an opportunity to hear directly from registrants, reflecting on what you enjoy about your work and how professional standards guide your practice. As Caroline Ogunsola, Professional Development Lead Nurse at East London NHS Foundation Trust, says: “Your contribution matters – nursing is a lifelong journey of impact and continuous development.” Roisin Devlin, Assistant Director of Nursing and Midwifery at South Eastern Health and Social Care Trust, says: “Take pride in your title and remember people will feel the impact you made on them long after you have forgotten.” To nursing professionals across all settings in the four countries of the UK – we would like to say: ''Thank you for your dedication, resilience, and the essential role you play for people and communities every day.''

Best wishes

Paul Rees MBE Chief Executive and Registrar Professor Donna O’Boyle MBE Acting Executive Director of Professional Practice

^There are older models too, that can help healthcare and education deal with racism, inequity, inequality and AI. 

 *Not to me personally, of course - part of a mass NMC mailing on this special day.

Previously: 'safety' : 'lifelong' : 'model' : 'nurse' : 'values' : 'racism'

Paper: Geopolitical factors and mental health I [mapped to h2cm]

" ... we propose that mental health must be seen as a key strategic goal of foreign policy and be used as a measure of success of the foreign aid to ensure that individual people with mental illness are guaranteed a role and support in the civil society and their needs – clinical or social – do not get swept under the carpet. To this end, we examine some key statistics and to address the mental health needs of those worst placed, we propose an index – the Compassion, Action, Pragmatism and Evidence (CAPE) Vulnerability Index – that identifies the most vulnerable communities so that international aid may be more appropriately targeted, possibly ‘ring fenced’ making mental health a strategic building block of foreign policy." p.779.

individual

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INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

wither mental health in relief, shorter life compared with general population,  poverty including  As a child As an adult Vicious cycle 1: Disaster experiences - mental health Traumatic Stress Disorder**

Natural & man-made disasters, health crises, e.g. Ebola, Conflict, War Climate warming Humanitarian intervention: Emphasis on physical survival and physical health Statistics: globally Proposed index: the Compassion, Action, Pragmatism and Evidence (CAPE) Vulnerability Index – that identifies the most vulnerable communities

Vicious cycle 1: [**Intergenerational transmission of stress and trauma - Epigenetics, social memory]  Social upheaval, migration and displacement mental illnesses assoc with social failures such as poor parenting, school failure, domestic violence and toxic stress, impacted prospects on earning a living, stigma social exclusion Social Determinants of Health Displacement refugees, poverty, women, children,  trafficking, rape

Foreign Policy Relief: mental illness = denial of - human rights, vote, marriage, inheritance, make a will Vicious cycle 2: corruption - inequality sequestration of assets crime, law & order Disaster ('declaration') Mental health problems cost the world some US$2.5 trillion per year  (US$16.1 trillion by 2030) Foreign aid & assistance Foreign policy Populism

Persaud, A. et al. (2018) Geopolitical factors and mental health I. International Journal of Social Psychiatry, 64(8) 778–785. DOI: 10.1177/0020764018808548
https://journals.sagepub.com/doi/abs/10.1177/0020764018808548?journalCode=ispa&

n.b. I have added epigenetics and the intergenerational transmission of stress and trauma.

Optimism - Pessimism c/o Baggini & Macaro

INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

Cognitive flaws, or psychological adaptations? 'Van der Lugt: "reality confound" ... Optimists believe they have more control over what happens than they actually do.'   Dunning-Kruger Effect:  people tend to overestimate their own expertise. Baumeister:  "The negativity effect"   Norem: "defensive pessimism"	Optimism and Pessimism are independent scales. 'Age also makes a difference, for the simple reason that life and its potential future vary accordingly.' 'Designated Cassandra'^ Rotation of role. 'When your prospects are bleak, a gloomy outlook is realism, not pessimism.'
'... how optimistic we feel depends not just on us, but on our life circumstances.  Think about how race, class and social inequality have real impacts on life chances.'	'In western culture, optimism is valorised more than pessimism.' 'To suggest that people struggling in an unequal system should simply adopt a more positive attitude is to turn social and economic problems into psychological ones.'

^With apologies.

Source: J. Baggini, A. Macaro. In defence of pessimism. Or. why optimism is not quite a prerequisite for achieving a valued goal. FT Weekend Magazine, 1131: June 28, 2025, pp.18-20.
https://www.julianbaggini.com/in-defence-of-pessimism/

Books noted in the above article:

Sharot, T. (2011). The optimism bias: A tour of the irrationally positive brain. Pantheon/Random House.

Tierney, J., & Baumeister, R.F. (2019). The power of bad: How the negativity effect rules us — and how we can rule it. New York: Penguin.

Van der Lugt, M. (2025). Hopeful Pessimism. Princeton University Press. https://doi.org/10.2307/jj.17707125

See also:

Baumeister, R. F., Bratslavsky, E., Finkenauer, C., & Vohs, K. D. (2001). Bad is stronger than good. Review of General Psychology, 5(4), 323–370. https://doi.org/10.1037/1089-2680.5.4.323