Risk and Social Welfare [1 ed.] 9781608767984, 9781607416913

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Copyright © 2009. Nova Science Publishers, Incorporated. All rights reserved.

Social Issues, Justice and Status Series

Copyright © 2009. Nova Science Publishers, Incorporated. All rights reserved.

RISK AND SOCIAL WELFARE

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Powell, Jason L., and Azrini Wahidin. Risk and Social Welfare, Nova Science Publishers, Incorporated, 2009. ProQuest Ebook Central,

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Risk and Social Welfare Jason L. Powell and Azrini Wahidin (Editors) 2009. ISBN: 978-1-60741-691-3

Powell, Jason L., and Azrini Wahidin. Risk and Social Welfare, Nova Science Publishers, Incorporated, 2009. ProQuest Ebook Central,

Social Issues, Justice and Status Series

RISK AND SOCIAL WELFARE

JASON L. POWELL Copyright © 2009. Nova Science Publishers, Incorporated. All rights reserved.

AND

AZRINI WAHIDIN EDITORS

Nova Science Publishers, Inc. New York

Powell, Jason L., and Azrini Wahidin. Risk and Social Welfare, Nova Science Publishers, Incorporated, 2009. ProQuest Ebook Central,

Copyright © 2009 by Nova Science Publishers, Inc. All rights reserved. No part of this book may be reproduced, stored in a retrieval system or transmitted in any form or by any means: electronic, electrostatic, magnetic, tape, mechanical photocopying, recording or otherwise without the written permission of the Publisher. For permission to use material from this book please contact us: Telephone 631-231-7269; Fax 631-231-8175 Web Site: http://www.novapublishers.com NOTICE TO THE READER The Publisher has taken reasonable care in the preparation of this book, but makes no expressed or implied warranty of any kind and assumes no responsibility for any errors or omissions. No liability is assumed for incidental or consequential damages in connection with or arising out of information contained in this book. The Publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or reliance upon, this material.

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Independent verification should be sought for any data, advice or recommendations contained in this book. In addition, no responsibility is assumed by the publisher for any injury and/or damage to persons or property arising from any methods, products, instructions, ideas or otherwise contained in this publication. This publication is designed to provide accurate and authoritative information with regard to the subject matter covered herein. It is sold with the clear understanding that the Publisher is not engaged in rendering legal or any other professional services. If legal or any other expert assistance is required, the services of a competent person should be sought. FROM A DECLARATION OF PARTICIPANTS JOINTLY ADOPTED BY A COMMITTEE OF THE AMERICAN BAR ASSOCIATION AND A COMMITTEE OF PUBLISHERS.

LIBRARY OF CONGRESS CATALOGING-IN-PUBLICATION DATA Powell, Jason L., 1971Risk and social welfare / Jason L. Powell , Azrini Wahidin. p. cm. Includes index. ISBN 978-1-60876-798-4 (E-Book) 1. Public welfare. 2. Social policy. 3. Risk--Sociological aspects. I. Wahidin, Azrini, 1972- II. Title. HV40.P666 2009 361.6'5--dc22 2009015628

Published by Nova Science Publishers, Inc.

New York

Powell, Jason L., and Azrini Wahidin. Risk and Social Welfare, Nova Science Publishers, Incorporated, 2009. ProQuest Ebook Central,

CONTENTS Preface Part 1:

Contextualising and Conceptualizing Risk

1

Chapter 1

Introduction - Risk and Social Welfare: A Contextual Journey Jason L. Powell and Azrini Wahidin

3

‘A Conceptual Exploration of Risk: Crime, Human Security and Social Welfare’ Gabe Mythen

7

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vii

Part 2:

Risk and Social Welfare: Key Themes

25

Chapter 3

Risk and Social Work Steve Myers

27

Chapter 4

Risk and Aging Dawn C. Carr and Glenn W. Muschert

47

Chapter 5

Risk and Crime Hazel Kemshall

63

Chapter 6

Risk, Government and Social Policy Catherine McDonald

81

Chapter 7

Medicine and Risk John M. Chamberlain

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vi

Contents

Part 3:

Rethinking Risk: The Case of Trust

119

Chapter 8

From Risk to Trust? Reconfiguring Conceptual and Trust Relations in Health and Welfare Jason L. Powell and Azrini Wahidin

121

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Index

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PREFACE This book explores the relationship between risk and social welfare. Traditionally, need has been the major mechanism for allocating resources in public services, and social policy texts have addressed various state responses to social problems and the alleviation of need. However, in a period of state retrenchment and welfare restriction, rationing and targeting have become more intense. This book explores the extent to which, as a result, discourses of risk have replaced ‘need’ as a key principle of social welfare rationing and provision. It begins with an contextual overview of contemporary theories on risk and goes on to critically examine the relevance of risk to social policy and social welfare developments. This is achieved by drawing on recent social policy and case examples from aging, social welfare, social work, health, crime and criminal justice, medicine, and human security. It is hoped that the book will be of particular use to students, practitioners and policy makers.

Powell, Jason L., and Azrini Wahidin. Risk and Social Welfare, Nova Science Publishers, Incorporated, 2009. ProQuest Ebook Central,

Copyright © 2009. Nova Science Publishers, Incorporated. All rights reserved. Powell, Jason L., and Azrini Wahidin. Risk and Social Welfare, Nova Science Publishers, Incorporated, 2009. ProQuest Ebook Central,

Copyright © 2009. Nova Science Publishers, Incorporated. All rights reserved.

PART 1: CONTEXTUALISING AND CONCEPTUALIZING RISK

Powell, Jason L., and Azrini Wahidin. Risk and Social Welfare, Nova Science Publishers, Incorporated, 2009. ProQuest Ebook Central,

Copyright © 2009. Nova Science Publishers, Incorporated. All rights reserved. Powell, Jason L., and Azrini Wahidin. Risk and Social Welfare, Nova Science Publishers, Incorporated, 2009. ProQuest Ebook Central,

In: Risk and Social Welfare Editors: J. L. Powell, A. Wahidin

ISBN: 978-1-60741-691-3 © 2009 Nova Science Publishers, Inc.

Chapter 1

INTRODUCTION - RISK AND SOCIAL WELFARE: A CONTEXTUAL JOURNEY Jason L. Powell1 and Azrini Wahidin2 1

University of Liverpool, Liverpool L69 3BX, United Kingdom Queens University Belfast, Northern Ireland, United Kingdom

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2

INTRODUCTION ‘Risk’ is an increasingly important issue in sociology in general and social welfare in particular. Risk itself has come to assume accelerating prominence in sociological writings of Ulrich Beck. Beck (1992) claims that modernization helps the self become an agent via processes of individualization which they both see as indicative of neo-liberalism; they advocate that the self become less constrained by traditional group identities and institutions but more constraint by the dynamics of markets (labour markets, consumer-markets) and secondary institutions, and becomes therefore a project to be reflexively worked on in the context of a globalized world. As we see the development of this the new global order, some risks such as those caused by hazardous industries, are transferred away from the developed countries to the Third world. Beck acknowledges that some social groups are more affected than others by the distribution and growth of risks, and these differences may be structured through inequalities of class and social position. The disadvantaged have fewer opportunities to avoid risk because

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Jason L. Powell and Azrini Wahidin

of their lack of resources compared with the advantaged. By contrast, the wealthy to a degree (income, power or education), can purchase safety and freedom from fear (Beck, 1992: 33). However, it is the gestation and the constellations of the risks, which are unknown, and thus risk affects those who have produced or profited from them, breaking down the previous social and geographic boundaries evident in modern societies. Beck (2001) makes the point that risk is not an option which could be chosen or rejected in the course of political debate. Instead this is an inescapable product and structural condition of advance industrialisation of where we produce the hazards of that system. He further exemplifies this point by examining contemporary hazards associated with nuclear power, chemical pollution and genetic engineering and bio technology that cannot be limited or contained to particular spaces, and that which cannot be grasped through the rules of causality, and cannot be safeguarded, compensated or insured against. They are therefore “glocal”: both local and global. Risk society is thus “world risk society” and risks affect a global citizenship. The questioning of the outcomes of modernity in terms of their production of risks is an outcome of reflexive modernisation. An awareness of risk, therefore, is heightened at the level of the everyday. In order to tap the ‘everyday’, we may wish to explore the domain by which risk and reflexivity are seen as key: social welfare. To compound this, Anthony Giddens claims that risk is an important factor in the reflexive shaping of subjects in welfare regimes and must be situated within four critical contexts. First, it is claimed that traditional responses to risk are no longer appropriate. Second, and a key factor highlighting the point above, developed societies are themselves less predictable. Faith in the ability of the State or scientific experts to manage risk on citizens’ behalf has therefore diminished. Third, people must anticipate and address risk. Whether this is best achieved by collectively sharing the responsibilities that may lead to individualisation. Four, traditional definitions of risk, premised on technical measures, neglect the social construction of these and of the risks themselves. Similar to the critical observations of Leonard (1997), this poses fundamental questions about the way we define ‘welfare subjects’. By representing risk as a centrally defining discourse of “late modernity” offers a new perspective: it allows the interrogation of how social groups are made subjects within particular domains of social welfare. The more societies are modernised, the more welfare subjects acquire the ability to reflect upon the social forces of their existence within the conditions of risk constraints. Hence, we need to understand the major social forces which impinges on shaping social welfare itself. In a period of state retrenchment and welfare restriction, rationing and targeting have become more

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Introduction - Risk and Social Welfare: A Contextual Journey

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intense. This book explores the extent to which, as a result, risk and social welfare have become key principles of welfare practices and provision in neo-liberal societies. How do we address this? We are fortunate to have a number of authors who have written outstanding chapters around social issues of concern exploring the relevance of risk grounded in a critical discussion.

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STRUCTURE AND ORGANISATION The book is in three parts. The first part of the book examines the contextual and conceptual complexity of risk in its relationship to social welfare. In chapter two, Gabe Mythen has powerfully illustrated that conceptualising risk and social welfare moves beyond traditional definitions that highlighted risk as a key feature of understanding the environment. Mythen moves beyond this and with great verve displays the social implications of risk for theorising social welfare. Part two of the book examines the relationship of risk to thematic issues in social welfare. This is achieved by drawing on recent social policy and case examples from aging, social work, social policy, crime and criminal justice and medicine. For example, in chapter three, Myers critically explores how social work has had to grapple with the issue of risk in its understanding of user groups, in particular vulnerable people. He suggests that social work must move on from its traditional base of evidence-based practice and engage with issues of risk and reflexivity in professional relations with social groups. Following on from this, in chapter four, Carr and Muschert expand on the idea of risk and social welfare by exploring the ways in which the development of the risk society is related to cultural changes and current issues in social welfare: aging. In particular, drawing from examples from North America, they examine the risks facing older adults, including health and victimization, and connect this to types of risk assessment. In chapter five, Kemshall provides a commanding critique of current debates on crime and risk. Her critique focuses on how risk and crime is: evidenced by the political shove of justice and penal policy ; by representations of the media; and policy considerations focused on ‘high risk’ offenders and the management of risk. In chapter six, Macdonald powerfully illustrates how risk has been socially constructed through construction of moral panics by the State. She explores the issue of the “risk epedemic” in social policy by use of Australia as a case study to illustrate the way risk is problematized. In chapter seven, Chamberlaine explores the relationship between risk and medicine. In a thoughtful provoking chapter, Chamberlaine assesses the rise of the risk society by linking it to underlying recent reforms in medical governance in the UK. He suggests that this is a more

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Jason L. Powell and Azrini Wahidin

fundamental shift in the conditions under which medical governance and citizenship can be practiced as a result of the economic and political re-emergence of neo-liberalism. Part three of the book attempts to raise questions about whether risk provides an adequate analytical tool to examine social facets of social welfare. In chapter eight Powell and Wahidin attempt to rethink social theorizing by moving from risk to theorizing the possibility of ‘trust’. It is a provocative argument but one of which we claim that mobilising conceptual tools that are the opposite to risk provides some creative debate about nature of social welfare in modern society. It is envisaged that this exciting book will contribute, in some way illustrate, how examining risk and social welfare is an important means of enhancing our understanding of social relations in everyday life and explanations of society which should be challenging and challenged.

REFERENCES

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Beck, U (1992) The Risk Society, Polity London Beck, U. (2001), World Risk Society, Polity Press, London Giddens, A. (1990), The Consequences of Modernity, Polity Press, Oxford Leonard, P (1997) Postmodern Welfare, Routledge, NY

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ISBN: 978-1-60741-691-3 © 2009 Nova Science Publishers, Inc.

Chapter 2

‘A CONCEPTUAL EXPLORATION OF RISK: CRIME, HUMAN SECURITY AND SOCIAL WELFARE’ Gabe Mythen

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University of Liverpool, Liverpool L69 3BX, United Kingdom

INTRODUCTION The idea and the language of risk has become omnipresent in contemporary society. Risk stretches across and connects together a range of domains, from work, the economy and pensions, through health and welfare, to crime, national security and the environment. Up until the last three decades, risk was primarily used as a technical term to estimate and quantify future harms. As such, the language of risk was largely confined to the ‘hard’ disciplines of medicine, economics, engineering and the natural sciences. However, from the early 1980s onwards, the ‘softer’ social sciences have drawn attention to the subjective dimensions of risk. Since this time a great deal has been written in the social science literature about the ubiquity of risk and the ways in which various threats and dangers bespeckle the lived experiences of individuals in western cultures (see Beck, 1992; Culpitt, 1999; Lupton, 1999). The turn to risk within the academy has led to the concept becoming a focal point for trans-disciplinary debate (Taylor-Gooby and Zinn, 2006; Mythen and Walklate 2006a). The gravitation toward risk as a unit idea is understandable when one considers the gamut of mass mediated catastrophes that have blighted the world in recent

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history. Incidents such as the 9/11 attacks on New York and Washington, the Madrid Train bombings, the Banda Ache Tsunami, the devastating earthquake in China’s Sichuan Provence and the cyclone which destroyed swathes of Myanmar have served to underscore the global presence of risk. Meanwhile, the habitual specter of risk has lingered long over political and media discussions in the UK, exemplified by a mélange of moral panics, including those around knife-crime, pedophiles ‘grooming’ children on the internet and underage alcohol consumption. We are, it would seem, threatened by all manner of threats - the ‘credit-crunch’, rising energy and food prices, the pensions ‘time-bomb’, violent crime and terrorist sleeper cells. In this chapter I wish to trace the turn to risk as a means of explaining the impact that theories of risk have had in framing the nature of sociocultural events and processes. I begin by defining risk and outlining the growing influence of discourses of risk on social, political, economic and cultural life. From here, I provide a capsule account of three interpretive frameworks that have sought to understand the effects of risk - namely the risk society, governmentality and culture of fear perspectives. To provide a carapace for subsequent chapters, I finish by elaborating some of the ways in which social science theories can be deployed to elucidate the practices and dynamics that shape human security and social welfare in contemporary Western cultures.1 Before delineating the key theoretical perspectives it is first necessary to understand the core historical reasons for the turn to risk - both in terms of the mounting cultural presence of the concept and the inflection toward risk as a paradigm for understanding social behaviour.

THE TURN TO RISK The word risk is relatively fresh, emerging in European languages over the last four centuries. The contemporary English term risk is said to find its roots in the Latin resegare through the Italian risico, derived from the verb riscare meaning to run into danger. Although Italian language is the most likely parent of what we understand in Anglophone countries today as risk, it is important to note that there remains a lack of consensus amongst etymologists about the origins of the word. Some historians believe that the original roots of risk lie in the Arabic risq, meaning to acquire good fortune or wealth. Others maintain that risk is a 1 To be clear from the outset, it is not my intention to provide a systematic critique of theories of risk, merely to offer them up as particular ways of conceptualising issues around welfare and human security. For critical commentaries on the work of Beck, Furedi and Foucault see, respectively, (Denney, 2005; Mythen and Walklate, 2006c; Lupton, 1999).

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‘A Conceptual Exploration of Risk’

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derivation of the Greek word rhiza meaning cliff-face, tying the historical meaning of risk to the perils of sailing dangerously close to coastal rocks (Ayto, 1990: 446). Most commentators are agreed that use of the word risk can be linked to the development of principles of maritime insurance, with the term being used to describe the balance between opportunities and dangers in sailing the seas (Wilkinson, 2001: 91). This derivation introduces a more neutral slant on risk, in the sense that it opens up the possibility of gains as well as losses. Yet in contemporary times risk is habitually used to connote threat, to describe the possibility of being affected by adverse outcomes or exposure to harm. In addition to harm, risk is also connected to probability, uncertainty and futurity (see Mythen, 2004). By the early twentieth century, bolstered by previous advances in mathematical thinking, risk had become firmly attached to the concept of probability. Probability assessments of various forms are fundamental in insurance and finance, typically expressed through estimates of exposure to market risk and the range of outcomes of investment decisions for borrowers and lenders. Risk as a way of estimating probability remains absolutely central to both the development and the demise of capitalist economies, shaping the actions of governments, investors, banks and stockbrokers. In everyday parlance, risk is also indexed to uncertainty. Risks are potentially harmful events which may or may not transpire in the future (Adam, Beck and van Loon, 2000: 2; Giddens, 1988: 27). These properties of harm, probability and uncertainty are themselves melded to visions of the future. Risks are essentially hazards that have futurity (Lupton, 1999: 74; Ewald, 1991: 207). Once social risks are identified through the horizon scanning assessment practices of institutions, responsibility for protecting the public against such dangers becomes necessary. Risks are cast as upcoming dangers that need to be managed and reduced both by individual agency and the structural actions of health, welfare and security institutions. As we will discuss later, following this logic, risk ushers in structural forms of societal regulation and individualized forms of self surveillance. Nevertheless, our attempts to predict and control risk cannot and do not guarantee our safe keeping. Nor do they necessarily render us more fearless and secure. If we take the issue of burglary, despite the collective attentions of politicians, the police, the judiciary and assorted neighborhood watch schemes - allied to a veritable panoply of personal security devices such as window locks, burglar alarms, closed circuit cameras and security lights - people’s properties still get burgled. We need to recognize that social risks are resistant to attempts to design them out, be they structural or agential.

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Insofar as avoiding hazards has been an integral part of human life for some time, over the last three decades risk2 has had profound effects on formal politics, social institutions and the contents of everyday life (see Boyne, 2003; TaylorGooby and Zinn, 2006; Mythen and Walklate, 2006a). While citizens have - to greater and lesser degrees - become habituated to living with risk, the modern turn to risk is historically unprecedented. Prior to the 1980s, risk was seen as a technical term associated with methods of calibration. Whereas medics, scientists, environmentalists, meteorologists and economists used risk primarily as a mode of measuring objective hazards, in the 1980s social scientists became increasingly concerned with the social and subjective sides of risk. In this decade an assortment of incidents - amongst them the Chernobyl reactor explosion, the Union Carbide disaster and the BSE crisis - led to public skepticism about the expertise of dominant institutions and their capacity to adequately manage risk. Such catastrophes - allied to wider technological developments which aided the circulation of information about risk - were instrumental in the formation of a climate in which the public are reluctant to place unconditional trust in experts. Given widespread media attention to an ensemble of uncertain situations when experts themselves have disagreed on the nature and extent of risk - among them the MMR vaccine, global warming and mobile phone masts - it is of little surprise that the people have become less trustful of expert systems and more willing to challenge expert opinion (Beck, 1992: 167; Lupton, 1999: 19; Wales and Mythen, 2002). In many respects, heightened public sensitivity to risk can be seen as something of a double-edged sword. Along the inner blade, the relatively free flow of information in the public sphere means that individuals are aware of a comparatively wide range of hazards to the self, society and the environment. Further, risk regulators have themselves become more aware of the subjective processes and cultural networks through which people routinely make sense of risk. However, on the outer edge, increased risk awareness compels individuals to incessantly deal with risks and encourages us to reflect on social situations using a calculus of risk. Everyday activities such as using an automated cash machine, purchasing food or taking one’s children to the swimming baths have all become practices that require mental risk evaluations. As we shall see, some would argue that these mundane forms of invoking risk as a mode of thinking through social experience can lead to an unhealthy climate of risk aversity in which issues of safety dominate and freedom of expression is constrained.

2 Understood as a concept, a process and a mode of organization.

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THEORIZING RISK While the natural sciences, medicine and economics have been central in the development of realist approaches to risk, the social sciences have tended more toward constructionism. Realist approaches have been predominantly quantitative in nature and include activities such as deploying data to identify risk and devising statistical formula to estimate harm. By contrast, the social sciences have focussed on the qualitative, investigating the ways in which risks are culturally constructed and comprehended. This inflection has entailed scrutinising the role that institutions, cultural practices and social processes play in shaping what we think and do about risk. In this oeuvre, a palette of theories have explored the indents made by risk on individuals, institutions and culture.3 These have included the macro sociological systems theory proposed by Niklas Luhmann (1993), the culturally oriented anthropological approach devised by Mary Douglas (1985; 1992) and the cognitively based psychometric paradigm (Slovic et al., 2000). As insightful as these theories may be, in the domain of human security and social welfare three further theories of risk are perhaps more resonant. These are, in turn, the risk society thesis fashioned by Ulrich Beck, the governmentality theory rooted in the work of Michel Foucault and the culture of fear perspective advocated by Frank Furedi. Before teasing out these resonances, it is necessary to sketch out the contours of each approach. Beck’s risk society perspective (1992, 1995, 1999) represents a bold attempt to link the social and environmental harms routinely created by the capitalist system to the wider crisis of modernization. Beck posits that rapid economic and techno-scientific development in the West over the last half a century has generated a dangerous confection of environmental risks that give rise to radical changes in politics, welfare and social policy. Beck is at pains to stress the unique nature of the ‘mega-hazards’ churned out by capitalist industrialization and unfettered techno-scientific expansion. The historical narrative delineated by Beck suggests that during the transition from ‘pre-industrial’ to ‘industrial’ society, the destructive force of natural disasters was kept in check through institutional interventions. However, the concomitant processes of mass production and techno-scientific development that have solidified and quickened since the 1950s have produced a series of volatile ‘manufactured risks’. While pre-industrial cultures were dogged by localised ‘natural hazards’ - such as earthquakes, floods and famine - as industrial society gives over to the ‘risk society’, global manufactured risks such as terrorist attacks, AIDS and chemical pollution blight 3 And, indeed, vice versa.

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the lived environment. These ‘side effects’ of capitalist modernization are anthropogenic, temporally expansive, impossible to regulate and potentially universal in their effects. For Beck, the novel and destructive force of manufactured risks adversely affects people’s health, security and welfare, engendering a movement way from a regimented industrial society towards an unplanned and chaotic risk society. (1992: 45) is that the incapacity of institutions to manage manufactured risks through welfare systems and environmental regulation is testament to the catastrophic conditions of the risk society. In essence, the most urgent societal problems are not direct consequences of a lack of ‘social goods’, such as income, housing and healthcare, but stem from a glut of ‘bads’, such as crime, toxic waste and terrorism. This sea change in the priorities of social distribution has important ramifications for political practices and social policy. One of the ironies of the transformation in distributional logic from goods to bads is the gradual social democratization of (in)security. Under the logic of goods, differentiated patterns of affluence and poverty hierarchically order the have’s and have not’s. By contrast, in the risk society, universal social problems affect both rich and poor alike. As in the case of environmental pollution produced in wealthy Western nations, the progenitors of harm are eventually affected by their own risk production. Such ‘boomerang effects’ indicate that previous forms of social insurance are not sufficient to protect against mobile, global risks. As the media raise risk awareness, public knowledge of the range and severity of harms increases. For Beck and his advocates (see Giddens, 1998; 1999), this makes the political climate of the risk society labile and conflictual, with the broader authority of social institutions being constantly questioned. While Beck is considered the chief architect of the risk society thesis, the governmentality perspective is associated with a larger band of scholars. The roots of governmentality theory can be traced back to the work of Michel Foucault (1978, 1980, 1991). Although Foucault did not write explicitly about the subject of risk in any great detail, his work has been seized upon and expanded by a cluster of social scientists interested in risk, uncertainty and systems of social insurance (see Castel, 1991; O’Malley, 2004; 2006; Dean, 1999). Governmentality theory essentially describes the underlying basis of regimes of power that have emerged in different epochs. In comparison with preceding epochs, the operation of power in contemporary society is said to be diffuse rather than direct, filtering through institutional matrixes and relying on the active consent of citizens (Dean, 1999: 19; Denney, 2005: 35). The governmentality thesis describes the segmentation of life into various institutional fields - such as family, economy, education, hospitals, prisons - which are bound by forms of governance (Foucault 1991: 96). State institutions seek to achieve order and

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promote discipline through neo-liberal values and customs that combine to constitute bodies of social knowledge. Following Foucault’s genealogical method, governmentality scholars have analysed the ways in which risk calculations are used to assess, measure and order populations. Fundamental to the ideological ordering of society through risk is the elastic notion of discourse. In Foucauldian usage discourse refers to language, ideas and practices that act as channels for the representation of knowledge. Dominant institutions disseminate discourses that lead to the formation of discrete forms of knowledge which determine what is knowable and thinkable about a particular issue. For instance, the police, criminal justice agencies, doctors, scientists and teachers direct discourses about risk which govern both how risk is defined and managed. Foucauldians argue that expert institutions strategically deploy discourses of risk not only to channel information to the public, but also to reinforce dominant values that reduce political opposition to the status quo. For Foucault (1978; 1980) discourses discipline and restrict human agency by generating ‘truths’ about society which become interiorized by individuals. The interiorization of discourse through inculcation and adherence to preferred social norms enables people to make sense of the world whilst simultaneously reproducing power relations not by force but by self reproduction. As self-evident ‘truths’ cluster into discursive regimes which direct behaviour, people become practised in bringing themselves to order (Allen 2004: 39). Thus, governmentality equates to a ‘specific economy of power - in which societies are ordered in a decentred way and wherein society’s members play a particularly active role in their own self governance’ (Dupont and Pearce 2001: 125). In effect, citizens respond to discourses by taking up subject positions that require them to manage their own risks, be they around personal health, welfare, relationships or careers (Dean, 1999). Expert discourses of risk provide the boundaries of (in)appropriate action, surveying and regulating cultural practices and reproducing productive bodies that uphold the dominant social order. Sharing some constructionist turf with Foucauldian thinkers, the culture of fear thesis popularised by Furedi (2002; 2005; 2007) suggests that the language of risk has become culturally ubiquitous. The omnipresent reinforcement of a range of security threats is symptomatic of a tendency to focus on the negative aspects of everyday life. In Furedi’s opinion, the perpetual construction and articulation of various risks has led to fear becoming ‘a means through which people respond to and make sense of the world’ (Furedi, 2007: 7). Furedi argues that fear is a generic and free-floating phenomenon that connects to a range of incidents and processes. Juxtaposing Beck’s realist emphasis on catastrophic threats, Furedi believes that fears about risk are culturally constructed, being promulgated, promoted and manipulated by politicians, the mass media and those working in

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the welfare and security industries. A fearful population is a population that is more easily governed and more likely to invest in a burgeoning array of security products. Ceaseless media coverage of impending threats to human security and government incitements that the public be aware of a concatenation of risks, encourages individuals to become introspective and fearful. The production of fear is multivalent, appearing at different levels and nodes of cognition, emotion and experience. In this sense, fear is as much a way of interpreting lived experience than a response to actual harms: ‘many of us seem to make sense of our experiences through the narrative of fear. Fear is not simply associated with high-profile catastrophic threats such as terrorist attacks, global warming, AIDS or a potential flu pandemic … there are also the quiet fears of everyday life’ (Furedi, 2007: 1). Our reliance on fear as a lens of categorizing and understanding obscures the fact that - following indicators of life expectancy, health and mortality rates - contemporary western societies remain safe and secure places to live. Further, the cultural fixation with high consequence but low probability risks diverts public and political attention away from deep-rooted global problems of poverty, malnutrition and disease. Sharing some ground with governmentality thinkers, Furedi reminds us that risks are not simply extant and self evident entities. Although institutions may use methods of risk assessment to identify and calibrate harms, such methods are themselves rooted in a geo-social context and are the products of individual and collective cultural values and choices: ‘the impact of fear is determined by the situation people find themselves in, but it is also, to some extent, the product of social construction. Fear is determined by the self, and the interaction of the self with others; but it is also shaped by a cultural script that instructs people on how to respond to threats to their security’ (Furedi, 2007: 5).

APPLYING THEORIES OF RISK: CRIME, SECURITY AND SOCIAL WELFARE Having discussed the concept of risk and documented the turn to risk within the social sciences, it is worth demonstrating how the theories recounted here can be deployed to enable an appreciation of prescient social trends. What follows is intended not as a systematic application, but rather a suggestive taster of the possibilities of risk theory. I wish, in essence, to demonstrate some of the concrete ways in which theories of risk can be mobilised to provide portals for viewing critical and contested contemporary issues. To enhance breadth, I will connect

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each perspective outlined to a discrete problematique around crime, security and social welfare. Frank Furedi’s work on the sociocultural production of anxiety lends itself to an analysis of contemporary fears around crime in Western societies. Drawing on the findings of criminological research into fear of crime, Furedi (2007: 3) discusses the role of the media in producing moral panics about spectacular but relatively rare violent crimes. Borrowing from the pioneering work of David Garland (1990), Furedi posits that fear of crime is currently a more widespread problem than criminal acts themselves. Statistical surveys that claim to reveal the extent of ‘fear of crime’ are not value free and often speak more about people’s perceptions of the local environment, quality of life and their degree of discomfort with social change (see also Lee, 2007). Despite this in the UK and the US the fear of crime industry has sizeable social effects and attracts heavy media and political coverage. Tracking Furedi (2007: 3) we might suggest that the reporting of ‘fear of crime’ surveys perversely serves to increase rather than decrease public fear: ‘this process of trying to quantify a cultural mood means that the fear of crime becomes objectified, and thus can acquire a force of its own. Its objectification may turn it into a ‘fact of life’, and this can help to legitimate, if not even encourage the fear response’. In a climate of anxiety about crime risks, fear can be harnessed by government as a tool for seeking public endorsement for the implementation of new security measures (Walklate and Mythen, 2008). Further, public fears can also be taken advantage of by those working for profit in private security industries. A concatenation of ‘fear entrepeneurs’ have emerged to cater for our worst fears, touting a dilating array of security wares to keep the public ‘safe’ from crime (Furedi, 2007). To shadow the culture of fear in practice, we can examine current anxieties in the UK about ‘knife-crime’. The British Crime Survey (2008) first took measurements of knife crimes in 2007-2008 and reported an estimated 22,000 criminal incidents involving the use of knifes. Putting aside the reliability of the data,4 this of course, constitutes a serious problem that requires addressing. Yet, following the culture of fear perspective, it is the scale of the political outcry and the degree of media focus that is most noteworthy. Leading up to and following on from the announcement of these figures, the media - especially tabloid newspapers and TV news programmes devoted significant coverage to knife-crime and, in particular, the deaths of teenagers who were victims of stabbings. Newspaper front pages ran with marmalade dropping headlines such as ‘Knife-Crime Britain’, the Lord Chief

4 The British Crime Survey does not, for instance, interview those under the age of 16 who may be both offenders and victims of knife-crimes.

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Justice rashly diagnosed an ‘epidemic’ and the Mayor of London referred to knife-crime as a ‘scourge’. This epidemic was described as spreading out from the cities into Britain’s towns and villages (Leach, 2008). These sensationalist and rash responses render an exceptional and isolated problem generic and endemic. Without belittling the tragedy of the victims or the existence of the problem, what has been lacking in the media moral panic and the political rhetoric is adequate cultural contextualization and balance of response. Through the lens of the culture of fear approach we might want to ask what goes unreported and which potential messages of reassurance become muted. Amidst such small print we might learn that more than half of ‘knife-crimes’ in the UK occur in just three cities, with a significant number of fatal incidents being gang related (Stewart, 2008). What goes missing in the frenzy of the media and political mix it seems is a response which is commensurate to the magnitude of the risk. As Garside (2008) observes: ‘reporting has been out of all proportion to the scale of the problem and has distracted attention from where the real harm to young people lies. Far more young people kill themselves than are killed by others, for instance’. Shadowing Furedi’s thesis we can survey the inputs of the media, politicians and the security industries in constructing ‘fear of crime’. From the angle of risk perception and risk management, we might also recognize that institutional responses to ‘public fears’ are not necessarily in kilter with the degree of threat. As Furedi has directed aspects of his analysis to fear of crime, Ulrich Beck (2002; 2006) has oriented the risk society thesis toward security issues relating to the terrorist risk. Alongside violent crime, terrorism has become one of the most potent and mediated symbols of risk in Western cultures in the last decade. Following on from the terrorist attacks associated with Al Qaeda in the USA, the UK and Spain, the issue of how best to maintain human security has ascended the political agenda. Insofar as terrorism is an omnipresent historical phenomenon, the nature of the threat posed by Islamist terrorist networks is said to have increased in scale leading some security experts, politicians and academics to hail a new form of international terrorism (Morgan, 2004).5 In seeking to illuminate the changing quality of terrorism, we can return to the central planks of the risk society thesis. Terrorism can be classified as a ‘manufactured risk’ in the sense that terrorists produce harm through human volition, deploying devices created through scientific and technological knowledge and principles. Beck’s claims about the catastrophic nature of manufactured risks are well illustrated by the numbers perishing on 9/11. The globality of threats defined in risk society theory

5 It is important to note that the discourse of ‘new terrorism’ is both contestable and problematic (see Mythen and Walklate, 2006b; McGhee, 2008).

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can also be related to the international topography of new terrorism and the geographical span of attacks (Beck, 2006: 110). Similarly, at a first glance, the dispersal of the terrorist threat reflects Beck’s claims about the universality of manufactured risks. Given that the prescribed objective of networks such as Al Qaeda is to injure or kill civilians, it is impossible to guard against being a victim. Even affluent and powerful Westerners rich in cultural, political and economic capital cannot immunize themselves against harm. Indeed, these groups of people are the prime targets of terrorist groups (Beck, 2006: 152). Finally, we can detect elements of the risk society’s ‘boomerang effect’ in the way in which terrorist groups have turned science and technology and the materials of globalization against producing nations through the use of mobile devices and activities such as phishing, money laundering and the manufacture of chemical weapons (see Ericson, 2008: 59; Mythen, 2008). While Furedi and Beck’s work can be mobilized to read issues around fear of crime and terrorism respectively, the work of Foucauldian scholars has been frequently applied in the domain of welfare, with tSeveral commentators have described the neo-liberal restructuring of welfare that has occurred in Britain since the 1990s as driven by a movement away from need and toward risk as an organizing principle (see Kemshall, 2006; Lupton, 1999: 98). The new quest of welfare governance is the lessening of individual risk rather than the satisfaction of collective needs (Culpitt, 1999: 35; Kemshall, 2002: 22). In this sense, welfare policies are not so much geared around the meeting of human needs or the pursuit of a collective good, but rather the prevention of risk and the transference of responsibility for risk from the State to the individualThe governmentality take is centrally bound up with how security and risk are operationalised through welfare policies by a disciplinary State seeking to secure order (see Culpitt, 1999: 21). Both understandings of welfare and individual responsibility are said to be shaped by an institutional matrix which includes politicians, welfare workers, medical professionals, lawyers and civil servants. This institutional matrix has, in recent times, sought to rationally manage risks to the population through various forms of data gathering, policing and regulation (May and Powell, 2006: 133). . Foucauldians have been alert to the concomitant shifts in discourse that have accompanied transformations in the welfare system and the risk responsibility transfer from citizens to the State. Civil servants have become ‘welfare managers’, active ‘welfare consumers’ have replaced dependent clients and the unemployed metamorphosed into ‘job seekers’ (Fergusson, et al., 2004: 150; Kemshall, 2006: 62). As such, what were previously cast as interpersonal relationships become formalized through risk-based technologies of governance that encourage personal responsibility and individual risk management. As

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Fergusson et al. (2004: 153) argue, the process of privatized prudentialism through which individuals are encouraged to be responsible for calculating and managing their own risks has become an embedded feature of contemporary lived experience.Changes in policies governing the distribution of unemployment benefits in the UK illustrate well the ways in which disciplinary risk management techniques aim to cajole and bring citizens to order. Since the emergence of the Welfare system in 1945 unemployment benefit had been seen by many as a citizens’ right. Yet changes in legislation bought in since the 1980s by both Conservative and New Labour government’s make State benefit a conditional and interim privilege (Kemshall, 2006: 63). The rules surrounding entitlement to benefit have been tightened significantly in the last two decades, with claimants having to demonstrate that they are actively and persistently attempting to gain employment. In recent times, the Government has sought to reduce dependency on unemployment benefits through a range of disciplinary policies, including extending the school leaving age to seventeen years old and devising a range of compulsory programs targeted at the long term unemployed. Institutional discourses around welfare benefits - and concomitant scaremongering about economic ‘drain on the system’ - make individuals liable for their own safety management and encourage blame by attributing risk to marginalized minorities. The clustering together of welfare practices with moral judgments about groups that are (un)deserving of support simultaneously extends the surveillant tentacles of the neo-liberal State and responsibilizes its citizens. In recent history in the UK, stigmatizing risk discourses have sought to target specific groups identified as dependent on State welfare provision including Afro Caribbean minority groups, Eastern European migrants and single parents. While contemporary disciplinary discourses are arguably more oblique, the targeting of ‘demanding’ welfare groups continues. References to an aberrant group of young people tagged as ‘NEETs’ (Not in Education, Employment or Training) have become common in governmental language around the reform of unemployment benefits. Attendance on a confection of qualifications-based training courses intended to improve ‘employability’ has become mandatory for people classified as NEETs (see Kingston, 2008). In these vignettes, we can see how discourses and technologies of risk around welfare serve to reinforce State governance and intensify the classification and control of citizens. As governmentality thinkers posit, the dissemination of dominant discourses can function as a tactic of disciplinary control through which right thinking citizens are encouraged to come to order.

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CONCLUSION Having considered the concept of risk and provided capsule accounts of how risk theories can be put to work in the domains of crime, security and welfare it is worth drawing the chapter to a close by commenting on the distinct knowledge drivers which steer each perspective. It is evident that competing theories of risk carry distinct assumptions about how risk is constructed, deployed and managed. As such, culture of fear, risk society and governmentality theories open up and peep through different apertures which can themselves be related to the epistemological underpinnings of each perspective. Emphasizing the deleterious effects of unfettered turbo-capitalism on the environment, Beck’s appeal for social reformation necessitates that manufactured risks are assumed as concrete entities. This realism is consciously blended with aspects of constructionism which work themselves out in relation to his acknowledgement of the institutional shaping of danger and allusions to diverse cultural perceptions of risk. Beck’s work has both political prescience and environmental clout, but the historical narrative is far too neat and general. Whether or not the novel mega-hazards defined as the most critical to resolve are those that should be exercising social and political consciences is contestable. One could make an equally - if not more convincing case - that the most pressing issues that require resolution today remain the old burdens of global poverty, malnutrition, disease, warfare and human rights abuses (see Mythen, 2005; Grayling: 2007: 65). In contrast to the realism within the risk society thesis, the governmentality thesis is characterised by much stronger elements of constructionism (Lupton, 1999: 35). Catalysed by an emphasis on the power of discourses in ordering ways of thinking and acting, governmentality thinkers have been stirred to unpick the methods and technologies through which governments regulate welfare and social security. In the Foucauldian version, risks are defined by discursive practices that are unrecognisable outside of dominant belief systems (Ewald, 1991: 199). Thus, while risk society theorists are troubled by the malign effects of manufactured risks, governmentality thinkers instead wish to warn of the ways in which discourses of risk serve to simultaneously responsibilize citizens and reinforce governance. Rather than focussing on the ways in which individuals and groups perceive risk, Foucauldians are seeking to deconstruct the language of risk and to highlight aspects of incitement and coercion embedded within risk discourses. Unsurprisingly, the governmentality approach has been criticised for over accenting the disciplinary function of institutions and underplaying human agency in resisting and shaping social conditions. Furedi’s culture of fear approach is also predominantly constructionist, resting on the creation of fear via a plethora of

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institutional interactions, practices and strategies. This said, Furedi, like Beck, wishes to hang on to some notion of the ‘real’ dangers in society, rather than simply those that preoccupy the over active minds of media professionals and Government ministers. In contradistinction, Furedi’s approach is perhaps less hung up on the harmfulness of risk and more on the process by which individuals and groups are defined as dangerous. Insofar as Beck is exercised by the environmental consequences of anthropogenic risks, Furedi is foremostly interested in the ways in which risks are rendered socially significant through the operationalisation of a culture of fear. The culture of fear approach adopted by Furedi does tap into the mood of the zeitgeist, but it is rich in anecdotal examples and lacking in empirical engagement with what people actually do with the anxious promptings of dominant institutions. Indeed, without establishing the extent to which individuals and groups actually are fearful or the conditions under which this takes place, it may be more legitimate to talk about different degrees of, or potential cultures of fear. In conclusion, the theories of risk discussed here do not provide a flawless entrée into the social and cultural world. They should be perceived not as giant windows on the world, but more as hermeneutic frames which offer a particular view of the social world. Despite the flaws, considered as an ensemble, these approaches do offer interesting and enlightening ways of conceiving of and understanding the processes and practices at play around crime, security and welfare in contemporary society. Of course, once they assume popularity, theories are wont to be to be criticised, disassembled, stretched and reshaped. Insofar as I have focussed on the possibilities of risk theories we must be mindful too that such theories need to engage with the messier empirical realities of everyday life. Our analysis has been commentary based and situational rather than grounded in the lived experiences and articulations of particular individuals or groups. A full critical consideration of risk theory is beyond the ambit of this contribution, but we must be clear that conversations about risk within the social sciences are often conducted in foreign grammar. The meaning of risk in governmentality accounts is vastly different from that verbalised by proponents of the risk society thesis. Where one speaks of risk in terms of its capacity to generate power, order and control, the other defines risk in relation to adverse consequences on the environment and the health of citizens. Rather than seeking a master theory which acts as an panacea or rigidly committing to one school of thought, we are perhaps better served by beginning with micro level processes and practices and considering the multiple ways in which theories of risk can elucidate them. Taking in the broader picture, the widespread applicability of risk as a unit idea has enabled interchange and debate between scholars working in assorted

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academic disciplines (Mythen and Walklate, 2006; Taylor-Gooby and Zinn, 2006). As will become clear through the contributions in this book, the beauty of risk lies in its seemingly universal explanatory promise. There are few social problems that one can think of that do not relate to the idea of risk. Yet we would do well to heed a note of caution too, as the ubiquitous beauty of risk is also its beast. Where everything is risky, then somehow nothing is. Further, the very liquescence of risk can lead to it being appropriated, manipulated and ideologically abused by power brokers. Thus, amidst the possibilities of risk, it is perspicacious to keep a trained eye on its limits both as an explanatory concept and as a broader cultural totem.

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REFERENCES Adam, B., Beck, U. and van Loon, J. eds. (2000) The Risk Society and Beyond, London: Sage. Ayto, J. (1990) Dictionary of Word Origins, London: Bloomsbury. Allen, J. (2004) ‘Power in its Institutional Guises’, in G. Hughes and R. Fergusson, eds. Ordering Lives: Family, Work and Welfare, London: Routledge. Beck, U. (1992) Risk Society: Towards a New Modernity, London: Sage. Beck, U. (1995) Ecological Politics in an Age of Risk, Cambridge: Polity Press. Beck, U. (1999) World Risk Society, London: Sage. Beck, U. (2002) ‘The Terrorist Threat: World Risk Society Revisited’, Theory, Culture and Society 19: 39-55. Beck, U. (2006) Cosmopolitan Vision, Cambridge: Polity Press. Boyne, R. (2003) Risk, Buckingham: Open University Press. Burnett, J. and Whyte, D. (2005) ‘Embedded Expertise and the New Terrorism’, Journal for Crime, Conflict and the Media, 1(4): 1–18. Castel, R. (1991) ‘From Dangerousness to Risk’, in G. Burchell, C. Gordon and P. Miller, eds. The Foucault Effect: Studies in Governmentality, London: Harvester Wheatsheaf. Culpitt, I. (1999) Social Policy and Risk, London: Sage. Dean, M (1999) Governmentality: Power and Rule in Modern Society, London, Sage. Denney, D. (2005) Risk and Society, London: Sage. Douglas, M. (1985) Risk Acceptability According to the Social Sciences, New York: Sage.

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Douglas, M. (1992) Risk and Blame: Essays in Cultural Theory, London: Routledge. Dupont, D. and Pearce, F. (2001), ‘Foucault contra Foucault: Rereading the ‘Governmentality’ Papers’, Theoretical Criminology, 5: 123–58. Ewald, F. (1991) ‘Insurance and Risk’ in G. Burchell, C. Gordon and P. Miller, eds. The Foucault Effect: Studies in Governmentality, London: Harvester Wheatsheaf. Ericson, R. (2008) ‘The State of Preemption: Managing Terrorism Through Counter Law’, in L. Amoore and M. de Goede, eds. Risk and the War on Terror, London: Routledge. Foucault, M. (1978) The History of Sexuality, Harmonsworth: Penguin. Foucault, M. (1980) Power / Knowledge, Brighton: Harvester. Foucault, M. (1991) ‘Governmentality’ in G. Burchell, C. Gordon and P. Miller, eds. The Foucault Effect: Studies in Governmentality, London: Harvester Wheatsheaf. Furedi, F. (2002) Culture of Fear: Risk Taking and the Morality of Low Expectation. London: Continuum. Furedi, F. (2005) ‘Terrorism and the Politics of Fear’, in C. Hale, K. Hayward, A. Wahidin and E. Wincup, eds. Criminology, Oxford: Oxford University Press. Furedi, F. (2007) ‘The Only Thing We Have to Fear is the Culture of Fear Itself’, viewable at http://www.spiked-online.com/index.php?/site/article/3053/ accessed 1st October 2008. Fergusson, R., Hughes, G. and Neal, S. (2004) ‘Welfare: From Security to Responsibility?’, in G. Hughes and R. Fergusson, eds. Ordering Lives: Family, Work and Welfare, London: Routledge. Garland, D. (2001) The Culture of Control: Crime and Social Order in Contemporary Society, Oxford: Oxford University Press. Garside, R. (2008) ‘Knife Crime: Perception Versus Reality’, The Guardian 18th July. Giddens, A. (1998) ‘Risk Society: The Context of British Politics’ in J. Franklin, ed. The Politics of Risk Society, Cambridge: Polity Press. Giddens, A. (1999) The Reith Lectures: Risk. http://news.bbc.co.uk.reith_99 Accessed 1st October 2008. Grayling, A. C. (2007) The Choice of Hercules: Pleasure, Duty and the Good Life in the 21st Century, London: Weidenfield and Nicolson. Kemshall, H. (2006) ‘Social Policy and Risk’ in G. Mythen and S. Walklate, eds. Beyond the Risk Society: Critical Reflections on Risk and Human Security, London: McGraw-Hill. Kemshall, H. (2002) Risk, Social Policy and Welfare, Buckingham: OUP.

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Kingston, P. (2008) ‘Government’s plans for Neet group criticised’, The Guardian 7th May. Leach, B. (2008) ‘Knife Crime Worse Than Thought, New Figures Show’, Daily Telegraph, 21st September. Lee, M. (2007) Inventing Fear of Crime: Criminology and the Politics of Anxiety, Willan Devon. Luhmann, N. (1993) Risk: A Sociological Theory, NewYork: Aldine de Gruyter. Lupton, D. (1999) Risk, London: Routledge. May, T. and Powell, J. (2007) ‘Foucault: Interpretive Analytics and the Constitution of the Social’, in T. Edwards, ed. Cultural Theory: Classical and Contemporary Positions London: Sage. McGhee, D. (2008) The End of Multiculturalism? Terrorism, Integration and Human Rights, Buckingham: OUP. Mythen, G. (2004) Ulrich Beck: A Critical Introduction to the Risk Society, London: Pluto Press. Mythen, G. (2005) ‘From Goods to Bads? Revisiting the Political Economy of Risk’, Sociological Research Online, 10 (3) http://www.socresonline.org.uk/ 10/3/mythen.html Mythen, G. and Walklate, S. (2006a) ‘Towards a Holistic Approach to Risk and Security’ in Beyond the Risk Society: Critical Reflections on Risk and Human Security, London: McGraw-Hill. Mythen, G. and Walklate, S. (2006b) ‘Criminology and Terrorism: Which Thesis? Risk Society or Governmentality?’ The British Journal of Criminology, 46(3): 379-98. Mythen, G. and Walklate, S. (2006c) ‘Communicating the Terrorist Risk: Harnessing a Culture of Fear?’ Crime, Media, Culture: An International Journal, 2(2): 123-142. Mythen, G. (2008) ‘Sociology and the Art of Risk’, Sociology Compass, 2(1): 299-316. O’Malley, P. (2004) Risk and Uncertainty, London: Glasshouse Press. O’Malley, P. (2006) ‘Criminology and Risk’, in G. Mythen and S. Walklate, eds. Beyond the Risk Society: Critical Reflections on Risk and Human Security, London: McGraw-Hill. Slovic, P. (2000) The Perception of Risk, London: Earthscan. Stewart, E. (2008) ‘Knife Crime Not Increasing’, The Guardian 13th July. Taylor-Gooby, P. and Zinn, J. (2006) Risk in Social Science, Oxford: Oxford University Press. Wales, C. and Mythen,G. (2002) ‘Risky Discourses: The Politics of GM Foods’, Environmental Politics, 11(2): 121-44.

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Wilkinson, I. (2001) Anxiety in a Risk Society, London: Routledge.

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PART 2: RISK AND SOCIAL WELFARE: KEY THEMES

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Chapter 3

RISK AND SOCIAL WORK Steve Myers University of Salford, Salford, M5 4WT, United Kingdom

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INTRODUCTION Risk has become an increasing concern of social work in the UK during the previous two decades, influencing policies and practices as well as warranting significant theorising by social work and related academics. This development of and preoccupation with risk has been hotly contested in epistemology, research, policy and practice across the range of activities and locations of what we may describe as social work. The practice of social work is influenced by broad notions of risk and how these are constructed and applied to understanding, managing and working with people who come within the scope of social welfare services. This has led to changes in the application and performance of social work including tensions about the purpose and intention of the range of social work activities, the relationship between the worker-service user and the philosophical basis of the profession. Is social work to be located within the certainties of a rational, technical, functional, scientific-diagnostic intervention, or is it more accurately located within the uncertainties and contingencies of a moral, critical, reflexive, aesthetic and practical-useful approach? This chapter chooses a broad understanding of social work as an activity that is difficult to boundary, but ranges across locations, structures and ‘social groups’ that are deemed to warrant state support and/or intervention due to their vulnerability/threat to themselves/others. These binary constrictions are not

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always easy to disaggregate, so an aggressive young person (threat) may well also inhabit a deprived social space warranting care and concern (vulnerable). Social work will be used loosely but emerge from some of the specifics of the illustrations of theory, research, policy and practice.

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AN OCCUPATION PRE-OCCUPIED WITH RISK? The social work literature about risk has been steadily growing and developing during the previous decade, emerging from changes in policy and risktheory that impacted directly on practice and in conceptualising what was happening in the macro-context. Social work academics have drawn on theory about perceived moves to centre-stage risk in society generally, with Beck (1992, 1999) and the notion of the risk society, Giddens (1990, 1998) and reflexive modernisation, and Foucault (1979) and governmentality being regularly marshalled to provide understanding about the basis of policy and practice developments (e.g. Webb, 2006; Ferguson, 2004; Parton (ed.), 1996; Kemshall, 2002). Charting the changes towards a preoccupation with risk (or more specifically risk-assessment, risk-reduction and risk-management) has led to debate and discussion from the emerging social work academy about the very nature of social work; what it should do and how it should go about doing it. It has opened debates about the philosophical basis of social work, the ontological and epistemological positions taken and the future direction of practice. Specifically within the social work, the increasing focus on risk has influenced policies and practices, with a relationship with the evidence-based practice movement claiming a broader scientific-technological-rational basis for all social work activity. This understanding of the world finds the search for factors, characteristics and actuarial calculation of risk both achievable and desirable-the truth is out there and can be located and understood. These have been powerful arguments in calming the anxieties of social work which had been caricatured as being subjective (as a pejorative), unscientific, research-poor and unable to make informed, rational, correct judgements. The development of risk as central to social work has been linked to wider social and economic changes, specifically the rise of neo-liberal political systems of thought and governance (Kemshall, 2002). The contraction of the welfare state both as an organizing concept and in the scope of practical provision has been the subject of considerable interest, with for example Giddens (1998) and Rose (1999) arguing that the move away from universal solutions to social problems to a more individualized approach is based on the regulation of risk and the

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promotion of the ‘entrepeneurial self’. This regulatory function of the state replaces the previous provider function, assisting and insisting that citizens are encouraged to take responsibility for their own future and the management of their economic, social and personal risks. The role of the state is to provide a (minimum) framework to ensure that people make correct, informed, responsible choices thus reducing state interference/support. However, the forcing of people to be free to make choices presumes an equal access to resources that stratified societies do not offer, making achievement of the neo-liberal ideal of rational, competent actors extremely difficult. Increasingly the inability to respond appropriately to the freedoms offered is constructed in terms of moral and personal deficits, the failure to take responsibility for individual actions. This rolling back of universal provision and development of the regulatory functions of the state is most clearly exemplified by economic strategies, where the private sector is allowed to lead economic development with various degrees of state regulation. The recent financial global crisis has been exacerbated by the lack of effective regulation and can be seen as a consequence of a neo-liberal agenda. The ‘privatisation of risk’ (Webb, 2006:60) has consequences for citizens who can no longer expect the same level of universal benefits from the state as previously enjoyed. People must now avoid (or be made to avoid) a culture of dependency on such provision, hence the pejorative terminology associated with young single benefit-claiming mothers and other groups deemed to be excessively demanding on welfare. The terminology of social work is also reflective of these presoccupations, with people now described as ‘service users’, ‘consumers’, or in need of ‘empowerment’. This lexicon is not necessarily benign, although it may have good intentions, and reflects the individualization of those who enage with social work provision. Empowerment is often contructed as enhancing the skills of the person to make responsible decisions and choices,thus avoiding challenging the broader socio-economic structures that impact negatively on people’s lives. Those who are marginalised in this risk society are increasingly subject to surveillance; they are both at risk and risky, with different forms of intervention depending on their specific moral failing (homelessness, single parenthood, poor educational achievement, offending, drug-using). Rather than viewing their problems as the product of broad structural disadvantage, they are compartmentalized into individualizing sub-groups with programmes to deal with their personal deficits. In terms of social work practice, the logical outcome is the focused intervention by specialist workers to deal with these atomized problems, perhaps not located within the scope of ‘traditional’ social work at all. The development of Youth Offending workers is an example of this, where social work is not viewed as particularly useful in applying the assessment protocols,

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actuarial frameworks, discrete programmes and values of preventing offending. The application of ‘scientific’ methods of risk assessment promotes the ‘instrumental rationality’ concept of Weber (Webb, 2006), where professional expertise is limited to deciding on the appropriate intervention to achieve specific outcomes, with little recognition of the complexity and moral issues involved. If someone is violent then they require Anger Management; if someone has been assaulted then they require trauma therapy; if someone cannot find employment then they need social skills training. This investigation-diagnosis-intervention model is linear and prone to support by positivistic knowledges, yet struggles to incorporate complexity, social inequalities and personal agency. Knowing what has been effective with similar problems that people faced does not necessarily translate into effective practice with each individual with those problems. The problem becomes the person and pathologised site of intervention. Risk assessment has become a key task of social work across the many places in which it is practiced (Parton, 1996). Some of the examples of risk assessment policies, procedures and protocols will be developed later in the chapter, but it is useful to be clear about the hopes of risk assessment and how this is conceptualized. The aspiration to predicting and determining probable outcomes is a common feature of risk assessments, where risks are identified, quantified and then prioritized through pre-existing criteria. The outcome is a probability of risk as harm, leading to the allocation (or not) of resources and interventions. The process is permeated by actuarialism, whereby the methods of calculating risk in the world of financial insurance have been translated into the social field. However, there are major criticisms of this approach to risk, not least that finding objective facts in the social world is extremely problematic and that claims to certainty are questionable as socio-cultural influences provide the context in which all such decisions are made, leading inevitably to subjective judgements (Douglas and Wildavsky, 1982). As Parton says ‘Risk assessment suggests precision, and even quantification, but by its nature is imperfect’ (1996:109). The denial of subjectivity and the assumption of scientific certainty leads to practices that marginalize the engagement of the person receiving social work; the only contribution required is data related to pre-identified categories of concern. Within risk society the role and authority of professionals is questioned (Rose, 1999), and it can be argued that the growth of risk assessments supported by scientific knowledge acts as a way of making defensible decisions and providing increased credibility for organizations. The cultural privileging of the scientific lends strong support to difficult decisions, and having an image of certainty helps to generate more confidence in systems that are inherently uncertain, as they work with the complexities of the human. If a decision is based

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on actuarial probabilities and the outcome is an undesired one, then the system has been followed with the best knowledge at the time to make a defensible decision. Young (1999:392) describes actuarialism as ‘calculative of risk; it is wary and probabilistic; it is not concerned with causes but with probabilities, not with justice but with harm minimisation’. It is about governance rather than social work values. The following sections of this chapter explore the ways in which risk is constructed and deployed within two sites of social work practice: criminal justice and child protection, illuminating the policies and practices linked to the previous discussion.

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CRIMINAL JUSTICE Criminal justice has long been a site of social work activity, primarily through the Probation systems1 providing support and guidance for those who have offended. The original (and continuing in sites of some resistance) approach of focusing on the needs of the offender to encourage and enable life-choices and resources that would improve both the quality of life of the person and reduce the damage done to society has undergone significant challenge and change. Increasing socio-political intolerance of crime has underpinned a shift in the ways in which crime and those who commit it are viewed and responded to, reflected in policies, protocols and procedures that are increasingly mandated by legislation and guidance. The expressed desire of criminal justice policy has been to reduce offending through the identification of those individuals who are most likely to re-offend and/or present the greatest danger to the public. To this end, there has been a growth in the use of risk assessment tools that claim varying success in identifying those who are likely to be most dangerous. O’Mally (2000) argued that in the US (which with Canada has produced and introduced several risk assessment frameworks, procedures and management strategies) this has led to a situation of exclusion and incarceration of those deemed to be ‘beyond rehabilitation’, where the risk (political as well as for potential victims) of recidivism is too high to warrant management in the community. Classical punishment for behaviour based on assumptions of moral choice and (however limited) agency has been supplanted by notions of rational calculation and

1

Probation for offenders was first introduced in the UK in 1907.

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scientific judgement; that those who are risky/dangerous can be identified and therefore controlled/contained. The introduction and application of risk assessment protocols has developed within Probation/Offender Management Systems for specific as well as general offending. Sexual and other violence has been prioritised for intervention with several risk assessment protocols being in current use (Probation 2008a). These include commercial tools such as Static-99 (an actuarial tool for sex offenders), VRS (Violence-Risk Scale), HCR-20 (Historic-Clinical-Risk, 20 factors), VRSSO (Violence-Risk Scale, Sex Offender version), PCL-R (Psychopathy ChecklistRevised) and Risk Matrix 2000 (also for sex offenders). The investment in such tools reflects the assumption that recidivism can be reasonably quantified and predicted, but is also linked to the perceived failures of the previous probation model of social work. The introduction of new approaches with the explicit aim of reducing the alleged vagaries of individual worker judgement, plus a move to describing the workers as ‘Offender Managers’ and ‘Offender Supervisors’ and the criminal justice system as ‘correctional’ changes the role of the social workerwith-offenders away from what is recognisably (both professionally and in lay understanding) ‘social work’. Fitzgibbon (2008) analyses the impact the refocussing on risk has had on criminal justice workers and argues that there has been a process of deskilling and re-skilling. The traditional ‘therapeutic’ role/approach of criminal justice practice, underpinned by holism and seeking an understanding of the individual complexities and richness of the person, has been replaced by a bureaucratically-driven ‘Taylorisation’ of the workforce that is concerned with the application of centrally imposed rules and criteria. The professional judgement of the worker is limited to ensuring that the established criteria are being accurately identified, rather than any broader role utilising their knowledge and skills. These changes have been critiqued extensively by the academics and/or practitioners within criminal justice, but there also appears to be concerns within the government departments that all is not well with their approach. As research and evaluation of the new initiatives has emerged, it is apparent that many of these are not as effective as their proponents would have us believe. In the face of sustained criticism of the theory and research underpinning the policies, there have been attempts to modify both the claims made for such approaches and in their application. For example, the Probation Service (2008b:2) recognised the limitations of the Risk Matrix 2000 and issued guidance that illustrates some of the arguments that had been raised against the wholesale acceptance of such an approach:

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It is recognised that RM2000 is limited in that it cannot provide any information about whether or not individual offenders in each risk category will re-offend, it only gives information as to which offenders are relatively more likely to do so. Moreover, it gives a long term assessment of the likelihood of reconviction and so is not sensitive to day to day changes in an individual’s circumstances that might indicate heightened risk. RM2000 cannot therefore be used to monitor fluctuations in risk that might indicate that action is necessary to protect the public. It cannot measure changes in risk levels and so does not identify when and how to intervene.

This neatly encapsulates the limitations of this approach to risk: it produces fixed, narrow, static subjects generated by aggregate data from similar groups-the individual circumstances, complexities and dynamism are minimised. The preoccupation with risk has led to significant changes in the response to youth offending, a site of contested sense-making where debates about welfare, punishment, responsibility, morality and development abound (Muncie, 2009). The political context of a ‘hardening’ of attitudes towards youths and youth crime has led to the introduction of legislation and guidance designed to identify and manage those children/young people who are deemed to be ’at risk’, not of vulnerability to social, personal and economic pressures, but of the likelihood of becoming involved in criminal behaviour. Early intervention in the lives of children/young people to prevent them becoming a threat to society is a key thrust of this ‘new’ youth justice (Goldson, 2000), with claims that the technologies of risk assessment and prediction can assist in the management of this (Farrington, 1996). Factor-based approaches based on the study of delinquent children/young people can be used to develop frameworks and checklists to identify those who are likely to become offenders or those who are likely to go on to re-offend. This approach has become rationalised within youth justice practice through the application of the ASSET tool2, a computerised checklist of static and dynamic evidence-based factors that result in an overall score of seriousness. This in turn suggests a particular course of management, either sentencing or intervention. Practitioners and academic critics have found this problematic for a number of reasons, including the limitations of the factors, their subjective construction and the reduction in professional judgement and interaction traditionally brought to understanding young people and criminal behaviour. Pitts (2001) has described this move to a more controlled and bureaucratised approach as ‘Korrectional Karaoke’ and the ‘zombification of youth justice’, critiquing the reductionist technologies within this way of thinking that view young people as 2

For a fuller discussion of the construction and evaluation studies of the ASSET, see Smith (2007).

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no more than the factors identified and practice as only dealing with these elements of the whole. The influence of Cognitive Behavioural Therapy (CBT) fits neatly as a practice theory within this, as it has at its core the assumption that ‘wrong-thinking’ can be changed through the identification and transformation of cognitive distortions. Criminal behaviour is an individual matter of pathology/deficit (the distortions are variously created by attachment problems, learned behaviour or environment generally), which requires the attention of experts who can diagnose and treat the problem. Criminal justice practice in the UK has been highly influenced by assessments and intervention based largely on CBT principles, underpinned by research from Canada and the US claiming significant success rates (Goldson and Muncie, 2006). However, as research and evaluation has progressed, the claims for success wane as larger numbers of more diverse people are subjected to these approaches. These ways of working may have some effect on specific populations, but the factors become so broad that they inevitably include large numbers of children who do not offend. Webster et al (2006) undertook a longitudinal study of young people and confirmed that many of the static risk factors associated with criminal behaviour (e.g. poor educational attainment, single parent families, school refusal) were present in the non-offending population, and had closer links to poverty than to criminal career. Children and young people living in poverty and deprivation are likely to be defined as ‘at risk’ of offending and targeted as such. However well-meaning this may be (and indeed may attract much-needed resources) the focus tends to be on the outcomes of poverty (familial and personal) rather than on the structural problem of poverty itself. The political context is redrawn away from the social and onto the personal. The targeting of the poor for limited intervention is also a clumsy approach; Webster et al found that there was a high rate of ‘false negatives’, where significant numbers of children and young people who had multiple criminogenic factors did not develop criminal behaviour. The dangers of labelling children at an early age of ‘becoming’ criminals include approaches that may well confirm that identity when they are placed under state surveillance. The importance of socio-economic environment was highlighted by Wikstrom and Loeber (1997) in the extensive Pittsburgh Youth Study3, where a child with low risk factors would still fare worse in a poor area than a child with high risk factors who lived in an affluent area. Nonetheless the current political thrust is encapsulated by the following statement by the former UK Prime Minister:

3

The study analysed the lives of 15000 young people in the city

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There is now a wealth of empirical data to analyse. The purport of it is clear. You can detect and predict the children and families likely to go wrong. (Blair 2006)

Even the proponents of a factor-based approach have been moved to clarify their claims:

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Any notion that better screening can enable policy makers to identify young children destined to join the 5 per cent of offenders responsible for 50–60 per cent of crime is fanciful. Even if there were no ethical objections to putting "potential delinquent" labels round the necks of young children, there would continue to be statistical barriers. Research into the continuity of anti-social behaviour shows substantial flows out of – as well as in to – the pool of children who develop chronic conduct problems. This demonstrates the dangers of assuming that anti-social five-year-olds are the criminals or drug abusers of tomorrow. (Sutton et al. 2005)

Despite the criticisms of the risk agenda in policy and practice, the Criminal Justice and Immigration Act of 2008 (www.justice.gov.uk) codified the previous sentencing options into one Youth Rehabilitation Order (YRO) that comprises of various components decided upon by the factors highlighted in the assessment. This ‘Scaled Approach’ (YJB, 2009) seeks to match the elements of a sentence to the pertinent factors in the offending, personality, family and environment of the young person. The ASSET process is completed and the outcome leads to an appropriate (scaled) type and intensity of intervention. The imagery of an appropriate drug treatment for a diagnosed illness is useful here, where the patient is given the prescribed dosage of treatment to deal with their symptoms.

CHILD PROTECTION The inceasing emphasis on risk, risk assessment and risk management within social work has been illustrated within the field of child protection/welfare, through the introduction of policies, procedures and practices that reflect central concerns about how to protect children from danger. The UK has followed a particular approach in addressing these concerns, which is highlighted by comparison with mainland European approaches. The ambivalence of the UK to the socio-economic outlook of European welfare models and the flirtation with US modes of welfare delivery have generated a system that remains focused on identifying and intervening with those children and families who are ‘at risk’,

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leading to practices that are forensic and individualizing, rather than supportive and global (Trotter et al, 2001; Kemshall, 2002). Child protective services in the UK4 tend to be discrete teams that investigate, assess and decide on whether legal thresholds have been met for the state to intervene in the private affairs of the family. Mainland European approaches locate potential or actual harm to children within broader welfare services of education and health, underpinned by a social contractual understanding that the state should provide supportive interventions to promote the general welfare of its citizens (Parton, 2006). The use of risk in the UK is located within this structure, leading to practices that claim the ability to identify and manage the dangers faced by children, primarily within their families. The social context of childhood has been identified as a major influence on how risk is constructed within protective services. Childhood itself is subject to historical change, as the discourses surrounding it develop and respond to social understandings and temporal concerns. The growing ambivalence towards children and childhood has been recognized and discussed in terms of a ‘moral panic’ (Critcher, 2003) and as being ‘invested with a growing sense of anxiety and panic.’ (Buckingham, 2000:3). Jenks (1996) has argued that the conditions of late modern society have created uncertainty and a lack of safety/security, a consequence of which is the investment in childhood as being a site of nostalgic security (childhood used to be better) and future aspirations (children are our hope for a more secure world). Adults project current anxieties onto children/childhood in ways that mould policies and practices, as well as relationships. Beck and Beck-Gernsheim (1995) argue that there has been an increased emotional investment by adults in children and childhood, as representations of a more ‘traditional’, secure past and as projections of their own hopes and aspirations for the future. The mythologies of ‘Golden Ages’ of childhood are marshalled to support such notions, despite the clear evidence that these are fantasies rather than reflecting historical realities (James and James, 2004). Children become subjected to broader social concerns that focus on the need to protect them and what they represent from the corrupting and threatening adult world as well as their own propensity to become corrupted and threatening. Constructing an idealized and normative image of children and childhood places children in a position of vulnerability and threat, where the narrowed confines of expectation need to be vigorously protected and policed. The earlier discussion on youth crime demonstrates one aspect of this, as children need a firm response when they refuse 4

The four nations of the UK are increasingly introducing separate legislation and guidance on child welfare, some of which is significantly different in emphasis and associated practice.

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to act within the boundaries of expected childlike behaviour. Risks to children need to be anticipated, monitored and eliminated where possible through state policies and practices, with an emphasis on intervening in children’s lives ‘in terms of their future, rather than being recognized in their own right’ (James and James, 2004: 193). The broadening of intervention in children’s lives from a protection from abuse perspective to a much wider ‘safeguarding of all children and childhood itself’ (Parton, 2006: 152) has been a key determinant of UK policy since the inception of the Labour government in 1997. Risks to children and childhood have been re-conceptualised within discourses that expand the repertoire of danger away from narrow extreme-harm formulations to a much more interventionist strategy of ensuring that all children fulfilled their (and society’s) potential. Risk in late modern society exists for all children in different forms at different times, given the expansion of risk-parameters and the development of expectations of childhood. In order to ensure the safety of those specific children who were in particular danger of greatest harm, as well as providing for the wellbeing of all children, it was necessary to develop surveillance procedures that covered the whole population. The impact of high-profile deaths of children such as Victoria Climbie hastened the process of change in protective systems, based on concerns that social workers were unable to identify and prevent danger to children due to personal or systemic failures. The conclusions of the investigations into these tragedies (e.g. Laming, 2003) echoed previous investigations into past deaths, such as that of Maria Colwell in 1973, and several points of comparative concern have been identified (Parton, 2006 in Smith, 2008): • • • • • •

Communication failures Poor recording of basic information Non-use of existing case files Lack of direct communication with the children themselves Over-readiness by professionals to believe what was said to them by carers Absence of appropriate supervision

These issues may on the face of it appear rather technical, however their chosen emphasis indicates an assumption that the problem lies with the implementation of the system, rather than raising questions about the processes and methods of the system itself. The assumption is that the structures and guidance, if adhered to, will provide the most effective protection for children,

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thus side-stepping broader questions about the whole approach. The ambiguities in the Laming Report can be encapsulated by two quotations from it: I remain amazed that nobody in any of the key agencies had the presence of mind to follow what are relatively straightforward procedures (2003:4)

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It is unrealistic to expect that it will ever be possible to eliminate the deliberate harm or death of a child-indeed, no system can achieve this (2003:361)

The latter point reflects the realities of child welfare, however the final recommendations of the Laming Report were firmly within the spirit of the former quotation, ‘focused on finding better ways of organizing the processes in place to identify and manage the risk of harm to children’ (Smith, 2008:10). State organizations providing services (health, education, social care) for children were to work together to ensure the safety and well-being of children, in the context of identifying and managing risk through common procedures and understandings. The Children Act 2004 introduced the structures for ensuring that the reemphasis in children’s services was implemented in England. Informed by the Laming report, and the legislative outcome of the green paper Every Child Matters (www.everychildmatters.gov.uk), these reforms had the expressed intention of re-focusing children’s services and introducing new systems to manage risk. Indeed, the concept of risk was broadened out to include a much wider range of threats to the welfare and healthy development of children, including bullying, discrimination and environmental factors. Rather than a ‘passive’ stance of responding to specific individual concerns, the guidance promotes a much more active approach to seeking out, reducing or eliminating risks (HM Government, 2006:77): Everybody who works or who has contact with children, parents and other adults in contact with childrenshould be able to recognize, and know how to act upon, evidence that a child’s health or development is or may be being impaired and especially when they are suffering, or at risk of suffering, significant harm.

The emphasis on creating effective systems of information-sharing between the myriad organizations involved in the lives of children included specific guidance on how this should be undertaken, including structures (DoH, 1999), information systems (DfES, 2006) and practice (DfES, 2004). Local Safeguarding Boards were formed, with a strategic as well as operational role in coordinating and developing services. In order to capture the risk to children within the framework of safeguarding, the importance of initial assessment screening was

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highlighted with specific recommendations and prescribed processes. Information technology has been introduced to assist this process, with what has become known as the Integrated Children’s System (ICS) being universally applied within each local authority area. The ICS allows for the monitoring and analysis of all information collected on children, with the intention of responding to the criticisms in successive child death inquiries that poor collaboration and information-sharing by professionals have been major factors in these events. Early identification of ‘problems’ would lead to an appropriate response to ensure that these difficulties (health, anti-social behaviour, educational achievement, poor family context) are dealt with before they become detrimental to the child (and a burden the state). Smith (2008) raises several questions about the above re-focusing of safeguarding that link directly with the theory and practices of risk. The first is that of presuming that increased sophistication and detail in the processes and procedures will lead to increased effectiveness and a more definitive outcome. The presumption of achieving certainty, underpinned by evidence-based protocols, indicators, matrices and factors, may lend itself to defensible decisions, but can broaden the range of risks to a point where all children are subjected to these and it is problematic to make sense of an overall picture of the situation. By spreading responsibility across professional boundaries and disciplines the different understandings of risk, childhood and harm may create less consistency in practice with confusion and differing interpretations. Secondly, the expansion of monitoring and surveillance processes will undoubtably generate an enormous quantity of information that will need to be assessed and responded to. Increasing the number of factors of concern and encouraging early referral for assessment are inevitably data-producing, yet the protocols demand decisions and outcomes within particular specified and narrow time-scales. Failure to do so within these expectations is viewed by the inspection regime as a failure per se with severe consequences, viz. the investigation into the death of Baby Peter (Laming, 2009). The inability to meet targets is construed as the organizational problem, rather than the imposition of inappropriate, inflexible and complexity-reducing targets and time-scales. There is emerging evidence that the ICS systems and associated performance targets are inherently problematic due to their design (Broadhurst et al, 2009), with social workers trying desperately to ensure that they maintain the protection of children despite the demands of a system that has ‘immutable timescales and excessive audit requirements’ (Broadhurst et al, 2009:1). As referrals increase, resources do not necessarily follow, and the systems begin to feel the strain. One consequence of this is that the initial assessment of referrals begins to prioritise information that is

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a clearer indicator of high risk to children, even though this may mean that other indicators go uninvestigated. Judgements are made based on information that may be partial, and this filtering means that the stated aim of responding to the needs of all children is rolled back to those who appear at risk of significant and obvious harm. Broadhurst et al (2009:14) warn that due to the volume of referrals ‘workers must make quick categorizations absed on limited information: this will inevitably mean that some cases are filtered out that may require intervention’. The threshold for intervention is raised by a combination of lack of resources and inflexible technological processes. The use of a plethora of guidance and protocols to assess the intial information also lends itself to a high rate of ‘false positives’ and ‘false negatives’, as the risk factors identified as located within ‘risky families’ are also prevalent in a great deal of the whole population (Munro and Calder, 2005). Parton encapsulates this as:

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Intervention increasingly becomes probabilistic and anticipatory and is not just based on the diagnosis of pathology in an individual or set of relationships but on an actuarial analysis of risk factors which are continuously monitored and managed (2006:175)

Again the reliance on the certainty of a ‘scientific’ approach leads to the contruction of rather naïve risk factor protocols and matrices without fully acknowledging their limitations or theoretical bias (Myers, 2007). Increasing the number of risk factors is likely to have the outcome of including a much larger population in its range, involving families and children in a system that is viewed as negative, stigmatizing and iatrogenic. This ‘net-widening’ will include many who should not fall within concern, and will make the task of filtering those who require assistance and/or control more difficult. A third concern is that the resources required to manage and respond to the increased data will make social workers ‘information processors’, rather than being able to undertake a professional role and work directly with children and their families. Broadhurst et al, based on their ethnographic research of front-line child protection social workers, state that ‘data input demands seriously eroded valuable face-to-face time with children and their parents/carers’ (2009:14). This loss of valuable skills in making sense of complex situations and undermining what Lipsky (1980) called the ‘street level bureaucrat’ is a major concern. Lipsky emphasized the importance of local decision-making and professional discretion to ensure effective practice, circumstances that have been made impossible (indeed perhaps attracting disciplinary measures) with the implementation of

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rigid, centralized systems and processes. Dealing with dysfunctional IT systems and an increased workload has placed an increasing burden on children’s social workers which is supported by emerging research (Peckover et al, 2008) With a focus on managing the information gathered, and the allocation of resources to undertake this task, the potential for non-urgent services to have their funding transferred is obvious. General preventative services can be dispensed with as the ‘more effective’ data analysis is produced, thus allowing resources to be targeted at those most ‘at risk’. The reductionism in this approach shifts resources from community support as of right, to targeted intervention where the need has been established. Poverty becomes sidelined in the more measurable individualized and pathologised risk factors, usually located within the person or family. Finally, the application of systems that are predicated on surveillance and externally imposed risk factors do not lend themselves to easy and constructive engagement with children and their families. The complexities of children’s lives, the interplay of various risk factors, the local enactment of risk factors (one person’s risk factor is another’s opportunity; what is the specific probability of the risk factor in this particular situation?) are all minimized or denied, leading to what Smith warns as an ‘undue focus on superficial indicators of risk and actuarial calculations’ (2008:13). Horwarth (2002:203-4), in discussing the introduction of the Common Assessment Framework, also warned against the over-emphasis on following forms, processes and procedures rather than interpretation, concerned that ‘making sense of the information…becomes secondary and the focus on both identifying and meeting the needs of the child is lost’. It appears that the development of risk assessment and management in child protection through the application of technological approaches may compromise the safety and welfare of children.

CONCLUSION The preoccupation of social work with risk is a response to the development of neo-liberal socio-political agendas with the added uncertainty of living in a ‘risk society’. The drive to certainty in a world of decreasing confidence in systems and structures has led social work to embrace policies and procedures that enforce the need to identify, assess and manage the risks from and to people in ways that threaten the traditional values of social work and the traditional valuing of the professional. Broader concerns with social justice are subsumed in the need to regulate risky populations; reflexive professional practice with complexity is

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subsumed by the instruction to apply technological processes to manage risk. The rise of rational-technical approaches including Evidence-Based Practice and actuarialism has promoted the development of a multitude of protocols, procedures, frameworks and information systems that claim to assist in the true identification of risks and the correct ways of responding to them. This formulation of risk poses a major challenge to the continuation of social work as a distinct, transferable professional approach, as well as a potential threat to the relationship between worker and service users. In this latter issue, the danger is that social workers will become mere seekers and processors of limited predetermined information, with service users viewed as no more than the risk factors on the checklist. Paradoxically, this approach may well generate as much danger as the approach it sought to criticize for being subjective and uninformed, by failing to recognize that subjectivity is at the heart of human understanding, and that knowledge is complex and contradictory. Social workers continue to be educated to be reflexive, ethical professionals, which will hopefully allow them to engage critically with policies and practices that may seek to limit their skills, creativity and commitment to justice.

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REFERENCES Beck, U. (1992) Risk Society: Towards a new modernity. London: Sage Beck, U. (1999) World risk society. Cambridge: Polity Press Beck, U. and Beck-Gernsheim, E. (1995) The Normal Chaos of Love. Cambridge: Polity Press Blair, A. (2006) "Our nation's future: Social exclusion" speech to Joseph Rowntree Foundation, York, 5 September. Broadhurst, K., Wastell, D., White, S., Hall, C., Peckover, S., Thompson, K., Pithouse, A. and Davey, D. (2009) ‘Performing ‘Initial Assessment’: Identifying the Latent Conditions for Error at the Front-Door of Local Authority Children’s Services’. British Journal of Social Work Advance Access published January 18, 2009, 1-19. DOI:10.1093/bjsw/bcn162 Buckingham, D. (2000) After the Death of Childhood: Growing Up in the Age of Electronic Media. Cambridge: Polity Press Critcher, C. (2003) Moral Panics and the Media. Buckingham: Open University Press DfES (2004) Common Assessment Framework. London: DfES DfES (2006) Information Sharing: Practitioners’ Guide. London: DfES DoH (1999) Working Together to Safeguard Children. London: HMSO

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Douglas, M. and Wildavsky, A. (1982) Risk and Culture. University of California Press: London Farrington, D. (1996) Understanding and Preventing Youth Crime. York: Joseph Rowntree Foundation Ferguson, H. (2004) Protecting Children in Time: child Abuse, child protection and the consequences of modernity. Basingstoke: Palgrave Fitzgibbon, D. W. (2008) ‘Deconstructing Probation: risk and developments in practice’. Journal of Social Work Practice 22; 1-85 Foucault, M. (1979) ‘Governmentality’, in Ideology and Conciousness, No. 6, pp. 5-21 Giddens, A. (1990) The Consequences of modernity. Cambridge: Polity Press Giddens, A. (1998) ‘Risk Society: The context of British politics’, in J. Franklin (Ed.), The Politics of Risk Society, Cambridge: Polity Press Goldson, B. (ed.) (2000) The New Youth Justice. Lyme Regis: Russell House Press Goldson, B. and Muncie, J. (eds) (2006) Youth Crime and Justice. London: Sage HM Government (2006) Working Together to Safeguard Children: A Guide to inter-agency working to safeguard and promote the welfare of children. London: Stationary Office James, A. and James, A. L. (2004) Constructing Childhood: Theory, Policy and Social Practice. Basingstoke: Palgrave Macmillan Jenks, C. (1996) Childhood. London: Routledge Kemshall, H. (2002). Risk, Social Policy and Welfare. Open University Press: Buckingham Laming Report (2003) The Victoria Climbie Inquiry: Report of an Inquiry by Lord Laming (Cm 5730) London: The Stationery Office Laming Report (2009) The Protection of Children in England: A Progress Report. London: The Staionery Office Lipsky, M. (1980) Street-Level Bureaucracy: Dilemmas of the Individual in Public Services. New York: Russell Sage Foundation Middleton, L. (1999) ‘Could do better’. Professional Social Work, November:8/9 Muncie, J. (2009) Youth and Crime, 3rd Edition. Open University Press: Buckingham Munro, E. and Calder, M. C. (2005) ‘Where Has Child Protection Gone’, Political Quarterly 76:3, 439-45 Myers, S. (2007) ‘(De)constructing the Risk Categories of the AIM Assessment Model for Children with Sexually Harmful Behaviours’, Children and Society, 21:5, 365-371

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O’Malley, P. (2000) ‘Uncertain Subjects: Risks, Liberalism and Contracts, Economy and Society, 29 (4): 460-84 Parton, N. (ed.) (1996) Social Theory, Social Change and Social Work. London: Routledge Parton, N. (2006) Safeguarding Childhood: early intervention and surveillance in a late modern society. Basingstoke: Palgrave Macmillan Peckover, S., White, S. and Hall, C. (2008) ‘Making and Managing Electronic Children: e-assessment in child welfare’, Information Communication and Society, 11(3), 315-94 Probation Circular 21 (2008a) Managing High Risk of Serious Harm Offenders with Severe Personality Disorder. London: Probation Service/Ministry of Justice Probation Circular 02 (2008b) Dynamic Risk Assessment of Sex Offenders. London: Probation Service/Ministry of Justice Pitts, J. (2001) ‘Korrectional Karaoke: New labour and the Zombification of Youth Justice’. Youth Justice, 1 (2): 3-16 Rose, N. (1999) Powers of Freedom: Reframing Political Thought. Cambridge University Press: Cambridge Sutton, C., D. Uttting and D. Farrington (2005) Support from the Start: Working with Young Children and their Families to Reduce the Risks of Crime and Anti-Social Behaviour, Home Office Research Brief RB524, London (March 2005). http://www.justice.gov.uk/ publications/criminal-justice-bill.htm Smith, R. (2007) Youth Justice: Ideas, Policy, Practice. Cullompton: Willan Publishing Smith, R. (2008) From Child Protection to Child Safety: Locating Risk Assessment in the Changing Landscape, in M.C. Calder (ed) (2008) Contemporary Risk Assessment in Safeguarding Children. Lyme Regis: Russell House Publishing Trotter, C., Sheehan, R. and Oliaro, L. (2001) Decision Making, Case Planning and Case Management in Child Protection: A Review of the Literature. Department of Human Services: Victoria Webb, S. A. (2006) Social Work in a Risk Society: Social and Political Perspectives. Basingstoke: Palgrave Webster,C., MacDonald, R. and Simpson, M. (2006). ‘Predicting Criminality? Risk Factors, Neighbourhood Influence and Desistance’. Youth Justice 6 (1): 7-22 Wikstrom, T. and Loeber, R. (1997) ‘Individual Risk Factors, Neighbourhood SES and Juvenile Offending’, in M. Tonry (ed) The Handbook of Crime and Punishment. New York: Oxford University Press

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Young, J. (1999) ‘Cannibalism and bulimia: patterns of social control in late modernity’. Theoretical Criminology, 3(4): 387-407

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Chapter 4

RISK AND AGING1 Dawn C. Carr and Glenn W. Muschert Miami University, Oxford, Ohio, USA

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INTRODUCTION The idea that age is a risk factor for a number of adverse outcomes is pervasive in western culture. This is evident in anti-ageing rhetoric in the media that suggest that individuals can delay the problems associated with ageing by using certain products or engaging in certain behaviors (e.g., exercising or volunteering). However, the ideology of risk in the context of ageing also represents a major paradigm shift in the way that older people are conceptualized as a demographic category. For example, the anxiety associated with population ageing has shifted attention from ways to support this “deserving” group to a reexamination of older adults as a “dependent” group. Both the growing capability of older adults to remain productive (even if not always in the labor force) and the growing number and proportion of older adults in the population have raised questions about the way social policies address the needs of this group. This chapter expands on the idea of risk and welfare by exploring the ways in which the development of the risk society is related to cultural changes and current issues in ageing. In particular, we examine the risks facing older adults,

1 The authors would like to acknowledge the collaboration the following colleagues in the Miami University Silver Alerts Project: Tirth Bhatta, Elizabeth Bozzelli, J. Scott Brown, Jennifer Kinney, Lydia Manning, Gina Petonito, Emily Robbins, and Robert Seufert.

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including health and victimization, and connect this to types of risk assessment. We then illustrate these issues via discussion of the recent development of Silver Alert plans in many U.S. states, policies that mandate procedures for helping locate seniors with dementia who go missing. Silver Alerts illustrate ways in which the idea of risk is being used to redefine ageing issues in a way that targets a specific variety of older people and to mitigate a problem expected to grow in the near future for that group. Finally, we offer concluding reflections about age as a category of risk assessment, and point out potential caveats or ironies to this approach. In closing, we offer suggestions for future research in the area of risk and ageing.

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FROM AGE TO NEED TO RISK In many nations, the institutionalization of pension programs and formation of the medical/industrial complex created the foundation for the introduction of the welfare state, and ultimately, the ageing enterprise (Estes, 1979; 2001). The idea of the ageing enterprise as the commodification of programs and businesses targeting older people emerged as a way of making sense of how ageing and old age are defined and treated in society. It also clarified the role of ideology in shaping those conceptions and approaches to social programming for older people (Estes, 2001). In particular, the logic of benefit disbursement in early systems followed a rationale whereby people above a given chronological age (e.g., 65) were viewed as deserving of social welfare. During the height of the introduction and development of many age-based social programs (predominantly in the 1960s in the U.S.), older adults’ need was implied because the prevalence of older adults who were needy was very high. As a result, most social programs targeting older adults and ageing issues have awarded benefits to citizens based on age alone. For many advocates raising attention about the needs of older adults, such programs represented a major success because the overall welfare of older adults was viewed as a societal responsibility. Some scholars raised concerns that age-based programs inadvertently perpetuated ageism by conferring the status of “needy” to all individuals over a given age threshold (e.g., Binstock, 1983; Neugarten, 1983), in general, however, the link between age and need was justified in serving the purpose of improving the economic and health status of older adults. The effects of population ageing, however, elicit discussions about redefining the way social support mechanisms distribute resources and how responsibilities for distribution should be delegated in the private and public spheres (Myles and Quadagno, 1991). Partly, this ideological shift was a response to the increased

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cost of social programs targeted to older people due to the growing number of recipients. This motivated explorations about new ways to distribute social welfare, potentially displacing age-based and/or need-based approaches observed in earlier decades. By the 1980s, the number of older adults in industrialized nations had increased greatly and many older people were able to enjoy long periods of healthy retirement. Thus, ideological debates about age- and needbased programs were complicated by the visibility of overall improvements in older adults’ health and economic status. Furthermore, the growing number of people eligible to receive benefits from social programs increased substantially, raising concerns about the sustainability of such programs due to the shrinking ratio of workers to non-workers in the population. Thus, the combination of the increased cost of maintaining social programs for older adults and the growing capability of many older adults opened the door for blaming older people for the cost of old age programs, and led to discussions about the role individuals should play in off-setting those costs (Minkler, 1996). The effects of population ageing ultimately made the role older adults play in society a salient political issue. Literature on the productivity and potential of older adults began to emerge in the 1980s (e.g., Butler and Gleason, 1985), at a time in which there was a growing awareness about the increasing proportion and actual number of people age 65 and older who remained capable of contributing to society. However, the growing number of people in the oldest ages (85+), who are the most likely to face physical and cognitive decline, raised attention to the potential problems that such a society may face in caring for this vulnerable group of older people. In fact, the potential contribution of older adults in later life was depicted as a way to counter-balance the risks associated with population ageing (as is depicted in productive ageing literature such as Morrow-Howell, Hinterlong, and Sherraden, 2001). As a result, marked improvement in the health and welfare of older adults in recent decades weakened the link between age and need in later life. Subsequently, age and risk has become a more intuitive approach for managing the problems facing older people and an ageing society. Using risk as an approach to addressing the social welfare of older adults means focusing on the issues facing specific groups of older people who are at the highest risk of experiencing problems, rather than all people age 65 and older. Thus, the fears associated with population ageing set the stage for a new ideological framework for managing the risks associated with age and ageing, justified by the logic that it is no longer financially feasible to address the general welfare of older people. The logic of risk-assessment is being used as a new basis for distribution of social welfare benefits within the current demographic and socio-cultural context.

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AGING IN A RISK SOCIETY As a salient social issue, ageing intersects with the concepts of risk in the contemporary social scene. In this section, we briefly explore the development of the risk society, and its subsequent focus on efforts to provide for the social security of older people and protect society from the problems associated with population ageing. We contextualize this discussion by exploring the variety of risks to which older people may be exposed, with attention toward the risk tolerance of older adults. Risk is an everyday part of public life, and the mitigation or management of risks is often assumed by public sector agencies (Bessant et al., 2003). As a result, the idea of risk has become an important concept in the social problems literature. The discourse of risk has demonstrated the extent to which risk is part of everyday life. Awareness of the risks individuals face every day has been heightened in recent decades following major catastrophic events like Three Mile Island (1979), Bhopal (1984), Chernobyl (1986), and more recently, by terrorist attacks (Zinn, 2008b). (See Clarke and Short [1993] for a review of scholarship in the sociology of risk). Among the seminal thinkers in risk, Ulrich Beck (1992; 1999) argues that there are both objective and subjective aspects to risk. Objective risks are evident in the consequences to risk that are a part of people’s everyday lives. The subjective element to risk is evident in the public discourse about how risks create (or suppress) fear, thereby influencing efforts to safeguard against risks. Beck situates his conceptualization of the contemporary risk society in the interplay between both of these varieties of risk, real (objective) and socially constructed (subjective). A further exploration of risk and security helps clarify how age is conceived as a risk factor. In an objective sense, risk may be viewed as a real danger which is perceived as a transgression of social values (Zinn, 2008a). For example, early in the 20th century, employment in later life was tenuous because older people were likely to experience health conditions that limited their ability to work, placing older people at a high risk of becoming poor. In many democratic states, societies sought to off-set the risk of becoming poor and disabled in later life by creating universal healthcare and retirement programs. These programs made it the collective responsibility to ensure that older adults were protected from becoming frail and impoverished. Thus, if older adults were exposed to health and economic risks, strongly held social values would be violated. The subjective quality of ageing as a social risk may have to do with its putative effect on the society at large. Subjectively, societal ageing can be interpreted as creating unintended consequences by increasing the complexity of

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social relations through greater numbers of retired people compared to working people. Part of the perceived success of the growing numbers of people reaching old age and to overall improvements in life expectancy is due to technological advances (e.g., social and medical advances) that improved length and quality of life (Zinn, 2008a). This, in coordination with demographic and social changes, has ultimately resulted in increased anxiety surrounding the societal cost of maintaining an older population structure (Gee and Gutman, 2000). There are also risks that may vary by age, including risks of accidents, disasters (both technological and natural), victimization, loss of control in systems (e.g., food standards or product safety), work-related injuries, loss of work (e.g., layoffs or downsizing), health risks (e.g., injuries or illness), abuse/neglect, and loss of independence. In fact, in an actuarial sense, ageing itself is frequently viewed as a risk factor, one related to the likelihood of a number of negative outcomes. Risk tolerance may be different depending on the group exposed to the risk, just as perception of risk may depend on the age of those considered at risk.

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AGE AS A RISK FACTOR If we define safety as an acceptable level of risk, and security as the efforts to achieve or maintain a given level of risk (Vestermark, 1996), risk perception can be understood as contextually related to the probability of an event’s occurrence and the severity of its outcome (Zinn, 2008b). For example, the tolerance of risk is higher when driving in a car than when flying in an airplane, and this tolerance is related to both the probability and the severity of an accident. The concepts of safety (acceptable level of risk) and security (probability and severity of the outcome) help explain the logic behind the way age has become accepted as a risk factor. In the following sections, we focus on two varieties of risk that tend to increase with age, and thus, tend to initiate societal responses to mitigate risk: health and victimization.

HEALTH AND AGING The professional discourse of risk as it relates to health is often framed as a set of practices for managing collective fear about future health events (Petersen and Wilkinson, 2008). The idea of health as a risk factor stems from epidemiological research that examines the relationship between individual and/or

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societal characteristics and the likeliness of experiencing a health event (Alaszewski, 2006). Thus, health care as ‘risk management’ rationalizes the conduct of the individual and the social body by highlighting potential harm and identifying sources of danger. Risk management as it relates to health and ageing is associated with death and disability. The major causes of death in our society have shifted in recent years such that rather than dying due to complications from acute illnesses (e.g., the flu), people are more likely to die from chronic diseases in later life (e.g., cancer or heart disease) (see Omran, 1971). Thus, age, health, and risk have become intertwined in that chronic health problems that result in disabilities and reliance on others for care is a reality for most people. Physical disabilities and cognitive impairments may limit older adults’ ability to care for themselves for extended periods in later life, and the risk of experiencing disabling health problems increases with age. For example, on average, women will become disabled and need care for 3.7 years and men for 2.2 years after the age of 65 (Kemper, Komisar, and Alecxih, 2005/2006). Risk of becoming cognitively impaired also increases with age. Estimates of severe cognitive impairments suggest that approximately 4.5 million adults in the U.S. are currently living with Alzheimer’s disease, a number which is expected to quadruple over the next forty years (Alzheimer’s Association, 2007). Although health issues are typically measured at the individual level, when an individual becomes disabled or unable to care for him/herself, other people must become involved in his/her care. There are different ways people manage the risks associated with becoming disabled in later life. One approach is with the purchase of long-term care insurance. This can be used as a mechanism to manage the financial risk of becoming disabled by providing people with the security of knowing that, if they are no longer able to care for themselves, they can hire someone to care for them. The cost of long-term care insurance is determined by one’s risk of becoming disabled, and since the risk of experiencing chronic health problems increases with age, the cost of long-term care insurance also increases with age. Since few people prepare for becoming disabled when they are young, by the time people begin to consider purchasing long-term care insurance, the cost is typically very high and potentially unaffordable. Therefore, only a very small proportion of the population actually owns a long-term care insurance policy (Robbins, 2008). Although there are other mechanisms in place to help individuals manage the risks associated with becoming disabled and dependent in later life, in general, most people exclusively rely on social insurance programs like Medicare, which covers acute health problems for older people and is not designed to cover to the costs of long-term care. Therefore, in order to manage health problems in later life,

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individuals either have to pay for care directly from personal savings income or rely upon family members or friends for informal care. Thus, the risk associated with declining health in later life is dispersed to individuals and their families in countries where long-term care is not universally provided. Especially with the cost of healthcare increasing, discussions about the health problems individuals and groups of individuals (i.e., older adults) may face in the future often have the unintended consequence of intensifying social anxiety about the uncertainties of future health problems (Wilkinson, 2001). The redefinition of health in terms of risk corresponds with a substantial change in the focus of the behaviors of individuals in influencing the collective good, namely, with regard to the formation of human capital (i.e., the resources individuals have that will help them contribute to society). One example of the way in which a shift to individual responsibility has occurred with regard to ageing and health is in the language of the “successful aging” rhetoric, whereby individuals are encouraged to remain active in order to delay the onset of disability (e.g., Rowe and Kahn, 1997). This ideology is perpetuated by literature that examines the factors associated with the onset of health problems in later life, especially those which suggest that individual behavior is linked to health outcomes. Critics suggest that this approach may lead to the conclusion that those with poor health outcomes in later life are to blame for their dependent status (e.g., Minkler, 1996). Given that a risk society is one in which individuals are expected to take responsibility and an active role in managing their relationship to risk (Rose, 1999), it is unsurprising that interventions have been used to legitimize the encouragement of certain behaviors viewed as risky to society (Petersen and Wilkinson, 2008).

CRIME AND AGING Criminological research has clearly identified the types of crime victimization experienced by older adults, including the risk factors associated with victimization. When compared with other age groups (including those twelve and younger), those 65 and above are the least likely to be arrested for most violent and property crimes (Federal Bureau of Investigation, 2003). Similarly, those 65 and older are at significantly lower risk for victimization in violence offenses (Bureau of Justice Statistics, 2002) and property offenses (Bureau of Justice Statistics, 2000). However, elders may be vulnerable to other varieties and forms of abuse. For example, in the U.S., the National Center on Elder Abuse (2001) suggests that seniors may be exposed to four varieties of abuse (physical, psychological, sexual, and financial) and active or passive neglect.

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Much of the research in these areas examines the risk factors associated with victimization, abuse, and neglect (see Macmillan, 2001; Peguero and Lauck, 2008 for reviews). In particular, a variety of social circumstances may increase risk of victimization, including living in poverty; social isolation; substance abuse (commonly alcoholism); physical or mental disability; and minority status. Gender has a complex relation to victimization, as men are at higher risk of victimization in street crimes, while women are more likely to be victims of sexual abuse. The status of caregivers is related to an older person’s risk of victimization as well, as substance abuse and poor mental health of caregivers increases the risk that an older adult will be victimized. Finally, living alone, while potentially correlated with social isolation, has a protective quality, in that it reduces the older person’s exposure to potential victimizers and abusers (Peguero and Lauck, 2008). Another line of research examining older adults’ fear of victimization complements the sober assessments of such risks. Such studies of fear of victimization cover two types of risk assessment: direct and altruistic. First, criminological research has tended to indicate that fear of crime increases with age, despite the fact that victimization decreases with age (see Ferraro, 1995, p. 67-8 for a review). However, subsequent research indicates that many measures used to study fear of crime do not accurately measure the phenomenon in older adults (LaGrange and Ferraro, 1987). Therefore, we can view older adults as a group that has a low probability of victimization and a low level of fear about their own victimization. Thus, we cannot look to older adults as a source of direct fear for safety efforts to control risk of victimization. Instead, we must look beyond this group to understand efforts to maintain security. The fear that individuals have for the safety of others may also be relevant in the assessment of risk of victimization of seniors. Warr (1992) describes such altruistic fear as the concern that individuals have for the safety of others. Children are the most common object of altruistic fear, as women are more likely to fear for their children than their husbands, while men demonstrate the opposite tendency. A later study identified a further gendered aspect to altruistic fear, and found that women were likely to fear not only for their children, but also for their elderly parents and siblings (Snedker, 2006). While all in contemporary society live with the idea that we are at risk of having bad things happen (see Beck, 1999), our altruistic fear is not evenly distributed. Given the varying levels of concerns for others’ safety, it is not surprising that much of the academic research and policy development has surrounded children, a typical focus of altruistic fear. In comparison, the level of altruistic fear experienced toward elders is small, although the recent development of Silver Alert systems in many U.S. states may

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signal the expansion of altruistic fear to encompass older adults. Silver Alerts provide an example of a policy intended to mitigate a known category of risk for a sub-population of older adults: the problem of missing adults with dementia.

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ADDRESSING RISK IN LATER LIFE: THE EXAMPLE OF SILVER ALERTS The recent development of Silver Alert policies in the U.S. serves to exemplify the way in which the conception of risk and welfare intersect with age. Silver Alert policies, instituted at the state level, establish plans for finding older adults reported missing. These policies propose to mitigate risks associated with victimization and cognitive decline in later life by creating an organized effort to identify missing older people with dementia. Projected increases in the size of the older population and in the number of older persons with dementia may have sparked the development of such policies. In part, the motivation for the development of Silver Alert policies is related to the fact that a portion of those with dementia engage in wandering behavior, and therefore, may be at risk of becoming lost. The antecedents of Silver Alerts are AMBER Plans, which stands for “America’s Missing: Broadcast Emergency Response.” AMBER Plans were developed in the U.S. in the early- to mid-2000’s in response to high profile abduction cases (Muschert, Young-Spillers, and Carr, 2006), with the national AMBER Alert plan being instituted in 2005. Similar to Silver Alerts, AMBER Alerts may be issued by police when a child is reported missing. Both AMBER Alerts and Silver Alerts release relevant information via broadcast media, including a description of the individual who is missing, and any other pertinent information that may help citizens or search teams in identifying the missing individual. Although there has, thus far, been little evaluation of the effectiveness of AMBER Alerts, preliminary studies suggests they may not be as successful as hoped (Griffin, Miller, Hoppe, Rebideaux, and Hammack, 2007; Griffin and Miller, 2008). It is surprising that with even less research to support the development or evaluation of Silver Alert plans, they are emerging at a rapid pace. Silver Alerts first appeared in the U.S. in 2006, and by the beginning of 2009 there were seventeen states with active plans. The national Silver Alert plan was enacted in September 2008, providing funding for numerous states to develop similar plans. Subsequently, a number of states have Silver Alerts on their

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legislative agenda for 2009, and the development of such policies is expected to continue at a rapid pace. Silver Alert systems piggy-back on the infrastructure present for AMBER Alerts, and although the criteria for activating a Silver Alert vary by state, the defining feature of most plans is that the missing individual is an older person suffering from a cognitive impairment. (See Carr, Muschert, Brown, Robbins, Kinney, Petonito, and Manning [n.d.] for an overview of the development of policies and their criteria for activation.) The establishment of Silver Alerts is intended to manage the risk associated with wandering, theoretically lowering the risk that someone will wander away from home and not be found. These programs can offer support for caregivers, whether private or institutional; however, there is some controversy about the cost of this support with regard to the autonomy and rights of those with dementia. Wandering behaviors are neither universal nor necessarily problematic for the individuals with dementia. In fact, although wandering can be a particularly challenging behavior for caregivers of those with dementia, research suggests that wandering behaviors can be therapeutic and can promote feelings of autonomy and empowerment among those with the impairment (Kearns, Rosenberg, West, and Applegarth, 2007). Furthermore, although some literature depicts wandering as a problem to be controlled or prevented (Dewing, 2006), wandering is often purposeful for the individual with dementia (Robinson, Hutchings, Corner, Finch, Hughes, Brittain, and Bond, 2007). The scarcity of research on the subject of adults who have gone missing due to dementia and cognitive impairments raises further questions regarding whether the introduction of Silver Alerts is an appropriate solution for managing the risks associated with the growing number of people with dementia. The establishment of Silver Alerts may reflect the growth of altruistic fear regarding the safety of older adults, particularly those with dementia. The logic of this trend fits with the ageing and risk approach. As noted above, the risk approach to social welfare supports the ideology that those who are at risk should receive greater protection and care, with extreme risk groups receiving the highest levels of support and care. Almost without critical discussion, elders with dementia have been labeled as being at-risk, and their behaviors, as problematic. However, do the risks justify the use of Silver Alerts techniques? The expansion of media alert systems to locate elders may represent a form of control creep (Marx, 1988), in which techniques of control have the tendency to expand in their applications. In this context, the labeling of a segment of the elder population as ‘at-risk’ may lead to increased oversight by the state. While the data strongly indicate that older adults are less likely to be victimized than members of younger

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cohorts, we nonetheless see the expansion of control techniques, in this case, in the guise of caring for an at-risk segment of the population. The introduction of Silver Alerts may be seen as an inexpensive way to manage the increasing number of people expected to have cognitive impairments. Although Silver Alerts can be activated by both informal caregivers and formal caregivers, for individuals in the community or individuals in institutions, in general, it is depicted in the media especially as a tool to help caregivers of elders in the community avoid placing their loved one in an institution (e.g., DeMarco, 2009). The media often instills fear about the potential dangers facing individuals with dementia, and suggests that it is in the best interests of older people with dementia if Silver Alert plans are in place. While the sentiment behind the proposed benefits of this policy may be altruistic, it may also support ideological beliefs regarding individual responsibility for managing the risks and problems associated with population ageing.

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CONCLUDING REFLECTIONS Our discussion has raised some concerns about the conceptualization of age as a risk factor, and the use of risk as a mechanism by which to attend to the social welfare of older adults. First, we examine a potential unintended consequence of diminishing the autonomy of older adults by using ageing and risk as criteria for the allocation of social welfare. The line between caring and control is blurry at best, and even well-intentioned efforts to provide care may lead to unintended negative outcomes. While many unintended consequences are unforeseeable, careful consideration may reveal serious consequences. (See Cherkaoui [2007] for a recent review of Max Weber’s concept of unintended consequences). In particular, the identification of a group as being ‘at-risk’ might justify increased supervision and help from public agencies (Bessant et al., 2003). Ironically, those older adults with greater exposure to risk might be more vulnerable to unintended mechanisms of social control, many of which are an outgrowth of well-meaning efforts to study and protect those very groups. Our concern is that such policies, like Silver Alerts, might contribute to negative stereotypes about older adults, and may violate the civil liberties of some elders who may wish to maintain mobility or keep their whereabouts unknown. While the apparent intention behind Silver Alert programs is to support vulnerable older adults and their caregivers, we question whether the balance between caring and control is always maintained. A second irony to the use of age itself as a risk factor lies in the in the fact that as age increases, so does the probability of becoming disabled and dying.

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With the increased cost of social policies supporting older adults as a whole, conceptualizing age as a risk factor provides a method to target the greatest problems facing older adults by addressing the needs of a specific variety of older people, namely, those most likely to be “dependent.” Settersten (2007) raises concerns about this approach because it distances older people from one another, placing them into categories and taking attention away from the challenges facing older adults as a whole. Thus, the issues that affect older adults as a group may be overlooked. Political agendas that serve the interests of the group as a whole may be abandoned or disregarded altogether unless we pay close attention to the important issues facing all older adults in today’s society, not just specific subpopulations. In other words, paying greater attention to the problems facing a subpopulation of older adults viewed to be at-risk might ultimately lead to the disempowerment of the entire group. Because “risk-based research informs practices that promote more intensive focus on the behaviours of targeted groups” (Bessant et al., 2003, p. 115), the use of risk to distribute social welfare is likely to diminish the social power of older adults. Although the use of age-based approaches was accused of promoting “compassionate ageism,” a risk-based approach may place older adults in an even more vulnerable position. The dominance of discourses of risk and ageing raises some important issues regarding the way social welfare benefits are allocated. The use of risk as a way to approach old age policies may seem logical given that it targets those who are the most likely to need support. However, caution is warranted because the logic seems to be tied to the neoliberal tendency to make social welfare the responsibility of individuals. We encourage continued exploration of the relevance of risk in distribution of social welfare to older people. However, we suggest that rather than focusing on those at the highest risk for needing a given form of support, that social welfare be focused on ways to facilitate trust between older adults and society without diminishing the social power, rights, and autonomy of older people as a group.

REFERENCES Alaszewski, A. (2006). Health and risk. In: Taylor-Gooby, P. and Zinn. J. O (eds). Risk in social science, pp. 160-179. Oxford University Press, Oxford. Alzheimer’s Association. (2007, March 20). Alzheimer’s disease prevalence rates rise to more than 5 million in the United States. Retrieved September 26, 2008 from http://www.alz.org/news_and_events_rates_rise.asp Beck, Ulrich. (1999), World Risk Society, Malden, MA, Polity Press.

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Beck, Ulrich. (1992), Risk Society: Towards a New Modernity, Newbury Park, CA: Sage. Bessant, Judith, Richard Hill, and Rob Watts. (2003). “Discovering” Risk: Social Research and Policy Making. New York: Peter Lang. Binstock, R. H. (1983) The aged as scapegoat. The Gerontologist, 23, 136-143. Bureau of Justice Statistics. (2002). “Age Patterns in Violent Victimization, 19762000.” Washington, DC: U.S. Department of Justice. Bureau of Justice Statistics. (2000). “Crimes Against Persons 65 or Older, 199297.” Washington, DC: U.S. Department of Justice. Butler R., and Gleason, H. (eds.). (1985). Productive aging: Enhancing vitality in later life, Springer, New York. Carr, D., Muschert, G. W., Brown, S., Robbins, E., Kinney, J., Petonito, G., and Manning, L. (n.d.) “Silver alerts and the problem of missing adults with dementia.” Unpublished manuscript. Cherkaoui, Mohamed . (2007), Good Intentions: Max Weber and the Paradox of Unintended Consequences. Oxford, UK: Bardwell Press. Clarke, Lee and James F. Short, Jr. (1993). “Social Organization and Risk: Some Current Controversies.” Annual Review of Sociology 19: 375-99. DeMarco, B. (2009, January 19). Help make the Silver Alert Program happen in Indiana. OurAlzheimer’s.com. Retrieved on February 2, 2009 from http://www.healthcentral.com /alzheimers/c/12995/56180/program-indiana. Dewing, J. (2006). Wandering into the future: Reconceptualizing wandering ‘A natural and good thing.’ International Journal of Older People Nursing, 1(4), 239-249. Estes, C. (1979). The Aging Enterprise: A Critical Examination of Social Policies and Services for the Aged. San Francisco: Jossey-Bass. Estes, C. (2001). Social policy and aging: A critical perspective. Thousand Oaks, CA: Sage Publications. Federal Bureau of Investigation. (2003). “Age-Specific Arrest Rates and RaceSpecific Arrest Rates for Selected Offenses, 1993-2001.” Washington, DC: U.S. Department of Justice. Gee EM, Gutman GM (eds). (2000). The Overselling of Population Aging: Apocalyptic Demography, Intergenerational Challenges, and Social Policy. Toronto, Ontario: Oxford University Press. Griffin, Timothy and Monica K. Miller. 2008. “Child Abduction, AMBER Alert, and Crime Control Theater.” Criminal Justice Review 3(2): 159-176. Griffin, Timothy, Monica K. Miller, Jeffrey Hoppe, Amy Rebideaux, and Rachel Hammack. 2007. “A Preliminary Examination of AMBER Alert’s Effects.” Criminal Justice Policy Review 18(4): 378-394.

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Kearns, W. D., Rosenberg, D., West, Lisa, and Applegarth, S. (2007). Attitudes and expectations of technologies to manage wandering behavior in persons with dementia. Gerontechnology, 6(2), 89-101. Kemper, P., Komisar, H. L., and Alecxih, L. (2005/2006). Long-term care over an uncertain future: What can current retirees expect? Inquiry, 42, pp. 335350. Macmillan, Ross. 2001. “Violence and the Life Course: The Consequences of Victimization for Personal and Social Development.” Annual Review of Sociology 27: 1-22. Marx, Gary T. (1988) Undercover: Police Surveillance in America. Berkeley, CA: University of California Press. Minkler, M. (1996). Critical perspectives on aging: New challenges for gerontology. Ageing and Society, 16, pp. 467-487. Morrow-Howell, N., Hinterlong, J. and Sherraden, M. (eds.). (2001). Productive aging: Concepts and challenges. The Johns Hopkins University Press, Baltimore. Muschert, G., Young-Spillers, M., and Carr, D. C. (2006). “Smart” policy decisions to combat a social problem: The case of child abductions 20022003. Criminal Justice Policy Review, 3 (2). Myles, J. and Quadagno, J. (eds.). (1991). States, labor markets, and the future of old age policy. Philadelphia: Temple University Press. National Center on Elder Abuse. (2001). A Response to the Abuse of Vulnerable Adults: The 2000 Survey of State Adult Protective Services. Washington DC: National Center on Elder Abuse. Neugarten B. L., (ed.) (1983). Age or need? Public policies for older people. Beverly Hills, CA.: Sage. Omran A. R. (1971). The epidemiologic transition: a theory of the epidemiology of population change. Millbank Mem. Fund Q. 49(4):509.37 Peguero, Anthony A. and Amanda Lauck. (2008). “Older Adults and Their Vulnerabilities to the Exposure of Violence.” Sociology Compass 2(1): 62-73. Petersen, A. and Wilkinson, I. (2008). Health, risk and vulnerability: An introduction. In Petersen, A. and Wilkinson, I. (eds.) Health risk and vulnerability, pp. 1-15. Routledge, New York. Rose, N. (1999). Powers of freedom: Reframing political thought. Cambridge: Cambridge University Press. Robbins, E.J. (2008). Long-term care insurance in the United States: Perspectives from independent insurance agents. VDM-Verlag, Saarbrücken, Germany. Robinson, L., Hutchings, D., Corner, L., Finch, T., Hughes, J., Brittain, K., and Bond, J. (2007). Balancing rights and risks: Conflicting perspectives in the

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management of wandering in dementia. Health, Risk and Society, 9(4), 389406. Rowe, J. W., and Kahn, R. L. (1997). Successful aging. The Gerontologist, 37, pp. 433-440. Settersten, RA, Jr. (2007). The new landscape of adult life: Roadmaps, signposts, and speedlines. Research in Human Development, 4 (3-4), 239-252. Snedker, Karen. (2006). “Altruistic and Vicarious Fear of Crime: Fear for Others and Gendered Social Roles.” Sociological Forum 21(2): 163-195. Vestermark, S.D., (1996). “Critical Decisions, Critical Elements in the Effective School Security Program.” In Hoffman, A.M. (ed.), Schools, Violence, and Society. Westport, CT: Praeger. Warr, Mark. (1992). “Altruistic Fear of Victimization in Households.” Social Science Quarterly 73(4): 723-736. Wilkinson, I. (2001). Anxiety in a risk society. London: Routledge. Zinn, Jens O. (2008a), “A Comparison of Sociological Theorizing on Risk and Uncertainty.” Pp 168-210 in Jens O. Zinn (ed.) Social Theories of Risk and Uncertainty. Malden, MA: Blackwell. Zinn, Jens O. (2008b), “Introduction: The Contribution of Sociology to the Discourse of Risk and Uncertainty,” Pp 1-17 in Jens O. Zinn (ed.) Social Theories of Risk and Uncertainty. Malden, MA: Blackwell.

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Chapter 5

RISK AND CRIME Hazel Kemshall De Montford University, Leicester, UK

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INTRODUCTION Crime is an arena in which risk concerns tend to dominate policy and management (Kemshall 2003). This risk infused approach is evidenced by the political steer of justice and penal policy (particularly in the Anglophone countries); media attention to ‘risky crime’ and ‘risky offenders’; and policy considerations focused on ‘high risk’ offenders and the management of risk. This chapter seeks to plot some of the key policy and practice responses to the risk agenda, most notably the emergence of the new penology, crime prevention strategies, and public health approaches to crime management, particularly sex offending. Underpinning these approaches is a trust in the promise of prediction (predominantly through actuarial risk assessment tools), a belief in the rational actor as the archetypal criminal ready for desistance if the costs outweigh the benefits, and that crime can be managed away through rational and informed responses to risk. The chapter seeks to provide an introductory critique of these assumptions and highlights why they can have limited utility in crime 1 management.

1

A more extensive review can be found in Kemshall, H. (2008) Understanding the Community Management of High Risk Offenders. Open University/McGraw-Hill.

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THE NEW PENOLOGY Whilst there is some dispute about the nature and extent of the new penology (O’Malley 2001) there is some consensus about the main precursors and key themes: • • • •

• •

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•

The rise and extension of capitalism, and the development of techniques to discipline and regulate the workforce particularly the ‘underclass’. The use of actuarial risk practices to ensure civil stability and social order. Concerns with the management of the ‘dangerous class’ and the risk distribution of ‘bads’. The role of risk in social utility thinking, in particular the influence of modernist reason and rational thought in the development of economic and legal approaches to social and penal policy. Economic pressures on crime management and concerns to effectively and efficiently manage criminal justice systems. The retreat from liberal crime management and penal policy under certain conditions of advanced liberalism (Kemshall 2003: 29). (From Kemshall 2006: 77).

The new penology has been critiqued on a number of grounds, most notably that it is rarely delivered in pure form. A growing body of empirical evidence on actuarial and new penological practices indicates that criminal justice practitioners and sentencers mediate risk-based policy (Kemshall 1998; Lynch 2000; Robinson 2001). For example, practitioners circumvent risk assessment tools and target risky behaviours selectively (see Baker 2007 on ASSET; Kemshall 1998, 2003, 2007 on probation risk tools).Sentencers have also resisted risk-based sentencing (including sentences for ‘public protection’) on the grounds that such sentencing reduces judicial independence and flexibility (Freiberg 2000), can result in unjust anomalies (for example a ‘three strikes and you are out’ sentence for a minor offence), and difficulties in establishing thresholds of risk and danger for indeterminate sentences for public protection (see Stone 2004). Politicians and policy makers also face significant limits in implementing risk-based penal strategies. ‘Bifurcation’, that is twin-track sentencing based on risk is quickly challenged by ‘punitive populism’, particularly where offenders or offences are taboo (e.g. sexual offenders) or where offences are against vulnerable victims (e.g

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children) (Kemshall 2008a). Such offenders and offences can result in media and public calls for harsh sentencing. O’Malley (1999, 2001) has argued that the distinction between retributive and risk-based penality has been over-stated, and that public protection has acted as a ‘veneer’ for increasingly retributive and emotive sentencing (Pratt 2000a,b). Under the guise of public protection, sexual (and to a lesser extent violent) offenders have been singled out for preventative sentencing and restrictive measures upon release (Nash 2006; Kemshall 2008a). Public, media and political perceptions that the ‘punishment should fit the crime’ have been somewhat at odds with the ‘punishment should fit the risk’. In England and Wales this tension has been particularly challenging for the judiciary, with judges making Indeterminate Sentences for Public Protection (IPPs) with tariff terms of less than 4 years, and suggestions by the Lord Chief Justice that some murderers do not need to serve life greeted with predictable tabloid headlines such as: ‘So much for justice: free killers earlier says top judge’ (Daily Mail, March 10th, 2007, page 12); and ‘Let killers out: they’re clogging up jails’ (The Sun, March 10th, 2007, page 2). The demonization of sex offenders has been particularly acute (Simon 1998; Garland 2001; Pratt 2000a, b) and is an area where protection and punishment merge (Pratt 2000a,b,). The penal climate in the UK and other Anglophone countries since the 1990s has seen the relationship between proportionality and protection increasingly strained (Kemshall 2008a for the UK; Petrunik 2002 on USA and Canada; Pratt 1997, 2006 on Australia and New Zealand). Across the Anglophone countries this has resulted in growing prison populations (Kemshall 2008a) and various measures to contain risky offenders when released into the community. Interestingly, whilst such measures claim to reduce risk, they can have inadvertent consequences. For example, in England and Wales the HMIP thematic on Sex Offenders noted sex offenders subject to restrictions prohibiting living in proximity to schools and parks resulted in social isolation, distance from their own families and support networks, and lack of reintegration. (HMIP and HMIC 2005; see also Levenson and Cotter 2005a). In addition, this type of policy can result in sex offenders being accommodated together in a small geographical area. The over-use of exclusion zones has also been seen as problematic, preventing employment/education and destroying access to supportive or family networks (Levenson and Cotter 2005a; Worth 2005). In the USA Levenson and Cotter identified 14 states that have exclusion zones prohibiting sex offenders from living within close proximity to a school, park, day care centre or school bus stop (p.168). They note that the zones range from 500ft, to up to 2,000 feet and in California to a quarter of a mile from a

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school and prohibits sex offenders residing within 35 miles of a victim or witness. Interestingly, they cite studies in which the evidence for proximity to children resulting in recidivism is mixed (see Walker, Golden and VanHouten 2001; Colarado Department of Public Safety 2004; Minnesota Department of Corrections 2003). They contend that the over-use of exclusion zones may result in homelessness and transience thus making risk management harder. It also produces illogical responses to risk, potentially displacing risk onto more vulnerable people, summed up by one offender thus:

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I couldn’t live in an adult mobile home park because a church was 880ft away and had a children’s class that met once a week. I was forced to move to a motel where right next door to my room was a family with three children –but it qualified under the rule. (Levenson and Cotter 2005a : 175).

The risk assessment techniques and strategies required to support the new penology have also proved problematic (see Kemshall 2003, ch.3 for a full review), spawning an industry in the production and evaluation of risk assessment tools (see Bonta 1996; Bonta and Wormith 2007 for example). This ‘risk factorology’ has been critiqued on a number of grounds, not least the difficulty in attributing causal weight to individual risk factors, recognising that such causes are not merely additive (Farrington 2000: 7), and that subtle differences in initial conditions may over time produce large differences in outcomes (Byrne 1998: 228). For example, a proportion of children risk-marked for delinquency do not go onto offend. Research into the use of risk assessment tools over the last 10 years or so, has also revealed how actuarial practices (and their tools) are mediated by both workers and institutional barriers to implementation (see Kemshall 1998 on probation officers; Lynch 2000 on parole officers; Kemshall and Maguire 2001 on public protection panel decisions).

RISK AND PREVENTION The increased penal focus on risk has also resulted in attention to preventative strategies across the whole crime spectrum, ranging from preventative sentencing to crime prevention policies aimed at environmentally ‘managing crime away’ (Ekblom 1997, 2001). Prevention has proved a popular strategy with politicians and policy makers, not least because it was seen as potentially more costeffective. In addition, prevention was seen as a more effective alternative than post-crime interventions, particularly with intractable offenders. ‘Designing crime

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out’ offered an alternative to failed interventions with ‘incorrigibles’. Through the management of environments and ‘situational crime prevention’ policy makers sought to reduce crime opportunities (see Clarke and Mayhew 1980 for an early example). This resulted in the surveillance of public spaces by CCTV, the introduction of neighbourhood watch, a ‘locks and alarm’ approach to burglary control, and various initiatives to make cars theft proof. This crime prevention approach has been criticised on a number of grounds, not least that such initiatives often fail to reduce crime but merely displace it, ironically to areas less able to tolerate crime or to protect themselves from it (Hughes 1998). The actual crime prevention techniques have also been found wanting, for example, CCTV images have not always provided sufficient evidence to support an arrest or conviction. In addition, offenders have also proved adaptive in calculating and managing situational crime prevention strategies (Ekblom 1997, 2001), either moving crime to other less well protected areas, or to other less well regulated crime arenas (e.g the internet). Policy makers and practitioners in crime prevention have to ‘think thief’, and constantly adapt their strategies to stay one step ahead of the criminal. More often than not they are in the position of catch up, and prevention strategies are outmoded almost as soon as they are introduced. Recent approaches to environmental crime risk management have been more sophisticated, with attention to offender cognitions and behaviours; victim vulnerability and responses; and environment management. Alcohol related violence in the night-time economy (NTE) is a key area where this work has been pioneered. Night time alcohol related violence has been tackled by a pioneering programme in Cardiff- the ‘Tackling Alcohol-related Street Crime’ (TASC). The project comprised effective liaison between police and licensees; improvements to the behaviour of door staff; training of bar staff; a cognitive-behavioural programme for repeat offenders; and targeted policing at ‘hot-spots’. TASC was independently evaluated by Maguire and Nettleton (2003, Maguire and Hopkins 2003) for the Home Office, with researchers arguing that TASC resulted in an eight percent reduction in violent incidents and that TASC offered value for money in the reduction of health care services subsequently required. The researchers estimated savings of £3,200 per offence, with £130,000 for ‘serious wounding’; £2040 for other wounding; and £550 for ‘common assault’ (Maguire and Nettleton 2003). TASC also illustrated how the following preventative strategies can be effectively used:

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• • • • • •

opposition to entertainment and drinks licences changes to late night transportation changes to police patrols marshalling of taxis policing in pedestrian areas using plastic glasses (to reduce facial injuries from ‘glassing’).(see Shepherd 2007; Goodwin and Shepherd 2006; Warburton and Shepherd 2004, 2006).

However, as Maguire and Nettleton importantly point out TASC failed to influence local planning policy on the location of licensed premises, and failed to gain any agreement to change alcohol-marketing strategies. Without these broader strategies, initiatives like TASC run the risk of making only a limited impact (Maguire and Nettleton 2003). In terms of the targeted nature of the initiative, TASC has made an important contribution to the management of violence in the night time economy, particularly in the volume of persons seeking emergency treatment, with a 35% ‘overall decrease’ in Cardiff as compared to an ‘18% decrease in England and Wales over the same period’ (Shepherd 2007). Youth has been another policy area subject to prevention strategies, again on the grounds of effectiveness and efficiency (Kemshall 2008b), although as Solomon and Garside point out ‘10 times more is spent on custody than on prevention’ (2008: 9). The UK currently has one of the highest juvenile prison populations in Western Europe (Goldon 2005), paralleled by the failure of the youth justice system to meet most of its targets (Solomon and Garside 2008). Youth justice, particularly in the Anglophone countries, has been characterised by the risk factor prevention paradigm, characterised by the use of formal risk assessment tools, risk factors (largely static) generated by meta-analytical techniques (see Case 2007 for a full review), and longitudinal research studies into predictive factors for later delinquency (see West and Farrington 1973 for example). The risk prediction paradigm has been much critiqued for its subservience to pre-determined policy ends (Armstrong 2004), methodological and theoretical difficulties (Kemshall et al 2006), and the failure to recognise social and structural factors (Case 2007). Preventative strategies have been concerned with identifying ‘at risk youth’ including ‘at risk families’ for early interventions of increased social engineering and social regulation (Kemshall 2008b). More recently this has extended to the social engineering of communities (e.g through the USA’s Communities that Care initiatives (Catalano et al 2002), and the ‘million dollar block’ projects (Gonnerman 2004). These projects involve city

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mapping in the USA which indicates those blocks that generate the most imprisoned offenders typically costing one million dollars per year (in 2005 there were 35 blocks fitting the bill in Brooklyn alone), and in one case a five million dollar price tag. These blocks occur in the poorest of city neighbourhoods, and also contain a high volume of probationers and parolees (Trying to Break the Cycle of Prison at Street Level, available at www.nytimes.com/2007/11/23/ us/23mapping.htm, accessed 7th May 2008). These prison spending maps have begun to influence political debate and criminal justice and social policy spending: One state, Connecticut, has even gone so far as to change its spending priorities, taking dollars out of the prison budget and steering them towards the neighborhoods with the highest incarceration. (Gonnerman 2004, available at www.villagevoice.com/news/0446.gonnerman, 58490.1.html).

In the UK, the Nottingham early intervention programme is intended to reduce social exclusion and reduce crime by ‘identifying adults and children at risk before they become Nottingham’s future problems’ (Hilary Armstrong, www.cabinetoffice. gov.uk/thirdsector/news, accessed 7th May 2008). The scheme will use the following techniques:

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• • • • •

Family nurses to assist teenage mums, and the use of Sure Start Children’s Centres to teach parenting skills. Mentoring for young people targeting those children ‘at risk’ of becoming involved in serious crime. Supporting victims of domestic violence through family support projects. A sanctuary scheme to provide safety for victims of domestic violence. The Drug Aware Scheme to tackle illicit drug use and trade.(see Nottingham Early Intervention launch at th www.nottinghamcity.gov.uk/news_page, accessed 7 May 2008).

In the social policy arena, work with youth is increasingly about ‘tough love’, promoting self-risk management, self-regulation and active citizenship (Jordan 2000). The language of ‘need’, ‘at risk’, and vulnerability has begun to elide into the language of risk, harm and danger (Goldson 2000, 2002; Kemshall 2009). Every Child Matters (Department of Education and Skills, 2003) and the Children Act 2004 extend concerns and interventions to children not only in need of protection but also to children seen as presenting a risk to others (Sharland 2006). In England and Wales the Youth Inclusion Projects targeted at the 50 most

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troubled children in the community also characterise such children as the most troublesome (Kemshall 2008b).

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RISK AND THE RATIONAL ACTOR Penal and crime policies based on risk have presumed the rational actor, the person who, if given information on risk including costs and benefits, will alter their behaviour (including criminal behaviour) accordingly (see for example Cornish and Clarke 1986). The rational actor has been much critiqued in risk research (Lupton 1999), not least on the grounds that this paradigm ignores the role of emotion in decision-making (Slovic 2000); the social context within which risk decisions are actually made (Bloor 1995; Rhodes 1997); and the role of social/structural constraints on choice (Kemshall et al 2006). Knowledge of a risk does not necessarily mean we will act on it or necessarily choose what outsiders consider to be the most rational course of action. For example, Denscombe (2001) found that young smokers are not ignorant of the risks but choose to diminish, justify and ignore them because smoking was integral to their identity. Other studies of health risks indicate that knowledge of a risk does not necessarily change behaviours (Alaszewski 2006; see Hobson-West 2003 on MMR; Ruston and Clayton 2002 on heart disease; Thirlaway and Hegg 2005 on alcohol and cancer). Interestingly people tend to adopt strategies to manage their anxieties about risk but are less likely to change their behaviour - for example in response to alcohol campaigns people justify continued drinking by stating they ‘only drink wine and not spirits’, and ‘only red wine because it is good for you’ (Alaszewski 2006; Thirlaway and Hegg 2005). In the crime arena, the presumption of the rational actor has underpinned situational crime prevention (see above), but also corrective programmes with offenders based on Cognitive Behavioural Therapy (CBT). Such programmes presume that ‘straight thinking’ can be taught and that rational thinking can be inculcated. CBT programmes have been seen as part of a broader strategy to ‘responsibilise offenders’ (Kemshall 2002) making them active citizens responsible for their own choices, for transcending their own circumstances and avoiding risks. This responsibilisation agenda has been critiqued on a number of grounds, not least that it fails to recognise the structural inequalities that mitigate against ‘active citizenship’: In brief, some sections of the population do not have the resources to become expert risk managers of their fate and the ‘activeness’ of some citizens

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can be heavily curtailed by poverty, social exclusion, and geographic location.(Kemshall 2006: 85). Putting it bluntly, ‘straight thinking’ may have limited impact if you return from prison to a ‘million dollar block’.

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Recent work (Farrall 2002; Maruna 2001) has ‘re-introduced the social’ with increased attention to the social conditions and immediate circumstances required to avoid offending (May 1999). These desistance studies have increasingly focused on the interaction between agency and structure, resilience to risk, and the construction of non-criminal identities (Maruna 2001). Risk choices are seen as both situated in context and structural in nature as well as merely individual. Greater attention is focused on the requirements to lead a ‘Good Life’ rather than on risk factors and risky profiles and reflects a more positive framing of human agency (see McMurran and Ward 2004; Maruna 2001; Ward and Maruna 2007; Ward and Stewart 2003a). The ‘Good Lives Model’ (GLM) is essentially a strengths based approach which ‘focuses on promoting individuals’ important personal goals, while reducing and managing their risk for future offending’ (Whitehead et al 2007: 579). In brief: It takes seriously offenders’ personal preferences and values- that is, the things that matter most to them in the world. It draws upon these primary goods to motivate individuals to live better lives; and …therapists seek to provide offenders with the competencies (internal conditions) and opportunities (external conditions) to implement treatment plans based on these primary goods. (Whitehead et al 2007: 580).

For example, a sex offender may pursue relatedness and social/physical intimacy through inappropriate sexual relations with children (Ward and Stewart 2003a). GLM will focus on positive and pro-social approach goals to achieve these ‘primary goods’ of intimacy legitimately and emphasise avoidance goals to prevent harm. The model has also been applied to violent offenders although robust evaluative studies are still awaited (Whitehead et al 2007). In brief, GLM works with the offender to reframe approach goals and the means to achieve them positively and legitimately, and assists the offender in reconstructing a new identity that can action personal goals legally (Whitehead et al 2007). However, GLM has been critiqued on a number of grounds, not least that it is culturally and context specific, developed from work with indigenous peoples and lacks transferability. There is also a danger that attention to risks may be lost within a therapeutic focus on needs. The model also has limited efficacy with psychopaths

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who display limited empathy and remorse (Whitehead et al 2007; Hemphill and Hart 2002). Comparisons of GLM to more traditional risk management strategies including CBT are lacking (see Bonta and Andrews 2003 for a full review) and at present a body of robust evaluations of GLM is awaited. It has proved difficult to establish in a multi-modal approach the impact achieved by GLM over and above more traditional risk management methods.

BROADER APPROACHES TO CRIME RISKS Alternative approaches are emerging, in particular Public Health Approaches (PHA) to taboo risks such as sexual offending and paedophilia. In brief, the characterisation of sexual and violent offending as a public health problem is most easily attributable to the work of Richard Laws (1996, 2000). In brief, Laws argues that traditional, reactive responses to such offending located predominantly in the criminal justice system have not proved to be effective in reducing the incidence of sexual or violent offending, and that perversely such approaches inflate public fears and rejection, particularly of sex offenders (2000: 30). The PHA is located at three levels: the primary, secondary and tertiary:

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•

•

•

•

The primary level: at which the goal is prevention of sexually deviant behaviour before it starts, for example the identification and prevention of sexually deviant behaviour in children, and the long-term prevention of adults in engaging in sexual abuse. The secondary level: at which the goal is the prevention of first time offenders from progressing, or the opportunistic and ‘specific offence’ offender from becoming a generalist. The tertiary level: at which the goal is effective work with persistent and more serious offenders. Specific goals are usually effective treatment programmes and relapse prevention. (See Laws 2000: 31).

Laws argues that as an alternative to (largely ineffective) incarceration, increased efforts should be targeted at levels 1 and 2. Craven, Brown and Gilchrist (2006, 2007) apply this approach to sexual grooming, that is, the targeting of children for sexual abuse by offenders. They argue that preventative work could be targeted at:

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(1) identifying potential offenders at the onset of their sexual interest in children; (2) intervening with these potential offenders as they begin grooming behaviours; (3) intervening as they groom the environment and significant others (for example gaining the confidence of parents); (4) intervening once they are grooming the child; (5) work with them long-term to prevent further offending. (6) (Adapted from Craven et al 2007: 69).

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The PHA also presumes a rational actor, but a somewhat different Rational Choice Actor (RCA) than that posed by either crime prevention or CBT. In the latter characterisations the RCA is seen as incompetent (gets caught), is unwilling/unmotivated, lacks capacity to change, and requires compulsion/correction to do so (see Kemshall and Wood 2007). In contrast, the PHA sees the RCA as competent (already making choices and decisions), has the capacity to change if this is enhanced and built on, motivation can be promoted, and treatment should be voluntary and if possible early (Kemshall and Wood 2007): The primary approach is to seek strategies to retain the offender in the community by managing out, reducing or limiting problematic behaviours rather than by excluding the offender from the situation. In this approach it is the conduct of the person that is important, and those that manage their risk effectively remain integrated. (Kemshall and Wood 2007: 213).

PHA has a number of advantages, not least in promoting greater public awareness of criminal behaviours, enabling the public to take greater responsibility for crime management in their midst (without vigilante action), and in promoting safe community reintegration of difficult and at times taboo offenders. There are however, limits to PHA. In particular, PHA seeks to place responsibility for some key crime risks (and they are usually sex offending ones) with communities. However, it is a moot point as to whether communities want and can carry out such a responsibility. Adults and the communities they comprise may have differing levels of tolerance and acceptability of child sexual abuse, and PHA advocates may underestimate the difference in personal and community resources to respond to such risks (Kemshall and Wood 2007; Kemshall 2008a). Gated, privileged communities may be in a better position to manage such risks than classic ‘sink

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estates’. Public Health Approaches have also been critiqued for potentially displacing responsibility for risk management (particularly for crime) from the State onto the public (Kemshall and Wood 2007), thus reducing expenditure on crime risks, and displacing the risk of failure from the State to the public.

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CONCLUSION Risk continues to play a significant role in the formation and implementation of crime prevention and penal policies. However, how risk is framed, understood and deployed by policy makers varies, ranging from the managerialist approach of the new penology, to the public health strategies for dealing with sex offenders in the community. Central to many of the policy approaches is the notion of the rational actor, although this heuristic device of the policy arena is increasingly discredited by research into risk decision making. Paralleling such critique has been the introduction of social factors and the social actor, a person making risk decisions within context, and subject to constraints and limits upon their choice. More recent policy initiatives seek to merge individual decision making with local structural factors (such as the impact of ‘million dollar blocks’ on the behaviour and choices of individuals), and the Good Lives Model seeks to combine the notion of the social actor with issues of structural opportunity and support combined with the individual’s motivation to change. Whilst evaluations of the Good Lives Model are embryonic, this alternative framing of the risky crime actor is gaining ground and poses an interesting contrast to the traditional rational actor. Perhaps the most interesting development is the application of public health approaches to crime risks. They represent a mixture of environmental risk management combined with public education and awareness raising, and are notable for their multi-agency approach and their use of non-statutory agencies. The potentially higher engagement of local communities in local risk management strategies is also novel. PHA has been lauded for its preventative approach, and for enabling communities to be more easily engaged in local risk management. On a more critical level, PHA also presents a new, and potentially more subtle strategy for ‘responsibilising’ the public for risk.

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Ekblom, P. (2001) Future Imperfect: Preparing for Crimes to Come. Criminal Justice Matters, 46 (winter)38-40. Farrall, S. (2002) Rethinking What Works with Offenders: Probation, Social Context, and Desistance from Crime. Cullompton, UK: Willan. Farrington, D. P. (2000). Explaining and preventing crime: The globalization of knowledge - The American Society of Criminology 1999 Presidential Address. Criminology, 38, 1-24. Freiberg, A. (2000) Guerillas in our midst? Judicial responses to governing the dangerous. In: M. Brown and J. Pratt (eds.) Dangerous Offenders: Punishment and Social Order. London: Routledge. Garland, D. (2001) The Culture of Crime Control: Crime and Social Order in Contemporary Society. Oxford: Oxford University Press. Goldson, B. (2000) ‘Children in Need’ or ‘Young Offenders’? Hardening Ideology, Organizational Change and New Challenges for Social Work with Children in Trouble. Child and Family Social Work 5: 255-265. Goldson, B. (2002) New Labour, Social Justice and Children: Political Calculation and the Deserving-Undeserving Schism. British Journal of Social Work 32: 683-695. Goldson, B. (2005) Taking Liberties: Policy and the Punitive Turn. In: H. Hendrick (ed.) Child Welfare and Social Policy. Bristol: Policy Press. Gonnerman, J. (2004) Million-Dollar Blocks: The Neighbourhood Costs of America’s Prison boom. Available at www.villagevoice.com/news/0446.gonnerman, 58490.1.html). Goodwin, V. and Shepherd, J. (2006) The development of an assault patient questionnaire to allow accident and emergency departments to contribute to Crime and Disorder Act local crime audits. Journal of Accident and Emergency Medicine 17: pp: 196-198. Hemphill, J. F. and Hart, S. D. (2002) Motivating the unmotivated: Psychopathy, treatment, and change. In: M. McMurran (ed.) Motivating the offender to change: A guide to enhancing engagement in therapy. Chichester: John Wiley and Sons, pp: 193-200. HM Inspectorate of Probation and HM Inspectorate of Constabulary (2005)

Managing sex offenders in the community. A Joint Inspection on Sex Offenders. London: HM Inspectorate of Probation and HM Inspectorate of Constabulary. Hobson-West, P. (2003) Understanding Vaccination Resistance: Moving Beyond Risk. Health, Risk and Society, 5: 273-283. Hughes, G. (1998) Understanding Crime Prevention: Social Control, Risk and Later Modernity. Buckingham, UK: Open University Press.

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Jordan, B. (2000) Social Work and the Third Way: Tough Love as Social Policy. London: Sage. Kemshall, H. (1998) Risk in Probation Practice. Aldershot, UK: Ashgate. Kemshall, H. (2003) Understanding risk in criminal justice. Buckingham, UK: Open University Press. Kemshall, H. (2006) Crime and risk. In: P. Taylor-Gooby and J. Zinn (eds.) Risk in social science. Oxford: Oxford University Press. Kemshall, H. (2007) Risk assessment and risk management: the right approach? In: M. Blyth, E. Solomon and K. Baker (eds.) Young People and ‘risk’. Bristol, UK: Policy Press. Kemshall, H. (2008a) Understanding the community management of high risk offenders. McGraw-Hill. Kemshall, H. (2008b) Risks, Rights and Justice: Understanding and Responding to Youth Risk. Youth Justice 8 (1) 21-38. Kemshall, H. (2009) Risk, Youth and Social Policy. In: J. Wood and J. Hine (eds.) Work with Young People: Theory and Policy for Practice. London: Sage. Kemshall, H. and Maguire, M. (2001) Public Protection, Partnership and Risk Penality: The Multi-Agency Risk Management of Sexual and Violent Offenders. Punishment and Society, 3 (2) 237-264. Kemshall, H., Marsland, L., Boeck, T. and Dunkerton, L. (2006) Young People, Pathways and Crime: Beyond Risk Factors. The Australian and New Zealand Journal of Criminology 39 (3) 354-370. Kemshall, H. and Wood, J. (2007) Beyond Public Protection: An examination of community protection and public health approaches to high risk offenders. Criminology and Criminal Justice 7 (3) 203-222. Laws, R. D. (1996) Relapse prevention or harm reduction? Sexual Abuse: A Journal of Research and Treatment, 8 (3), 243-248. Laws, D.R. (1999) Relapse Prevention: The State of the Art. Journal of Interpersonal Violence, (8) pp. 285-302. Laws, R. D. (2000) Sexual offending as a public health problem: A North American Perspective. Journal of Sexual Aggression, 5 (1), 30-44. Laws, D.R. (2003) The rise and fall of relapse prevention. Australian Psychologist, 38, (1) pp. 22-30. Laws, D. R. and Marshall, W. (2003) A Brief History of Behavioural and Cognitive Behavioural Approaches to Sexual Offenders. Part 1: Early Developments. Sexual Abuse: A Journal of Research and Treatment 15 (2) 93-120. Lupton, D. (1999) Risk. New York: Routledge.

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Lynch, M. (2000) Rehabilitation and Rhetoric: The Ideal of Reformation in Contemporary Parole Discourse and Practices. Punishment and Society 2 (1) 40-65. Maguire, M. and Hopkins, M. (2003) Data analysis for problem-solving: alcohol and city centre violence. In: K. Bullock and N. Tilley (eds.) Crime Reduction and Problem-Oriented Policing. Devon: Willan. Pp: 126-153. Maguire, M. and Nettleton, H. (2003) Reducing Alcohol-related violence and disorder: An Evaluation of the TASC Project. Home Office Research Study No. 265. London: Home Office. Maruna, S. (2001) Making Good: How Ex-Convicts Reform and Rebuild their Lives. Washington, DC: American Psychological Association. McMurran, M. and Ward, T. (2004) Motivating Offenders to Change: An Organizing Framework. Legal and Criminal Psychology 9: 295-311. Minnesota Department of Corrections (2003) Level three sex offenders residential placement issues. St Paul, MN: Minnesota Department of Corrections. Nash, M. (2006) Public Protection and the Criminal Justice Process. Oxford: Oxford University Press. O’Malley, P. (1999) Volatile and contradictory punishment. Theoretical Criminology, 3 (2) 175-196. O’Malley, P. (2001) Risk, Crime and Prudentialism Revisited. In: K. Stenson and R. Sullivan (eds.) Crime, Risk and Justice: The Politics of Crime Control in Liberal Democracies. Cullompton, UK: Willan. Petrunik, M. (2002) Managing unacceptable risk: Sex offenders, community response and social policy in the United States and Canada. International Journal of Offender Therapy and Comparative Criminology, 46 (4) 483-511. Pratt, J. (1997) Governing the Dangerous. Sydney: Federation Press. Pratt, J. (2000a) The return of the wheelbarrow men: or, the arrival of postmodern penality? British Journal of Criminology, 40: 127-145. Pratt, J. (2000b) Emotive and ostentatious punishment: its decline and resurgence in modern society. Punishment and Society, 2 (4) 127-145. Pratt, J. (2006) The Dark Side of Paradise: Explaining New Zealand’s History of High Imprisonment. British Journal of Criminology, 46: 541-560. Rhodes, T. (1997) Risk Theory in Epidemic Times: Sex, Drugs and the Social Organisation of ‘Risk Behaviour’. Sociology of Health and Illness, 19 (2) 737-748. Robinson, G. (2001) Power, Knowledge and ‘What Works’ in Probation. Howard Journal of Criminal Justice, 40 (3) 235-254. Ruston, A. and Clayton, J. (2002) Coronary Heart Disease: Women’s Assessment of Risk-A Qualitative Study. Health, Risk and Society, 4: 125-137.

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Sharland, E. (2006) Young People, Risk Taking and Risk Making: Some Thoughts for Social Work. British Journal of Social Work, 36: 247-265. Shepherd, J. (2007) Preventing alcohol-related violence: a public health approach. Criminal Behaviour and Mental Health 17: pp: 250-264. Simon, J. (1998) Managing the monstrous: sex offenders and the new penology. Psychology, Public Policy and Law, 4 (1-2) 452-467. Slovic, P. (2000) The Perception of Risk. London: Earthscan. Solomon, E. and Garside, R. (2008) Ten Years of Labour’s Youth Justice Reforms: an independent audit. The Hadley Trust and Centre for Criminal Justice Studies, Kings College London. Stone, N. (2004) ‘Dangerous’ Offenders: No basis for concluding a risk of ‘serious harm’. Probation Journal, 53 (3) 299-303. Thirlaway, K. J. and Hegg, D. A. (2005) Interpreting Risk Messages: Women’s Responses to a Health Story. Health, Risk and Society, 7: 107-121. Walker, J., Golden, J. and VanHouten, A. (2001) The geographic link between sex offenders and potential victims: A routine activities approach. Justice Research and Policy, 3 (2) 15-33. Warburton, A. L. and Shepherd, J. P. (2004) Development, utilisation and importance of accident and emergency-derived assault data in violence management. Emergency Medicine Journal 21: 473-477. Warburton, A. L. and Shepherd, J. P. (2006) Tackling alcohol related violence in city centres: effect of emergency medicine and police intervention. Emergency Medicine Journal 23: 12-17. Ward, T. and Maruna, S. (2007) Rehabilitation. Key Ideas in Criminology Series. London: Routledge. Ward, T. and Stewart, C. (2003a) Criminogenic Needs and Human Needs: A Theoretical Model. Psychology, Crime and Law, 31 (3) 282-305. West, D. J. and Farrington, D. P. (1973) Who Becomes Delinquent? London: Heinemann. Whitehead, P. R., Ward, T. and Collie, R. M. (2007) Time for a Change: Applying the Good Lives Model of Rehabilitation to a High-Risk Offender. International Journal of Offender Therapy and Comparative Criminology 51 (5) 578-598. Worth, R. (2005) Questions about legality and effectiveness. The New York Times, p. 1, October 3rd.

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Chapter 6

RISK, GOVERNMENT AND SOCIAL POLICY Catherine McDonald The University of Queensland, Brisbane QLD 4072 Australia

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INTRODUCTION In Australia and elsewhere, there is an epidemic of ‘risk’. Everywhere one turns – the popular media, government reports, ministerial statements, journalists’ queries and politicians’ doorstop responses, scientific and medical prognostications, organisational protocols, and professional journals – all provide evidence that risk has become the zeitgeist of the contemporary era. It is an epidemic which has broken national boundaries and swept the ‘western’ world. But it most certainly is not an epidemic which has gone unnoticed by the professional watchers of the state of the particular nation in which said watchers are located. Rather, a vast academic literature has developed to note/categorise/explain/manage the rapidly morphing risks that continue to break out all over. In the aptly named journal Risk Analysis, Althaus (2005: 569) usefully examines how different disciplines understand risk: for example as something which is calculable (logic and mathematics); as an objective reality (science and medicine); as a decisional phenomenon (economics); as a judicable phenomenon (law). She also identifies three loose categories of sociological perspectives on risk. The first is the ‘risk society’ perspective made famous by Ulrich Beck (1992) and Anthony Giddens (1990). Although with different emphases, these by now seminal accounts suggest that the escalation of risk is ubiquitous, inevitable, and

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unstoppable – largely as a result of ‘globalisation; rapid social, economic and environmental change; and the unintended consequences of progress’ (Green, 2007: 397-398). The second sociological category concerned with risk is pursued by those engaged with understanding and applying the latter work of Foucault on emerging manifestations of governing (governmentality). Two of the most well known of these is Mitchell Dean (1999) and Nicolas Rose (1999), whose accounts are, among other things, concerned with appreciating the increasing privatisation of risk associated with neoliberal regimes of governing which are drawing individuals into an increasingly seamless web of surveillance – by selves and ‘authorised’ others. Ably represented by such folk as Deborah Lupton (1999), the third approach – the sociocultural perspective – is ‘an attempt to marry the anthropological, risk society and governmentality arguments in order to produce a concerted synthesis to understanding risk as a societal phenomenon’ (Althaus, 2005: 576). This latter category, I propose, speaks to my opening claim – the existence of a wide ranging epidemic of risk. In this chapter I wish to sketch the contours of the epidemic as it plays out in one national context – Australia – a context which, because of its continent-asisland status and its flinty eyed border control, has long managed to protect itself from many forms of foreign pestilence. But as will become clear, it has failed spectacularly in regard to the risk epidemic which has ruthlessly taken hold and, in multiple guises, spread across the nation. I do so by discussing two categories or manifestations of risk which more or less mirror the overall sociological oeuvre identified by Althaus. The first of these I call the moral panics – an escalation of rather shrill public discussions on dreadful risks that threaten most of us living in this extravagantly proportioned island in various ways. These risks articulate reasons for and authorise government intervention into people’s lives. The second level is qualitatively different. It is represented first in attempts by governments to manage the (politically) risky business of the state, largely through delegation of wicked problems and other (perhaps less dire) but nonetheless tricky matters to non-state sectors. It is also represented in the rampant privatisation of risk to individuals as Australian governments pull out of the social contract established in the 20th Century to collectively manage life risks that always have had and will continue to have the potential to trip up the citizenry. Taken together, these two levels illustrate well complexities and dimensions of the Australian version of the risk epidemic.

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MORAL PANICS AND RISK In 1982, Stanley Cohen came up with the notion of moral panics to describe exaggerated fears expressed and promoted in public forums about an issue or a group of people. Moral panics serve a purpose, he suggested, in that the attention of the public shifts away from issues of governance and focuses instead on the ‘problem’ or ‘problems’ identified. There are quite a few moral panics running in Australia at the moment and in the context of this chapter, I can only describe some. In doing so however, the examples given are presented in an explicit hierarchy which, for the risk sceptic, move in seriousness from the vaguely ridiculous to the tragic.

A Fat Australia

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The first is the furore about a proposed epidemic of national obesity. Quoting a press release from a 2003 Meeting of Australian Health Ministers, I note the following: Australian Health Ministers, meeting in Sydney today, acknowledged that the nation is facing an epidemic of obesity and agreed that joint national action must be taken to increase healthy eating and physical activity amongst children, young people and their families (Australian Health Ministers, 2003).

In 2007, in the run up to a Federal election, the Shadow Minister for Health released a policy statement, of which I provide some excerpts below: A Rudd Labor Government will make obesity a National Health Priority Area – to help tackle the increasing burden obesity is placing on the nation’s health system. ……Currently, around three million Australians are obese, and more than 7 million Australians in total are overweight. These numbers are increasing rapidly – it is estimated that by 2020 a staggering 75 per cent of the population will be overweight or obese (Roxon, 2007).

On June 22, 2008, the Adelaide Mail (along with virtually all the Australian newspapers) ran the following editorial: The home of the athletic, bronzed Aussie has won yet another gold medal – we now are the fattest nation on Earth. We're even fatter than super-sized Americans, according to the report, Australia's Future Fat Bomb by the Baker

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Catherine McDonald Heart and Diabetes Institute. Some will dispute the claim to gold, but it is worth considering as you tuck into your big, greasy fry-up breakfast today. There is no doubt that as a nation, we have gone from fab to flab. It is a national disgrace (Adelaide Mail, 2008).

Urgent action is called for to manage the future risks to individual citizens as well as the risks to health services (and government expenditure) our rising obesity is heralding. Some suggested responses include: a ‘Healthy Towns’ competition (to mirror an Australian classic – the ‘Tidy Towns’ competition) to reward communities who collectively loose weight; subsidizing gym memberships; and rationing surgery to those fortunate people who can demonstrate weight loss.

A Drunken Australia

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Another terrible risk facing Australians (especially young people, but also all of us) are those associated with alcohol consumption. Again, as reported on the Nine television network’s influential Sunday program in 2003, we have an epidemic: Every weekend around Australia, teenagers gather around the backyard barbecue or at parties, drinking to excess. It has always been thus, but in recent years, a growing number of adolescents — and some pre-teens, as young as 10 or 11 — have had to go to hospital and, in the worst cases, dozens of teenagers die each year (Dalley, 2003).

In 2006, the ‘epidemic’ continued, as evidenced by this newspaper story: More than 500 young Victorians a year are getting so drunk they need paramedic help. Ambulance officers warn that youth boozing is at epidemic proportions. A senior paramedic said alcohol-related violence was skyrocketing and the number of children being seen for alcohol poisoning was on the rise (Hind, 2006).

Fast forward to February 20 2008 when the Australian Broadcasting Commission reported the utterances of Prime Minister, Kevin Rudd: I am concerned about what I describe as an epidemic of binge drinking across the country. I think it is not good. It is not good for young people’s health

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and it’s certainly not good in terms of coping with addictions in general …. Frankly, I just think it is starting to get somewhat out of control. Speaking for example to some of the police around the country, their concern is that alcoholism, not alcoholism, alcohol abuse lies at the core of increasing spates of urban violence (Rudd quoted in Lane, 2008).

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The most recent contribution to the risky business of drinking alcohol concerns pre-mixed drinks known as ready to drink (RTD) ‘alcopops’, apparently popular with teenagers. These are considered to be especially insidious because they are understood to be part of a concerted campaign to mislead and corrupt young people: An alcohol industry insider has admitted companies deliberately target young people by sweetening ready-to-drink alcopops to mask the taste of alcohol and appeal to the "younger palate". Cheap, sugary drinks packaged in bright colours are the best way to start people drinking at an early age, said Mat Baxter, a partner in the media planning agency Naked Communications."It's one of the few drinks where you don't necessarily know you're drinking alcohol and that's a conscious effort to make those drinks more appealing to young people. [The] drinks are very much about masking the alcohol taste."Australians were the most prolific RTD drinkers in the world, Mr Baxter said. The 2005 national secondary schools survey showed that 47 per cent of 12- to 17-year-old girls and 14 per cent of boys had drunk pre-mixed spirits in the last week. Australian Bureau of Statistics figures revealed a 9 per cent jump in RTDs on the market between 2005 and 2006. (Stark, 2006).

However, this particular moral panic is not confined to young people as the following report on ABC Radio’s Breakfast program illustrates: Consuming more than four middie-sized beers [each less than a half pint] or three glasses of wine may be classed as a binge under the new guidelines to be introduced next month. Coalition health spokesman Tony Abbott accused the federal government of simply trying to create hysteria over binge drinking. Other health groups say setting the binge limit at what was once thought to be a safe amount of alcohol is unrealistic (Bannerman, 2008).

Apparently we are (except for the teetotallers) all prone to binge drinking; at risk due to an apparent propensity to bring hand to mouth and consume unwarranted substances. As a consequence we will, it is inferred, develop horrible medical conditions, cost the nation a fortune and die young.

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A Frightened Australia Moving up the risk continuum we are, furthermore, subject to another category of risk, also operating as a form of moral panic. In this instance I discuss the apparent risk posed to Australians by immigrants – both legal and illegal. While Australians have always been a little (sometimes very) suspicious of incoming migrants, during the era of the previous Howard conservative government this took on a new (and shameful) intensity. It takes several forms; from mild paranoia about young African (legal) refugees in the suburbs, to the whipping up of unwarranted fear of ‘illegals’ coming to our shores in small, leaky, foreign vessels. In regard to the former, on October 3 2007 for example, all of the commercial television stations played a (largely erroneous) news story about a group of Sudanese young men, a ‘gang’, robbing a bottle shop. These stories were reported on the Australian Broadcasting Commission’s Media Watch, a program devoted to exposing media beat ups:

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“Good Evening. If you can, put racism claims aside for a moment. Because tonight we can show you the terror experienced by a Noble Park shopkeeper at the hands of an ethnic gang. They’ve been identified by Police as predominantly Sudanese youths caught on camera stealing and striking fear into those around them…” — Channel 7, Melbourne News, 3rd October, 2007 “New footage has emerged showing Sudanese gangs terrorising shopkeepers in Noble Park. Business owners are demanding more protection from local authorities while the Federal Government has announced it’s shutting the door to African refugees.” — Channel 9, Melbourne News, 3rd October, 2007 (ABC, Media Watch, 8 October, 2007)

On 5 October, the then Immigration Minister repeated allegations he had made about African immigrants, and defended his government’s decision to cut the intake of African refugees: Immigration Minister Kevin Andrews has catalogued the failings of Sudanese refugees as justification for slashing the intake of African migrants. Mr Andrews last night issued a list accusing Sudanese migrants of fighting each other in bars, forming gangs and congregating in parks to drink alcohol. (Haywood, Phillip and Wray, 2007).

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A Determined Australia

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Predictably, this lead to a resurgence of references to two infamous incidents in Australia’s recent political history – both used to instill fear and loathing into the Australian population in the interests of conservative victories in elections The first I report is what is known as the ‘Children Overboard’ incident, in which the Government claimed in October 2001 leading up to an election that a group of middle eastern refugees threw their children overboard into the ocean from a small boat in an effort to get the Australian navy vessel HMAS Adelaide to pick them up and take them to Australia. As the transcript below illustrates, the refugees were presented as odious persons who would stoop to any depths to get to Australia: PHILIP RUDDOCK, FORMER IMMIGRATION MINISTER: A number of people have jumped overboard and have had to be rescued. More disturbingly, a number of children have been thrown overboard. HELEN DALLEY: Former immigration minister, Philip Ruddock, announced to the nation as fact that asylum seekers had thrown children into the sea off their boat that very morning in their desperate bid to reach the mainland. Minister Ruddock portrayed these events as a premeditated and deliberate tactic by these people to force Australia to rescue them. PHILIP RUDDOCK: It was clearly their intention to do this and it's clearly their intention to put pressure on us. HELEN DALLEY: This news both shocked and polarised the public, particularly when the Prime Minister and several senior ministers made a meal of it. JOHN HOWARD: I express my anger at the behaviour of those people and I repeat it. I can't comprehend how genuine refugees would throw their children overboard. ALEXANDER DOWNER: We've made it clear that they won't be coming to mainland Australia. They're not types of people we want integrated in our community, people who throw children overboard. It's simply just appalled people in this country. (Dalley, 2004).

The then Immigration Minister and the then Prime Minister were later exposed as deceitful and manipulative leaders who would themselves stop at nothing to gain the political edge. The reality was that the boat the asylum seekers were travelling in was sinking, and the occupants were forced to try and swim to the Adelaide. Against government instructions, the navy crew went in to the water and rescued the refugees. The entire sorry saga and its consequences were

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subsequently documented in a Senate Inquiry (Commonwealth of Australia, 2002). The Executive Summary of that report states that:

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At the broadest level, the Committee has found that a number of factors contributed to the making and sustaining of the report that children had been thrown overboard from SIEV 4. They included genuine miscommunication or misunderstanding, inattention, avoidance of responsibility, a public service culture of responsiveness and perhaps over-responsiveness to the political needs of ministers, and deliberate deception motivated by political expedience.

This most unfortunate affair was preceded by another just as detestable – the affair of the M.V. Tampa. In this instance, obeying the laws of the sea, the Norwegian cargo vessel rescued over four hundred Afghani asylum seekers from their sinking vessel. While refused permission by the Australian Government, the captain sailed towards Australian territory (Christmas Island) until his vessel was boarded by the Australian SAS. An international scandal soon evolved which did little to enhance the reputation of the Australian Government. Vividly recounted by Marr and Wilkinson (2003), it is really a tale about how a government whipped up a storm of fear of terrorism in the general population, again for electoral gain, at the expense of helpless refugees. As judged in the Senate Inquiry (Commonwealth of Australia, 2002), this incident and the one previously described were both deliberate. As many noted at the time both incidents served to divide the Australian population into the elite ‘left’ and the majority of ‘ordinary Australians’. For the purposes of this chapter, it is important to note that these incidents were two standouts in a ten year pattern of politics that, in the context of the 9/11 attacks and the Bali bombings, used a manufactured fear of ‘illegal’ refugees to legitimate a punitive policy orientation to people entering or attempting to enter the country without visas.

A Concerned Australia The final example of a moral panic-induced surge of riskiness – no less and perhaps more tragic than Australia’s treatment of asylum seekers – is the recent policy development known as ‘The Intervention’. In June 2007, the previous Howard Government responded to a formal report about indigenous child abuse in the Northern Territory (Northern Territory Board of Inquiry into the Protection of Aboriginal Children from Sexual Abuse, 2007). The Intervention has, without doubt, also polarised Australia provoking a veritable storm of debate, outcry,

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claim and counterclaim (Altman and Hinkson, 2007; Chaney, 2007; Marr and Peatling, 2007; Pearson, 2007). Describing Territory child sexual assault as a ‘national emergency’, the then Prime Minister and the relevant Minister subsequently set in motion a massive bureaucratic scramble to put in place the highly invasive Intervention into remote indigenous communities. It involves such measures as alcohol restrictions, computer audits to detect pornography, changes to the land tenure arrangements and the permit systems, more police, more night patrols, the appointment of government business managers in townships, making income security entitlements conditional on sending children to school, financial management including quarantining payments to food, clothing and shelter, safe houses, and compulsory health checks of children (Australian Government, 2008). In effect, these Northern Territory communities are now governed in a manner like no other Australian community (and which no other Australian community would tolerate), wiping away in one stroke most of the autonomies hard won by indigenous people. The political response and subsequent public commentary was and is characterized by hyperbole and critics were positioned as condoning continued child sexual assault by default. The Australian indigenous leadership has been damaged and publically sidelined from decision making, no consultations either with national leaders or with local elders occurred. The Northern Territory Government was soundly humiliated, resulting ultimately in the resignation of the Chief Minister. Whatever the outcomes of the intervention – good and bad – it is interesting to note that there have been other reports over many years about indigenous child sexual assault which did not lead to such as response (Hunter, 2007). In addition, indigenous child sexual assault rates are significantly lower in the Northern Territory than they are in Victoria and New South Wales (Australian Institute of Health and Welfare, 2005). Furthermore, very little evidence has subsequently emerged of child sexual or other abuse in the targeted communities. Finally, the Ministerial and Prime Ministerial Press release which announced the estimated $1.3 billion Intervention took place in June 2007, five months before the last Federal election. Suggestive of the previous moral panics about asylum seekers and refugee immigrants, the political nature of the Intervention responding to the ‘riskiness’ of remote indigenous communities, cannot be dismissed. As suggested in my opening comments, the moral panic risks are about governments either wanting to ‘do’ things to people or actually ‘doing’ things to people. The next category of risk that has emerged in the Australian risk epidemic is more predictable in that it involves governments wanting to avoid engaging in anything that might be remotely risky to themselves.

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RISK TRANSFER

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A German nonprofit scholar coined the term ‘mellow weakness’ to typify nonprofit organisations (Seibel, 1996; 1989). These organisations, he suggests, are often characterised by the phenomenon of low performance-high persistence (Meyer and Zucker, 1989). In doing so, he also suggested that governments have increasingly developed a propensity to transfer wicked problems (or at least tricky issues) they are charged with managing to non-state locations. They do this to reassign the political risk of failure away from themselves while at the same time, maintaining the appearance that they are responding by funding others (nonprofit and for-profit providers) to manage the issue, service or problem. Such developments are driven by a large and (it seems) growing literature that proposes that non-state service delivery of state functions is preferable than service delivery by clumsy, self interested, rent seeking and inefficient state bureaucracies (Grossman and Hart, 1983; Schwartz, 1994). In these instances, however, the ‘principals’ are not necessarily interested in high performance of their ‘agents’ but rather in symbolic problem solving. In the first part of this section of the chapter I examine some Australian examples of what can be understood as risk transfer: in the fields of corrections, child protection and employment services.

RISKY CORRECTIONS Due to problems experienced by state governments in managing prisons, Australia has vigorously followed the path of the United States in the privatisation of corrections. In most states during the 1980s there was significant public pressure to reform what was believed to be a ‘decaying and inefficient penal system’ (McCartney, 2000: p. 307), which exposed state governments to sustained public opprobrium. Usually championed in terms of greater efficiencies, higher levels of effectiveness and increased accountability to the public, the Australian states have transferred a high proportion of their corrections load to, in the main, private firms. Five of the seven states moved to privatise corrections. In Queensland, for example, the high risk area of remand and reception (noted for high rates of self harm and deaths in custody) was transferred to a private firm, Of the Australian states Victoria is the most privatised, and by the time three new prisons were commissioned in 1997, Victoria had the highest percentage of prisoners privately incarcerated in the world (Sands, 2004). Prior to the advent of

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private prisons, the public system was plagued with problems resulting in considerable adverse publicity for the Victorian Government (Harding, 1997). Essentially, the utility of privatised corrections depends on the degree of public accountability: for funds and for practices. The regulator of the system in Victoria is the Office of the Correctional Services Commissioner, who is responsible for ‘policy, planning and standards, monitoring and assessment, access to Freedom of Information and coordination of complaints to and from the Ombudsman’ (Van Groningen, 1995). However, concerns have been raised about the independence of the Commissioner and about the fact the Office reports to the Minister not to Parliament, with the consequential diminution of accountability. Further, in 2000, an independent inquiry was conducted following a spate of deaths in custody in the private prisons. It recommended that while improvements needed to be made in performance monitoring and in transparency and accountability to the public; overall, the system functioned quite well (Kirby, 2000). Nevertheless, Victoria’s private prisons are considered to be less accountable than is desirable, and ‘the risks normally borne by the government in its provision of prison services are transferred to the private sector’, (Sands, 2004: 147).

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RISKY CHILD PROTECTION A similar form of risk transfer has recently occurred in relation to how the Victorian state government manages child protection. In a new system introduced in 2007, the Victorian Government has legislated that the primary arena of intervention into families considered to be ‘at risk’ is undertaken by nonprofit family support services. The rationale for this is that sustained involvement with the statutory child protection system is bad for children and families. In general terms, the statutory authority charged with child protection has responsibility for assessment of cases notified to it. After investigation and when no application for a Protection Order is made, the case is transferred to a ‘secondary child and family service’ (Office for Children, 2005). In Victoria, six percent of notifications result in a Protection Order (ibid), so intervention by Child Protection (the responsible statutory body) in the bulk of cases is time limited and episodic. For most families at risk of harming their children (that is, experiencing significant difficulties) the therapeutic intervention and family support is undertaken by the nonprofit sector. Furthermore, the Department has, through the provisions of funding contracts, enjoined agencies to connect with each other in

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localised service delivery systems. One agency is nominated as lead agency, which takes referrals from Child Protection, assesses their needs, and manages further referral for intervention to one of the other partner agencies. If there is no ‘space’ in the system, the lead agency or another contracted for the task have the role of ‘managing’ the case until intervention is able to commence. From a risk perspective, the agency charged with that management has a very tricky job. By definition, these are high risk cases, yet as they wait for assistance to lower that risk, the nonprofit organisation ‘managing’ these families inevitably face what may well be an escalating risk of harm occurring to the notified children because there is no intervention. In this way, the manifest political risks associated with ‘failure’ in child protection have shifted from the state to the nonprofit sector.

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RISKY EMPLOYMENT SERVICES The final example I use in this first category of government risk transfer is taken from the Commonwealth Government in the field of employment services. In 1998, the Australian Government adopted what the OECD (2001) considered to be one of the most radical experiments in employment services to the unemployed – the Job Network. Replacing the long-standing government-operated labour exchange, the Australian government created an integrated quasi-market of employment services linking the purchaser (the federal Department of Employment and Workplace Relations [DEWR]) with two categories of provider. One of these is Centrelink, the primary Commonwealth Government run income support agency, and the other is the Job Network, a system of approximately 115 for-profit and non-profit human service agencies operating in over two thousand different sites across the nation. Job Network agencies work within formal contractual arrangements entered into with DEWR. However, on a day-to-day basis, they engage primarily with Centrelink which provides referrals, makes payments to and maintains disciplinary oversight of the unemployed. Job Network members provide different types of employment services to the unemployed, depending upon their assessed degree of employability. Those adjudged as the most employable receive basic labour exchange services provided by a networked electronic information system run by the government, accessed via remote terminals located in each Job Network outlet. Those assessed as having significant barriers to employment and/or have been unemployed form more than twelve months are assigned to more intensive assistance. Individuals fitting this category are required to work closely with a Job Network case manager. Through a range of assessments and

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interventions, this intensive level of assistance is designed to render an unemployed person ‘job ready’, and to assist them into employment through 1 whatever means are considered individually appropriate (McDonald and Marston, 2005). Failure to engage with a case manager and failure to undertake prescribed activities can result in a ‘breach’, in which a case manager reports the person to Centrelink which then decides whether to impose a regime of financial penalties in the form of deductions from income support payments. The Job Network and the case management relations within it provide an example of the self-activation and disciplinary dimensions of advanced liberal workfare states. In terms of risk, two issues come to mind. First, due to sustained employment growth over the past five years (although unemployment is again rising), those that can successfully negotiate the labour market are in work. The remaining four to five percent who cannot get work have what is euphemistically known as ‘multiple employment barriers’ (health and mental health issues, disability, age, physical appearance, poor literacy, poor numeracy, labour market discrimination and so forth). With an overarching policy framework which valorises paid employment as the most important role for adults to achieve, to not work is a serious matter. While the blame is heaped squarely on the unemployed, the responsibility to overcome the ‘barriers’ rests with the case managers in the Job Network agencies. In this way, the Government transfers risk. Second, it has been argued by some economists that the primary reason for unemployment rising and falling is not the limitations of the unemployed or the inefficaciousness of the case managers and Job Network agencies, but in the monetary policy of the government itself (Mitchell, 2000; Mitchell and Watts, 1997). A primary goal of contemporary governments is to manage that most fearsome monster – inflation. Enter the non-accelerating inflation rate of unemployment (the NAIRU). The Reserve Bank of Australia, independent of the government, but nevertheless, a child of the Australian state, shifts interest rates up and down to slow down or speed up the economy accordingly. This is what causes shifts in the underlying rate of unemployment. Nevertheless, the management of it –for succeeding or failing to get people into employment – rests with the Job Network, not the government.

1

These means typically involve assessment, job search training including the development of resumes, basic skills training, referral to other training outlets, and referral to other types of assistance, some financial assistance for personal grooming or job interviews and so forth. People who are assessed as having disabling personal and/or emotional issues are referred to another program called Personal Assistance, also provided, in the main, by the Job Network.

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All of these examples are illustrative of one form of risk transfer – governments shifting out of contexts and modes of service delivery where mud is both likely to fly and to stick. But there is another, even more insidious type of risk transfer, the transfer of responsibility for human dependencies and life’s contingencies away from the state and onto to families and individuals. This forms the substance of my last, concluding, section.

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PRIVATISING CITIZENS’ RISK In the contemporary Australian risk epidemic, the long-standing orientation to managing citizens’ risks – centralized wage fixing, income security policies and programs and other social services – has waned. Many life risks faced by citizens are still mostly managed by the provision and use of ‘welfare’, but public welfare consumption in whatever form is an increasingly residual activity, and confined to fewer and fewer people. Instead, citizens are enjoined to use market solutions to manage such risks. In contrast to the past, contemporary Australian policy debates deploy the concept of risk in two main ways – first, as a technical fix to an (overloaded) system, and second, as a moral discourse inscribing new identities. In the first, developments associated with late modernity are held to pose new sets of risks (most notably an aging population) that the existing institutional arrangements of the welfare state cannot manage. In the second the notion of risk is employed through neo-liberal discourse to reject and invalidate the welfare state, to problematises welfare dependency, and individualise responsibility for managing life course risks. The institutional arrangements of the post-war welfare state were designed to manage certain types of risks and to respond to the risk structure of its times; predicated on the prevailing family type and prevailing labour market conditions. As these conditions have disappeared and as the family disintegrates, the role of policy is to promote alternative institutional arrangements to manage the emergent categories of risk. A key Australian example, keenly watched by other countries, was the development of compulsory occupational superannuation to privately fund the retirements of future generations of aging people. The concept of risk is employed largely as a political strategy. The dominant political discourse of neoliberalism problematises welfare dependency, and privatises the management of all forms of care and responsibility right across the age spectrum. In other words, risk is employed as a device to legitimise the winding back of collective responsibility for managing social dependencies, social problems, and even the small problems of everyday life. In the process, the new

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strategies of managing social dependencies as ‘risk’ involves the ascription of particular categories of people to new, highly disciplined and socially excluded social identities. On one hand, the welfare state (which once collectivised risk) has given way to the new state in which risk is increasingly privatized, and in which the responsibility for managing risk is re-located away from the state and into communities, families and individuals. Good citizens, good families and good communities are those that exercise responsibility for their own security. At the same time, those that do not or cannot manage themselves are separated out, dispersed into fragmented and hierarchically-ordered zones of ‘riskiness’. In the process, the older approaches to risk which emphasised social solidarity and collective responsibility for all citizens within a society recede, and different classes of citizens, determined according to their adjudged degree of ‘riskiness’, are created exhibiting qualitatively different relations with the state. In Australia’s case, these processes play out along a hierarchy of scale. The most widespread and important was the Howard Government’s overturing the long-standing model of social protection. Reflecting an historic compromise between labour and capital, the Australian version of the welfare state robustly upheld citizenship rights - primarily articulated as industrial rights (Wearing, 1994). In the interests of protecting the viability of a recently industrialized economy, Australia developed a comprehensive system of tariff protection and a legislatively founded and protected centralized wage fixing system. The latter became the primary mode of redistribution and social protection (Castles, 1983), complemented by employer-funded sickness and other entitlements (Smyth, 1994). Australian (male) wages were kept artificially high, a system which both encouraged and allowed families to meet their own needs. Other health, education and social services developed incrementally, largely in response to political mobilization of interest groups (Watts, 1987). As the 20th century progressed, highly targeted and selective income support funded through general Federal tax revenue was established for people falling outside of the labour market. Health services, education, and welfare were funded primarily by the Federal government delivered through a complex mixed economy of welfare (Lyons, 2001). During the early 1970s, this approach was abruptly overhauled, and a period of extensive, even eccentric, welfare state building began (McDonald and Marston, 2002a). Over a heady three year period (1972-1975) the Australian government created, for example, a universal health insurance system, free tertiary education, a publicly funded legal aid system, an extensive community health program, an ambitious urban regeneration program, and an expansive regional employment program (Johnson, 1989). Substantial

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efforts were made to overhaul the income security system, decreasing its selectivity and opening it up to previously excluded groups such as single mothers. Unfortunately, the brief expansionary period coincided with global economic processes which fundamentally re-wrote that historic compromise and firmly squashed any nascent flirtation with social democratic ideals (Jamrozik, 2001). Accordingly, during the last two decades of the 20th century, the brief 1970s social democratic turn in the Australian welfare state was slowly and steadily overturned. The central plank of the Australian system, centralized wage fixing, was steadily dismantled rendering the wage earners’ welfare state an historical artefact. Further, the removal of the tariff walls opened up the Australian economy to that complex of global economic forces which, as happened in other industrialized nations reconfigured industry and the domestic labour market. In doing so, workers and their families were exposed to the risk of economic downturn in ways previously unimaginable. In addition macroeconomic policy prioritized the reduction of inflation over employment generation. As a consequence, unemployment and underemployment grew rapidly and the traditional reliance on full-time life-long employment upon which the original welfare model was predicated became redundant (McDonald and Marston, 2005). Further, irrespective of political orientation, sustained Federal government fixation with reducing budget deficits heralded an unrelenting fiscal squeeze and associated widespread cuts in funding for services. At the same time, Australian governments became increasingly disengaged from direct service delivery and more and more services were devolved to the other sectors, including the informal sector (McDonald and Marston, 2002b). In keeping with OECD recommendations, Australian income security policy began to undo any pretence of social citizenship rights, and fractured the dependent population back into the categories of deserving and undeserving poor (Ziguras et al, 2003). Services in the new regime are largely delivered by the nonprofit and market sectors under the aegis of the Federal and State governments. One key example of this has been the erosion and residualisation of public health insurance coupled with the use of an active instrument to encourage people to switch to private health insurance. Another example is the steady decline of public funds for (nonprofit) childcare coupled with shifts in the mechanisms for subsidising child care costs. This in turn has lead to an explosion of for profit entrants into that market accompanied by escalating costs to families. Public dental health services have all but disappeared, leaving people reliant on an expensive private system of providers. This, in turn, has lead to an oral care crisis, particularly among the poor. Private education and privatised ‘public’ transport;

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private rehabilitation and private nursing homes; private hospitals and private employment services: the list goes on and on. In total, the market has become fixed as the key mechanism for managing lives and the vestiges of a riskprotecting state carrying part of the burden of living has slipped below the radar of most Australians. As the previous section suggests, Australian governments are now more concerned with protecting themselves from fiscal and political risk than with managing the risks of citizens. And as the section before that illustrated, governments are using risk as moral panic to deflect the (potentially critical) gaze of the public away from themselves. The once famous wage earners’ welfare state supported by a state funded and facilitated mixed economy of welfare has morphed into a fragmented service delivery system driven predominantly by market principles. Those once highly regarded principles of welfare – social justice, responsiveness, equity – have become quaint notions more reflective of an earlier, more innocent age. In the process, the welfare of Australians has been eroded. Finally, there is a thought which teases at the edge of consciousness – perhaps the Australian risk epidemic is really a pandemic.

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Marr, D. and S. Peatling 2007, ‘Entering dangerous territory: Everyone is tarred with the same brush under John Howard’s Emergency Response legislation’, Sydney Morning Herald, 11 August 2007. Marr, D. and Wilkinson, M. 2003, Dark Victory, Allen and Unwin, Sydney. McCartney, C. 2000, ‘Corrections in Australia: Is the future private?’ in Chappell, D. and Wilson, P. Crime and the Criminal Justice System in Australia: 2000 and Beyond. Butterworths, Sydney, 357-370. McDonald, C. and Marston, G. 2005, ‘Workfare as Welfare: Governing Unemployment in the Advanced Liberal State’ Critical Social Policy.25 (3): 374-401 McDonald, C. and Marston, G. 2002a. Fixing the niche: Rhetorics of the community sector in the neo-liberal welfare regime, Just Policy, No. 26, September. McDonald, C. and Marston, G. 2002b. Patterns of governance: The curious case of non-profit community services in Australia, Social Policy and Administration, 36: 376-391. Meyer, M.W. and Zucker, L. 1989, Permanently Failing Organizations, Sage, Newbury Park. Mitchell, W.F. 2000, ‘The Causes of Unemployment’, in The Unemployment Crisis in Australia: Which way out? S. Bell (Ed.), Cambridge University Press, Melbourne: 49-87. Mitchell, W.F. and Watts, M.J. 1997, ‘The Path to Full Employment’, Australian Economic Review, V. 30: 436-444. Northern Territory Board of Inquiry into the protection of Aboriginal Children from Sexual Abuse, 2007, Little Children Are Sacred, Northern Territory Government, Darwin. Office for Children, 2005, protecting Children: The Next Steps, Department of human Services, Melbourne. Organisation for Economic Cooperation and Development, 2000. Innovations in Labour Market Policies: The Australian Way. OECD, Paris. Pearson, N. 2007, ‘Politics aside, an end to the tears is our priority', The Australian, 23 June 2007. Rose, N. 1999, Governing the Soul: The shaping of the private self. 2nd Edition. London, Free Association Books. Roxon, N. 2007, ‘Obesity a National Health Priority Area under a Rudd Labor Government’. Media Statement. 20 November. < http://www.alp.org.au/ media/1107/mshea201.php>, Accessed 15 July, 2008.

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Sands, V. 2004, ‘Victoria’s Partly-Privatised Prison System: An Accountability Report Card’, The Asia-Pacific Journal of Public Accountability, Vol. 26, 2: 135-154. Schwartz, H.M. 1994, ‘Public Choice Theory and Public Choice: Bureaucrats and State Reorganisation in Australia, Denmark, New Zealand and Sweden in the late 1980s’, Administration and Society, 26 (1): 48-77. Seibel, W. 1996, ‘Succesful Failure: An Alternative View on Organisational Coping’, American Behavioural Scientist, Vol. 39 (8): 1011-1034. Siebel, W. 1989, The Function of Mellow Weakness: Nonprofit Organizations as Problem Nonsolvers in Germany, in: Estelle James (ed.), The Nonprofit Sector in International Perspective. Studies in Comparative Culture and Policy, New York/London: Oxford University Press: 178-192. Smyth, P. 1994) Australian social policy: The Keynesian chapter, Kensington, University of New South Wales Press. Stark, J. 2006, ‘Revealed: How alcopops lure the young’, Sydney Morning Herald, August 6. Accessed July 15, 2008. Van Gringen, J. 1995, ‘Competition in the Provision of Government Justice Services’, Paper delivered to the Competitive Government and the public Sector Conference’, RIPAA Annual State Conference, 2 August. Watts, R. 1987, Foundations of the National Welfare State, Sydney, Allen and Unwin. Wearing, M. 1994, Disclaiming citizenship? Social rights, social justice and welfare in the 1990s, in M. Wearing and R. Berreen (eds.), Welfare and social policy in Australia: The distribution of advantage (pp. 177-198), Sydney, Harcourt Brace. Ziguras, S., Dufty, G. and Considine, M. 2003. Much obliged: Disadvantaged job seekers’ experience of the mutual obligation regime, Melbourne, Brotherhood of St Lawrence, St Vincent de Paul Society and the Centre for Public Policy, University of Melbourne.

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Chapter 7

MEDICINE AND RISK John M. Chamberlain University of Chester, Chester CH1 4BJ, UK

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INTRODUCTION The analysis of medicine and risk is indelibly linked to a core disciplinary concern within sociology with the nature of ‘good governance’ and ‘good citizenship’ (Rose 1999). This chapter discusses recent developments in medical governance in relation to two key ‘schools of thought’ concerned with the analysis of risk in today’s society – respectively, the ‘risk society’ and the ‘governmentality’ perspectives (Lupton 1999). In doing so my aim is not to offer a definitive critical analysis of these viewpoints concerning medical risk. To do so would take up considerably more space than is available. Rather, I seek to achieve two inter-related goals by highlighting points of agreement between the risk society and governmentality perspectives. First, I aim to reinforce the importance of paying close attention to the type of subject-citizen promoted by ‘liberal mentalities of rule’ as they seek to minimise risks threatening the wealth, health, happiness and security of the population (Rose and Millar 1992). Second, I aim to establish areas for further empirical investigation in relation to medical governance. For in spite of repeated calls for investigation into doctors training and regulatory arrangements (i.e. Elston 1991 2004) little empirical research has been published on this topic (Chamberlain 2008). Sociologists who concerned themselves with the analysis of expertise at the beginning of the twentieth century by and large possessed an uncritical acceptance

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of professional practitioner’s altruistic claim to place the needs of their clients above their own material self-interest (McDonald 1995). In doing so they reflected the social mores of the time, which dictated that the good patient play a subservient role during doctor-patient encounters, in much the same way that the good citizen knew their place within the established oligarchic governing order (Moran 2004). But times have changed. Over the last four decades sociologists have become more critical of professional practitioners altruistic claims (Friedson 2001). An ever-growing series of high profile malpractice cases - such as the general practitioner Harold Shipman who murdered over 215 of his patients - have reinforced to sociologists the need to advocate the adoption of more open, transparent and publicly accountable governing regimes (Davies 2004). Furthermore, the public now expects to play a significant role in treatment decision-making and planning, just as they expect to have their voices heard and opinions listened to by their democratically elected political leaders (Lupton 1999). They refuse to accept the legitimacy of the traditional elitist and paternalistic view of professional and state forms of governance, which dominated western societies until relatively recently (Moran 2004). As the following discussion of the rise of the risk society will highlight, underlying recent reforms in medical governance is a more fundamental shift in the conditions under which good governance and good citizenship can be practiced as a result of the economic and political re-emergence of liberalism (Rose and Miller 1992).

THE POLITICAL RE-EMERGENCE OF LIBERALISM ‘I think we’ve been through a period where too many people have been given to understand that if they have a problem, it’s the government’s job to cope with it. “I have a problem. I’ll get a grant”. “I’m homeless, the government must house me”. They’re casting their problem on society. And, you know, there is no such thing as society. There are individual men and women, and there are families. And no government can do anything except through people, and people must look to themselves first. It is our duty to look after ourselves, and then to look after our neighbour.’ Thatcher (1987: 10)

The 1970s saw the renewal of liberalism as an economic and political ideology, with its emphasis on enterprise and individualism, advocacy of ‘rolling back the state’, and belief in the ability of the discipline of the market to promote consumer choice, improve service quality and minimise risk (Elston 1991). The

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neo-liberalism of Margaret Thatcher’s conservative government of 1979 possessed an overriding concern for the ‘3 Es’ - economy, efficiency and effectiveness – and had its ideological roots in classical liberalism (Rhodes 1994). This emerged in the seventeenth and eighteenth centuries, through the works of a variety of writers, such as Thomas Hobbes, John Stuart Mills, Adam Smith, Thomas Locke, Jeremy Bentham and Herbert Spencer. The concept of ‘possessive individualism’ lies at the heart of classical liberalism (Macpherson 1962). Macpherson (1962) argues that for these thinkers the individual and her capabilities ‘pre-figure’ the circumstance into which she is born. In short, her talents and who she is owes nothing to society, rather she owns herself, and she is morally and legally responsible for herself and herself alone. She is naturally selfreliant and free from dependence on others. She need only enter into relationships with others because they help her pursue her self-interests. According to this viewpoint, society is seen as a series of market-based relations made between selfinterested subjects who are actively pursuing their own interests. Only by recognising and supporting this position politically and economically will the greatest happiness for the greatest number be achieved. Classical liberalism is a critique of state reason which seeks to set limits on state power (Peters 2001). A very real problem here is that frequently individual members of society do not start their lives equally. This fact led social reformers in the nineteenth and twentieth century’s to advocate changes in working conditions, poor relief and public health. A huge literature was produced by social activists of the time, such as Henry Mayhem, linking inequality and poverty to disease and death (White 2001). Furthermore, contra the ethos of liberalism, John Maynard Keynes argued for a strong interventionist role for the state in regulating the market, protecting working and living conditions, as well as promoting public health. Adopting Keynesian economics to control the tendency of capitalism to operate in ‘boom and bust’ cycles formed an important part of the foundation of the post-second world war welfare state in the United Kingdom (Green 1987). However, large fluctuations in oil prices and economic recessions occurred in most western economies in the 1970s. This led to the labour government of 1976 devaluing the pound and seeking the support of the International Monetary Fund (IMF) (Graham and Clark 1986). The IMF provided credit and loan arrangements that in turn led to a political recognition of the need to introduce competitive practices into the workings of the welfare state. This eventually led to the privatisation of previously publicly owned industries such as electricity, rail and water (Cutler and Waine 1994). Concurrently, the ideas of a number of prominent ‘liberalist’ social commentators such as Friedrich Hayek (1973) and Milton Friedman (1962) - who both advocated a liberal market-based system instead of state-dominated welfare

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provision - became increasingly influential within the political arena. Particularly after the collapse of the Soviet Union. This led to Fukuyama (1992) arguing that the ‘end of history’ had occurred, and the only contender for legitimate government was now liberal democracy. Integral to which was the economic necessity of free-market capitalism.

THE RISE OF THE RISK SOCIETY

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‘Each person’s biography is removed from given determinations and placed in his or her own hands.’ Beck (1992: 135)

Whether they agreed with Fukuyama or not, these changes reinforced to sociologists that tied up with the political re-emergence of the ‘enterprise culture’ of liberalism was a renewed focus on the individual, particularly the idea that the individual alone possesses ultimate responsibility for herself, as the apparent gradual withdrawal of the state from welfare provision forces her ‘to make the transition from dependent, passive welfare consumer to an “enterprise self”’ (Burchell 1996: 85). For the idea that an individual’s life is her own enterprise may mean she has to submit herself to an endless process of self-examination, self-care and self-improvement. But it also means that she is now ‘free from the social forms of industrial society – class, stratification, family [and] gender status’ (Beck 1992: 87). Her life is no longer mapped out for her. Who she is, and who she could possibly be, is no longer defined by her locality, her occupation, her gender, or even her religious affiliation. This does not mean that inequalities no longer exist. Only that they can no longer so easily attributed to the traditional sociological categories of class, race, age or gender (Beck 1992). So her identity is fluid and negotiable, detached from traditional social structures and cultural mores, she is able to reflexively construct her life biography as she sees fit. She is in a very real sense the creative artist of her life. For risk theorists such as Beck (1992) and Giddens (1990 1991) a key defining feature of modern society – or ‘late’ or ‘high modernity’ as they call it is that there has been ‘a social impetus towards individualisation of unprecedented scale and dynamism…[which]…forces people – for the sake of their survival - to make themselves the centre of their own life plans and conduct’ (Beck and Beck-Gernsheim 2002: 31). In Risk Society (1992) Beck argues that as capitalist-industrial society gives way under the tripartite forces of technology, consumerism and globalisation, there is a ‘categorical shift’ in the nature of social

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structures, and more importantly, the relationship between the individual and society. Furthermore, as working conditions change, and the technology and communication revolutions continue at pace, more than ever before individuals are required to make life-changing decisions concerning education, work, selfidentify and personal relationships, in a world where traditional beliefs about social class, gender and the family are being overturned (Lupton 1999). This state of affairs leads to a concern with risk management entering centre stage within society’s institutional governing apparatus, as well as individual subject-citizen’s personal decision-making process (Mythen 2004). Risk theorists argue that throughout human history society’s have always sought to ‘risk manage’ threats, hazards and dangers. But these management activities have been concerned with natural risks, such as infectious diseases and famine. However, in today’s technologically advanced society, individuals are seen to be both the producers and minimisers of risk (Giddens 1990). That is, within the conditions of high modernity, risks are by and large seen to be solely the result of human activity (Mythen 2004). Even events previously held to be natural disasters, such as floods and famine, are now held to be avoidable consequences of human activities that must be ‘risk managed’ (Lupton 1999). Hence society’s institutions and expert bodies need to become ever more collectively self-aware of their role in the creation and management of risk (Beck and Beck-Gernsheim 2002). While for the individual uncertainties now litter their pathway through life to such an extent that it appears to be loaded with real and potential risks. So they must seek out and engage with on a seemingly evergrowing number of information resources, provided by a myriad of sources, as they navigate through their world. In the risk society ‘[we] find more and more guidebooks and practical manuals to do with health, diet, appearance, exercise, lovemaking and many other things’ (Giddens 1991: 218). A key defining feature of the risk society is the demystification of science and technology, as well as a growing uncertainty about truth and claims to truth (Mythen 2004). Advances in communication technology - such as the mobile phone, the internet and the twenty-four hour news channel - have not just made individuals constantly aware of the risks associated with modern living, they also reinforce the limitations of technical and expert knowledge to cope with and even solve them (Lupton 1999). So much so that ‘attitudes of trust, as well as more pragmatic acceptance, scepticism, rejection and withdrawal, uneasily co-exist in the social space linking individual activities and expert systems. Lay attitudes towards science, technology and other esoteric forms of expertise, in the age of high modernity, express the same mixture of attitudes of reverence and reserve, approval and disquiet, enthusiasm and antipathy, which philosophers and social

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analysts (themselves experts of a sort) express in their writings’ (Giddens 1991: 7). Within the risk society, a sense of growing (perhaps even mutual) distrust characterises the relationship between the public and experts (Giddens 1999). At the same time, a pervasive and seemingly increasingly necessary reliance on an ever-growing number of experts appears to be a key feature of the individuals’ personal experience of everyday life (Mythen 2004). Consequently, expert authority can no longer simply stand on the traditional basis of position and status. Not least of all because an individuals’ growing need to manage risk and problem solve their everyday life, to make choices about who they are and what they should do, means that personal access to the technical and expert knowledge of the elite is now regarded as an inherent right. No longer the sole preserve of those elite few who have undergone specialist training. As Giddens (1991: 144-146) notes: ‘technical knowledge is continually re-appropriated by lay agents…Modern life is a complex affair and there are many ‘filter back’ processes whereby technical knowledge, in one shape or another, is reappropriated by lay persons and routinely applied in the course of their day-today activities…Processes of re-appropriation relate to all aspects of social life – for example, medical treatments, child rearing or sexual pleasure’. Risk society theorists frequently observe that modern individuals increasingly find themselves having to make ‘risk laden’ choices ‘amid a profusion of reflexive resources: therapy and self-help manuals of all kinds, television programmes and magazine articles’ (Giddens 1992: 20). In doing so, they echo the views of authors operating from a governmentality perspective (Lupton 1999). For both focus upon how in today’s society individual acts of self-surveillance and selfregulation are not only central to the formation of a persons sense of personal identity, but also the management of risk at the individual and group levels, and therefore can be said to be a key mode by which the population is governed ‘at a distance’ without recourse to direct or oppressive intervention (Rose and Miller 1992).

GOVERNMENTALITY AND ‘NEO-LIBERAL MENTALITIES OF RULE’ ‘Modern selves have become attached to the project of freedom, have come to live in terms of [that] identity, and to search for means to enhance that autonomy.’ Rose (1990: 250)

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A key point of difference between the governmentality and risk society perspectives lies in their conception of the individual-subject. For it is arguable that in spite of noting that an individual’s sense of self is now arguably more than ever before a product of her own making, risk society authors nevertheless seem to often stay wielded to the idea of the subject as an autonomous actor possessing a coherent core self (Elliott 2001). Consequently, they often adopt a ‘positivist ego psychology, which is hostile to any notion that the self is complexly structured and differentiated’ (Peterson 1997: 190). Indeed, on occasion Giddens in particular seems to accept that the concept of the sovereign individual self lies at the heart of society to such a degree that he could be accused of being an uncritical apologist for liberalism’s ‘possessive individualism’, and concurrent advocacy of a selfreliant ‘enterprise culture’, with its focus upon encouraging ‘autonomous, productive, individuals’ (du Guy 1996a: 186). In contrast, following Foucault, governmentality theorists firmly historicise their conception of the individual by discursively locating it within the history of Western thought through critiquing the post-enlightenment conception of the rationally autonomous subject (Peters 2001). They advocate an alternative viewpoint whereby individual subjectivities are neither fixed nor stable, but rather are constituted in and through a spiral of power-knowledge discourses - generated by political objectives, institutional regimes and expert disciplines - whose primary aim is to produce governable individuals (Deleuze 1988). Aside from this noticeable difference, the risk society and governmentality perspectives share much in common. Both argue that there has been a profound shift in ‘the nature of the present’ (Rose 1992: 161) and the way ‘[we] come to recognise ourselves and act upon ourselves as certain kinds of subject’ (Rose 1992: 16). Due in no small part to the re-emergence of liberalism and the growing ascendancy of the concept of the enterprise self throughout all spheres of modern social life (Gordon 1996). For example, Burchell (1996) argues that neoliberalisms dual advocacy of the self-regulating free individual and the free market has led to ‘the generalisation of an “enterprise form” to all forms of conduct’ (Burchell 1996: 28). Similarly, du Guy (1996a 1996b) argues that enterprise - with its focus upon energy, drive, initiative, self-reliance and personal responsibility - has assumed a near-hegemonic position in the construction of individual identities and the government of organisational and everyday life. Enterprise, he concludes, has assumed ‘an ontological priority’ (du Guy, 1996a: 181). Consequently, as Burchell (1993: 275) notes: ‘one might want to say that the generalization of an “enterprise form” to all forms of conduct – to the conduct of organisations hitherto seen as being non-economic, to the conduct of government, and to the conduct of individuals themselves – constitutes the

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essential characteristic of this style of government: the promotion of an enterprise culture.’ The risk society and governmentality perspectives both focus upon the changing relationship between individuals and experts during the last four decades. The re-emergence of liberalism in the 1970’s re-activated classical liberalisms concern with the liberty of the individual, advocacy of free markets, and call for less direct government. It emphasised the entrepreneurial individual, endowed with freedom and autonomy as well as a self-reliant ability to care for herself, and furthermore, driven by the desire to optimise the worth of her own existence (Rose 1999). Governmentality theorists such as Rose (1993: 285) argue that this has led increasingly to the relocation of the authority of expertise from the political into the economic sphere where it is increasingly ‘governed by the rationalities of competition, accountability and consumer demand’. Rose argues that during the nineteenth and twentieth centuries the increasingly rational, experimental and scientific basis of modern forms of expertise led to them becoming integral to the exercise of political authority. So much so that experts gained ‘the capacity to generate ’enclosures’, relatively bounded locales or fields of judgement within which their authority [was] concentrated, intensified and rendered difficult to countermand’ (Rose 1996: 50). However, as a result of the rise of the enterprise self, the enclosures are now being ‘penetrated by a range of new techniques for exercising critical scrutiny over authority – budget disciplines, accountancy and audit being the three most salient’ (Rose 1996: 54). Power (1997) and Rose (1999) emphasise the enormous impact of the trend in all spheres of contemporary social life towards audit in all its guises - with its economic concern with transparent accountability and standardisation particularly for judging the activities of experts. This is because two technologies are central to the promotion of the enterprise self at the organisational and individual levels. A ‘technology of agency’, which seeks to promote the agency, liberty and choices of the individual as they strive for personal fulfilment, and a ‘technology of performance’, which seeks to minimise risk by setting norms, standards, benchmarks, performance indicators, quality controls and best practice standards, in order to survey, measure and render calculable the performance of individuals and organisational structures (Dean 1999). As Dean (1999:173) notes: ‘from the perspective of advanced liberal regimes of government, we witness the utilisation of two distinct, yet entwined technologies: technologies of agency, which seek to enhance and improve our capabilities for participation, agreement and action, and technologies of performance, in which these capabilities are made calculable and comparable so that they might be optimised. If the former allow the transmission of flows of information from the bottom, and the formation

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of more or less durable identities, agencies and wills, the later make possible the indirect regulation and surveillance of these entities. These two technologies are part of a strategy in which our moral and political conduct is put into play within systems of governmental purposes.’ Bound up with the technologies of agency and performance of the enterprise culture, is what can be called a progressive and insipid process of ‘contractualization’ (Burchell 1993). Here, in a concerted effort to manage risk, institutional roles and social relations between individuals are increasingly defined in terms of explicit contract, or at the every least, ‘in a contract like way’ (du Guy 1996a). For the promotion of the enterprise form involves the creation of processes where subjects and their activities are ‘reconceptualised along economic lines’ (Rose 1999: 141). Gordon (1991: 43) argues that entrepreneurial forms of governance rely on contractualization as they seek ‘the progressive enlargement of the territory of economic theory by a series of redefinitions of its object’. That is, entrepreneurial forms of governance ‘re-imagine’ the social sphere as a form of economic activity by contractually a) reducing individual and institutional relationships, functions and activities to distinct units b) assigning clear standards and lines of accountability for the efficient performance of these units, and c) demanding individual actors assume active responsibility for meeting performance goals, primarily by using tools such as audit, performance appraisal and performance-related pay (du Guy 1996a). Here judgement and calculation are increasingly undertaken in economic cost-benefit terms, which gives rise to what Lyotard (1984: 46) terms ‘the performativity principle’. Whereby the performances of individual subjects and organisations serve as measures of productivity or output, or displays of ‘quality’ and the ability to successfully minimise risk, so ‘an equation between wealth, efficacy and truth is thus established’ (Lyotard 1984: 46).

REFORMING MEDICAL GOVERNANCE ‘[Technologies of Performance]…subsume the substantive domains of expertise (of the doctor, the nurse, the social worker, the school principal, the professor) to new formal calculative regimes.’ Dean (1999: 169)

Osborne (1993) discusses how since the re-emergence of liberalism there has been a gradual reformulation of health care policy and practice, so that ‘the field of medicine’ is, to a greater degree than ever before, simultaneously both

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governed and self-governing. A key part of this process is the subjection of the activities of medical practitioners to an additional layer of management and new formal ‘calculative regimes’ (Rose and Miller 1992). Such as performance indicators, competency frameworks and indicative budget targets (Rose 1993). This process began with the 1979 conservative administration, which possessed a firm neo-liberal commitment to ‘rolling back the state’ and introducing free market philosophies within the public and private spheres (Dean 1999). Thatcherism emphasised the entrepreneurial individual, endowed with freedom and autonomy, and a self-reliant ability to care for herself, and driven by the desire to optimise the worth of her own existence (Rose 1993). For example, the conservative home secretary Douglas Hurd stated in 1989 that ‘the idea of active citizenship is a necessary complement to that of the enterprise culture’ (quoted in Barnett 1991: 9). A new form of citizenship was being promoted by the changing conditions caused by the re-emergence of liberalism and having a direct affect upon medical governance. Indeed, reviewing NHS reform during the mid-1990s, Johnson (1994: 149) noted that ‘government-initiated change has, in recent reforms, been securely linked with the political commitment to the “sovereign consumer”. In the case of reform in the National Health Service, this translates…[to a] stress on prevention, the obligation to care for the self by adopting a healthy lifestyle, the commitment – shared with the new GP – to community care’. This state of affairs did not end with the election of ‘new labour’ in 1997 (Dean 1999). Although generally critical of many of their conservative predecessors’ health policies, under the guise of treating ‘patients as equal partners in the decision-making process’ (Department of Health, 2000: 2), new labour introduced a comprehensive, management-led system of clinical governance into the NHS, designed to set and monitor standards governing health care delivery (Department of Health 1998). Clinical governance is officially defined as ‘a framework through which the NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish’ (Department of Health 1998: 33). Clinical standards are set nationally by the National Institute for Clinical Excellence (NICE), which was established in 1999. This body makes recommendations on the cost effectiveness of specific treatments and disseminates clinical standards and guidelines, based upon evidence-based research, for compulsory use by doctors. It also plays a role in developing what are called National Service Frameworks (NSFs) which look at the pathways between primary (i.e. community based) to secondary (i.e. hospital based) care followed by certain patient types (i.e. those suffering from heart disease, diabetes

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or mental health issues) to identify activity levels and productivity figures and improve service resource allocation. The local implementation of the NSF guidelines and NICE clinical standards are monitored by what was first called the Commission for Health Improvement (also established in 1999) which has more recently been renamed the Commission for Healthcare Audit and Inspection (CHAI). CHAI is empowered to visit hospital and primary care trusts and ensure they are following good clinical governance guidelines. It awards star ratings, similar to those given to hotels, and likewise scores them based on their performance against set criteria, for example, length of time patients spend on a waiting list. CHAI is supported in its activities by the National Patient Safety Agency (NPSA), which was established in 2002 and focuses on promoting good health care practice. Given new labour’s reforms, it is unsurprising that in his review of NHS reform Light (1998: 431-2) stated that: ‘the national framework for performance management is extensive. The White Papers propose establishment of evidencebased patterns and levels of service, clinical guidelines, and clinical performance review, in order to ensure patients of high uniform quality throughout the service’. Furthermore, Slater (2001: 874) believes that NHS reforms in general, and clinical governance in particular, have established ‘a rationalistic bureaucratic discourse of regulation which reveals itself through increasingly extensive rule systems, the scientific measurement of objective standards, and the minimisation of the scope of human error. Behind it lies a faith in the efficacy of surveillance as a directive force in human affairs’. This new rationalisticbureaucratic discourse, with its focus on the surveillance and management of risk through standard setting and transparent performance monitoring, has presented a significant challenge to the authority of medical elites, such as the royal colleges and medical schools, who have traditionally been left alone to oversee the arrangements surrounding medical training and discipline (Stacey 2000). To ensure their continued ‘fitness for purpose’ medical elites have had to adapt and adopt more open, transparent and inclusive governing regimes, which furthermore rely upon a risk focused best-evidenced approach to medical governance (LloydBostock and Hutter 2008). This has required medicine’s training programmes, disciplinary mechanisms and regulatory inspection regimes possess clear standards that can be operationalised into performance outcomes against which the ‘fitness to practice’ of members of the profession can be regularly checked in a transparent and accountable manner (Irvine 2003 2006). Medical elites have had to accept that the risk management of the activities of doctors will no longer is solely undertaken ‘in house’ by them alone (Stacey 2000). More than ever before, there is inter-professional co-operation and

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managerial and lay involvement in the regulation of medical expertise (Davies 2004). A fact reinforced when the Health and Social Care White Paper was recently announced (The Secretary of State for Health 2007). This proposed a key reform concerning arrangements for ensuring every doctor is ‘risk managed’ to ensure they are ‘fit to practice’ – revalidation. Revalidation consists of two elements - relicensing and specialist recertification (Donaldson 2006). Relicensing embeds medical regulation with the government’s clinical governance agenda. Doctors currently have to undergo an annual check of their performance, known as annual appraisal, as part of their NHS employment contract. But as it currently operates it would not have prevented Shipman from killing his patients (Smith 2005). Under the new proposals appraisal will still occur annually, but it will now be significantly strengthened, with greater managerial and lay involvement in the direct testing of a doctor’s competence in regards to key day to day tasks. All doctors will now have to successfully pass the relicensing requirement that they have successfully complete five annual appraisals in order to stay on the medical register (The Secretary of State for Health 2007). Specialist recertification is new and like recertification will occur every five years. It will involve a thorough ‘hands on’ assessment of a doctor, by the relevant royal college, of their ‘fitness to practice’ in their chosen medical specialty (Donaldson 2008). It is expected that a mixture of clinical audit, direct observation, simulated tests, knowledge tests, patient feedback and continuing professional development activates, will together ensure specialist recertification (Chamberlain 2008). Both relicensing and specialists recertification elements of the revalidation process will be piloted over the next two years with a view of formally introducing them nationally from 2010 onwards (Donaldson 2008).

LIBERAL MENTALITIES OF RULE AND ‘POSITIVE’ AND ‘NEGATIVE’ LIBERTY ‘[Under liberal mentalities of rule] a person’s relation to all his or her activities, and indeed his or her self, is…given the ethos and structure of the enterprise form.’ Rose (1999: 138)

Policy developments such as revalidation reinforce the need to undertake a dedicated research programme into medical governance. It is widely acknowledged that such a programme is needed as their currently is a lack of published research on the topic (Gray and Harrison 2004). Yet sociologists need

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to keep in mind that current changes in medical governance take place against the background of a broader societal shift in the grounds under which the legitimate governance of the population can be practiced (Rose 1999). Governmentality theorists remind us that changes in how expertise operates are directed towards the object of good governance - the population in general and the individual subject-citizen in particular – as much as they are experts themselves (Rose 1999). For changes in how good citizenship is practiced are bound up with shifts in the conditions under good governance operates. In terms of Berlin’s (1969) famous dichotomy of ‘positive’ and ‘negative’ liberty, although liberal mentalities of rule may appear at first to promote ‘negative liberty’ (i.e. the personal freedom of the individual-subject to decide who they are and discover what they want to be), in reality they promote ‘positive liberty’ (i.e. that is a view of who and what a citizen-subject is and should be). It certainly can be argued that a key facet of advanced liberal society is its central concern with disciplining the population without recourse to direct or oppressive intervention. Yet liberal mentalities of rule seek to promote good citizenship by discursively constructing and promoting subjective positions for subject-citizens to occupy in relation to the form of the enterprise self. Typically, this is associated with a ‘bundle of characteristics’ such as energy, resilience, initiative, ambition, calculation, self-sufficiency and personal responsibility (Rose 1996). For the world of enterprise valorises the autonomous, productive, self-regulating individual, who is following their own path to self-realisation, and so it requires all society’s citizens ‘come to identify themselves and conceive of their interests in terms of these…words and images’ (du Guy 1996a: 53). As was touched upon earlier, the concept of the self as enterprise requires that the possession of an essential core self is taken as the central feature of personal identity (Rose 1990 1993 1996 1999). How else could individuals be expected to become responsible for themselves and the care of their bodies and not be a burden on the state? The very notion of the enterprise self requires a political commitment to the idea that all individuals are capable of self-fulfilment. This is the core mechanism by which the self-regulatory capabilities of the individual can be enhanced and entwined with the key objectives of governance - the security, health, wealth and happiness of the general population (Barry, Osborne and Rose 1996). Consequently, failure to achieve the goal of self-fulfilment is not associated with the possession of a false idea of what it means to be human, or that individuals do not possess an essential core self which is the ‘real’ and ‘true’ them for all eternity. Rather, it is the fault of poor choices, a lack of education or the ‘dependency culture’ created by the welfare state (Dean 1999). It is the result of ‘learned helplessness’, which in itself can be resolved with ‘programmes of

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empowerment to enable [the individual] to assume their rightful place as selfactualizing and demanding subjects of an “advanced” liberal democracy’ (Rose 1996: 60). The sociological analysis of medicine and risk needs to focus upon this point as it considers the type of citizen and forms of subjectivity promoted and sustained by the governing regimes of the risk society (Peterson and Bunton 1997). For it is arguable that under the guise of advocating personal freedom and minimal forms of government as the ‘natural way of things’, liberal mentalities of rule run the risk of promoting a highly limiting view of what it is to be a human being, let alone a good citizen, within today’s increasingly complex social world.

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REFERENCES Barnett, M. (1991) The Politics of Truth Cambridge Polity Barry, A, Osborne, T and Rose, N. (1996) Foucault and Political Reason University College London Press Beck, U. (1992) Risk Society: Towards a New Modernity London Sage Beck, U. and Beck-Gernsheim, E. (2002) Individualization: Institutionalised Individualism and its Social and Political Consequences Sage Publications Berlin, I. (1969) Two Concepts of Liberty, in I. Berlin (2002) Four Essays on Liberty Oxford University Press Burchell, G, Gordon, C and Miller, P. (1991, editors) The Foucault Effect: Studies in Governmentality Harvester Wheatsheaf Burchell, G. (1993) Liberal Government and Techniques of the Self Economy and Society 22 (3): 267-282 Burchell, G. (1996) Liberal Government and Techniques of the Self, in Barry, A, Osborne, T and Rose, N. (1996) Foucault and Political Reason University College London Press Chamberlain, J.M. (2008) Governing Medicine – A Study of Doctors Educational Practices Unpublished PhD Thesis, The University of Liverpool 2008 Cutler, A and Waine B. (1994) Managing the Welfare State Oxford: Berg Davies, C. (2004) Regulating the Health Care Workforce: Next Steps for Research Journal of Health Services Research and Policy 9 (Supplement 1): 55 - 61 Dean, M. (1999) Governmentality: Power and Rule in Modern Society Sage Publications Deleuze, G. (1988) Foucault University of Minnesota Press Department of Health (1998) A First Class Service: Quality in the New NHS DOH London

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Department of Health (2000) The NHS Plan DOH London Donaldson, L. (2006) Good Doctors, Safer Patients London: Department of Health Donaldson, L. (2008) Revalidation the next steps London: Department of Health du Guy, P. (1996a) Organising Identity: Entrepreneurial Governance and Public Management, in Hall, S and du Guy, P (1996, editors) Questions of Cultural Identity Sage Publications du Guy, P. (1996b) Consumption and Identity at Work Sage Publications Elliott (2001) Concepts of the Self Cambridge Polity Press Elston, M.A. (1991) The Politics of Professional Power: Medicine in a Changing Medical Service, in Gabe, J, Calman, M and Bury, M (1991, editors) The Sociology of the Health Service Routledge Elston, M.A. (2004) Medical Autonomy and Medical Dominance, in Gabe, J, Bury, M and Elston, M.A. (2004) Key Concepts in Medical Sociology Sage Publications Friedman, M. (1962) Capitalism and Freedom University of Chicago Press Friedson, E. (2001) Professionalism: The Third Logic Cambridge Polity Press Fukuyama, F. (1992) The End of History and the Last Man Penguin Giddens, A. (1990) The Consequences of Modernity Cambridge Polity Giddens, A. (1991) Modernity and Self-Identity: Self and Society in Late Modernity Cambridge Polity Giddens, A. (1999) “Risk and Responsibility” Modern Law Review 62(1): 1-10. Gordon, C. (1991) Governmental Rationality: An Introduction, in Burchell, G, Gordon, C and Miller, P. (1991, editors) The Foucault Effect: Studies in Governmentality Harvester Wheatsheaf Gordon, C. (1996) Foucault in Britain in Barry, A, Osborne, T and Rose, N (1996) Foucault and Political Reason University College London Press Graham, D and Clark, P. (1986) The New Enlightenment The Rebirth of Liberalism Macmillan Gray, A and Harrison, S. (2004, editors) Governing Medicine: Theory and Practice Open University Press Green, D. (1987) A Missed Opportunity?, in Green, D, Neuberger, J, Young, M and Burstal, M. (1987 editors) The NHS Reforms: Whatever Happened to Consumer Choice? London Institute of Economic Affairs Hayek, F. (1973) Law, Legislation and Liberty Routledge and Kegan Paul Irvine, D. (2003) The Doctors Tale: Professionalism and the Public Trust Radcliffe Medical Press

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Irvine, D. (2006) Success Depends Upon Winning Hearts and Minds BMJ 333: 965-6 Johnson, T.J. (1994) Expertise and The State, in Gane, M and Johnson, T.J. Foucault’s New Domains Routledge Light, D.W. (1998) Managed Care in A New Key: Britain’s Strategies for the 1990s International Journal of Health Sciences (28) 3: 427-44 Lloyd-Bostock, S and Hutter, B. (2008) Reforming Regulation of the Medical Profession: The Risks of Risk Based Approaches Health, Risk and Society (10) 1: 69-83 Lupton, D. (1999) Risk Routledge Lyotard, J F. (1984) The Postmodern Condition A Report on Knowledge University of Manchester Press Macpherson A. (1962) The Political Theory of Possessive Individualism Oxford Clarendon Press McDonald, K.M. (1995) The Sociology of the Professions Sage Moran, M. (2004) Governing Doctors in the British Regulatory State, in Gray, A and Harrison, S. (2004, editors) Governing Medicine: Theory and Practice Open University Press Mythen, G. (2004) Ulrich Beck: A Critical Introduction to the Risk Society London: Pluto Osborne, T. (1993) On Liberalism, Neo-Liberalism and the Liberal Profession of Medicine Economy and Society (22) 3: 345-56 Peters, M. (2001) Poststructuralist, Marxism and Neo-Liberalism: Between Theory and Practice Rowman and Littlefield Peterson, A. (1997) Risk, Governance and the New Public Health, in Peterson, A and Bunton, R. (1997, editors) Foucault Health and Medicine Routledge Peterson, A. and Bunton, R. (1997, editors) Foucault Health and Medicine Routledge Power, M. (1997) The Audit Society Oxford University Press Rhodes, R. (1994) The Hollowing Out of the State: The Changing Nature of Public Services in Britain Political Quarterly Volume 65: 138-151 Rose, N. (1990) Governing the Soul: The Shaping of the Private Self Routledge Rose, N. (1992) Governing the Enterprise Self, in Heelas, P and Morris, P. (1992, editors) The Values of the Enterprise Culture Routledge Rose, N. (1993) Government, Authority and Expertise in Advanced Liberalism Economy and Society 22 (3): 283-299

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Rose, N. (1996) Governing Advanced Liberal Democracies in Barry, A, Osborne, T and Rose, N. (1996) Foucault and Political Reason University College London Press Rose, N. (1999) Powers of Freedom: Reframing Political Thought Cambridge University Press Rose, N. and Miller, P. (1992) Political Power Beyond the State: Problematics of Government British Journal of Sociology 43 (2): 173-205 Slater, B. (2001) Who Rules? The New Politics of Medical Regulation Social Science and Medicine (52): 871-83 Smith, J. (2005) Shipman: Final Report London: Department of Health Stacey, M. (1992) Regulating British Medicine John Wiley and Sons Stacey, M. (2000) The General Medical Council and Professional SelfRegulation, in Gladstone, D. (2000, editor) Regulating Doctors Institute for the Study of Civil Society Thatcher, M. (1987) Interview Women’s Own, October 1987: 8-10 The Secretary of State for Health (2007) Trust, Assurance and Safety – The Regulation of Health Professions in the 21st Century London: Stationary Office White, K. (2001) The Early Sociology of Health London Routledge

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PART 3: RETHINKING RISK: THE CASE OF TRUST

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Chapter 8

FROM RISK TO TRUST? RECONFIGURING CONCEPTUAL AND TRUST RELATIONS IN HEALTH AND WELFARE Jason L. Powell1 and Azrini Wahidin2 1

University of Liverpool, Liverpool L69 3BX, United Kingdom Queens University Belfast, Northern Ireland, United Kingdom

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INTRODUCTION This final chapter explores the concept of ‘trust’ in relation to the theoretical study welfare across Western society in general and the UK in particular. We ask the question if trust is the missing conceptual tool that needs to be re-appropriated within social theory and attempts to interpret social welfare? The book has covered great ground in relation to risk and relationship to social facets of welfare: the conceptualisation of risk, crime, medicine, social policy, social work and aging, Whilst these debates frame the key issues in terms of risk and welfare, we wished to conclude the book by asking if the opposite of ‘risk can be used to shed light on social relations in the realm of social welfare: ‘trust’. There are increasing attempts to conceptualize the notion of ‘trust’ in social theory as a pivotal dimension of modern society (Giddens, 1991). However, the early statement that ‘social science research on trust has produced a good deal of conceptual confusion regarding the meaning of trust and its place in social life’ (Lewis and Weigert 1985 quoted in Powell, 2005, 104) seems to be still valid

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especially as applied to social welfare. Trust is on the one hand incompatible with complete ignorance of the possibility and probability of future events, and on the other hand with emphatic belief when the anticipation of disappointment is excluded. Someone who trusts has an expectation directed to an event. The expectations are based on the ground of incomplete knowledge about the probability and incomplete control about the occurrence of the event. Trust is of relevance for action and has consequences for the trusting agent if trust is confirmed or disappointed. Thus, trust is connected with risk (Giddens, 1991). Up to now there have been few attempts to work out a systematic scheme of different forms of trust in between welfare subjects and institutions or policies that impinge on their identity performance. Trust receives a great deal of pubic exposure grounded in the assumption that the level of trust placed by the public in particular people, offices, professions, institutions or systems is critical to its continuing authority. For example, since the erosion of public trust in institutions such as, for example, the Brown government in UK with it losing 25 million people’s bank details and identity or the £25 billion financial loss of UK bank Northern Rock in late 2007 or the recently maligned ‘credit crunch’, ‘trust’ has attracted more and more attention. Yet what does it mean? There are increasing attempts to conceptualize the notion of ‘trust’ in social theory as a pivotal dimension of modernity (Giddens, 1991). Trust, either personal or impersonal (Misztal 1996), can be viewed as fundamental to inter-personal informal relationships (Brownlie and Howson 2005), to the working of organizations (Morgan 2002), and to professionals (Gilbert 2001) - all fundamentally linked to the occidental world of modernity (Delanty 2005). A deal of theorising has taken place against a backdrop of concerns over the weakening of community bonds and the challenges this holds for democratic institutions. In one conceptualization as ‘social capital’, trust can be seen as synthetic providing a form of glue or binding of individuals in communities (Phillipson, 2005) involved in a myriad of apparently independent social relationships (Giddens 1990, 1991, Putnam 1993, Fukuyama 1995, Misztal 1996, Lane 1998, Seligman 1997, Sztompka 1999, Uslaner 1999). In part, these discussions were provoked by and consequentially exposed the limitations of rational choice models and the post-emotionalism thesis as a means of explaining human behaviour (Taylor-Gooby and Zinn 2007; Dean 2007). ‘Trust’ itself is an essentially contested concept. Trust can extend to people with a sense of shared identity (Gilson 2003, Tulloch and Lupton 2003). Individuals produce trust through experience and over time. It cannot be immediately and with purpose be produced by organizations or governments without dialogical interaction with people on issues affecting their lifestyles and life-chances such as care, pensions,

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employment and political representation (Walker and Naeghele, 1999). Möllering (2001) takes the relational theme further by distinguishing between trust in contracts between individuals and the State in areas such as pension provision; trust in friendships across intergenerational lines; trust in love and relationships, and trust in foreign issues associated with national identity. There is a multiplicity of ways that trust has been defined but the central paradox is how to creation of the conditions of building conditions of trust across personal-organisationalstructural tiers in an increasingly uncertain world. Seligman’s (1997) theorising of trust identifies important conceptual issues concerning the relationship between trust, confidence, faith and familiarity. Trust is unconditional while confidence enjoys more certainty than trust. We can have confidence in systems and roles but trust only in persons. Seligman suggests trust differs from faith, as unconditionally is secular and not related to deity while familiarity is a mechanism for maintaining confidence and ontological security. Alternatively, Sztompka (1999) provides a model of a trust culture that has five conditions for trust: normative coherence; stability of social order; transparency of social organisation; familiarity of social environment and accountability of professionals and institutions. His model gives a lot to tradition in the production and maintenance of trust. In addition, he suggests that social stability is compatible with social change so long as change is gradual, regular, predictable and consistent. Discontinuous change and the fragmentation of tradition forms of authority result in a parallel disintegration of trust. Conditions all too familiar as characteristics of post-modern society (Rose 1996, 1999) leading to the conclusion implicit in Sztompka’s own discussion that this model is incapable of explaining trust in post-modern society underpinned by unpredictability. We consider the implications of theorizing trust and suggest that it provides analytical and experiential insight into the dynamics of social relationships in social welfare. We caution that in order to full embed ‘trust’ in theoretical analysis we need a ‘way forward’ (Sibeon 2004) that synthesises discussions of trust with the conditions set by governmentality analysis. We suggest that Michel Foucault’s (1978) concept of ‘governmentality’ enables the exploration of the relationship between different conceptions of trust, the mechanisms for managing populations and the production of self-managing professionals who are, in this sense, trusting. According to Foucault governmentality comprises three tiers: it is the result of transformations within the modern state; it is a tendency to institutionalize a particular form of power, and it is the “ensemble formed by institutions, procedures, analyses and reflections. . .calculations and tactics” (pp.102-3) that enable the exercise of power directed towards the regulation of a population using

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various apparatuses of expertise. Indeed, we aim to demonstrate the deployment of particular rationalities supporting trust and trust-based relationships as tactics of government. For without trust, welfare activities reliant on co-operation between families and communities with future orientated expectations have no satisfactory basis on which they might be established. By drawing out the cost and benefits of trust-based relationships, identifying the way the facework of experts maintain the legitimacy of systems and promotion social cohesion, is part of the process of constructing professional authority. Whilst it is analytically audacious to articulate trust with governmentality in the light of professional expertise in social welfare, it provides an important reference point that raises rich conceptual questions about nature and meanings of attachment related to trust. We begin the next section by attempting to highlight the levels of trust that impinges on social relationships at: individual, community, organisational and systemic levels.

NAVIGATING THE CONCEPTUAL COMPLEXITY OF TRUST

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Trust: Individuals, Organisations, Community and Systems The first key focus for theorising trust has been the interpersonal qualities of the individuals involved. Sztompka (1999) challenges theorists who consider interpersonal forms of trust as the primary form based on face-to-face encounters while subordinating all other forms of trust, collectively referred to as social trust. Rejecting any differentiation between interpersonal trust and social forms of trust, he proposes that the ever-increasing impersonal nature of relationships in systems is underpinned by our experiences of trust in face-to-face relations. This reliance on the interpersonal aspect of trust suffers from similar problems to Giddens (1990) use of ‘ontological security’, a product of early childhood experiences, as a prerequisite for individuals being able to form trusting relationships. This conservative element leaves those without positive childhood experiences stuck in a psychoanalytic mire with no potential for trusting, or by implication being trustworthy, while also failing to offer any means of recovery. A number of theorists (Davies 1999, Giddens 1991, Mechanic 1998) note the expectations lay people have of experts or professionals while at the same time this interpersonal level provides the human aspect or ‘facework’ for more impersonal forms of trust. Expectations of professionals include the following: specific competencies, specialised areas of knowledge and skills, disinterestedness and disclosure. Of particular importance are communication skills and the ability to present complex

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information. Alongside, run role expectations that demand experts act ethically and with integrity as true agents of their clients, requiring them to put personal beliefs and interests aside and acting to maximise benefit and to do no harm. Creating specialized spaces reinforced by fiduciary norms arising from: the custody and discretion over property, the opportunity and possession of expertise and the access to information; regulates the power/knowledge relationship between expertise and laypersons (Giddens 1991, Shapiro 1987). The second level of trust is at community level. Evidence exists of a positive correlation between levels of interpersonal trust and levels of social capital (Putman 1993, Rothstein 2000), leading in part to calls for increasing the levels of civility and community responsibility in everyday life. However, while theorists (Misztal 1996, Putman 1993, Taylor-Gooby 1999, 2000, Sztompka 1999, Rothstein 2000, Dean 2003) support the idea of social norms and values overriding rational models of human behaviour, they say little about how these norms and values become established. Rothstein claims that the link between interpersonal trust and social capital is weak, as are propositions about the direction of community relationships. Rejecting functionalist explanations linking norms to the established configurations of power, he proposes a theory of ‘collective memories’ creating social norms in communities as a strategic political process. The essential ingredient is the creation of conditions of community relationships built on common values. The third key issue is on trust and organisational context. Challenges to the ‘trustworthiness’ in organisations, regardless of whether they are public or third sector organisations, can have profound effects on confidence in that system. Producing increased demands for regulation, information and transparency; that is, increasing the demands for distrust. The fourth major area of concern for theorising trust has focussed on the declining trust in both state mediated social systems such health and welfare and the professions embedded therein (Davies 1999, Phillipson, 1998, Welsh and Pringle 2001). Conceived as impersonal or systems trust (Giddens 1990, 1991, Luhmann 1979) this form of trust is developed and maintained by embedding expertise in systems that do not require the personal knowledge of any individual by another. Such systems employ a range of techniques of distrust i.e. audit processes, target setting and third party inspections to demonstrate trustworthiness. Part of the confusion concerning the different levels of trust rests, according to Möllering (2001), with the failure to distinguish between the functional properties of trust and the foundations of how trust is created in health and social care. The former are the outcomes of trust i.e. expectations, concerning issues

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such as: order, co-operation, reducing complexity and social capital. While the latter concern the nature or bases of trust, which, due to the assumption that they are rational, become lost and therefore not explored. Moreover, individuals make decisions on partial knowledge, a mix of weak inductive knowledge and faith regarding the consequences of an action. Möllering suggests that in some circumstances relational aspects producing either confidence or reciprocity might support decision-making. However, this knowledge moves us close to confidence, which according to Seligman’s (1997) is a different quality. Nevertheless, building on Möllering’s theory, Brownlie and Howson (2005) argue that trust is relational and impossible to understand in isolation. Trust occurs as individuals extract the known factors while bracketing off or suspending the unknown factors to avoid confusing decisions with uncertainty. Gilson (2003) takes up this relational aspect of trust and claims that relationship issues provide the main challenges for health and welfare services. Making the link between systems and social capital, she compares UK and US health systems. Concluding that the general acceptance by the UK population of the altruistic element of the UK welfare system stands in stark contrast with the distrust, which accompanies welfare and health in the USA where there is a belief that the system is organised to maximize the benefits for the medical profession. Gilson argues that trust involves both cognitive and affective elements. The former relates to a risk calculation where the costs and benefits of an action are calculated alongside of the degree of uncertainty derived from the dependency on the actions and intentions of another while the latter is linked to the generation of emotional bonds and obligations. Altruism provides a special case of trust where trusting and trustworthiness promote the social status of those involved in giving. Consequences for those dependent on giving remains a key question. For as Giddens (1990) notes trust is a very specific case of dependency: a dependency on expertise. Seligman argues that trust, conceived as it is in this debate, is unique to modernity. In traditional societies, trust has quite different bases. Moreover, sociological theories, which suppose a general change in modernity (cf. Beck, 1992, Giddens 1994), assume that with the erosion of traditional institutions and scientific knowledge trust becomes an issue more often produced actively by individuals than institutionally guaranteed. To resolve these tensions we propose Foucault’s Governmentality thesis as the means to identify the role of trust, along with the mechanisms for the deployment of trust and the role of professional expertise. Social institutions such as health and social care disseminate a particular ethic of the self into the discrete corners of everyday lives of the population. Supported by a discursive framework promoting co-operative

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relations between people, communities and organisations this ethic is future orientated and promotes qualities and values that sustain trust-based relationships and forms of action. In the process of building co-operative relations, the role of professionals and professional authority is established. The next section carefully examines the conceptual possibilities for articulation of trust and governmentality.

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LINKING PROFESSIONAL AUTHORITY WITH TRUST AND GOVERNMENTALITY Conceptually there are tensions but also interesting theoretical possibilities between late [high] modern and post-structuralist conceptions of society. Both identify the fragmentation of traditional forms of authority and expertise, and acknowledge the increasing complexity this produces through the availability of multiple sources of information and different lifestyle choices. As noted earlier late [high] modern conceptions of trust, acknowledge uncertainty and risk as the basis for necessitating trust and point to the failure of rational choice theories as evidence of the existence of social trust. Likewise, governmentality theorists, discuss risk and uncertainty at length (Rose 1996, 1999, Osborne 1997, Petersen 1997), but leave the discussion of [social] ‘trust’ to an observation that trust, traditionally placed in authority figures, has been replaced by audit (Rose 1999). The problem of creating co-operative relations between individuals and within groups and communities, both in the present and for the future, is left unresolved. Foucault’s summary of the working of the state provides a useful starting point for this discussion: “it is the tactics of government which make possible the continual definition and redefinition of what is within the competence of the State and what is not, the public versus the private , and so on; thus the State can only be understood in its survival and its limits on the basis of the general tactics of governmentality.” (Foucault 1979:21)

Our contention is that the ‘governmentality thesis’ as it has been developed by writers such as: Rose and Miller (1992), Burchell (1991), Rose (1996, 1999), Osborne (1997), Petersen (1997) holds the potential to overcome many of the problems experienced in theorising trust. It provides a means of extending the critical debate over trust. Linking discussions concerning the bases of trust: the conditions Möllering (2001) describes as essential for trust to happen with discussions focusing on the outcomes of trust i.e. social capital, systems or

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impersonal trust and interpersonal trust (Putnam 1993, Seligman 1997, Luhmann 1979, Giddens 1990, 1991, Sztompka 1999, Rothstein 2000). Moreover, governmentality provides the means for identifying the mechanisms for deploying particular rationalities across the social fabric. In particular, the interplay between state intervention and the population that institutionalizes expertise as a conduit for the exercise of power in modern societies (Johnson 2001). Institutionalizing expertise establishes a range of specialized spaces: at once both hidden and visible, providing opportunities across the social landscape for a range of professionals. Experts who work on individuals inciting self-forming activity and individual agency, producing the self-managing citizen central to neo-liberal forms of government, 'enterprising subjects' or what Burchell (1991: 276) terms 'responsibilisation'. Thus enabling an explanation of trust that avoids resorting to a functionalist argument or an overly deterministic approach limited to either class action or the meaning-giving subject. Furthermore, governmentality can overcome the condition laid by Sztompka (1999) that trust cannot exist in conditions of discontinuous change. Indeed, in the context of discontinuous change, particular rationalities and their associated technologies become politicized, leading to increased conflict in the relationship between the state and expertise making trust an evermore valuable commodity. In analysing the activities of government, Rose and Miller (1992: 175) argue, we must investigate 'political rationalities' and technologies of government - 'the complex of mundane programmes, calculations, techniques, apparatuses, documents and procedures through which authorities seek to embody and give effect to governmental ambitions'. In this case, rationalities, operating as discourses and social practices embodying a particular practical ethic, work to reproduce the norms, values and obligations associated with trust. Producing a subject position that values trustworthiness as both a personal characteristic and a characteristic sought in others. Both experts/professionals and the user/customer of health services emerge as the self-managing ethical subjects of neo-liberal rule (Miller 1993, Davidson 1994, Rose 1999). For governmentality theorists an analysis of neo-liberal regimes reveals individuals as inculcated with values and objectives, orientated towards incorporating people as both players and partners in marketised systems including health and welfare. Participation in markets along with the potential for unbounded choice are inextricably entwined with a creative tension, an ethical incompleteness, where private [selfish] desire and public [selfless] obligation produce the rational self-managing actor of neo-liberal rule. In a dialectical relationship that works to form individual identity through the exercise of a modern consumerist citizenship (Miller 1993). Such regimes exhort individuals;

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indeed expect them to become entrepreneurs in all spheres, and to accept responsibility for the management of 'risk'. Government is concerned with managing the conduct of conduct, the processes through which people 'govern' themselves, which includes an obligation to manage one’s own self-identity (Petersen 1997). Theorists of modernity such as Putman (1993), Sztompka (1999) and Rothstein (2000) leave trust to arise organically through the interaction of individuals within groups and communities. The idea that increasing the levels of social interaction to effect a positive consequence on the levels of social and individual trust has a benign attraction, but it tells us little about how or why these norms, values and obligations associated with trust exist in the first place. Alternatively, the analysis of governmentality recognizes these discourses and social practices as the outcome of something more ordered. Not ordered in the sense of designed and managed but the consequence of what Foucault described as strategy: loosely connected sets of discourses and practices that follow a broad trajectory with no necessary correspondence between the different elements (Dreyfus and Rabinow 1982). One tactic, increasingly used within the strategy of government as they struggle with the challenge of managing populations across an ever more complex range of social contexts, is the promotion of co-operative relations within different programmes and technologies. This works to promote, establish and maintain an ethic of co-operation and trustworthiness producing the trusting subject as a version of the disciplined subject, socially valued and malleable. Evidence of this can be found in a range of policy initiatives disseminated by national and local government drawing on communitarian discourses and including an endless array of devices promoting partnerships and active citizenship e.g. Caring about Carers (DoH 1999), Independence, Well-being and Choice (DoH 2005). Devices targeting communities and neighbourhoods through initiatives promoting community activities often focussed on a variety of locally based independent and autonomous groups. In areas where co-operative relations have failed and require rebuilding the deployment of discourses of empowerment is evident, inciting ‘damaged subjects’ to self-manage (Rose 1996). Located in initiatives such as Health Action Zones, Community Development Projects and Public Health activities a range of experts and lay volunteers work on individuals encouraging them to take responsibility for their health and engage in self-forming activities, self-care and self-help (Rose 1999). Alongside this promotion of co-operative relationships, neo-liberal rule increasingly repositions the state as the co-ordinator of activity rather than the provider. New, often contradictory, rationalities of competition and co-operation,

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of participation and consumerism, substitute for earlier forms of public provision. Nevertheless, these contradictory rationalities maintain sufficient coherence to provide the basis for state intervention through professional and lay activity. One such example in welfare is health. Health is the restructured relationship between the private health sector and the British National Health Service [NHS] (DoH 2002, Lewis and Gillam 2003). Until recently, the private health sector distanced itself from the NHS arguing quality and choice while those committed to a public health service rejected private sector values. Now, a range of policy initiatives such as the use of private sector surgical facilities, the ability to have particular treatments at a facility chosen by the patient (DoH 2003a) and Private Finance Initiatives [PFIs] have blurred the boundaries between the public and private health sectors. Fixing large sections of the private sector as the reserve capacity of the NHS expanding and contracting on demand without the political consequences of public hospital closures. Furthermore, the use of private capital shifts fiscal liabilities from the present to the future while at the same time distancing the state from responsibility for the maintenance and refurbishment of hospital and other health service facilities and equipment. Such developments suggest a re-articulation of the discursive structure of private, voluntary and statutory sector organisations in what Clarke and Newman (1997) describe as processes of colonisation and accommodation. Alongside State interventions aimed at provoking co-operative and trust-based relationships, such movements point to the way major institutions of society can become repositories of trust, providing both the example and the experience of trusting while also building the capacity for trust-based relationships across the social fabric. However, in contrast to functionalist conceptions of social institutions as repositories of trust e.g. Misztal (1996), we need to identify the dynamic interplay between the state and the means of intervention at its disposal. The challenges faced by the state over the last twenty-five years or so such as the increasing health costs of an ageing population (Rose 1999, DoH 2005) have been matched by rapid social change. One effect of this has been the fragmentation of welfare away from a monolithic state organisation to one coordinated and financed by the state but disciplined by market mechanisms such as commissioning and competitive tendering (Clarke and Newman 1997, Lewis and Gillam 2003). Another effect has been the politicization of the technical i.e. professional expertise (Johnson 2001), where a variety of forms of expertise competes for dominance. Under such conditions, trust is also politicized (Gilbert 1998). Trust becomes a commodity for exchange (Dasgupta 1988). Demanding new forms of governance and producing a paradox, autonomy for organisations

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and professionals released from direct management by the state is matched by ever more-complex forms of surveillance and control (Rose 1999, Gilbert 2001).

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WELFARE, PROFESSIONAL AUTHORITY AND GOVERNMENTALITY One feature of the established order in the last quarter of the last century was one where the institutionalized interests of state professionals were considered to stand in opposition to both the views of particular sections of the state and the newly produced subject position of ‘welfare consumer’ (Clarke and Newman 1997). Since the 1980s, claims of a decline in the authority of the professions accompanied this process. Public perceptions of failures of professional selfregulation articulate as institutionalized self-interest (Davies 2000), paralleled by the increasing power, or resistance, of health service users and welfare consumers to discipline professional activity. Managerialist techniques such as contracts and demands for transparency in exchanges unite managerial and user based discourses in an uncomfortable marriage (Rose 1999, Shaw 2001, Stewart and Wisniewski 2004, McIvor et al. 2002), frustrating the radical voice of user movements in social welfare (Clarke and Newman 1997). Alongside, a massive increase in the access to the information, particularly through the internet, further complicates the situation. Specialist information, once the sole privilege of the professions, is now widely available, changing the relationship between professionals and laypersons once again challenging professional authority (Hardey 2005). For Rose and Miller: 'governmentality is intrinsically linked to the activities of expertise, whose role is not weaving an all-pervasive web of "social control" but of enacting assorted attempts at the calculated administration of diverse aspects of conduct through countless, often competing, local tactics of education, persuasion, inducement, management, incitement, motivation and encouragement' (Rose and Miller 1992: 175). This web of activity and the specialized spaces created for expertise, work to construct professional authority, condensing the different levels of trust: interpersonal, systems and social capital; into the facework of experts. The fragmentation of expertise, once embedded in the directly managed institutions of the state, has enabled the dispersal of this expertise throughout the third sector leading to a re-articulation of the discourses that support professional activity and trust in expertise.

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It is notable that despite the conflicts of the 1980s, the professions appear to carry on relatively unscathed leading to the conclusion that the decline in the authority, power and popularity of the professions has been overstated. One key factor is that certain tasks and activities demand professional competence especially in circumstances where the outcome cannot be pre-determined (Clarke and Newman 1997). Once again, revealing the paradox of autonomy and increasing regulation in the relationship between the state and professional activity. Returning to the earlier quotation from Foucault, what has occurred in this period is the re-articulation of government objectives and a re-structuring of the realms of professional jurisdiction and authority (Johnson 2001). Regulation and control of expertise through audits and contracts are disciplinary techniques that have modernized the tricky issue of governing professional activity. Accompanied by a re-articulation of professional discourse objectifying the activity of expertise rendering it both manageable (Rose 1999), and enabling the surveillance of professional activity across a landscape no longer defined by institutions and buildings of the poor law. Central to this process is a paradox where the need for experts to manage complex and unpredictable situations has led to trust in professional autonomy becoming almost exclusively located with the management of risk (Rose 1996, 1999, Petersen 1997, Kemshall 2002). Competence in the management of risk is therefore the central basis, which maintains the professional status of health and welfare professionals. Failure in this respect can lead to very public examinations of the competence of individual professionals, in particular where there is danger of a legitimation crisis. Professionals who, despite evidence of system failure, experience a form of symbolic sacrifice and public humiliation, recent examples include Dr Marietta Higgs [Cleveland Child Abuse Inquiry], Lisa Arthurworrey [Victoria Climbie’s social worker] (James 2005) and Professor Sir Roy Meadows [expert witness in child death cases (Laville 2005)]. Challenges to traditional or institutionalized expertise by new or nonconventional forms of expertise also demonstrates this re-structuring of the objectives of government and the jurisdiction of professionals. Some problems have persistently frustrated traditional forms of expertise in health care and social welfare at the same time widely dispersed and contract based activity enables entry for alternative approaches. Here again the dynamic quality of Governmentality, demonstrates processes of colonisation and accommodation. Lee-Treweek (2002) explores this process in the context of a complementary therapy, cranial osteopathy, describing how traditional medicine accepts elements of complementary practice on condition that the alternative approach accepts particular rituals and the primacy of the existing medical hierarchy. The need to

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manage chronic conditions such as skeletal and muscular pain, areas where traditional medicine has failed to provide a reliable treatment, enables a new form of expertise to institutionalise itself with the state. Securing trust in this specialized space enables this form of expertise to contest the hegemony of risk to its advantage. What emerges is a fusion of consumerist, traditional, alternative and complementary discourses articulated with discourses of co-operation, partnership and trust in health and welfare providing an matrix of spaces where a wider range of expertise, in both type and numerically, than ever before is embedded. At one level, experts identify risk at the same time as providing a general surveillance of the population, at another level they work within systems legitimated by a myriad of mechanisms of distrust while simultaneously working at another level on individuals to promote a general ethic of trust. Thus, the mechanisms constructing the contemporary authority of expertise are established. Condensing trust in the facework of experts places users of health and welfare in a dynamic context. Health and welfare policy continually redefines previous patterns of social relationships both within health and welfare agencies and between those agencies and their customers.

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CONCLUSION In the discussion of matrix inter-relationship trust, governmentality and professional expertise, we have acknowledged the contribution of a range of theorists to this increasingly important concept in the social sciences and in social welfare. We also note that the conceptualization of trust leads to confusion not only in the distinction between the bases of trust and the outcomes of trust, but also in the definition of what trust is and how trust can be differentiated from allied concepts such as confidence and familiarity. In addition, the recognition of the persistence of social and normatively based beliefs and values that act as synthetic, binding people into relationships that enable future orientated action is central to understanding the limitations of rational models of human behaviour and policy developed thereon. However, this theorising ignores identifying the mechanisms, which establish these trust-based values across the social fabric. These issues are of critical importance in health and social care. To address these pressures we explored Foucault’s conceptual ‘tool’ of Governmentality thesis as the means to identify the role of trust in postmodernity, coupled with the processes for the employment of trust and the position of professional expertise in this process. A discursive framework promoting co-operative relations between

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individuals, communities and organisations consolidated this. This ethic is future orientated and promotes qualities and values that sustain trust-based relationships and forms of action. In the process of building co-operative relations, the role of welfare professionals and professional authority is established. Claims that trust in professionals has declined is not substantiated given the pivotal role professionals continue to play in health and social care rather the reconfiguration of political objectives has changed the relationship between professionals and the state. The fact that some professional groups have found the process traumatic merely reinforces our claim that trust is politized, contested and functions as a commodity. The challenge for research and practice in social welfare is to move away from viewing trust as a benign side effect of human activity. Instead, we should be clear that trust is the intended outcome of a range of social policies and the discourses and practices that underpin those policies whose aim is the management of a population that is useful, productive and self-managing. Therefore, we need to focus on the interplay between social policy and the lives of individuals, families or groups and communities. Drawing out the costs and benefits of trust-based relationships, identifying the way the facework of experts maintains the legitimacy of welfare systems while simultaneously promoting social cohesion, and constructing professional authority. We require an analysis the micro-politics of trust, played out in a myriad of interactions between users, carers, volunteers, professionals and administrators, within health and social welfare. In addition, we have to identify the discourses and practices e.g. the distinction between trust and risk, that underpin this activity and the consequences of trust-based relationships for those involved in the everyday world of social welfare.

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Lunt, P., and Blundell, J. (2000). Public understanding of financial risk, in TaylorGooby, P. [ed.] Risk, Trust and Welfare. London: Macmillan pp 114 - 130. McIvor R, McHugh M, and Cadden C (2002). Internet technologies: supporting transparency in the public sector. International Journal of Public Sector Management, 15(3): pp 170 – 187. Mechanic, D. (1998). Public trust and initiatives for new health care partnerships. The Milbank Quarterly. 76(2), 281-302. Miller T. (1993). The Well-Tempered Self: Citizenship, Culture and the Postmodern Subject. Baltimore: John Hopkins University Press. Misztal, B, A. (1996). Trust in Modern Societies. Cambridge: Polity Press. Möllering, G., (2001). The Nature of Trust: From Georg Simmel to a theory of Expectation, interpretation and suspension. Sociology, 35(2): 404 – 420. Newman, J. (1998). The Dynamics of Trust, in A, Coulson [ed.] Trust and Contracts: Relationships in Local Government ,Health and Public Services. Bristol: Polity Press. Osborne T (1997). Of Health and Statecraft. In Petersen A and Bunton R [eds.] Foucault: Health and Medicine. London: Routledge. Petersen A. (1997). Risk, governance and the new public health, (Petersen A. and Bunton R. eds.) Foucault: Health and Medicine. London: Routledge, pp 189 – 206. Phillipson, C (1998) Reconstructing Old Age, Sage: London Powell, J.L. (2005) Social Theory and Aging, Rowman and Littlefield: NY Price, D., and Ginn, J. (2003). Sharing the crust? Gender, partnership status and inequalities in pension accumulation, in Arber, S., Davidson, K., and Ginn, J. [eds.] Gender and Ageing: changing roles and relationships. Buckingham: Open University Press 127 - 147. Putnam R D. (1993) Making Democracy Work: Civic traditions in modern Italy. Princetown: Princetown University Press. Rose N (1999). Powers of Freedom: Reframing political thought. Cambridge: Cambridge University Press. Rose, N (1993) 'Government, Authority, and Expertise in Advanced Liberalism' , Economy and Society, 22, (3): 283-99. Rose, N and Miller, P (1992) 'Political Power Beyond the State: Problematics of Government', The British Journal of Sociology, 43, (2), 172-205. Rose, N. (1996). The death of the social? Re-figuring the territory of government. Economy and Society. 25(3), 327-356. Rothstein, B (2000). Trust, Social Dilemmas and Collective Memories, Journal of Theoretical Politics, 12(4): 477 – 501.

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Seligman A B (1997). The Problem of Trust. Princetown: Princetown University Press. Shapiro S P. (1987). The social control of impersonal trust. American Journal of Sociology. November. 93(3): pp 623-658. Shaw S (2001) External Assessment of Health Care. British Medical Journal, 322(7290): 851 – 854. Stewart D and Wisniewski M (2004). Performance Measurement for stakeholders: The case of Scottish Local Authorities, International Journal of Public Sector Management, 17(2and3): pp 222 - 233. Sztompka, P (1999). Trust: A SociologicalTheory. Cambridge: Cambridge University Press. Taylor-Gooby P (1999). Markets and Motives: Trust and Egoism in Welfare Markets. Journal of Social Policy, 28(1): 97 – 114. Taylor-Gooby P (2000). Risk and Welfare, in P Taylor-Gooby [ed.] Risk, Trust and Welfare. Basingstoke: Macmillan pp 1 – 20. Tulloch, J and Lupton, D. (2003) Risk and Everyday Life. London: Sage. Uslaner E M (1999). Democracy and Social Capital, in M Warren [ed.]. Democracy and Trust. Cambridge: Cambridge University Press pp 121 - 150. Walker, A, and Naegele, G. (1999). The Politics of Old Age in Europe. Buckingham: Open University press. Watson, S. (2000). Foucault and the study of social policy, in Lewis, G., Gewirtz, S. and Clarke, J. (eds.). Rethinking Social Policy. London: Open University/Sage Publications. Welsh, T., and Pringle, M. (2001). Editorial. Social Capital: Trusts need to recreate trust. British Medical Journal, 323: 177 – 178.

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INDEX # 9/11, 8, 16, 88

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A ABC, 85, 86, 97, 98 abduction, 55 Aboriginal, 88, 97, 99 academic, 21, 33, 54, 81 academics, 16, 27, 28, 32 access, 29, 65, 91, 106, 125, 131 accidents, 51 accommodation, 130, 132 accountability, 90, 91, 108, 109, 123, 135 achievement, 29, 39 activation, 56, 93 activity level, 111 actuarial, 28, 30, 31, 32, 40, 41, 51, 63, 64, 66 actuarial risk assessment, 63 acute, 52, 65 administration, 110, 131 administrators, 134 adolescents, 84 adult, 36, 54, 61, 66 adults, 5, 36, 38, 47, 48, 49, 50, 52, 53, 54, 55, 56, 57, 58, 59, 69, 72, 93 advocacy, 102, 107, 108

age, 15, 18, 21, 34, 42, 47, 48, 49, 50, 51, 52, 53, 54, 55, 57, 58, 60, 85, 93, 94, 97, 104, 105 ag(e)ing, vii, 5, 47, 48, 49, 50, 51, 52, 53, 56, 57, 58, 59, 60, 61, 94, 121, 130 ageing population, 130 agent, 3, 98, 122 agents, 60, 106, 125 aging population, 94 aid, 85, 95 AIDS, 11, 14 AIM, 43 Al Qaeda, 16 alcohol, 8, 67, 68, 70, 78, 79, 84, 85, 86, 89 alcohol abuse, 85 alcohol consumption, 8, 84 alcoholism, 54, 85 alternative, 66, 72, 74, 94, 107, 132, 133 Alzheimer’s disease, 52, 58 ambivalence, 35, 36 American Psychological Association, 75, 78 American Society of Criminology, 76 analysts, 106 analytical techniques, 68 anger, 87 antecedents, 55 anthropogenic, 12, 20 anthropological, 11, 82 anxiety, 15, 23, 24, 36, 47, 51, 61 application, 14, 27, 30, 32, 33, 41, 74, 91 appraisals, 112

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Index

argument, 6, 128 arrest, 67 articulation, 13, 127, 130, 131, 132 Asia, 100 aspiration, 30 assault, 76, 79, 89 assessment, 9, 28, 29, 30, 31, 32, 33, 35, 38, 39, 44, 48, 49, 54, 66, 75, 77, 91, 93, 112 assessment tools, 66 assumptions, 19, 31, 63 asylum, 87, 88, 89 attachment, 34, 124 attacks, 8, 11, 14, 16, 50, 88 attitudes, 33, 105 Australia, 5, 65, 81, 82, 83, 84, 86, 87, 88, 90, 93, 95, 97, 98, 99, 100 authority, 12, 30, 39, 91, 106, 108, 111, 122, 123, 124, 127, 131, 132, 133, 134 autonomy, 56, 57, 58, 106, 108, 110, 130, 132 availability, 127 avoidance, 71, 88 awareness, 4, 10, 12, 49, 73, 74

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B Bali, 88 banks, 9 barriers, 35, 66, 92 baths, 10 behavior, 53, 55, 56, 60 behaviours, 58, 64, 67, 70, 73 belief systems, 19 beliefs, 57, 105, 125, 133 benchmarks, 108 benefits, 18, 29, 48, 49, 57, 58, 63, 70, 124, 126, 134 benign, 29, 129, 134 bias, 40 binding, 122, 133 binge drinking, 84, 85, 98 blame, 18, 53, 93 blaming, 49 blocks, 69 bonds, 122, 126 border control, 82

borrowers, 9 boys, 85 breakfast, 84, 97 Britain, 17, 115, 116 broadcast media, 55 Brooklyn, 69 budget deficit, 96 buildings, 132 bulimia, 45 bullying, 38 burglary, 9, 67 buses, 19

C calculus, 10 calibration, 10 campaigns, 70 Canada, 31, 34, 65, 78 cancer, 52, 70 capacity, 10, 20, 73, 108, 130, 135 capitalism, 19, 64, 103, 115 capitalist, 9, 11, 104 capitalist system, 11 capsule, 8, 19 carapace, 8 caregivers, 54, 56, 57 cargo, 88 Caribbean, 18 case study, 5 cast, 9, 17 casting, 102 catastrophes, 7, 10 category a, 92 causality, 4 centralized, 41, 94, 95, 96 channels, 13 chemical weapons, 17 Chernobyl, 10, 50 Chief Justice, 16, 65 child abuse, 88 child protection, 31, 35, 40, 41, 43, 90, 91, 92 child rearing, 106 child welfare, 36, 38, 44 childcare, 96

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Index childhood, 36, 37, 39, 124 children, 8, 10, 33, 34, 35, 36, 37, 38, 39, 40, 41, 43, 54, 65, 66, 69, 71, 72, 73, 75, 83, 84, 87, 88, 89, 91, 136 children’s lives, 37, 41 Christmas, 88 chronic disease, 52 chronic diseases, 52 circulation, 10 citizens, 10, 12, 17, 19, 20, 29, 36, 48, 55, 70, 84, 94, 95, 97, 113 citizenship, 4, 6, 69, 95, 96, 100, 102, 110, 113, 128, 129 civil liberties, 57 civil servant, 17 civil servants, 17 classes, 95 classical, 103, 108 classification, 18 clients, 17, 102, 125 clustering, 18 Co, 99, 135 coercion, 19 cognition, 14 cognitive, 34, 49, 52, 55, 56, 57, 67, 126 cognitive impairment, 52, 56, 57 coherence, 123, 130 cohesion, 124, 134 collaboration, 39, 47 colleges, 111 colonisation, 130, 132 Colorado, 75 commodity, 128, 130, 134, 135 communication, 37, 105, 124 communication skills, 124 communities, 68, 73, 74, 84, 89, 95, 122, 124, 125, 127, 129, 134 community, 31, 41, 57, 65, 70, 73, 74, 75, 76, 77, 78, 87, 89, 95, 99, 110, 122, 124, 125, 129 community relations, 125 community service, 99 community support, 41 competence, 112, 127, 132 competency, 110

141

competition, 84, 108, 129 complement, 110 complexity, 5, 30, 39, 41, 50, 126, 127 Complexity theory, 75 complications, 52 components, 35 compulsion, 73 conception, 55, 107 conceptualization, 50, 57, 122, 133 concrete, 14, 19 conduct problems, 35 confidence, 30, 41, 73, 123, 125, 126, 133 conflict, 128 confusion, 39, 121, 125, 133 Congress, iv Connecticut, 69 consciousness, 97 consensus, 8, 64 consent, 12 Constitution, 23 constraints, 4, 70, 74 construction, 5, 13, 33, 71, 107 constructionism, 11, 19 constructionist, 13, 19 consumer choice, 102 consumerism, 104, 130 consumers, 131 consumption, 8, 84, 94 contextualization, 16 continuity, 35 contracts, 91, 123, 131, 132 control, 9, 18, 20, 40, 51, 54, 56, 57, 67, 84, 103, 122, 131, 132 conviction, 67 cost effectiveness, 110 cost-effective, 66 costs, 49, 52, 63, 70, 96, 126, 130, 134 coverage, 14, 15 creativity, 42 credibility, 30 credit, 8, 103, 122 creep, 56 crime, vii, 5, 7, 12, 15, 16, 17, 19, 20, 31, 33, 35, 36, 53, 54, 63, 64, 66, 67, 69, 70, 73, 74, 75, 76, 121

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Index

crimes, 15, 53, 54 criminal acts, 15 criminal justice, vii, 5, 13, 31, 32, 64, 69, 72, 77 criminal justice system, 32, 64, 72 criminals, 34, 35 critical analysis, 101 criticism, 32 crust, 137 cultural influence, 30 cultural practices, 11, 13 cultural values, 14 culture, 8, 11, 13, 15, 19, 29, 88, 108, 109, 123 customers, 133 cycles, 103 cyclone, 8

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D danger, 8, 19, 31, 35, 37, 42, 50, 52, 64, 69, 71, 132 data analysis, 41 data gathering, 17 death, 38, 39, 52, 103, 132, 136, 137 deaths, 15, 37, 90, 91 decision making, 74, 89 decision-making process, 105, 110 decisions, 9, 29, 30, 39, 60, 66, 70, 73, 74, 105, 126 deficit, 34 deficits, 29, 96 definition, 92, 127, 133 delinquency, 66, 68 delivery, 35, 90, 92, 94, 96, 97, 110 demand, 39, 125, 130, 132 dementia, 48, 55, 56, 57, 59, 60, 61 democracy, 104 democratization, 12 denial, 30 Denmark, 100 Department of Corrections, 66, 78 Department of Education, 69 Department of Justice, 59 deprivation, 34

designers, 75 desire, 31, 108, 110, 128 deskilling, 32 developed countries, 3 deviant behaviour, 72 diabetes, 110 dichotomy, 113 diet, 105 differentiation, 124 direct observation, 112 disability, 52, 53, 54, 93 disabled, 50, 52, 57 disappointment, 122 disaster, 10 disbursement, 48 discipline, 13, 64, 102, 111, 131 disclosure, 124 discomfort, 15 discourse, 4, 13, 16, 17, 50, 51, 94, 111, 132 discrimination, 38, 93 disorder, 78 disseminate, 13, 126 distortions, 34 distribution, 3, 12, 18, 48, 49, 58, 64, 100 doctor-patient, 102 doctors, 13, 101, 110, 111 domestic violence, 69 dominance, 58, 130 dosage, 35 downsizing, 51 drinking, 70, 84, 85 drug abuse, 35 drug abusers, 35 drug treatment, 35 drug use, 69

E earthquake, 8 Eastern Europe, 18 eating, 83 economic activity, 109 economic change, 28 economic development, 29 economic status, 49

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Index economic theory, 109 economics, 7, 11, 81, 103 Education, 18, 69, 75, 98 educational attainment, 34 ego, 107 elderly, 54 elders, 53, 54, 56, 57, 89 election, 83, 87, 89, 110 electricity, 103 emergency departments, 76 emotion, 14, 70 emotional, 36, 93, 126 empathy, 72 employability, 92 employment, 18, 30, 50, 65, 90, 92, 93, 95, 96, 97, 112, 123, 133 employment growth, 93 empowered, 111 empowerment, 56, 114, 129 encapsulated, 34, 38 encouragement, 53 energy, 8, 107, 113 engagement, 20, 30, 41, 74, 76 England, 38, 43, 65, 68, 69, 135 enlargement, 109 Enlightenment, 115 enterprise, 48, 98, 102, 104, 107, 108, 109, 110, 112, 113 entertainment, 68 enthusiasm, 105 entrepreneurs, 129 environment, 5, 7, 10, 12, 15, 19, 20, 34, 35, 67, 73, 110 environmental change, 82 environmental factors, 38 environmentalists, 10 epidemic, 16, 81, 82, 83, 84, 89, 94, 97 epidemiology, 60 epistemological, 19, 28 epistemology, 27 equity, 97 erosion, 96, 122, 126 estimating, 9 ethics, 135 Europe, 138

143

examinations, 132 exclusion, 31, 42, 65 exercise, 95, 105, 108, 123, 128 expert, iv, 10, 13, 70, 105, 106, 107, 132 expert systems, 10, 105 expertise, 10, 30, 101, 105, 108, 109, 113, 124, 125, 126, 127, 128, 130, 131, 132, 133, 136 exposure, 9, 54, 57, 60, 122

F failure, 29, 39, 68, 74, 90, 93, 113, 125, 127, 132 faith, 111, 123, 126 false negative, 34, 40 false positive, 40 familial, 34 family, 12, 35, 36, 39, 41, 53, 65, 66, 69, 91, 94, 104, 105 family members, 53 family support, 69, 91 famine, 11, 105 fear, 4, 8, 11, 13, 15, 16, 17, 19, 50, 51, 54, 56, 57, 86, 87, 88 fear response, 15 fears, 13, 15, 49, 72, 83 February, 59, 84, 98 Federal Bureau of Investigation, 53, 59 federal government, 85 feedback, 112 feelings, 56 feet, 65 finance, 9 financial loss, 122 firms, 90 fitness, 111, 112 fixation, 14, 96 flexibility, 64 floating, 13 flow, 10 fluctuations, 33, 103 fluid, 104 focusing, 31, 38, 39, 49, 58, 127 food, 8, 10, 51, 89

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Index

forensic, 36 Foucault, 8, 11, 12, 21, 22, 23, 28, 43, 82, 107, 114, 115, 116, 117, 123, 127, 129, 132, 134, 135, 137, 138 fragmentation, 123, 127, 130, 131 framing, 8, 71, 74 freedom, 4, 10, 60, 106, 108, 110, 113, 114 freedoms, 29 funding, 41, 55, 90, 91, 96 funds, 91, 96 fusion, 133 futurity, 9

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G gangs, 86 gender, 104, 105 general practitioner, 102 generalization, 107 generation, 96, 126 Germany, 60, 100 gerontology, 60 gestation, 4 girls, 85 glasses, 68, 85 global warming, 10, 14 globalization, 17, 76 goals, 71, 72, 101, 109 gold, 83 governance, 5, 12, 17, 19, 28, 31, 83, 99, 101, 102, 109, 110, 111, 112, 113, 130, 137 government, 9, 14, 15, 19, 32, 37, 81, 82, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 102, 103, 107, 108, 110, 114, 122, 124, 127, 128, 129, 132, 137 government expenditure, 84 government intervention, 82 gravitation, 7 groups, 3, 4, 5, 17, 18, 19, 20, 29, 33, 49, 53, 56, 57, 58, 85, 95, 96, 127, 129, 134 growth, 3, 30, 31, 56, 93 guidance, 31, 32, 33, 36, 37, 38, 40 guidelines, 85, 110, 111

H hands, 86, 104, 112 happiness, 101, 103, 113 harm, 9, 11, 12, 16, 30, 31, 36, 37, 38, 39, 40, 52, 69, 71, 77, 90, 92, 125 hazards, 4, 9, 10, 19, 105 health, vii, 5, 7, 9, 12, 13, 14, 20, 36, 38, 39, 48, 49, 50, 51, 52, 53, 67, 70, 83, 84, 85, 89, 93, 95, 96, 101, 103, 105, 109, 111, 113, 125, 126, 128, 129, 130, 131, 132, 133, 134, 136, 137 health care, 12, 50, 52, 53, 67, 109, 111, 132, 136, 137 health insurance, 95, 96 health problems, 52, 53 health services, 84, 96, 128 health status, 48 heart, 42, 52, 70, 78, 84, 103, 107, 110 heart disease, 52, 70, 110 hegemony, 133 height, 48 heuristic, 74 Higgs, 132 high risk, 5, 34, 40, 50, 63, 77, 90, 92 hips, 125 HIV, 75 holism, 32 homeless, 102 homelessness, 29, 66 horizon, 9 hospital, 84, 110, 130 hospitals, 12, 97 hotels, 111 House, 43, 44 housing, 12 human, vii, 8, 10, 11, 13, 14, 16, 17, 19, 30, 42, 53, 71, 92, 94, 99, 105, 111, 113, 122, 124, 125, 133, 134 human activity, 105, 134 human agency, 13, 19, 71 human capital, 53 human rights, 19 human security, vii, 8, 11, 14, 16 humiliation, 132

Powell, Jason L., and Azrini Wahidin. Risk and Social Welfare, Nova Science Publishers, Incorporated, 2009. ProQuest Ebook Central,

Index hysteria, 85

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I iatrogenic, 40 identification, 31, 34, 39, 42, 57, 72 identity, 34, 70, 71, 104, 106, 113, 122, 128 ideology, 47, 48, 53, 56, 102 imagery, 35 images, 67 IMF, 103 immigrants, 86, 89 immigration, 87 Immigration Act, 35 impairments, 52 implementation, 15, 37, 40, 66, 74, 111 inattention, 88 incarceration, 31, 69, 72 incidence, 72 Incidents, 8 income, 4, 12, 53, 89, 92, 93, 94, 95, 96 income support, 92, 93, 95 increased workload, 41 independence, 51, 64, 91 Indiana, 59 indicators, 14, 39, 40, 41 indigenous, 71, 88, 89 Indigenous, 98 indigenous peoples, 71 individual action, 29 individualism, 102 individualization, 3, 29 industrial, 11, 48, 95, 104 industrialisation, 4 industrialization, 11 industry, 15, 66, 85, 96 inequality, 103 infectious, 105 infectious disease, 105 infectious diseases, 105 inflation, 93, 96 informal sector, 96 information systems, 38, 42 infrastructure, 56 injuries, 51, 68

145

injury, iv insight, 123 inspection, 39, 76, 111 inspections, 125 institutional response, 16 institutionalization, 48, 136 institutions, 3, 9, 10, 11, 12, 14, 19, 57, 105, 122, 123, 126, 130, 131, 132 instruction, 42 insurance, 9, 12, 30, 52, 60, 95, 96 integrity, 125 intensity, 35, 86 intentions, 29, 126 interaction, 14, 33, 71, 122, 129 interactions, 20, 134 interest groups, 95 interest rates, 93 interference, 29 intergenerational, 123 International Monetary Fund, 103 international terrorism, 16 internet, 8, 67, 105, 131, 136, 137 interpersonal relations, 17 interpersonal relationships, 17 interpretation, 41, 137 intervention, 27, 29, 32, 33, 34, 35, 37, 40, 41, 44, 69, 79, 82, 89, 91, 106, 113, 128, 130 interview, 15 interviews, 93 intimacy, 71 invasive, 89 investment, 9, 32, 36 investors, 9 island, 82 isolation, 54, 65, 126 Italy, 137

J January, 42, 59 Jordan, 69, 77 judges, 65 judiciary, 9, 65 jurisdiction, 132

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Index

justice, vii, 5, 13, 31, 32, 33, 35, 42, 44, 63, 64, 65, 68, 69, 77, 97, 100 justification, 86

K Keynes, 103 Keynesian, 100, 103 killing, 112 King, 136

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L labeling, 56 labor force, 47 labor markets, 60 labo(u)r, 3, 44, 47, 60, 92, 93, 94, 95, 96, 103, 110 labour market, 3, 93, 94, 95, 96 land, 89 land tenure, 89 language, 7, 8, 13, 18, 19, 53, 69 later life, 49, 50, 52, 53, 55, 59 laundering, 17 law, 81, 132 laws, 88 lawyers, 17 layoffs, 51 lead, 4, 10, 13, 21, 29, 39, 53, 56, 57, 58, 71, 87, 89, 92, 96, 132 leadership, 89 learned helplessness, 113 legality, 79 legislation, 18, 31, 33, 36 legislative, 38, 56 lenders, 9 lens, 14, 16 liberal, 18, 29, 64, 93, 101, 103, 108, 112, 113, 114, 128 liberalism, 3, 6, 64, 102, 103, 104, 107, 108, 109 liberty, 108, 113 life course, 94 life expectancy, 14, 51

lifestyle, 110, 127 lifestyles, 122 likelihood, 33, 51 limitations, 32, 33, 40, 93, 105, 122, 133 linear, 30 links, 34 literacy, 93 living arrangements, 75 living conditions, 103 local authorities, 86 local government, 129 localised, 11, 92 location, 68, 71, 75 London, 6, 16, 21, 22, 23, 24, 42, 43, 44, 61, 75, 76, 77, 78, 79, 98, 99, 100, 114, 115, 116, 117, 134, 135, 136, 137, 138 long period, 49 longitudinal study, 34 long-term, 52, 72, 73 long-term care insurance, 52 loss of control, 51 losses, 9 love, 123 low risk, 34

M macroeconomic, 96 macroeconomic policy, 96 magnetic, iv maintenance, 123, 130 malnutrition, 14, 19 malpractice, 102 management, 5, 16, 18, 28, 29, 31, 33, 35, 41, 50, 52, 61, 63, 64, 66, 67, 68, 69, 72, 73, 74, 77, 79, 89, 92, 93, 94, 105, 106, 110, 111, 129, 131, 132, 134 mapping, 69 maritime, 9 market, 9, 85, 92, 93, 94, 95, 96, 97, 102, 103, 107, 110, 130 marketing, 68 markets, 3, 108, 128 marriage, 131 Marx, 56, 60

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Index Marxism, 116 mask, 85 masking, 85 mass media, 7, 13 mathematical thinking, 9 mathematics, 81 matrix, 17, 133 meanings, 124 measurement, 111 measures, 4, 15, 40, 54, 65, 89, 109 media, 5, 8, 10, 12, 14, 15, 20, 47, 55, 56, 57, 63, 65, 81, 85, 86, 99, 136 medical expertise, 112 medical school, 111 Medicare, 52 medicine, vii, 5, 7, 11, 79, 81, 101, 114, 121, 132 men, 52, 54, 78, 86, 102 mental health, 54, 93, 111 messages, 16 Miami, 47 migrants, 18, 86 Milton Friedman, 103 Minnesota, 66, 78, 114 minorities, 18 minority, 18, 54 minority groups, 18 mirror, 82, 84 miscommunication, 88 misunderstanding, 88 mixed economy, 95, 97 mobile device, 17 mobile phone, 10, 105 mobility, 57 models, 35, 122, 125, 133 modern society, 6, 36, 37, 44, 78, 104, 121, 123 modernisation, 4, 28 modernity, 4, 42, 43, 94, 105, 122, 126, 129 modernization, 3, 11 monetary policy, 93 money, 17, 67 money laundering, 17 monolithic, 130 mood, 15, 20

147

moral judgment, 18 morality, 33 morning, 87 mortality, 14 mortality rate, 14 mothers, 29, 96 motion, 89 motivation, 55, 73, 74, 131 mouth, 85 movement, 12, 17, 28 multiplicity, 123 murder, 136 Myanmar, 8

N Nash, 65, 78 nation, 81, 82, 83, 85, 87, 92 national, 7, 55, 81, 82, 83, 84, 85, 89, 98, 100, 111, 123, 129, 135 national action, 83 national emergency, 89 National Health Service, 110, 130, 136 national identity, 123 national security, 7 natural, 7, 11, 51, 59, 105, 114 natural disasters, 11, 105 natural hazards, 11 natural science, 7, 11 natural sciences, 7, 11 need-based, 49 negative outcomes, 51, 57 neglect, 4, 51, 53, 54 neighbourhoods, 69, 129 neo-liberal, 3, 5, 6, 13, 17, 28, 29, 41, 58, 82, 94, 99, 103, 106, 107, 110, 116, 128, 129 neo-liberalism, 3, 6, 94, 103, 107 New South Wales, 89, 100 New York, iii, iv, 8, 21, 43, 44, 59, 60, 77, 79, 100, 135, 136 New York Times, 79 New Zealand, 65, 77, 78, 100 newspapers, 15, 83 NHS, 110, 111, 112, 114, 115, 130, 135 nodes, 14

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non-profit, 92, 96, 99 norms, 13, 108, 125, 128, 129 North America, 5, 77 NTE, 67 nuclear, 4 nuclear power, 4 nurse, 109 nurses, 69 nursing, 97 nursing home, 97

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O obese, 83 obesity, 83, 84 objectification, 15 objective reality, 81 obligation, 100, 110, 128 obligations, 126, 128, 129 observations, 4 occupational, 94 OECD, 92, 96, 99 offenders, 5, 15, 31, 32, 33, 35, 63, 64, 65, 66, 67, 69, 70, 71, 72, 73, 75, 77, 78 oil, 103 old age, 48, 49, 51, 58, 60 older adults, 5, 47, 48, 49, 50, 52, 53, 54, 55, 56, 57, 58 older people, 47, 48, 49, 50, 52, 55, 57, 58, 60 online, 22 opposition, 13, 68, 131 oral, 96 organ, 16 organization, 10 organizations, 30, 38, 122 orientation, 88, 94, 96 osteopathy, 132, 136 oversight, 56, 92 overweight, 83

P Pacific, 100 paedophilia, 72

pain, 133 pandemic, 14, 97 paper, 38, 75 Paper, 100, 112 paradigm shift, 47 paradox, 123, 130, 132 paranoia, 86 parenthood, 29 parenting, 69 parents, 18, 38, 40, 54, 73 Paris, 99 Parliament, 91 parole, 66 partnership, 133, 137 partnerships, 129, 137 passive, 53, 104 pathology, 34, 40 pathways, 110 patients, 102, 110, 111, 112 PCL-R, 32 pedestrian, 68 penalties, 93 penology, 63, 64, 66, 74, 79 pension, 48, 123, 137 pensions, 7, 122 perception, 16, 51 perceptions, 15, 19, 65, 131 performance, 27, 39, 90, 91, 108, 109, 110, 111, 112, 122 performance appraisal, 109 performance indicator, 108, 110 permit, 89 personal, 9, 13, 17, 29, 33, 37, 53, 71, 73, 93, 105, 106, 107, 108, 113, 122, 125, 128 personal goals, 71 personal identity, 106, 113 personal relations, 105 personal relationship, 105 personal responsibility, 17, 107, 113 personality, 35 persuasion, 131 Philadelphia, 60 philosophers, 105 philosophical, 27, 28 phone, 10, 105

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Index physical activity, 83 planning, 68, 85, 91, 102 plastic, 68 play, 11, 13, 20, 49, 74, 95, 102, 109, 134 poisoning, 84 police, 9, 13, 55, 67, 68, 79, 85, 89 policy initiative, 74, 129, 130 policy makers, vii, 35, 64, 66, 74 political leaders, 102 political opposition, 13 politicians, 9, 13, 16, 17, 66 politics, 10, 11, 88, 134 pollution, 4, 11 poor, 12, 28, 29, 34, 39, 50, 53, 54, 93, 96, 103, 113, 132 poor health, 53 population, 14, 17, 34, 37, 40, 47, 48, 49, 50, 51, 52, 55, 56, 57, 58, 60, 70, 83, 87, 88, 94, 96, 101, 106, 113, 123, 126, 128, 130, 133, 134 pornography, 89 positive correlation, 125 positivist, 107 poverty, 12, 14, 19, 34, 54, 71, 103 power, 4, 12, 19, 20, 58, 103, 107, 123, 125, 128, 131, 132 power relations, 13 pragmatic, 105 prediction, 33, 63, 68 pre-existing, 30 pressure, 87, 90 prevention, 17, 63, 66, 67, 68, 70, 72, 73, 74, 77, 110 prices, 8, 103 primacy, 132 primary care, 111 priorities, 12, 69 prisoners, 90 prisons, 12, 90, 91 private, 15, 29, 36, 48, 56, 90, 91, 96, 99, 110, 127, 128, 130 private sector, 29, 91, 130 privatisation, 29, 82, 90, 103 probability, 9, 14, 30, 41, 51, 54, 57, 122 probation, 32, 64, 66

149

probation officers, 66 problem solving, 90 problem-solving, 78 producers, 105 production, 4, 11, 14, 15, 66, 123 productivity, 49, 109, 111 professional development, 112 professions, 122, 125, 131, 132 profit, 15, 90, 92, 96, 99 progenitors, 12 program, 59, 84, 85, 86, 93, 95 programming, 48 promote, 13, 36, 43, 56, 58, 94, 102, 108, 113, 126, 133 property, iv, 53, 125 property crimes, 53 proportionality, 65 prosperity, 135 protected area, 67 protected areas, 67 protection, 31, 35, 37, 39, 40, 41, 43, 56, 64, 65, 66, 69, 77, 86, 90, 91, 92, 95, 97, 99 protocols, 29, 30, 31, 32, 39, 40, 42, 81 prudentialism, 18 psychology, 107 psychopaths, 71 public, vii, 9, 10, 12, 13, 14, 15, 31, 33, 48, 50, 57, 63, 64, 65, 66, 67, 72, 73, 74, 77, 79, 82, 83, 87, 88, 89, 90, 91, 94, 96, 97, 98, 100, 102, 103, 106, 110, 122, 125, 127, 128, 130, 132, 137 public awareness, 73 public education, 74 public funds, 96 public health, 63, 72, 74, 77, 79, 96, 103, 130, 137 public sector, 50, 137 public service, vii, 88 public welfare, 94 punishment, 31, 33, 65, 78 punitive, 64, 88

Q qualifications, 18

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Index

quality control, 108 quality of life, 15, 31, 51 questioning, 4 questionnaire, 76

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R race, 104 racism, 86 radar, 97 radical, 11, 92, 131 rail, 103 range, 7, 9, 10, 12, 13, 18, 27, 38, 39, 40, 65, 92, 108, 125, 128, 129, 130, 133, 134 rash, 16 ratings, 111 Rational Choice Theory, 75 realism, 19 realist, 11, 13 reality, 52, 87, 113 reception, 90 recessions, 103 recidivism, 31, 32, 66 reciprocity, 126 recognition, 30, 103, 133 reconviction, 33 recovery, 124 red wine, 70 redistribution, 95 reduction, 28, 33, 67, 77, 96 reductionism, 41 reflexivity, 4, 5 reforms, 5, 38, 102, 110, 111 refugees, 86, 87, 88 regeneration, 95 regional, 95 regular, 123 regulation, 9, 12, 17, 28, 29, 68, 69, 106, 109, 111, 112, 123, 125, 131, 132, 135 regulators, 10 rehabilitation, 97 reinforcement, 13 rejection, 72, 105 relapse, 72, 77

relationship, vii, 5, 27, 28, 42, 51, 53, 65, 105, 106, 108, 121, 123, 125, 126, 128, 130, 131, 132, 133, 134 relationships, 13, 17, 36, 40, 103, 105, 109, 122, 123, 124, 125, 127, 129, 130, 133, 134, 137 relevance, vii, 5, 58, 122 reliability, 15 rent, 90 reproduction, 13 reputation, 88 research, 15, 27, 28, 32, 34, 40, 48, 51, 53, 54, 55, 56, 58, 68, 70, 74, 101, 110, 112, 121, 134 researchers, 67 reserve capacity, 130 residential, 78 resilience, 71, 113 resistance, 31, 131 resolution, 19 resource allocation, 111 resources, vii, 4, 29, 30, 31, 34, 39, 40, 41, 48, 53, 70, 73, 105, 106 responsibilities, 4, 48 responsiveness, 88, 97 restructuring, 17 retirees, 60 retirement, 49, 50 retrenchment, vii, 4 revenue, 95 rhetoric, 16, 47, 53 risk assessment, 5, 14, 30, 31, 32, 33, 35, 41, 48, 54, 64, 66, 68 risk factors, 34, 40, 41, 42, 53, 54, 66, 68, 71 risk management, 16, 17, 35, 52, 66, 67, 69, 72, 74, 77, 105, 111 risk perception, 16, 51 risk society, 4, 5, 8, 11, 12, 16, 19, 20, 28, 29, 30, 41, 42, 47, 50, 53, 61, 81, 101, 102, 105, 106, 107, 108, 114 risks, 3, 4, 5, 9, 10, 11, 13, 15, 16, 17, 19, 29, 30, 38, 39, 41, 47, 49, 50, 51, 52, 54, 55, 56, 57, 60, 70, 71, 72, 73, 74, 81, 82, 84, 89, 91, 92, 94, 97, 101, 105 rolling, 29, 102, 110

Powell, Jason L., and Azrini Wahidin. Risk and Social Welfare, Nova Science Publishers, Incorporated, 2009. ProQuest Ebook Central,

Index rust, 126

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S sacrifice, 132 safeguard, 43, 50 safety, 4, 10, 18, 36, 37, 38, 41, 51, 54, 56, 69, 75 SAS, 88 satisfaction, 17 Saturday, 136 savings, 53, 67 scandal, 88 scarcity, 56 scepticism, 105 scholarship, 50 school, 18, 20, 34, 65, 85, 89, 101, 109, 111 scientific knowledge, 30, 126 scientists, 10, 12 scores, 111 search, 28, 55, 93, 106 secondary schools, 85 Secretary of State, 112, 117 secular, 123 security, vii, 7, 8, 9, 11, 12, 13, 15, 16, 17, 19, 20, 36, 50, 51, 52, 54, 89, 94, 95, 96, 101, 113, 123 segmentation, 12 selectivity, 96 Self, 114, 115, 116, 117, 135, 137 self-care, 104, 129 self-help, 106, 129 self-identity, 129 self-improvement, 104 self-interest, 102, 103, 131 self-regulation, 69, 106, 131 Senate, 88 sensitivity, 10 sentences, 64 sentencing, 33, 35, 64, 65, 66 series, 11, 102, 103, 109 service quality, 102 services, iv, vii, 27, 36, 38, 41, 67, 84, 90, 91, 92, 94, 95, 96, 99, 110, 126, 128 SES, 44

151

severity, 12, 51 sex, 32, 63, 65, 71, 72, 73, 74, 75, 76, 78, 79 sex offenders, 32, 65, 72, 74, 75, 76, 78, 79 sexual abuse, 54, 72, 73, 134 sexual assault, 89 sexual offending, 72 shape, 8, 106 shaping, 4, 9, 11, 19, 48, 99 sharing, 4, 38 shelter, 89 shores, 86 siblings, 54 side effects, 12 sites, 31, 92 skills, 29, 30, 32, 40, 42, 69, 93, 124 skills training, 93 smokers, 70 smoking, 70 social anxiety, 53 social behaviour, 8, 35, 39 social capital, 122, 125, 126, 127, 131 social care, 38, 125, 126, 133, 134 social change, 15, 51, 123, 130 social class, 105 social cohesion, 124, 134 social construct, 4, 14 social context, 14, 36, 70, 129 social contract, 36, 82 social control, 45, 57, 131, 138 social environment, 123 social exclusion, 69, 71 social fabric, 128, 130, 133 social factors, 74 social group, 3, 4, 5, 27 social inequalities, 30 social institutions, 10, 12, 130 social isolation, 54, 65 social justice, 41, 97, 100 social life, 106, 107, 108, 121 social norms, 13, 125 social order, 13, 64, 123 social policy, vii, 5, 11, 69, 78, 100, 121, 134, 136, 138 social problems, vii, 12, 21, 28, 50, 94 social regulation, 68

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152

Index

social relations, 6, 51, 109, 121, 122, 123, 124, 133 social relationships, 122, 123, 124, 133 social sciences, 7, 11, 14, 20, 75, 133 social security, 19, 50 social services, 94, 95, 135 social situations, 10 social skills, 30 social skills training, 30 social status, 126 social structure, 104, 105 social support, 48 social systems, 125 social theory, 121 social welfare, vii, 3, 4, 5, 6, 8, 11, 15, 27, 48, 49, 56, 57, 58, 121, 123, 124, 131, 132, 133, 134 social work, vii, 5, 27, 28, 29, 30, 31, 32, 35, 37, 39, 40, 41, 75, 109, 121, 132, 136 social workers, 37, 39, 40, 42 sociocultural, 8, 15, 82 sociological, 3, 11, 81, 82, 104, 114, 126 sociologists, 102, 104, 112 sociology, 3, 50, 101 solidarity, 95 solutions, 28, 94 Soviet Union, 104 Spain, 16 spawning, 66 specter, 8 spectrum, 66, 94 speech, 42 speed, 93 spheres, 48, 107, 108, 110, 129 stability, 64, 123 stakeholders, 138 standards, 51, 91, 108, 109, 110, 111 state intervention, 128, 130 statutory, 74, 91, 130 stereotypes, 57 strain, 39 strategic, 38, 125 strategies, 20, 29, 31, 63, 64, 66, 67, 68, 70, 72, 73, 74, 95 stratification, 104

stress, 11, 110 strikes, 64 stroke, 89 structuring, 132 students, vii subjective, 7, 10, 28, 30, 33, 42, 50, 113 subjectivity, 30, 42, 114 substance abuse, 54 substances, 85 suburbs, 86 success rate, 34 successful aging, 53 suffering, 38, 56, 110 Sun, 65, 98 Sunday, 84, 98 supervision, 37, 57 surgery, 84 surgical, 130 surprise, 10 surveillance, 9, 29, 34, 37, 39, 41, 44, 67, 82, 106, 109, 111, 131, 132, 133 survival, 104, 127 sustainability, 49 Sweden, 100 symbolic, 90, 132 symbols, 16 symptoms, 35 synthesis, 82 systems, 11, 12, 28, 30, 31, 37, 38, 39, 41, 48, 51, 54, 56, 75, 89, 92, 109, 111, 122, 123, 124, 125, 126, 127, 128, 131, 133

T tactics, 123, 127, 131 targets, 17, 39, 48, 58, 68, 110 tariff, 65, 95, 96 taste, 85 taxis, 68 teachers, 13 technological developments, 10 technology, 4, 17, 39, 104, 105, 108 teenagers, 15, 84, 85 teens, 84 television, 84, 86, 106

Powell, Jason L., and Azrini Wahidin. Risk and Social Welfare, Nova Science Publishers, Incorporated, 2009. ProQuest Ebook Central,

Copyright © 2009. Nova Science Publishers, Incorporated. All rights reserved.

Index television stations, 86 temporal, 36 tension, 65, 128 terminals, 92 territory, 88, 99, 109, 137 terrorism, 12, 16, 17, 88 terrorist, 8, 11, 14, 16, 50 terrorist attack, 11, 14, 16, 50 terrorist groups, 17 terrorists, 16 tertiary education, 95 theft, 67 theory, 11, 12, 14, 16, 20, 28, 32, 34, 39, 60, 75, 121, 125, 126, 137 therapists, 71 therapy, 30, 76, 106, 132 thinking, 9, 10, 18, 19, 33, 64, 70 third party, 125 Thomas Hobbes, 103 threat, 9, 16, 27, 33, 36, 42 threatened, 8 threatening, 36, 101 threats, 7, 13, 16, 38, 105 Three Mile Island, 50 threshold, 40, 48, 98 thresholds, 36, 64 time, 7, 10, 31, 39, 40, 49, 52, 66, 67, 68, 72, 88, 90, 91, 95, 96, 102, 103, 106, 111, 122, 124, 130, 132, 133 tolerance, 50, 51, 73 toxic, 12 trade, 69 tradition, 123 training, 18, 30, 67, 93, 101, 106, 111 trajectory, 129 trans, 7, 110 transcript, 87 transcripts, 97 transfer, 17, 90, 91, 92, 94 transference, 17 transformation, 12, 34 transformations, 17, 123 transgression, 50 transition, 11, 60, 104 transmission, 108

153

transparency, 91, 123, 125, 131, 137 transparent, 102, 108, 111 transport, 96 transportation, 68 trauma, 30 trend, 56, 108 trust, 10, 58, 63, 105, 121, 122, 123, 124, 125, 126, 127, 128, 129, 130, 131, 132, 133, 134, 137, 138 trusts, 111, 122 trustworthiness, 125, 126, 128, 129 Tsunami, 8

U ubiquitous, 13, 21, 81 uncertainty, 9, 12, 36, 41, 105, 126, 127 underemployment, 96 unemployment, 18, 93, 96 uniform, 111 Union Carbide, 10 United Kingdom (UK), 5, 7, 8, 15, 16, 18, 27, 31, 34, 35, 36, 37, 59, 63, 65, 68, 69, 75, 76, 77, 78, 101, 103, 121, 126 United States, 58, 60, 75, 78, 90 universality, 17 unpredictability, 123

V Vaccination, 76 vaccine, 10 values, 13, 14, 30, 31, 41, 50, 71, 125, 127, 128, 129, 130, 133 vessels, 86 victimization, 5, 48, 51, 53, 54, 55 victims, 15, 31, 54, 64, 69, 79 Victoria, 37, 43, 44, 89, 90, 91, 132, 136 vigilante, 73 violence, 32, 53, 67, 68, 78, 79, 84, 85 violent, 8, 15, 16, 30, 53, 65, 67, 71, 72 violent crime, 8, 15, 16 violent crimes, 15 violent offenders, 71

Powell, Jason L., and Azrini Wahidin. Risk and Social Welfare, Nova Science Publishers, Incorporated, 2009. ProQuest Ebook Central,

154

Index

visas, 88 visible, 128 voice, 131 vulnerability, 27, 33, 36, 60, 67, 69 vulnerable people, 5, 66

Copyright © 2009. Nova Science Publishers, Incorporated. All rights reserved.

W wages, 95 Wales, 10, 23, 65, 68, 69, 89, 100 war, 94, 103 War on Terror, 22 warfare, 19 water, 87, 103 wealth, 8, 35, 101, 109, 113 weapons, 17 web, 82, 131 weight loss, 84 welfare, vii, 4, 5, 6, 7, 8, 9, 11, 13, 14, 17, 19, 20, 28, 29, 33, 35, 36, 38, 41, 43, 47, 48, 49, 55, 57, 58, 94, 95, 96, 97, 98, 99, 100, 103, 104, 113, 121, 124, 125, 126, 128, 130, 131, 132, 133, 134 welfare state, 28, 48, 94, 95, 96, 97, 98, 103, 113 welfare system, 12, 17, 126, 134

well-being, 37, 38 western culture, 7, 8, 16, 47 Western Europe, 68 Western societies, 15 wholesale, 32 windows, 20 wine, 70, 85 winter, 76 withdrawal, 104, 105 women, 52, 54, 102 work activity, 28, 31 workers, 17, 29, 32, 40, 42, 49, 66, 96 workforce, 32, 64 working class, 97 working conditions, 103, 105

Y young men, 86

Z zeitgeist, 20, 81

Powell, Jason L., and Azrini Wahidin. Risk and Social Welfare, Nova Science Publishers, Incorporated, 2009. ProQuest Ebook Central,