This article was downloaded by: [Lynne Friedli]On: 14 December 2012, A - PDF document

This article was downloaded by: [Lynne Friedli]On: 14 December 2012, At: 03:31Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registeredoffice: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK Critical Public HealthPublication details, including instructions for authors andsubscription information:http://www.tandfonline.com/loi/ccph20 ‘What we’ve tried, hasn’t worked’: thepolitics of assets based public healthLynne Friedli aa Freelance researcher, London, UKVersion of record first published: 14 Dec 2012. To cite this article: Lynne Friedli (2012): ‘What we’ve tried, hasn’t worked’: the politics of assetsbased public health , Critical Public Health, DOI:10.1080/09581596.2012.748882To link to this article: http://dx.doi.org/10.1080/09581596.2012.748882 PLEASE SCROLL DOWN FOR ARTICLE Full terms and conditions of use: http://www.tandfonline.com/page/terms-and- conditions This article may be used for research, teaching, and private study purposes. Anysubstantial or systematic reproduction, redistribution, reselling, loan, sub-licensing,systematic supply, or distribution in any form to anyone is expressly forbidden.The publisher does not give any warranty express or implied or make any representationthat the contents will be complete or accurate or up to date. The accuracy of anyinstructions, formulae, and drug doses should be independently verified with primarysources. 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COMMENTARYWhatwevetried,hasntworked:thepoliticsofassetsbasedpublicLynneFriedliFreelanceresearcher,London,UKReceived25June2012;nalversionreceived29October2012Likeyouwesuffertherelentlesserosionofourlivelihoods,likeyouweareafictedbyanunendingvandalismwroughtuponeventhevaguestdreamforafuturenotdictatedbythosewhowouldkeepusprecarious.Wetooarefacingabravenewworldofausterity,shockeconomicsandclasswar.SolidaritywithClasse,studentprotestofQuebec,UniversityforStrategicOptimism2012Itisaparadoxofrecentepidemiologythatasmaterialinequalitiesgrow,sothepursuitofnon-materialexplanationsforhealthoutcomesproliferates.Atonelevel,agreaterrecognitionofpsycho-socialfactorshasdeepenedthe *Email:lynne.friedli@btopenworld.comCriticalPublicHealth,2012http://dx.doi.org/10.1080/09581596.2012.748882 2012Taylor&Francis 2011,2012a,2012b).Thisissurprising,becausethelanguageofassetsnowpermeatestheliteratureonhealthandhealthinequalities(Harrisonetal.2004;FootandHopkins2010;Foot2012;LindstromandEriksson2010;MorganandZiglio2010;McLeanandMcNeice2012;ScottishGovernmentandHAPI2012),andalsohasastrongpresenceinUKpolicyonpublicsectorreform,aswellasinwiderdebatesonsocialprotectionandpublicserviceentitlement(OSullivanetal.2009;Christie2011;Mair,Zdeb,andMarkie2011;ScottishGovernmentSocialResearch2011).Publichealthisresponsibleforunderstandingandactinguponthedistributionandcausesofpopulationpatternsofhealth,diseaseandwellbeing(Krieger2011,vii).Thismeanspayingspecialattentiontohowideasthatinuencepublichealthpolicyandprac-ticebothexplainthefactofhealthinequalitiesandaccountforwhoandwhatisrespon-(Birn2009).Thesequestionsarealwaysimportant.Theyassumeagreaterurgencyatthistimeofmajorpoliticaldebateabouttheroleandresponsibilitiesofthestateinrelationtohealth,andinthefaceofarenewedneo-liberalattackontheexistingrem-nantsofmarketregulationandthesocialrightsofcitizenship(BeckeldandKrieger2009,153).AsBeckeldandKriegerhaveobserved:Power,afterall,istheheartoftheandthescienceofhealthinequitiescannomoreshyawayfromthisquestionthancanphysicistsignoregravityorphysiciansignorepaineldandKrieger2009,170).Constructslikeasset-basedapproachesemergeandgaincurrencyinspecisocial,economicandpoliticalcontextsandarepressedintoserviceaspartofwiderideo-logicalconicts.Thispaperreectsonthetheoriesofpublichealththatliebehindthediscourseofassets,andaskswhytheassetsmovementhasjoinedtheattackonpublicsectorprovision,ratherthanaddressingthehealthimpactofcorporatepower.Italsocon-siderssomeofthereasonsfor,andconsequencesof,itsgrowingpopularityanduence,notablyinScotland,whereassetapproachesenjoystrongsupportfromthechiefmedicalofcer(ScottishGovernment2010,2011a,2011b;McLean2011;SCDC2011).nitionsofassetsAssetbasedapproachesareconcernedwithidentifyingtheprotectivefactorsthatsupporthealthandwellbeing.Theyofferthepotentialtoenhanceboththequalityandlongevityoflifethroughfocusingontheresourcesthatpromotetheself-esteemandcopingabilitiesofindividualsandcommunities.(McLean2011,2)Asset-basedapproachesareessentiallyaboutrecognisingandmakingthemostofpeo-sstrengths,toredressthebalancebetweenmeetingneedsandnurturingthestrengthsandresourcesofpeopleandcommunities(McLean2011,2),withacorre-spondingshiftinfocusfromthedeterminantsofillnesstothedeterminantsofhealth(salutogenesis).Althoughassetscanincludematerialresourcesland,buildingsandincome(Aradon2007;Cooke2010;ScottishGovernment2012)inpublichealth,moretypically,theprimaryfocusisonvaluingindividualandcollectivepsycho-socialattributes.Theseincludethefamiliarroll-callofselfesteem,aspiration,conoptimism,senseofcoherence(SOC),meaningandpurpose,theso-calledintangiblesuchasknowledge,skills,wisdomandculture,andkeyfeaturesofsocialcapital:socialnetworks,reciprocity,mutualaidcollectiveefLeary2006,2011;FootandHopkins2010;LindstromandEriksson2010).Asset-basedapproachesdrawonpositivepsychologyandtheworkofAntonovskyonSOC(Antonovsky1987;Seligman2003),aswellasontraditionsofcommunitydevelop-L.Friedli ment(McKnight1995,2010;OLeary2006)andhealthactivism,notablyinthedisabilityrights,user/survivorandrecoverymovements(Duffy2010a,2011;BoardmanandFriedliinpress).AlthoughAntonovskysanalysisacknowledgesthatpsychologicalattributesarestronglyinuencedbymaterialandsocialfactors(describedasgeneralisedresistanceresources),itistheconceptofsenseofcoherencethatdominatesintheassetsliterature.Basedonempiricalstudiesofpsychologicalresilienceinthefaceofprofoundadver-sity,AntonovskyarguesthatthepresenceorabsenceofSOCthebeliefthatlifeiscomprehensible,manageableandmeaningfulisfundamentaltounderstandinghealthylifeoutcomes,notwithstandingtheexperienceoftrauma.Individualswhoexperiencelifeasstructured,predictableandexplicable,whoarecondentthattheyhavetheresourcestomeetdemandsandwhobelievethatsuchdemandsarechallengesworthyofinvest-mentandengagementarethussaidtobeconsistentlymorelikelytohavepositivelifeoutcomes(Antonovsky1987;LindstromandEriksson2010).AnycorrelationbetweenSOCandbetterhealthisunsurprising.Themarkedsocialgradientinbothmentalillness(e.g.postnataldepression,anxietyandpsychosis)andlevelsofmentalwell-being(e.g.WarwickEdinburghMentalWell-beingScale)suggeststhatpsychologicalattributeslikeSOCarestronglylinkedtosocialposition(McManusetal.2009).Whatismore,whichattributesattractsocialvalueandeconomicrewardishighlyideological:hence,capital-ismincrisisprefersindependencesolidarity(Bauman2007).However,itisnotclearthatSOCisxed:oneve-yearfollow-upstudyfoundthatSOCisnotstable,andthatthelevelsignicantlydecreasesafteranegativelifeevent(Volanenetal.2007;Volanen2011).EvenastrongSOCdecreasedduringthefollow-upperiodandwasnomorestablethanamediocreorweakSOC.Theauthorsug-inthelightofthepresentstudy,itseemsthatSOCisdeterminednotonlybysocio-economicfactorsbutalsobycloseandsuccessfulsocialrelationshipsduringbothchildhoodandadulthood(Volanen2011,3,emphasisadded).Antonovskysworkispartofabroaderliteratureonwell-beingandresilience,andesthegrowinginuenceofpsychologicalandculturalexplanationsforhealth(forreviewsofcompetingtheoriesseeMcCartneyetal.2011;Mackenbach2012).Muchofthesupportforassetsapproachesispredicatedontheviewthatcondenceandself-esteemaredeterminantsofhealthandotheroutcomes.Marmotassertsthattakinganasset-basedapproachatalocallevelfostersgreaterlocalcondenceandself-esteemforpeopleandcommunities(Foot2012,3)althoughevidencetothiseffectisentirelyanecdotal.Asiswidelyacknowledged,thereisnopublishedevidencethatuseofabroadassetsbasedapproachcansuccessfullypreventorreversethemainavoidablecausesofill-health(NHSHealthScotland2012,3;seealsoMacKinnon,Reid,andKearns2006;McLean2011).Whatareavailablearecollectionsofcasestudiesthatinmanycaseshavebeenretrospectivelylabelledassetbased(McLeanandMcNeice2012).Astheauthorsmakeclear,theseexamplescannotanswerquestionsabouteffec-tivenessonewayortheother,althoughtheydoillustratehowquicklylocalprojectswilladoptalabelwhenithaspowerfulsupport.Nevertheless,lackofevidencehasnotpreventedadvocatesfromstatingthatitisjustiedtobeveryoptimisticaboutthepotentialoftheassetbasedapproach(Hills,Carroll,andDesjardins2010,97).Assetapproachesreectandreinforcetheviewthatthepsychologicalattributesofindividualscanbeextrapolatedtoexplainwhatishappeningtohealthatapopulationorsystemiclevel.Inotherwords,ananalysisofpsycho-socialfactorscanfunctionasanalternativetoaddressingquestionsofpowerandprivilegeandtheirrelationshiptothedistributionofhealthandthepoliticalproductionofsocialinequalities(Muntaner2004;Phelan,Link,andTehranifar2010;Friedli2012c).Likethewiderwell-beingCriticalPublicHealth debates(Friedli2009;ONS2011;Stoll,Michaelson,andSeaford2012),assetapproachesarestronglyassociatedwithanon-materialistpositionmoneydoesnotmatterasmuchasrelationships,senseofmeaningandbelonging,opportunitiestocon-tributeandautonomy:theresadifferencebetweenstarvingandfasting(Sen1992).Theimportanceofthepsycho-socialdomainisalsocentraltocritiquesofconsum-erism,materialismandthedominanceofmarketisedsolutionstohealthandsocialproblems(Michaelsonetal.2009).TheStiglitzReportcallsformeasuresofsocialprogressthatincludenon-marketactivities,sustainabilityandqualityoflife,asdoestheOECDGlobalProjectonMeasuringtheProgressofSocieties(ONS2011;Stiglitz,Sen,andFitoussi2009).Thesecritiquescometogetherincallstovaluethecontributionofthoseoutsidethemoneyeconomy:thecoreeconomyoffriends,family,neighboursandcivilsociety(Cahn2004).Itisnotablethattheassetsliteratureplacesahighvalueonvolunteering,forexample,andonalternativecurrencieslikeTimeAgreaterfocusonpsycho-socialfactorsispartofawideracknowledgementofthenonmaterialdimensionsofdeprivation,perhapsmostfamouslyinAmartyaSencallfortheabilitytogoaboutwithoutshametoberecognisedasabasichumanfreedom(Zaveleta2007).Peoplelivinginpoverty,aswellasothervulnerableorexcludedgroups,consistentlydescribethepainofbeingmadetofeelofnoaccount,whichisoftenexperiencedasmoredamagingthanmaterialhardship(Nussbaum2011).Fromthisperspective,inequalities(thelivedexperienceofinjustice)greatlyexacerbatethestressofcopingwithmaterialdeprivation(WilkinsonandPickett2006,2009).Whatisatstakeisthesocial,emotionalandspiritualimpactofpovertyandinequality,aswellasthebeliefthatwellbeingdoesnotdependsolelyuponeconomic(Sen1992).Intheirresistancetocitmodelsandtheirinsistenceonrecognisingandvalu-ingstrengths,asset-basedapproachesalsodrawonradicaltraditionsincommunitydevelopment:Theyspeaktotheresistanceofdeprivedcommunitiestobeingpathologised,criminalised,ostracised;tobeingdescribedinpublichealthreportsintermsofmultipledecitsanddisorders:chaotic,unengaged,anddisaffected(Friedli2011,2).Thesethemesareanimportantelementofworkonassets-basedcommunitydevelopmentbyKretzmannandMcKnight(1993),whicharguesthatbydecommunitiesintermsofdecits,servicesexploitneedandproduceclients,whereascommunitiesproducecitizens(McKnight1995,2010).Strengthsbasedapproachesarealsocentraltotherecoveryanddisabilityrightsmovementsandtheprinciplesofrespectforpeoplesselfdetermination,choice,controlandpotential,aswellasforsupportthatdoesnotunderminecitizenshipthemesthatndexpressionindebatesaboutpersonalisation(Duffy2010b,2011).Thesocialvaluesassociatedwithasset-basedapproachescelebrationofthepowerofthehumanspirit,recognitionofpeoplesstrengths,resourcefulnessandcreativityandtheempoweringnatureofcollectiveactionhavealonghistoryandarecommonfeaturesofsocialmovementsandtraditionsofstruggleforsocialjustice(Freire1972).Fromapublichealthperspective,thesevalueshavebeengivenaddedimpetusbygrowingevidencethatsocialindicatorsareconsistentlyemergingasmorecanttopopulationhealththanhealthbehaviours(Holt-Lundstadt,Smith,andLayton2010;Jutteetal.2010;HertzmanandSiddiqi2009).Theproblemwiththeassetsliteratureisthatrespectforpeoplescapacityforresistance(generallydescribedresilience)isabstractedfromanyanalysisofsocialinjusticeorthecausesofinequalities:namingwhoandwhataretheforcesandinstitutionscreatingandL.Friedli perpetuatinginequitableconditionsintherstplace(Birn2009).Sowhatemergesisanattempttoreproduce,inpoorercommunities,psycho-socialassetsthatareinfacttiedtomaterialadvantage,whileleavingpowerandprivilegeintact(Bourdieu1977).Thesilenceaboutpoliticalstruggle,andthemarkedabsenceofeithertradesunionsorstreetprotestsfrompublichealthsiterationofassetapproaches,precludesanyconsid-erationofhowSOC,forexample,mightbeforgedthroughtheexpressionofclasssolidarity.Oneexplanationforthisfailurebyomissionistheassetmovementdisproportionatefocusontheoperationofthewelfarestate,asopposedtotheoperationsofthemarket.Thisisevidentintheircentralpropositionthatpublicservicesgenerateneedandproducedependency.RationaleforassetsbasedapproachesWithstrongsupportfromtheChiefMedicalOfcer,theassetbasedapproachisnowbeingendorsedacrossScottishGovernmentandisbeingpromotedforuseacrossallsectorsandacrossthenationalframework(NHSHealthScotland2012,1)Therationaleforadoptingassets-basedapproachesincludesthreecoreprinciplesfocusonthedeterminantsofhealth(ratherthanillness);(2)startwithwhatpeoplehave(notwhattheylack);and(3)emphasisethecontributionofpsycho-socialfactorstohealthoutcomes.InScotland,thecentralargumentsarebroadlyasfollows:publichealthapproachestoreducinghealthinequalitieshavefailedvetried,hasntworked(ScottishGovernment2010)publicservicesareinefcientandunaffordable,requiringaradicalchangeindesignanddelivery(Christie2011,26)citapproaches,byfocusingonpeoplesneeds,ratherthantheirstrengths,pro-ducedependency(SCDC2011)ThepersistenceandwideningofhealthinequalitiesintheUK,notwithstandinganostensiblyfavourablepolicyenvironmentundertheNewLabourgovernment,(Mackenbach2011;BlakeleyandCarter2011)havebeenfrequentlycitedtosupportthecaseforasset-basedapproaches.MorganandZigliosuggestTheassetmodelmayhelptofurtherexplainthepersistenceofinequitiesdespitetheincreasedeffortsbygov-ernmentsinternationallytodosomethingaboutthem(MorganandZiglio2010,4),apointechoedbyFoot,whoarguesthatcurrentapproachestoimprovinghealthhavenotmadetheimpactonhealthinequalitiesthathadbeenanticipated(2012,9),andbyScotlandsCMO(ScottishGovernment2010).ThisviewhasaparticularresonanceinScotland,whereastrongbodyofresearchsuggeststhatneitherdeprivationnorlevelsofmaterialinequalitycanfullyaccountforScotlandspoorhealth.Ashasbeenwidelycommentedupon,theriseinmortalityinGlasgowsince1980isgreaterthaninMan-chesterandLiverpool,theothermostdeprivedcitiesintheUKanditremainsunclearwhatexplainsGlasgowsrecentexcessmortalityfromdrugs,alcohol,suicideandvio-lence,largelyamongworkingageadults(McCartneyetal.2011).Atthesametime,theassertion:whatwehavetriedtodate,(althoughwellmeaning),hasnotworkedtishGovernment2010,7)raisesimportantquestionsaboutwhatitis,exactly,thatpub-lichealthhastriedandinwhatcontext.CriticalPublicHealth AssetsandinequalitiesAssetsapproachesinviteindividualsandcommunitiestotakecontrolofmanagingpositivechangestotheircircumstancesbyco-producingtheinterventionsbywhichtheycanbesupportedoutofpoverty.(ScottishGovernment2011a,9)Whileitistruethattherehavebeenmanyeffortstoaddresshealthinequalities,therehasbeenamarkedfailuretoacknowledgethattheseeffortshaveoccurredinthecontextofrisingmaterialinequalities(Mackenbach2012)withincomeinequalitieslargelydrivenbywageinequalities.AlthoughthesetrendsoccuracrossEurope,incomeinequalityhasrisenfasterintheUKthaninanyotherOECDcountrysince1975,over-takingtheUSAinthe1990sandagainin2000.Inthedecadeupto2010,incomeinequalitiesintheUKwidenedsignicantly,drivenbyasharpincreaseintheincomesoftherichest(OECD2011;Cribb,Joyce,andPhillips2012).Thesamepattern,althoughslightlylessmarked,isevidentinScotland,whereincomeinequalityhaswid-enedsincedevolution(McKendricketal.2011).ThismeansthesharpinequalitiesoftheThatcheryearsandtheproblemsassociatedwiththemremain,exacerbatedbyevengreaterinequalitiesatthetopofthedistribution.Althoughrelativepoverty(beforehousingcosts)fellslightlyduringthe1990sandlargelycontinuedtofallupto20092010,ratesarestillwellabovethe1979gureof13.4%ofthepopulationlivinginpoverty(Cribb,Joyce,andPhillips2012).Itisdifculttopredictfutureincomeinequalitytrendsbecausemuchoftheimpactofcutsinwelfarebenetsisstilltocome(Cribb,Joyce,andPhillips2012),butincomeinequalityintheUKiswellabovetheOECDaveragetheGinico-efcientiscur-rentlyclosetoitshighestpointsince1961(OECD2011).Thisisnotaccidentalbuthasbeendrivenbyneo-liberalpolicy(Scambler2007).Sincethemid1980s,UKtransfersandtaxeshavebecomelessredistributive,benetshavebecomelessredistributive,tamountsaredeclining,eligibilityismorerestrictiveandmorepeoplearework-ingatlow-wagejobs:Britainhasoneofthehighestproportionsoflow-paidworkersinthedevelopedworldandtheshareoflow-paidworkintheBritishlabourmarkethasgrownsteadilyoverthepastthreedecades.(OECD2011;Cribb,Joyce,andPhillips2012;PennycookandWhittaker2012).Britainalsohassomeofthelowestsocialmobilityinthedevelopedworld,withearningsintheUKmorelikelytoreectthoseofourfathersthaninanyothercountry(CrawfordandMachin2011).Againstaback-groundofthegrowinggapbetweenrichandpoor,growingwageinequality,adeclineinthelivingstandardsoflow-andmiddle-incomehouseholdsthatlongpredatesthecurrentrecessionandincreasinglevelsofinsecurityandprecariousnessforhouseholdsbelowmedianincome(Hirsch,Plunkett,andBeckhelling2011;PennycookandWhit-taker2012;WhittakerandBailey2012),itisnotdifculttoidentifyplausiblereasonswhyinequalitiesinhealthhavealsoincreased.Ofcourse,incomeinequalityisnottheonlydriverofhealthandotherinequalities,butthesilenceoftheassetsmovementontheimpactofmajoreconomicshiftsonpeoplelivesisaseriousshortcoming.Thefocusonwelfareobscureswhatishappeninginthemarket.Forexample,thefailuretoanalysethehealthimpactofthefollowingtrends:sharpinequalitiesinthedistributionofthebenetsfrompreviousperiodsofeco-nomicgrowthgrowingwageinequalitytheshiftfromwagestoproL.Friedli fallsinrealearningstheriseincommoditypricestheriseinwomensemployment,whichhashelpedtosustainhouseholdincomesforlow-andmiddle-incomehouseholds,(whileincomefrommensemploymentfellsignireducedopportunitiesfororganisedresistancetopoorpayandworkingconditions(Cribb,Joyce,andPhillips2012;PennycookandWhittaker2012;WhittakerandBailey2012).InthecaseofScotland,forallthetalkofacultureofdependency,laboursupplyisoutstrippingdemandastherearecurrentlymorepeoplethanjobs.Therearemorepeo-plewithqualicationsthantherearejobsthatdemandthosequalicationsforentry(ScottishGovernmentSocialResearch2011,58).Otherfactorsimplicatedinincreasingorreinforcinghealthinequalitiesincludetheriseinspatialinequalitiesgentrithedisproportionateimpactofmotorvehicletrafconthepoorestcommunities,thepsycho-socialeffectsofgeographicalsegregationandtheprivatisationofpublicspace(Smith2002;Minton2009;Dorling2010;Slaterinpress).Therelativecontributionofpsycho-socialvs.materialfactorstohealthinequalitiesisalong-standingandongoingdebate.TheCommissiononthesocialseterminantsofhealthhasarguedthathealthinequalitiesareasymptom,anoutcome,andofinequali-tiesinpower,moneyandresources(CSDH2008;SolarandIrwin2011).Thesestruc-turalandmaterialinequalitiesresultinunequalexposure,bysocialposition,toarangeofhealthrisksandhealthadvantages.Animportantemergingliteraturehasalsocalledforagreaterfocusonpoliticalanalysisgoingbeyondsocialprocessesandthebiolog-icalimpactofstatushierarchiestoconsiderunderlyingpoliticalandeconomicsystems.Inotherwords,inequalitiesarenotaccidental(BeckeldandKrieger2009;CollinsandMcCartney2011;Krieger2011).Centraltotheseaccountsisanacknowledgementofclasspower,vestedandcompetinginterestsandtheirexpressioninstrugglesaroundemployment,pay,income,socialprotectionandhousing,orwhatBirndescribesassocietaldeterminants:howhealthisshapedbythepoliticalandeconomicinterestsofthosewithpowerandprivilege(Birn2009).Theseissuesarecompletelyabsentfromassetsdiscourse:perhapsbecauseencouragingcommunitiestoreectoninnerandinnateresourcesstartingfromwhattheyhave,ratherthanwhattheylacktoprecludequestionsaboutthedistributionofwealthandtheproductionofpoverty,inScotlandandelsewhere.Nevertheless,thinkingaboutpoliticaldeterminantsraisesques-tionsaboutwhytheprimaryfocusofassetapproachesisonpublicservices,ratherthanoncorporatepowerandthehealthconsequencesoftheUKsespeciallyunfetteredfreemarket(MacKay2011).AttacksonstateprovisionAssetsbasedapproachesarebeingusedbothtohighlightthefailingsofthepublicsec-torandtoreinforcetheviewthatthewayinwhichpoorpeoplemakeuseofwelfarets(incomeandservices)ismorallyawed(Friedli2011).Ourthreesocialframeworks(EquallyWell,AchievingourPotentialandtheEarlyYearsFramework)promoteanassets,ratherthanadecits,approach,totacklingpovertyandinequality.Thismeansbuildingthecapacityofindividuals,familiesandcommunitiestomanagebetterinthelongerterm,movingfromwelfaretowellbeingandfromdependencytoselfdetermination.(ScottishGovernment2011b,7)CriticalPublicHealth Therearetwomainstrands:rstly,theargumentthatpublicserviceshavefocussedontheproblems,needsanddeciencieswithincommunities(McLean2011,5)andsecondly,thatthisfocushasengenderedacultureofdependencythatstimulatesdemand(ScottishGovernment2010;SCDC2011,2).ImplicitinthisdiscoursearebeliefsdatingbacktothePoorLaws,namelythatsocialprotectionresultsinmoralandspiritualdeclineandthattakeupofwelfareisdrivennotbymarketfailure,butbycertaincharactertraitsdependencyandcopingstyle.(Friedli2011,11)Themovefromwelfaretowell-beingalsosignalsthatassetsbasedapproachesarepartofeffortstoreduceunaffordabledemand,toachievepublicspendingcutsandtopromoteaDIYresponsetolossofservicesandlossofbeneafocusonposi-tiveability,capabilityandcapacityleadingtolessrelianceonprofessionalservicesandreductionsinthedemandforscarceresources(McLean2011,9).AstheScottishGovernmentnotesinitschildpovertystrategy,Webelievethatsustainableimprove-mentsinpeopleslifechancesaremostlikelytobeachievedbyidentifyingandsup-portingthedevelopmentoftheirowncapabilitiestomanagetheirwayoutofpoverty(ScottishGovernment2011a,9).Inthisway,notonlyispovertyseenasanindividualmisfortune,(ratherthanthesystemicoutcomeofaparticulareconomicmodel),butthedebateaboutpublicservicesandthepublicsectorisframedintermsthatstigmatiseneeddependencyasmoralfailing,notasafactofthehumancondi-tionorevenareminderofwhatittobehuman.Therecurringleitmotifofthedependentpooralsoservestodisguisethenatureandextentofstatebenetsenjoyedbytherich:scalandeconomicpoliciesthatsupporttheprivilegesofwealth:land,property,inheritanceandcapitalgains.Forexample,thetaxexemptiononprivateeducationenjoyedbythe7%ofchildrenintheUKwhogoontobecome70%ofhighcourtjudges,onethirdofMPs,50%ofFTSE100ChiefExecutivesand50%ofmedicalconsultants(GuardianDatablog2012).Thepointis,ofcourse,thatbothrichandpoordependontheprevailingeconomicsystem,butwithratherdifferentconse-forhealthandotheroutcomes.Theextenttowhichthepublicsectorisimplicated,astheassetsliteraturesug-gests,inthefailuretoreducehealthandotherinequalities,raisesimportantissues.Thereisnowgrowingevidencethathealthservicesinuencepublichealthandthatpublichealthsystemsareunder-acknowledgedasadeterminantofhealth(Rasanathan,VillarMontesinos,andMatheson2011;SolarandIrwin2011).Atthesametime,toattributehealthinequalitieslargelytotheshortcomingsofthepublicsectorservestominimisetheimportanceofthemarketandthehighlydifferentialimpactofwiderglo-baleconomictrends.Whenproblemsareframedintermsofthecitapproachprofessionalsandacultureofdependencyamongthepoor,hardquestionsaboutcor-poratepowerareavoidedandtheneo-liberalattackonthevaluesofcollectiverespon-sibility,pooledriskanduniversalservicesgoesunchallenged.Blamingthepublicsectorthepublicservicesthatarebothpickingupthepiecesandpickingupthetabprovidesideologicalsupportfortheretreatofstateprovisionandletunregulatedfreemarketcapitalismoffthehook.Italsoappearstobeunsupportedbytheevidence.guresshowthatpublicservicesreduceinequalitiesintheUKmorethanalmostanywhereelse,andthisimpactincreasedoverthe2000s(OECD2011).Againstalltheodds,publicserviceshaveimprovedtheirimpactonreducinginequali-ties.Whilethereisalwaysacaseforimprovingservices,itisnotaradicalchangeinL.Friedli thedesignanddeliveryofpublicservices(Christie2011,26)thatisrequiredsomuchasaradicalchangeineconomicandscalpoliciesthatinScotland,aselse-where,sanctiongrossinequalitiesandobscenegreed(RiodeJaneiroDeclaration2011).ConclusionsAssetmodelstendtoaccentuatepositivecapabilitywithinindividualsandsupportthemtoidentifyproblemsandactivatetheirownsolutionstoproblemstheyfocusonpromotinghealthgeneratingresourcesthatpromotetheselfesteemandcopingabilitiesofindividualsandcommunities,eventuallyleadingtolessdependencyonprofessionalservices.(ScottishGovernment2010,7)Theradicalagendathatperhapsoriginallyinspiredcommitmenttoassetbasedapproachesstillneedsaddressing.Thisincludestherelationshipbetweenpublicsectorprofessionalsandthecommunitiestheyserve,thedemocraticdecitandabandonmentofareasofdeprivationbyboththemarketandthestate,steepincomehierarchieswithintheNHSandthesocial,materialandemotionaldistancebetweenthosewhodesignpublichealthinterventionsandthosewhoexperiencethem.Internationalcomparativestudiessuggestthat(therespectwereceivefromothers),controluenceoverthethingsthataffectourlives)andafliation(senseofbelonging)areuniversaldeter-minantsofwellbeing(KennyandKenny2006;Samman2007).Publichealthneedstopaymoreattentiontothefactorsthatinjuretheseneedsandthehealthimpactofinju-riestotheseneeds,underminingwhatSenhascalledthefreedomtoliveavaluedlife(Nussbaum2011).Butintheseeffortstoaddressthemissingdimensionsofpovertyanddeprivation(Samman2007),thedistributionofeconomicassetsisstilloffunda-mentalimportance.Thereisalinkbetweenlivingconditionsanddignity.Theideaofjusticeisparamount(Nussbaum2011).Theassetsliteratureincludesawiderangeofcasestudiesdescribingwhatcommu-nitieshaveachieved,inthefaceofconsiderableadversity,throughfocusingonassetsandadoptingstrengthsbased,glasshalffullapproaches(FootandHopkins2010;Mor-ganandZiglio2010;SCDC2011;Foot2012;McLeanandMcNeice2012).Theemo-tionalimpactofstoriesoftransformationlikethewidelycitedBeaconandOldHillestateinCornwallispowerful(Durie,Wyatt,andStuteleyundated;Friedli2011).Areminder,wherethatisneeded,thatmateriallydeprivedcommunitiesarerichinrela-tionships,resourcefulnessandcreativity.Thatcomingtogethertochangethingsforthebetterisinspiringandempowering.Manysuchprojectsprovideanurgentlyneededsanctuary,arefugefromgrimcircumstancesandrespitefromclassdisadvantage.But,itistheresponsibilityofpublichealthtodistinguishbetweenprovidingescapeforsomewhileleavingthesystemthatproducestheneedforescapeintact,andprovidingleader-shiponaddressingthedeterminantsofhealth.AsJohnMcKnight,foundingfatherofasset-basedcommunitydevelopmentrecentlyobserved:Wemustemphasiseagainthatthelocaleconomiccapacityforchoiceandsustenanceisthethresholdpolicyissue.Forwehaveeconomicallyabandonedfartoomanycommunitiesandleftatseathosecitizenswhohaveremained.Itisthesefellowcitizensandtheireconomicdilemmathatistherstpolicyissueofthetwenty-rstcentury.(McKnight2010,76)CriticalPublicHealth Ashasbeennoted,asset-basedapproachesalsodrawonthelanguageofrecovery,whichtraditionallyadoptedastrengths-basedlexiconasaformofresistancetotheimpositionofpsychiatriclabelsanddiagnosticcategories(Campbell2005).Bycontrast,theassetmovementemployspsychologicalconstructsthatvalidateaveryspecicandnarrowrangeofattributes:selfefcacy,aspiration,condence,optimism,positivethinking,agency,selfreliance,resilience.Thesecharacteristicsarefrequentlydescribedintermsofmentalwell-being,andareusedtoexplainhealthbehavioursandtoreinforcebehaviouristapproaches.Thediscourseofassetsmakesnoacknowledgementofthecon-testednatureofwhatconstitutesmentalhealthandmentalillness,ortherelationshipbetweenmultipleexpressionsofalienation,despairandselfharm,andexperiencesofoppressionandexploitation(SurvivorsHistoryGroup).Whilepublichealthralliestothecrythatfocusingonthepositiveisapublichealthinterventioninitsownright(Stewart-BrowncitedinFoot2012),complexquestionsareavoided;forexample,questionsaboutthesocialgradientinmentalillnessandinrecoveryfrommentalillness(Lorantetal.2003;HauckandRice2004;McManusetal.2009)andaboutthewiderstructuralfactorsthatinuenceindividualmentalillnessjourneys:individualandcollec-tiveexperiencesofpain,angeranddemoralisation.Instead,therapiesthataimtochangehowpeoplethinkareenthusiasticallycommissioned:itismoreimportanttobepositivethantohaveanaccurateperceptionofreality.Symptomsarereclassiedascauses:somethingwithinthespiritofindividualslivingwithindeprivedcommunitiesthatneeds(SCDC2011,3).Perhaps,themajorproblemwithpublichealthsuncriticaladoptionofasset-basedapproachesisthatitfailstodistinguishbetweenaradicalcritiqueofwelfare,onethatrmlylinkedtoananalysisofneo-liberaleconomicsandtheneo-liberalattackwelfare,whichbycontrast,supportsthefurtherde-regulationofmarketsandwithdrawalofthesocialrightsofcitizens.Ifthestrengthoftheassetsmovementisthatithasgenerateddiscussionaboutre-dressingthebalanceofpowerbetweenthepublicsector,publicservicesandlocalcommunities,itsfatalweaknesshasbeenthefailuretoques-tionthebalanceofpowerbetweenpublicservices,communitiesandcorporateinterests.Assuch,asset-basedapproachessoundthedrumbeatfortheretreatofstatutory,stateprovisionofbothpublicservicesandpublichealth.AcknowledgementsMythankstoMargaretCarlinforthepoliticsofworkingclassenlightenment,forherveryconsiderablecontributiontotheideasexpressedinthispaperandforhercommentaryandcriticalinput.ThispaperisdedicatedtothememoryofmybrotherChristianFriedli.1.EarlyversionsofthispaperwerepresentedatthePovertyAllianceUnderstandingPovertySeminarSeries:CommunityAssetsandPoverty(http://www.youtube.com/watch?v=dHC-SiZkjJk)andtheSocialistHealthAssociationHealthInequalityinScotlandandEngland(http://www.sochealth.co.uk/events/inequality/)andappearintheScottishAntiPovertyReviewWinter2011/12.2.http://universityforstrategicoptimism.wordpress.com/2012/06/10/london-plan-c-support-night-for-classe-quebec/.3.MargaretCarlinpersonalcommunication.4.TheSurvivorsHistoryGroupPageantofSurvivorHistoryL.Friedli 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