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    The crises in health and social care are rightly at the forefront of people’s anger about the government’s lack of preparation for an inevitable pandemic, as we now face with Covid-19. People are dying unnecessarily. An integral element, simmering under the surface, is the fragmentation of public health nutrition services that should provide food security within our communities so vulnerable people are kept in good nutritional status. Yet even before this crisis there was an estimated 3 million malnourished people, with an aging population this will increase, and 8 million people in food insecurity. As lockdowns began, research from the Food Foundation estimated 3 million households were already experiencing hunger. Inequalities underpin the right to life in this crisis: mortality rates for people living in deprived areas are double that for those in less deprived areas, and interlocks with ethnicity. Some highlight ‘obesity’ but is not the problem food and health inequalities? Poverty underpins people’s lack of access to foods of good nutritional quality. Rising poverty levels are driven by erosion of welfare state and neoliberal restructuring of our economy through deregulation, precarity and low pay. Child poverty has increased by 100, 000 over the past year with around 30% of all children living in poverty. Food poverty is increasing and requires structural change not short term solutions. To protect child health and meaningfully tackle poverty a host of fiscal steps are urgently required to enable families to buy food, such as basic living income and immediate action to increase welfare. This does not remove the need for a food security system that ensures a basic level of socially acceptable nutrition is available for all; that includes universal free school meals and hot meals for older people. Public health nutrition is more than just food. It’s about ‘social’ nutrition: the infrastructure of community resources that enable people to eat together and to collectively care.

    The networks of care within our communities have broken down as the infrastructure providing services and civil spaces have closed. There is little research that documents how the spending cuts and restructuring within public health has impacted public health nutrition. However, research is underway that aims to inform the inevitable public enquiry on Covid-19. As socialists, we need to go further and give a call to action to stop further privatisation and charitisation of PHN. Fundamentally, the interests of private industry and charity conflict with the welfare state. Despite the altruism of many involved, these organisations cannot meet current or future needs which will increase in the looming economic depression. They cannot enable the voices of those who are suffering in our communities.

    Privatisation of PHN began under New Labour as food companies were brought into public health policy. From the 2000s non-NHS providers entered PHN. Local government spending cuts and austerity hit prevention budgets including nutrition-based, child weight management and life style interventions. Cuts to nutrition-related services are broadly felt because nutritional health is cross-departmental involving education, community engagement, adult and children and young people’s services and a range of professions including health visiting. Nutrition was embedded in the Sure Start programme. Since 2010, 1000 children centres have closed as £1 billion has been cut from budgets. The number of community centres, lunch clubs and meals on wheels for the elderly has been decimated. In this crisis, the role of schools in feeding children has shown their centrality in community life. Yet there are barriers due to privatisation that limit a strategic approach. For example, in most neighbourhoods, schools have the only industrial kitchens capable of preparing and distributing foods to large numbers of people. Yet access to these is mostly controlled by private food companies, including multinationals, that hold the catering contracts. So, in many ways communities are isolated, disconnected from power and the resources to enable local solutions. Social theorists argue that ‘austerity localism’ brought cuts, disempowered local communities creating distrust and disconnect with local government. Community involvement is further limited by democratic deficits that are created by material constraints and lack of structural mechanisms. All this suggests that it will be harder for public health to connect with communities and understand the scale of their need. While not supporting the authoritarian Chinese State, community engagement was integral to the Chinese response.

    Responsibility for public health nutrition lies with local government who have enlisted third sector organisations (TSOs), social entrepreneurs, and food industry to construct the state’s food aid response in this emergency. From a dietetic standpoint, it is concerning that food banks can distribute foods that may unintentionally cause harm. For example, food banks only need warn of potential allergens, if they are set up as a business.  Food banks can distribute infant formula. This is risky  for example, for vulnerable families with complex needs and should not be the responsibility of food banks. It suggests a lack of a cross-departmental strategic approach that links with professionals such as nutritionists and health visiting teams.  Providing food at the general level of need is also problematic. The voluntary sector has strategic limitations in its ability to scale up according to need. In London, developing a strategic approach has been spearheaded by NGOs at City level, and boroughs through food action alliances. The food alliances are networks of non-state and non-industry providers, involving a range of activities such as food banks, food growers, community kitchens – supermarkets- fridges. They connect with local government through their public health departments. As crisis hit, they quickly turned their energies to organising emergency food aid. Phenomenal efforts are being made to scale up to meet increased demands. However, they face barriers. For example, many TSOs are involved in competitive processes to win and maintain local government contracts. Funding is often short term; a precarious situation for TSOs. In this crisis they need to collect evidence for ‘sustainability’, that is, to secure future funding.

    Despite the existence of resilience structures at regional and borough levels, strategies to meet increased food needs were not apparent. Indeed, there was little national food strategy (Lang, 2020). In London, as the crisis unfolded new charitable funding streams emerged. Four weeks into the crisis, the owner of London’s free newspaper, Evening Standard, and son of Russian oligarch intervened to feed ‘vulnerable’ Londoners through a new charitable alliance. This centralises food surplus supplies and distribution across boroughs. This role of charities is legitimised by London’s Mayor, albeit likely unintentionally. This upscaling of charities to deliver such large-scale logistical challenges raises concerns about the future direction for PHN.

    Altruism continues with the emergence of new food banks, food project social entrepreneurs and the Mutual Aids. With roots in 19th Century social welfare based on fraternalism not paternalism, these are today on the one hand wonderful, inspiring acts of solidarity but what will they become? There are many questions to consider: Do they adopt a public health perspective that considers inequalities including class and ethnicity or are these individual acts of charity and kindness? What is the class composition of the Mutual Aids? Will there be unintended consequences? Within communities, will they bridge or increase class divides and inequalities? Do they provide uniform and equitable support?  Do they contribute to food democracy within our communities? How are they accountable?

    These and other new solidarity networks enter into the terrain of unevenly shared and disjointed public health resources. Across London, a postcode lottery in public health nutrition pre-dates this Covid crisis. For example, eligibility for free school meals depends on the political priorities of local councils as well as government policy. Universal free school meals (UFSM) for all primary age children are provided in only 4 of the 33 boroughs. This includes children in families with no recourse to public funds (NRPF). Their temporary access to FSM during this crisis will be withdrawn as schools reopen. A cruel, intentional political act belonging to the ideology of hostile environment; socially divisive among young children teaching them that ‘others’ are undeserving and go hungry. What will Labour councils do when the onus for feeding children with NRPF returns to them?

    The differences between and within boroughs is seen at the level of schools. Schools take different approaches with some providing food for all children in-need and others based on FSM eligibility. Seven weeks since its introduction, the government’s voucher scheme that replaced FSM continues to be problematic, adding to the suffering of families; some schools are bypassing with their own voucher systems. Schools are filling the gaps but cannot do so as a cross-borough strategic approach due to privatisation. In contrast to London, New York took a pan-city approach with 400 public schools providing food for all adults and children in-need.

    Despite incredible efforts, TSOs, have made it clear they cannot fulfil the function to feed ALL in need:    ‘There is not enough free food or volunteer capacity to feed all economically vulnerable people through local authority and charitable means’. Instead they argue that central government should provide the financial means to enable everyone to buy food that meets their nutritional and cultural needs. From an ethical view it is irresponsible that central government assigns responsibility to local authorities and TSOs without giving the resources to carry out responsibility. It is well established that emergency food aid systems need to be nationally co-ordinated strategies. The UK government’s use of the armed forces for food distribution to the 1.5 million shielded clinically extremely vulnerable people, is recognition of the level of strategic organisation that is needed. It shows that only central government has the resources and therefore responsibility to feed ALL people in-need, across all vulnerabilities. It is not possible for this to be a function of TSOs. How do TSOs and local government decide ‘vulnerability’ without interlocking socially divisive ideas of ‘deserving’ and ‘undeserving’ poor? These are political decisions. Solving hunger takes political will (Caraher and Furey, 2018).


    The politics of privatisation and charitisation are felt most strongly on the frontline by the community food activists some engaged for decades in fighting to hold their communities together. One such leading activist and mother, Maya in South London, said

    I’m tired of fighting, fighting, fighting”. Yet she remains on the frontline running the local food bank/social supermarket. She says: diets will slump in areas like this … people use social supermarket but can’t get the foods children want … fresh fruits and vegetables have short shelf life ..we have to respond to new issues that come along …the hidden people that now come out who are in extreme poverty. While caring for her community she comments on new oppression by powerful borough groups and lack of accountability: people are going crazy with this food thing … there’s a lot of money around food …all they want to do is help the ‘poor’ people … they’re doing deliveries, taking selfies and putting it on twitter …  some people are stepping on our heads… others are cashing in on it.” On a part-time London living wage, she finds her own living standards are slipping backwards.

    What will emerge from this crisis? Local authorities will soon be planning their recovery processes. With depleted and finite funds will we see a redefining of ‘vulnerable’; a new means testing for referrals to emergency food aid? We are facing a long recession/depression with increased food poverty, malnutrition and hunger. This is potentially on an unprecedented scale. How will the increased charitisation together with ongoing cuts impact the public health infrastructure and jobs? Who will be providing food for public health? These are important questions for all of us in PHN whether Director of Public Health or unpaid community food bank worker. How we tackle feeding EVERYONE in-need is not just a practical question but a basic ethical one concerning food rights and health equity that requires reconnecting with our communities and schools for grassroots participation in decision-making. Enabling participation requires tackling the material conditions, of work and physical food environments, that underpin health inequalities.

    A weak public health nutrition infrastructure, including diminished community services, contributes to undernutrition, reduced immunity, more illness, more hospital visits. Pre-Covid estimates showed  £200 million could be saved in health and social care spend if greater attention is paid to caring for the nutritional status of vulnerable adults. This would contribute to the inequality seen in the distribution of Covid-19 death rates. Our right to nutritious food is essential to enable our rights to good health and longevity free from illness. To make this a reality, for all, will require fiscal measures that guarantee universal basic living income, that integrates food costs, as well as massive investment in communities and public health nutrition. One among many lessons for how we plan for food and health resilience in times of crisis, is to meaningfully, democratically involve our communities and workforces on the ground.

    Sharon Noonan-Gunning, Registered Dietitian, PhD in Food Policy.

    Caraher M., Furey, S. (2018) The Economics of Emergency Food Aid Provision: A Financial, Social and Cultural Perspective. Palgrave Macmillan. London.

    Lang, T (2020) Feeding Britain: Our Food Problems and How to Fix Them. Pelican Books.

    Comments Off on Covid-19: food and health inequalities and the future of public health nutrition

    Health inequalities persist and grow in the UK. Differences in morbidity and mortality add to rising public concerns about household poverty and children’s health and development. Current attempts to redefine and find new national lower measures for poverty in the UK when current measures show increases, talk endlessly about getting more information about poor people and their lives and involving them in defining the problems. This blog is about how the language used itself diverts attention from the real underlying issues, such as why, in the rich UK, are personal and public resources so badly distributed by government or the labour market that anyone is left without sufficient to choose an acceptable conventionally inclusive and healthy lifestyle. Whatever the role of freedom of choice in people’s lives, which is a basic premise of our marketised consumerist society, it follows that no one should have too few resources to exercise it as others do.

    Today’s problems are constant reminders of what Sir Douglas Black brought to wider public and political awareness as long ago as 1977. His report concluded that “poverty remains the chief cause of disease, and it is a factor which is beyond the immediate control of medicine”. ‘Disease’ here means all forms of ill-health, and the poverty referred to is not only that of the individual household lacking adequate disposable resources (mainly cash incomes) to be free to make its own healthy choices of food and socially-inclusive lifestyle, but also the lack of the collective resources of decent housing, health and care, children’s services, education, public transport, opportunities for adequately paid work and other collective means of enabling and empowering people to take a recognised part in their society over time. These are matters that Sir Donald Acheson’s report on Inequalities in Health reiterated in 1998 and others repeatedly have since then.

    Public expenditure on and availability of all of these collective as well as individual resources at the levels needed to prevent deprivations and health inequalities has been considerably reduced by deliberate government ‘austerity’ policy since 2010. It is just possible that the politicians who devised and maintained these anti-statist policies were unaware of the health consequences of their pursuit of austerity; at any rate, if not culpably ignorant and oblivious, they seem to disregard the reports which increasingly make the connections between their policies and the consequent growth in a wide range of social evils including health inequalities. Beyond a little fire-fighting in crisis situations the current political response is too often to focus on or even blame the victims, suggesting for instance that they wouldn’t be so unhealthy if they’d made the right lifestyle choices compatible with their resources. The current government does not acknowledge that the resources are inadequate for such choices.

    The obvious problem of inadequate resources and incompatible objectives, such as eating or heating, can’t be answered as long as we focus only on people in poverty and their own reports. The language we use to talk about the problems (the discourse, to use the technical jargon) not only distorts our focus on underlying causes but actually closes off some options for policy action, and this is being deliberately promoted for ideological reasons by some of the people involved. It’s part of the bigger story of attitudinal manipulation widely discussed in political circles, but it’s relevant in many other fields as well, and it affects social scientists as well as other publics. That’s why the current discourse matters when we discuss health problems.

    First, a note about the social science technical aspects. The discourse reflects the currently accepted explanatory paradigms, the self-consistent system of concepts and theories which any scientific system uses to structure its approaches in ways which make it seem like ‘common sense’ not needing to be questioned. That’s why to make sense of what’s happening now, we need to review,  brutally briefly, the succession of dominant poverty paradigms since the 19th century. The traditional paradigm was acceptance of class-based social stratification, given its authority by the dominant social order or even by religious beliefs, in which poverty was the way of life of the lowest layer of society, in terms of squalor and exclusion. Dividing poor people into the ‘roughs’ and the ‘respectables’, many well-off people assumed this was a matter of individual choice even if the system was immutable. But the earliest systematic attempts by such pioneers as Seebohm Rowntree showed the poorest people lacked adequate resources even for physical efficiency. He designed an artificially low ‘primary poverty’ budget to show it was inadequate for real life, but even so it was criticised for superfluity.

    This generated the second dominant paradigm in this field, poverty defined as and measured by household incomes below artificial minimum subsistence budgets. In the 20th century this generated an academic industry of competing prescriptions for variants of what the lowest level of living for poor ‘othered’ people could be, some allowing for minimal social participation expenditure as well or targeted on ‘healthy living’. Against this, during the 1930s, Sir John Boyd Orr argued that instead of prescribing minimum budgets for the lowest level of living at which people didn’t show nutritional deficiency symptoms, researchers should study empirically at what minimum levels of income households actually achieved optimum levels of nutrition. This generated lively scientific and professional association arguments for years. In the post-war period, the sociologist Professor Peter Townsend argued that if households were to be studied for sufficient spending on adequate nutrition, this applied even more strongly to adequacy of their resources for social participation. He suggested that seriously lacking resources for participation in conventional lifestyles was the conceptual definition of the social phenomenon of poverty, identifying its cause in the structure of resource distribution and pointing to a more appropriate measure of poverty than normative budgets based on the natural science measures of nutrition and health alone.

    This third paradigm thus raised the question of whose standards of adequacy of resources and life choices were to be applied to distinguish normally inclusive lives from poverty. Should they be the experts’ prescriptive (normative) views about healthy diets and lives, or the population’s views about inclusive lifestyles (though research experts are needed to discover empirically what they are)? The question of whose and what standards were to be applied, and the levels of various resources needed to enable inclusive lifestyles, became a matter for the poverty research industry, but some policy-oriented researchers (and many politicians) found it hard to accept the shift from expert to ordinary people in defining what an inclusive lifestyle and adequate resources might be. Some of this was caused by manifest confusion between the social science question of what levels and standards of resources were needed for social inclusion, adequacy, as defined by the whole population, and the completely different political question of what governments asserted ‘the taxpayer’ could afford for social security claimants.

    A larger problem, one which is rarely admitted openly but colours all such arguments, is the ancient class distinction between living standards Good Enough for Us, We the People, or sufficient for Them, the Poor. Evidence from social surveys and focus groups shows that when they ask about what levels of living are needed for poor people to escape poverty, participants offer more restrictive views than when they are asked about what all of ‘us’ need to live a minimally decent inclusive life in society. If the word ‘poverty’ is used in the question, responses often ‘other’ the victims as ‘them’. Thus although the currently dominant paradigms may succeed in dominating discourse to squeeze out previous ones, the older ones may leave persistent residues in common thought. Today’s focus on poor people’s lives which avoids the social and economic structures within which they occur harks back to the traditional paradigm of class divisions.

    This is no accident. It shows that it’s not only traditional social distinctions but ideology, how power should be used politically, which influences the discourse. The chief distinction is between the traditional conservative view that different minimum standards are naturally hierarchical since in that ideology each class has its ranked position and unequal status and the decent minimum may vary accordingly. By contrast, the socialist egalitarians argue that the minimally adequate inclusive lifestyle standards should apply to everybody. This reflects the recognition that conventionally inclusive lifestyles may remain unequal in many respects but everyone within them has sufficient resources to make choices and still be recognised as included or healthy. Inequalities remain but are no longer caused by a serious lack of resources, and are therefore not a poverty problem even if they are some other. For instance, assessing the promotion of ‘go private and get better service’ in the NHS then depends on whether the standard quality of services in this essential collective resource demonstrably meets the ‘good enough for us all’ expectations or whether it reflects a ‘NHS good enough for those who don’t have resources to make choices’ conservative austerity perspective.

    The focus of all the public argument right now against this background is the people in poverty as defined by the current paradigm, as people whose “resources are so seriously below those commanded by the average individual or family that they are, in effect, excluded from ordinary living patterns, customs and activities” (Townsend 1979). Why then do some anti-poverty organisations welcome more intensive study of people in poverty — “to fight poverty, we must first understand more about those in its grip” (The Guardian 17.9.18). This focus dominates much media framing of what to do about poverty. Even if the scope is broader, it’s the counterpart of studying malnutrition in terms of why don’t poor people eat greens instead of junk food. In terms of the old analogy of pulling drowning people out of the river downstream, it’s asking why don’t they swim, and planning to teach them better, instead of asking why did they fall in upstream — or even who keeps pushing them in. The article quoted calls on policy makers to use this focus “to help alleviate poverty in Britain”. But why not work to abolish it? The answer must lie on the political right where alleviating poverty is philanthropic and OK, while policy to abolish it is political and ‘lefty’.

    A discourse which focuses obsessively on the characteristics and experiences of people in poverty is a bit like first aid. Victims must of course be relieved, even if at that stage no account is taken of causes. But overall in the health field much more attention is rightly focused on prevention even while state funding is restricted. The danger of the discourse focusing only on victims is that it normalises acceptance of ill-health and alleviation (the conservative stance) instead of emphasising attention to its preventive ‘clean water’ of adequate resources. ‘Poverty porn’ attracts many television viewers and normalises ‘othered’ lifestyles whose deprivations and deviances are enforced. It’s a modern version of visiting Bedlam three hundred years ago. Of course ‘those who experience it are best able to describe it’, a perspective long emphasised by for instance community workers and mental health service patients (not forgetting victims of oppressive social security, as illustrated by ‘I, Daniel Blake’). But this is not the same as the shift to claiming that the ‘voices of the poor’ should be the principal source of valid evidence on how to abolish it. This would be like acknowledging that sick patients are the best guides to what their symptoms feel like, and then claiming their reports as scientific analysis of causes. Cholera patients report fever and diarrhoea, not polluted water supplies. A neglected factor in this well-meaning emphasis on victims’ accounts is the implication that people who aren’t suffering can’t understand it, or even that they lack empathy, which is used to discredit critics who look beyond symptoms to causes.

    The more the current discourse emphasises focus on people in poverty, the more it distracts from discussion of preventive measures, especially when these are discussed in terms of government policy instead of the foundations of good health. But to avoid policy argument as “not our business” gives covert support to ideological opposition to structurally redistributive policies, not the foundations of social policy for health and social security of resources for everyone. Evasion of those issues is discourse closure on prevention. Preventing poverty and health inequalities sounds good, but when it means trying to change the behaviour of victims without increasing their access to relevant individual and collective resources to adequacy levels, it’s dishonest.

    Poverty prevention is not the only subject closed off by discourse focusing primarily on the lives of people in poverty. In this world of inequalities, there doesn’t seem to have been interest in studying how far statistically normal individual variability in health experience overlaps with health inequalities which themselves correlate with variations in levels of individual or household power over resources and the availability of collective resources. No one expects the normal range to be dependent on resources alone, so we need research to establish what its contribution is. The ‘Money Matters’ research by Kerris Cooper and Kitty Stewart (JRF 2013; 2015) showed that (contrary to some conservative lobby groups’ claims) money indisputably does matter and others showed the causative networks by which it does. Regrettably the project failed to proceed to ask, ‘and if money matters, then how much money matters?’ If we are to have effective preventative policies to abolish poverty as well as alleviating it, then we need to know what the evidence suggests that bit of the anti-poverty target is.

    There is no theoretical reason (except perhaps in some neo-liberal economic or politically reactionary fantasies) why anyone in UK society should have too little power over resources to be able to make healthy choices without detriment to their conventionally decent socially-inclusive lives. Discourse matters because when it focuses only on poor people’s health it closes off the bigger problem of those structural inequalities which also damage everyone’s social health.




    John Veit-Wilson is Emeritus Professor of Social Policy of Northumbria University and guest member of Sociology at Newcastle University. He is author of Setting Adequacy Standards: How governments define minimum incomes (Policy Press 1998) and was poverty consultant to the Joseph Rowntree Foundation’s Money Matters research programme. He was a founding member of the Child Poverty Action Group in 1965.


    The case for a new Beveridge Report

    One of the last Labour Government’s real successes was to preside over an increase in life expectancy. In addition, the gap in life expectancy between the rich and poor decreased. Fast forward nearly 8 years, to March 2018 the Office for National Statistics published data showing that under Tory austerity the gap in life expectancy had widened. For women, the gap is the largest since the 1920s.

    There is overwhelming evidence that these inequalities are not inevitable. They are socially reproduced. They can be changed. And that should give us all hope. But it needs political will to tackle them, not the soundbites of this Government.

    In 2015, the International Monetary Fund stated that ‘widening income inequalities is the most defining challenge of our time’. Forty years ago, 5% of income in the UK went to the highest 1% of earners. Today it is 15%. According to the latest Sunday Times Rich List, the richest 1000 people in our society saw their wealth increase by 16% in the last year alone. This trend of increasing income inequalities has occurred in most high income countries, but some less than others.

    Like Nobel economist Joseph Stiglitz’s, the IMF’s analysis showed that inequalities are a drag on growth and can also make growth more volatile. It showed that raising the income share of the poorest 20% of the population increases growth by as much as 0.38% over five years. In contrast, increasing the income share of the richest 20% by 1% decreases it by 0.08%.

    The Organisation of Economic Co-operation and Development has also rejected ‘trickle down’ economics, so popular with Margaret Thatcher and her supporters, as the means of spreading income from the rich to the poor.

    In spite of promises to tackle these ‘burning injustices’, according to the Equality Trust, Britain’s top bosses are paid, on average, 165 times more than a nurse, 140 times more than a teacher and 312 times more than a care worker. Indeed it would take a typical UK worker 160 years to rake in the average annual amount handed to a FTSE 100 boss.

    The recent Equalities and Human Rights Commission report has revealed that the poorest tenth of households will on average lose about 10% of their income by 2022 – equivalent to £1 in every £8 of net income. This reflects other distributional analyses for example from the Institute of Fiscal Studies.

    Reducing the gap between rich and poor is not just good for the economy. As evidence from The Spirit Level shows, life expectancy increases, as well as educational attainment, social mobility, trust and more. Fairer more equal societies benefit everyone.

    In acknowledging the income inequalities that exist in the UK and the harm that this is doing to society as a whole, the question is what drives them and how to tackle them.

    As Labour committed to in last year’s manifesto, we need changes to economic policy to address the unfair tax burden and poverty pay. But we also need to radically transform our social security system so that, for example, 8 million people currently in low paid jobs are not left living in poverty while they wait for pay improvements, and neither are their children. And if you become sick or disabled you should not be twice as likely to live in poverty as non-disabled people, as 4 million disabled people are now. Similarly, the state pension age for men and women shouldn’t be quietly pushed back, leaving increasingly frail, elderly people unable to work, subjecting them to live in poverty.

    The 1942 Beveridge Report was the basis for a new welfare state set up after the Second World War, including the establishment of the NHS in 1948 and the expansion of social security. It was heralded as a revolutionary system that would provide ‘income security’ for its citizens ‘as part of a comprehensive policy of social progress’.

    Since 2010, we have seen social security spending cut by nearly £34bn, with another £12bn planned by 2022. Spending on the NHS is barely keeping pace with inflation, and is falling behind countries like Germany, France, the Netherlands, Denmark and Austria.

    We need a new Beveridge report for the 21st Century, defining a new social contract with the British people, addressing the poverty, inequalities and indignity millions of people, young and old, are enduring; bringing hope to a new generation as it did 70 years ago.

    Of course these reforms need to be coupled with reforms to the current dysfunctional and increasingly precarious labour market as part of a coherent and comprehensive industrial strategy. Labour’s plans for a national education service that is not just about preparing you for work but is enabling you to get the most out of life, are also essential to tackle the structural issues that drive these income inequalities.

    In addition to inequalities in income, inequalities in wealth, with land and property being the largest real asset, also need addressing. In 2002 it was estimated that 69% of the land in the UK was owned by 0.6% of the population. In the six years to 2011 the number of landholdings reduced by 10% but the size of these holdings had increased by 12%. So even fewer people own even more land.

    Many in housing policy emphasise that if we’re to solve the housing crisis in addition to building more homes, we need to tackle the cost and availability of land and address the volatility in the market. With average house prices in the UK in 2017 at over £226,000 (over £496,000 in London), the Nationwide Building Society has estimated that it would take 8 to 10 years for people on average incomes to save the 20% deposit needed to buy a house and even longer for someone on a low income. Which means wealth inequalities are increasing even more.

    And finally there’s inequalities in power. This is often the neglected inequality but is central to who we are as human beings. Power is complex. It is about having influence, control, even authority. We usually think of this as associated with having money or ‘corporate power’. But it is also about position and status. In who makes decisions and how. Whether corporate or other unaccountable, ruling elites, the dangers are clear. Elites exclude and marginalise, enabling prejudice and discrimination to thrive, and trust in others, in difference to suffer as a consequence.

    Inequalities are not inevitable but to tackle them in all their forms takes commitment, it takes courage and it takes leadership.

    First published on Debbie’s website 

    Tagged | Comments Off on A new social contract with the British people

    It’s lovely to be here and with my dear friend and former colleague, Dr Alex Scott-Samuel. Alex and I were co-Directors of a research unit at the University of Liverpool, and it’s really my tackle inequalities that drove me into politics.

    As a public health consultant for over 20 years, I knew that if you’re serious about tackling health inequalities you have to get policy right as its being designed.

    At the same time I was at Liverpool I was also chair of Rochdale Primary Care NHS Trust for nearly 5 years, resigning in 2006 over my concerns of the use of private healthcare companies in the NHS. As a lifelong Labour supporter, I decided to get stuck in to try and influence Labour’s health policy….and the rest, as they say, is history. I became an MP seven years ago, and it is truly an honour to do this job.

    Although I was critical about the use of the private sector in the NHS by the former Labour Government, under Labour the gap in life expectancy between the rich and poor did reduce. But I’m sure it will come as no surprise that a couple of weeks ago the ONS published data showing that under Tory austerity this gap is widening. For women, the gap is the largest since the 1920s.

    As you know, inequalities are NOT inevitable. They are socially reproduced. They can be changed. And that should give us all hope. But it needs political will to tackle them, not the soundbites of this Govt.

    Unfortunately in spite of all of this evidence, we are seeing a concentration of power in tiny elites more than ever. In 2015, the International Monetary Fund stated that ‘widening income inequalities is the most defining challenge of our time’. Forty years ago, 5% of income in the UK went to the highest 1% of earners. Today it is 15%. This trend of increasing income inequalities has occurred in most high income countries, but some less so than others.

    This work followed on from another IMF report which came out in support of Nobel economist, Joseph Stiglitz’s analysis that inequalities are a drag on growth and can also make growth more volatile. The Organisation of Economic Co-operation and Development has similarly rejected the ‘trickle down’ economics of the 1970s, so popular with Margaret Thatcher and other Thatcherites; this supposed that increasing wealth at the top would ‘trickle down’ to the rest of the food chain and that policies aimed at reducing inequality would remove incentives and slow growth.

    Now the evidence is clear: inequalities have slowed not increased growth. Raising the income share of the poorest 20% of the population increases growth by as much as 0.38% over five years. In contrast, increasing the income share of the richest 20% by 1% decreases it by 0.08%.

    In the UK, the Institute of Fiscal Studies has shown that working people on low incomes, particularly families with children, have lost proportionately more of their income than any other group since 2010 as a result of tax and benefit changes. If cuts to public services are added to this, the disproportionate negative impact on people on low income is even starker.

    All of this seems to have escaped the notice of the Chancellor on Tuesday & in his Budget last Autumn.

    Reducing the gap between rich and poor benefits everyone – in addition to increasing life expectancy, there’s increased educational attainment, social mobility, trust and so on as we know from evidence from Richard Wilkinson’s and Kate Pickett’s Spirit Level.

    To tackle these inequalities in income and wealth, in addition to reforms to the labour market, a coherent and comprehensive industrial strategy, and a national education service that is not just about preparing you for work but is enabling you to get the most out of life, we need a social security system that is there for us all in our time of need, just like the NHS is there to care for us if we become ill.  And of course we need a properly publically-funded NHS and social care system.

    But it’s the socio-economic determinants of health I want to focus on today.

    Since 2010 the Tories have inflicted a programme of spending cuts to the tune of £83 billion pounds. Under the Coalition, our social security system has particularly borne the brunt with swingeing cuts of nearly £34bn, with another £12bn planned. At the time austerity was first being implemented, the then Home Secretary, Theresa May, warned in a letter that “there are real risks that women, ethnic minorities, disabled people and older people will be disproportionately affected.” She went on to state that “Women, for instance, make up a higher number of public workers, and all four groups use public services more.”

    On this, she was right. The risks were realised and disabled people, ethnic minorities, women have been hit hardest. As most people here today will be aware, women have borne the brunt of Government cuts. House of Commons Library analysis revealed that a staggering 86% of the burden of austerity – largely changes to taxes and benefits – since 2010 has fallen on women. Yet it is under Theresa May as Prime Minister that we are seeing the very worst effects, with a huge proportion of the announced cuts yet to come.

    After nearly eight years, this government continues to pursue an economic agenda based on discrimination and inequality, slashing our public sector and cutting our social security system and our welfare system as a whole to the bone, while at the same time giving tax breaks to those on the highest incomes. Action to tackle industrial scale tax avoidance and evasion by the super-rich elite and big business can only be described as piecemeal. Attacks on some of the most vulnerable in our society through cuts to the social security support available are shameful, and they are damaging not just for the people experiencing this hardship, but for society as a whole.

    The inequalities that the people of our country are facing at the moment are reminiscent of a Victorian age. According to the latest Sunday Times Rich List, the richest 1000 people in our society saw their wealth increase by 16% in the last year alone.  In spite of promises to tackle these ‘burning injustices’, the income gap between the richest and poorest in society has almost doubled. According to the Equality Trust, Britain’s top bosses are paid, on average, 165 times more than a nurse, 140 times more than a teacher and 312 times more than a care worker. Indeed it would take a typical UK worker 160 years to rake in the average annual amount handed to a FTSE 100 boss.  The Equalities and Human Rights Committee has revealed that the poorest tenth of households will on average lose about 10% of their income by 2022 – equivalent to £1 in every £8 of net income.

    The recent EHRC report published this week found that the impact of policy decisions taken by the two Conservative administrations since 2015 will be to reduce incomes for the poorest, while increasing incomes for the richest 20%. Women lose more than men at every income level. Lone parents – the vast majority of whom are women – are particularly badly hit, losing about 15% of their net income on average, equivalent to almost £1 in every £6.  On top of this, we have seen a period of growing job insecurity and low pay, stalling productivity, rising precarity and self-employment, and falling living standards. Now we have the latest ONS labour market statistics showing a rise in unemployment.

    And then there’s inequalities in wealth with land and property being the largest real asset. In 2002 it was estimated that 69% of the land in the UK was owned by 0.6% of the population. In the six years to 2011 the number of landholdings reduced by 10% but the size of these holdings had increased by 12%. So even fewer people own even more land. Many in housing policy emphasise that if we’re to solve the housing crisis in addition to building more homes, we need to tackle the cost and availability of land and address the volatility in the market. With average house prices in the UK over £180,000 (over £460,000 in London), it has been estimated that it would take 22 years for people on low and middle incomes to save for a deposit. As a result many young people, but not exclusively, are living with their parents, or are renting, the so-called ‘Generation Rent’. Inequalities are now becoming intergenerational.

    And finally there’s inequalities in power. In status. In who makes decisions and how. This is often the neglected inequality but is central to who we are as human beings. When wealth and power are concentrated in a tiny elite, there tends to be less investment in education, health and infrastructure, which particularly benefits people on low incomes and enhances productivity. In the last 5 years, for example, public spending as a percentage of GDP, fell in health from 6.6% in 2009/10 to 6.1% in 2015/16 and in education from 3.8% to 3.1%.

    In addition to this lower investment, there has been a targeting of resources away from areas of high need. For example, many of you will recall how in 2011/12 the health inequalities weighting in NHS resource allocations was reduced from 15% to 10%. This was breathtaking. The recommendations from the Advisory Committee on Resource Allocation (ACRA) to maintain the health inequalities weighting at 15% were completely ignored by the Health Secretary at the time. The effect was to shift resources from deprived areas with high levels of unmet health need to affluent areas with better health; for example reducing Tower Hamlets’ budget allocation by 4.1% and increasing Surrey’s by 4.2%.  The Coalition followed this with a campaign to base NHS Resource Allocation Targets more on a population’s age profile. This would see the break with NHS resource allocation based on need which has been a fundamental component since 1970 and will see funding haemorrhage from deprived to affluent areas. If you couple this with the Government’s NHS privatisation agenda, the introduction of Personal Health Budgets, and the scandalous cuts to social care AND public health we can see the cumulative impact this will have on health inequalities.

    And the inequality in resource allocation doesn’t stop with healthcare. Collectively public spending cuts have been significantly greater in deprived areas. And again there is strong evidence of the relationship between public spending and, for example, life expectancy at birth. The immediate effects of this is already showing. In 2011 there was a significant surge in suicide rates for both men and women, but particularly for working age men with a 4% rise in 2012.

    On top of this shift in investment, the policies themselves have also been highly polarising, from reducing access to education by, for example, trebling tuition fees and scrapping education maintenance allowance, to patently not making work pay to removing workers’ rights and protections through the proliferation of zero hour contracts and low paid, poor quality jobs as well as restricting access to justice with legal aid and judicial review changes. All of these have further contributed to maintaining power with an elite.

    I will be writing more on inequalities in power soon.


    Since 2010 working people on low incomes, particularly families with children, have lost proportionately more of their income than any other group as a result of tax and social security changes. Regressive economic policies where the total tax burden falls predominantly on the poorest combined with low levels of public spending, especially on social security, are key to establishing and perpetuating inequalities.

    The Government’s cuts to social security are pushing more and more people into poverty. The Child Poverty Action Group estimate that cuts to Universal Credit alone will force 1 million children into poverty by 2020, while the ongoing freeze to the vast majority of social security payments means that 10.5 million households will see an average cut of £450 a year by 2020.

    Again, as with other Government cuts, low paid workers will lose the most from cuts and changes to Universal Credit, with women and ethnic minorities hardest hit according analysis by the Women’s Budget Group. The cut to the work allowance, the two-child limit, the freeze in payment levels, removal of the family element and the change in the taper rate mean that by April 2021 employed individuals who live in households claiming universal credit will be £1200 a year worse off than they would have been under the original Universal Credit system, with women losing more than men.

    As hopefully you already know, I have called on the Government to pause the chaotic roll out of their failing Universal Credit programme. Labour has committed to Universal Credit’s principles of reducing child poverty, simplifying the social security system and always making work pay in the past, but for me everything else is up for grabs.

    I want a radical overhaul of not just Universal Credit but the whole system, changing the culture from one that is demonising and dehumanising to a system that is supportive and enabling. And as the sixth richest country in the world, I don’t believe we should be letting people live in squalor without heating or eating either.


    We must address the adequacy of the social security system for our children, working age people and our pensioners too. You will know, as I do having travelled across the country as part of my pensions tour about women born in the 1950s who are sofa surfing because they can’t do the work they’ve done in the past in their 60s. We must do better for them.   We have been clear, there are several immediate actions the Government could and should take, but time and again they have refused. We would immediately offer women affected by Government changes to the state pension age the cost-neutral option to draw their state pension at age 64, allowing women who choose it to retire up to two years earlier. It is also right to extend pension credit to those who were due to retire before the increase in the pension age, which would benefit hundreds of thousands of women. This would provide approximately half a million women on the lowest incomes up to £159 per week. We have repeatedly called on the Government to implement this costed measure, but sadly they have so far refused to act.

    These measures are a start. They are actions the Government should take now! They are to compliment additional action on transitional protections. It also doesn’t preclude compensation. We want to continue working with women to right the wrong that they have been dealt.

    But in spite of the stalling of life expectancy, and decline for some groups, the Government has said that they are going to accelerate the increase in the State Pension Age to 68! It beggars belief.


    But after nearly eight years of Tory austerity, it is the impact on disabled people in the UK that is the cruelest. According to analysis by Demos/Scope, the 2012 Welfare Reform Act alone saw 3.7m sick and disabled people lose approx. £28bn of social security support. And this doesn’t include the cuts in support through social care. And the EHRC report on the cumulative impact of cuts, estimates a disabled adult has lost £2,500 pa since 2010.

    Half of those who live in poverty are disabled or live with someone who is disabled, because of the extra costs they face as a result of their disability or illness. This is completely unacceptable. Disabled people face barriers in all aspects of life – including in education, transport, access to justice, access to voting, housing, health and employment. Shockingly, the ‘disability employment gap’ remains high, at 31.3%, yet the Government has scrapped their 2015 manifesto commitment to halve this DEG.

    As our manifesto with and for disabled people, Nothing about you, Without you states, we support a social model of disability which recognises that people may have a condition or an impairment but they are disabled by barriers in society.

    As a starting point, we will end the current punitive sanctions regime and scrap the current cruel and dehumanising Personal Independence Payment and Employment Support Allowance assessments. Instead of supporting people, the process is often inaccurate and worsens existing health conditions. With 68% of decisions overturned at tribunal it is clear the system simply not fit for purpose and the distress and anguish these assessments cause cannot be underestimated.


    A social security system that fails to alleviate poverty is failing at the most basic level. Instead of a safety net we have a trap door.

    Like the NHS, our social security system should be there for all of us in our time of need, providing security and dignity in retirement, and the support needed should we become sick or disabled, or fall on hard times. It is a vital weapon in our fight against inequality.

    Fundamentally, we will transform our social security system as part of wider radical reforms to drastically reduce inequality and poverty. I have advocated that the Party needs to go further than we have already. We need a new social contract with the British people – we need a Beveridge 2 defining a welfare state for the 21st century.  I hope that I will have the opportunity to work on this and contribute to the fairer society that this country so desperately needs and I believe wants as well.



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    Poverty is an ongoing problem facing all societies, and there are many different ways of exploring the issue. On the one hand, there is concern with inequality, including the drivers behind the unequal allocation of advantage versus disadvantage. On the other hand, there is concern with measurement and definition. In the latter case, poverty defined in relative terms implies that no society will be without it.

    The measurement of poverty raises important issues regarding how it should be conceptualised. With an increasing awareness that reliance on income alone as a measurement of poverty has many limitations, the issue of measurement is undergoing a multidimensional turn, integrating insights about the various ways in which life can be impoverished.

    While poverty in the UK has declined since 2012 – when the UK had a higher poverty rate than most EU member states – progress is now at risk following policy changes in the 2017 Autumn Budget. The UK’s mixed record in tackling poverty should not come as a surprise: the integrated nature of wellbeing produces difficulties in evaluating poverty levels. The neglect of human life aspects, together with an over-emphasis on income, is certainly part of the problem. Thus, determining who the most deprived social groups are and in what ways they are experiencing deprivation is crucial for generating more effective poverty reduction initiatives and social protection interventions.

    We explore this challenge in a study that attempts to shift the focus of societal development from an income-oriented approach to a people-centric one. We make the case for an anti-poverty UK agenda that gradually shifts towards an appreciation of the multidimensionality of well-being. In particular, this study concentrates on life domains that: are considered to be important for British society; guide the development of public policy; and enable empirical exploration. The four dimensions of poverty available in the European Union Statistics on Income and Living Conditions, which correspond to the concept of poverty as outlined above, are:

    1. general health,
    2. living standards,
    3. housing deprivation, and
    4. financial deprivation; three indicators for income, two indicators each for housing and health, and six indicators for living standards (see Table below).
    Table 1. Dimensions of deprivation

    The first set of indicators deals with living standards and draws on five needs that reflect a person’s possession of adequate resources to enjoy a decent standard of living. These needs are:

    1. consumption of meat/protein at least every other day;
    2. ability to provide adequate heating of a dwelling;
    3. ability to spend a week-long holiday away from home at least once a year;
    4. living in an area with good environmental quality;
    5. having no serious problems with the dwelling.

    The analysis reveals that every household has a minimal acceptable diet, whereas crime and vandalism in the neighbourhood, as well as environmental pollution are identified as the most serious problems in this life dimension. In addition, as far as economically weak households are concerned, 27% of the population cannot afford to go on an annual holiday.

    Financial deprivation, being central for almost every form of subjective poverty, is included as the second dimension. Three main indicators are taken as component proxies: capability to face unexpected expenses, arrears on hire/purchase instalments, or other loan payments. A valid concern here is that UK households seem to find it difficult to make ends meet. An equally interesting fact is that within the financial security dimension households are less able to cope with unexpected expenses. In 2016, around 38% of the population considered that their current income was too little to face unexpected expenses and 16% struggled to make ends meet.

    The necessities most likely to be out of reach are those requiring either ready cash for emergencies or regular amounts of money for longer-term financial planning. The next set of multidimensional poverty indicators reflects financial stress related to housing facilities and households’ ability to pay rent, mortgage repayments, and utility bills. This is the most progressively growing category with 72% of the population perceiving housing costs as a burden.

    The final focus of the multidimensional poverty indicators is on the area of health inequalities, particularly how much inequality in the health sector is associated with unequal socio-economic structure. Three health indicators are included: (i) access to medical services (ii) access to dental services, and (iii) limitations in daily activity due to health problems. The third indicator uses data on the persons’ self-assessment of whether they are hampered in their usual activity by any ongoing physical or mental health problem, illness or disability. The analysis reveals that 4.5% of the population have unmet medical needs, and nearly 4.1% have unmet dental health needs. Limitations in activities due to health problems reach worrying levels: 22% of the population aged 16 and over experience long-standing limitations in their usual activities due to health problems. The final health indicator uses data on a person’s self-assessment of whether they are hampered in their daily activities by any ongoing physical or mental health problems, illness or disability. In the UK, 22% of the population report severe long-standing limitations. This is one of the highest shares of people reporting severe long-standing limitations within Europe.

    In an attempt to allow policymakers to identify economically deprived households more accurately, we analyse the severity of hardships experienced in the UK to explore if some socio-economic categories exhibit higher risks of poverty in multiple life domains. This opens several lines of debate in terms of policy implications and assesses whether living conditions have been declining.

    The findings suggest attention needs to be given to equity considerations, but also to gendered inequality. Across the dimensions of income poverty and multidimensional poverty, there is a relatively steady gender effect, and women are more likely than men to experience deprivation in multiple life domains. Moreover, households are partitioned according to the marital status of the household head in order to document the relationship between marital status and multidimensional poverty. The results suggest that, compared to married couples, for instance, singles with or without children have an especially higher probability of being deprived in multiple life domains.

    In addition, owner-occupancy, which is still most people’s aspiration in Britain, is generally associated with better living conditions. That can be attributed to its association with accumulation, or capital-rich/cash-poor owner occupiers. Indeed, owner occupation has been found to decrease the probability of experiencing deprivation in multiple dimensions. Of course, these results are suggestive rather than definitive, but they do point towards the hypothesis that the outcomes of multidimensional poverty are at least mediated by differences in owner-occupancy. This also suggests that policies about housing tenure and poverty need rethinking and carries along the need to be cautious regarding the policies relating to home ownership.

    Furthermore, as far as further education is concerned, less educated and non-working people irrespective of their gender and marital status have generally a higher probability of being deprived in multiple life domains. This not only confirms the need to focus on education but also implies the need for an efficient anti-poverty game plan in the UK, which includes the advancement of skills and education. In fact, such a policy agenda should be committed to generous investments towards improving educational levels and labour market opportunities.

    First published by the LSE Business Review

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    The roll-out of Universal Credit may be running five years later than planned, having wasted £40 million in botched IT, and been emasculated by austerity cuts since 2015, but its advocates in the DWP still argue that it is all going to be worthwhile in the end because its labour supply effects will get people into work and onto higher earnings. Sir Robert Devereux, the DWP Permanent Secretary, claimed this in a retirement interview: “the roll-out will see unemployment rates fall as disincentives are taken out of the system”. Esther McVey, the new Secretary of State for Work and Pensions, even seemed to claim that 3.1 million extra people were in work as a result of UC when at the time only 700,000 were on it.

    The impact assessment for UC in 2012 estimated that between 100,000 and 300,000 people would enter work and between 1 million and 2.5 million more hours would be worked as a result of UC. A parliamentary question in 2017 reduced the entering work number to 150,000 and made no claim on extra hours. The DWP presented estimates of the impact of UC in reports published in 2015 (the initial report and an update) and a further update in 2017. The latter found that UC claimants were 3 percentage points more likely to be in work after six months than matched jobseeker’s allowance claimants (56 per cent versus 53 per cent).

    The Office for Budget Responsibility concentrated on UC in its latest Welfare Trends report and was clearly not convinced enough by this evidence to take it into account. They concluded “we have not yet incorporated these (findings) into our forecasts, as it is not yet clear that the impact found for the simple cases migrated so far will be replicated for the more complex ones to come or if the resources devoted to the early cases will be sustained.”They point out that simple cases are unlikely to be representative of the overall caseload; that operational choices and resources available per case may not be representative of the policy when scaled up; and that the generosity of the UC system has been significantly reduced since the trials, with large cuts to work allowances taking effect in 2016-17. They reproduce with implicit hilarity the onerous job description for the 13,000 work coaches being recruited for UC at £24,000 to £26,000 per year, commenting these “stretching roles are modestly remunerated”. They conclude “that we will consider the updated estimates that are due to be published in the full UC business case later this year, but do not expect to make any new forecast judgements until UC is operating at greater scale across all types of claimant and for a sufficiently long period for robust evidence of any labour market effects to emerge.”

    So the jury is still out on whether, what is effectively the sole remaining claim for Universal Credit, will be realised.

    This was first publish on Prof Bradshaw’s own blog and is reproduced by his kind permission

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    In 1948 the leaflet distributed to every household about the forthcoming NHS said “Your doctor will give you a prescription for any medicines and drugs you need.”

    In 2018 NHS England is conducting a consultation which proposes to restrict prescriptions of over-the-counter medicines for 33 minor, short-term health concerns. About £569 million is spent each year on these items and these proposals could save about £136 million.  That sounds a lot, but as a proportion of the £124.7 billion English NHS budget it isn’t a lot.

    For most of us that is not a big problem.  Most of this stuff isn’t very expensive.    The recommended Chemists’ Own Head Lice Spray is £5.90, and that is one of the more expensive items involved.  We mostly don’t take headlice as seriously as we used to either.  But do we expect poor people to leave headlice untreated?  That seems a really good way of stigmatising them.  That is why we used to employ nurses specially to deal with headlice.

    Nit nurses

    But single people under 25  on Universal Credit are expected to live on £251.77 a month.  Once you reach 25 it goes up to the princely sum of £317.82  a month with £231.67  a month for a child. Some of the people to whom this applies are likely to have other problems. For example young pregnant women, who barely have enough money to eat properly.   It doesn’t seem sensible to put them in a position of choosing between food and medication.

    There are also problems for people in residential and nursing homes.  Many of them will have difficulty in caring for themselves, won’t be able to buy items over any counter, and have no disposable income at all.   The consultation document says that all care homes should be encouraged to adopt a Homely Remedies Policy, which would enable them to administer these low risk treatments.  It also appears to imply that the home should pay for them.  Given the financial situation of many care homes – and the medical condition of many of their residents, who are very likely to be suffering from minor pain, constipation, diarrhoea and the like – this seems unreasonable.

    The system of free prescriptions in England is a complete mess.  There is a list of illnesses which qualify you for free prescriptions. These are conditions for which there was life saving medication in 1968.   Cancer patients were added by Gordon Brown in 2009.   Everyone over 60 gets free prescription but younger people more than a couple of pounds over the means test limit (£57.90 for people under 25) have to pay £8.60 per item unless they can find £104 for a season ticket.


    ‘If livin’ were a thing that money could buy / The rich would live and the poor would die.’  It is, and these lines, from a spiritual temporarily made famous in the 1960s by Joan Baez, remain the best succinct description of the origins of health inequalities.

    Occasionally, that reality thrusts itself into the consciousness of the high-income world, as in the case of Hurricane Katrina and the Grenfell Tower disaster.  In the case of Katrina, when the hurricane hit and the levees broke (after years of governmental neglect), evacuation plans presumed that everyone had access to an automobile.  Those who could afford to do so packed up the car and drove to higher ground.  Others, overwhelmingly poor and African-American, were left to fend for themselves as refugees in their own country.  The disposability of certain populations, from the point of view of the powerful, was similarly evident in the case of the Grenfell Tower fire, where local government in an ultra-wealthy London borough appears to have skimped on basic fire protection measures in a social housing block.  Apart from high-profile disasters, the wisdom of the spiritual’s words is evident on a daily basis, although it seldom hits the headlines: in the small city of Stockton-on-Tees in the north of England where I live, differences in male life expectancy between the most and least deprived wards are larger than the national average differences between England and Tanzania.

    Life expectancy in Stockton

    Outside the high-income world, global health researchers and practitioners constantly confront the realities described in an article on ‘priorities for safe motherhood interventions in resource-scarce settings’.  The authors wrote (in 2010) that the basic interventions recommended by WHO – still far below the standard of care that would be considered normal in the high-income world – would cost US$1.80 per person per year in Uganda, but Uganda was spending only US $0.50 per person on maternal and newborn care.  So, in the health economists’ ubiquitous mantra, priorities must be set.

    The researchers who carry out these exercises cannot be faulted, and there is plenty of blame to go around, starting with the fact that a decade later, Uganda’s government was still not meeting  the target of allocating 15 percent of public expenditure to health that was agreed among African Union countries in 2001.  But that is only part of the picture, and it is important to move beyond the familiar vocabulary of resource-scarce settings to ask why some settings are resource-scarce and others not.  Those of us who do so in the academic world are considerably fewer in number than those who take such scarcities as given.  We are not nearly as well funded – the Trades Union Congress and people thrown out of work when transnational corporations relocate contract production from Mexico to China do not fund a lot of research – and (no coincidence) at greater risk of precarious employment.

    Nevertheless, we continue to insist that intellectually responsible answers in the global frame of reference must start with colonialism and its legacies.  They must consider more recent historical episodes such as the devastating legacy of structural adjustment programmes that – according to Nobel laureate and former World Bank chief economist Joseph Stiglitz – resulted in ‘a lost quarter-century’ of development in Africa.  A recent study shows that although the World Bank and International Monetary Fund abandoned the vocabulary of structural adjustment around the turn of the century, the relevant practices continue with little change.  Meanwhile, the logic of structural adjustment has been replicated in the decade of (selective) austerity programmes that followed the financial crisis.  Inquiries into the origins of resource scarcity must further consider such factors as the ‘disequalising’ effects of a global economic order that provides abundant opportunities for capital flight, which starves even countries with well intentioned governments of resources needed for health, education, and economic development.

    In the contemporary policy environment, one element in particular connects health inequalities around the world:  neoliberalism or, in the words of billionaire investor George Soros (what irony), market fundamentalism. Neoliberalism as a set of norms that guide and justify policy, ultimately equating financial worth with moral worth, conceptually links the dynamics of structural adjustment and capital flight with the fates of the victims in New Orleans and Kensington and Chelsea, and with those of working people quietly living shortened lives of desperation in Stockton-on-Tees (and other deindustrialised communities in the UK, the United States, and elsewhere).  The connections are not only conceptual of course; they are also material and institutional, operating through such channels as campaign money, capital flight and the networks of power and privilege epitomised by the World Economic Forum, where the global super-elite meet to worry about the threat posed to their fortunes by the rest of us.

    Daily Mirror cover

    Tracing these connections, in contexts half way around the world or as close to home as our local NHS trust in England, is time-consuming and often emotionally draining.  Yet the enterprise is essential to the larger task of demonstrating that neoliberalism is, ultimately and inescapably, deadly – a point clearly understood by at least one media outlet reporting on the Grenfell Tower fire.  Well spotted, say I.

    Especially when the context involves social determinants of health, the question of how much evidence suffices to demonstrate this is contested terrain.  Sir Michael Marmot (who chaired the landmark WHO Commission on that topic) and colleagues wrote in 2010 that: ‘It is hard to see how even ideologically driven commentators could think that having insufficient money to live on is irrelevant to health inequalities’.  This is preternatural optimism, as any observer of recent British health inequalities policy will realise, but further discussion must be left for another posting.

    This first appeared on the PEAH – Policies for Equitable Access to Health blog

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    The roll out of Universal Credit started in 2013, but the Department of Health doesn’t seem to have noticed.

    Form FP10

    Form FP10

    People entitled to Universal Credit who had net earning of less than £435 in a month should get free prescriptions and dental treatment on the same basis as  people in receipt of other means tested benefits. For those with a child and/or limited capability for work or limited capability for work related activity the figure is £935.

    Now the roll out of Universal Credit  is well under way, but the prescription form does not mention it. Claimants are officially advised by NHS England to tick the box for income-based Jobseeker’s Allowance.   They then have to sign the declaration that the information they put on the form is correct and complete. The NHS Business Services Authority can and does issue fines for people who don’t tell the truth on the form, with threats to take them to court if the fine is not paid.

    Stories are beginning to appear of patients who have stopped taking their medication  because of the stress of the process.  Others may have borrowed money for their prescriptions but the process for claiming refunds is far from easy. It is not designed for those who are unable to concentrate and feel overwhelmed.

    Gingerbread points out that “The official advice is pay first and claim later – but for many this is a cost they simply can’t afford. The aim has been a simplified benefits system; the reality is that the NHS and DWP systems (like so many other government departments) don’t work together, creating confusion, complexity and often additional costs for single parents.”

    There doesn’t appear to be any agreement between the Department of Work and Pensions about the documents which demonstrate entitlement to free prescriptions. The FP10 prescription form states that patients who are not sure what to do, should pay for prescriptions and at the same time, obtain a FP57 to claim a refund. They cannot obtain one after the event.

    That statement assumes they are capable at the time of dealing with the convoluted process and have available funds to pay for prescriptions, mindful of the fact that many claiming Universal Credit, cannot afford to feed themselves and their families and so rely on food banks.

    There are very obvious and very simple solutions, which any clear-thinking adult with no qualifications or administrative experience could recommend:-

    (1) tick any box on the prescription form, strike out the adjacent words and write “Universal Credit”, as long as something that simple and truthful would not result in a legally invalid fine or legally invalid court action;

    (2) ensure the DWP puts Universal Credit payments on one sheet of paper as now but add (a) figures, if any, for earnings or “take home pay” in the same period and (b) state on the one page, whether the combined figures prove entitlement to free prescriptions for the period in question;

    (3) require the NHS to confirm with the DWP past entitlements to free prescriptions and make refunds, without requiring claimants to apply for those;

    (4) ensure the NHS Business Services Authority knows how to write and explain things in ways which are easy to understand, rather than continually rejecting evidence of entitlement, because that evidence lacks “full” details, without saying what is missing and where that can be found;

    (5) demonstrate a determination to respect the law, by ensuring NHS civil servants cannot use tangled administration, to persistently subvert full compliance with the law, e.g. the legal duty to protect and promote both physical and mental health and the legal duty which came into force on the 1st August 2016, to provide information which is accurate, balanced, trustworthy and easy to understand, regardless of intellectual and sensory needs.

    Frank Field MP., who chairs the Work & Pensions Select Committee, has laid five written Parliamentary Questions, dated 10th & 29th November and 18th December.  Steve Brine, Parliamentary Under-Secretary at the Department of Health replied on 15th November to say:

    “National Health Service prescription forms (FP10) and claims for NHS funded sight tests (GOS 1) and for vouchers for glasses or contact lenses (GOS 3) will be amended to include a Universal Credit box in due course. Some NHS Help with Health Costs claim forms, for example HC5 refund claim forms, have already been amended to include a specific tick box to enable Universal Credit recipients to claim entitlement. All versions of dentistry claim forms were updated on 1 April 2016, to include a tick box for Universal Credit.

    A patient can currently make a claim for entitlement if in receipt of Universal Credit by ticking the “gets income based Jobseekers Allowance” on relevant forms. Guidance for both the public and healthcare practitioners (such as pharmacists, dentists and, opticians) has been included on NHS Choices with links from the Universal Credit webpages on”


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    Poverty as measured by material deprivation through lack of economic resources remains absolutely central to understanding the causation and patterning of most aspects of social exclusion and a wide range of social outcomes. This is the strongest message emerging from Poverty and Social Exclusion in the UK: Volume 2 – The Dimensions of Disadvantage, the second of the two-volume study based on the PSE-UK 2012 surveys. Attempts to wash ‘poverty’ out of the policy agenda and government target-setting are quite wrong and unsustainable.

    This volume, which I edited with Nick Bailey, sets out to explore the different ‘domains’ of social exclusion and the ways that these relate to each other and to the core issue of material poverty. Having examined a wide range of disadvantages, the overall conclusion is that reducing poverty is probably the most effective way to promote key societal outcome targets. This is notably the case for health, as shown in the chapter by Prior and Manley, and wellbeing/happiness, as discussed by Tomlinson and Wilson.

    Poverty and social exclusion

    The social harm caused by poverty is examined theoretically as well as through drawing on the PSE’s qualitative evidence in the contribution by Pemberton, Pantazis and Hillyard, who argue that several concepts currently in vogue within social policy discourse – such as resilience and risk – are inadequate in addressing this challenge. Increased risks of severe poverty and destitution, not unconnected to welfare reforms and cuts, are evidenced in the contribution by Bramley, Fitzpatrick and Sosenko, drawing on a combination of PSE and new special survey evidence.

    Concern about poverty and exclusion cannot be separated from concerns about inequality, with particular current concern about the contrasting trends and policies affecting the poorest and the most affluent in the UK, as is illustrated by the examination of wider measures of living standards presented by Patsios, Pomati and Hillyard. The striking trend towards more of poverty overall being among working households, as well as the extent of forms of ‘exclusionary employment’, is the main theme of Bailey’s contribution. This is not the only example of greater ‘precarity’ across wider sections of the community, as there is also a marked shift in this direction in housing as more households live in insecure private renting paying higher rents with little security, while financial stress affects approaching half of the population (Bramley and Besemer).

    Wilson, Bailey and Fahmy found that access to resources and support from social networks is less closely related to poverty and clearly for some households support from family, in particular, is often a key factor in coping with poverty – but in poorer communities family and neighbours may themselves be hard-pressed. Fahmy also shows that poverty does also limit the extent of civic and political participation, alongside factors like education and class.

    The domain on which social exclusion appears least related to material poverty is in fact access to local public and private services. Bramley and Besemer argue that this is ‘good news’, implying that through national and local policies, public spending and regulation, the natural tendency of market systems to reinforce inequality has been neutralised. Other good news stories include the above-mentioned examples of domains of exclusion which are not dominantly driven by poverty, improvements in some aspects of living standards and declines in some forms of exclusion (e.g. financial services), and gradual increases in reported happiness.  There has also been a dramatic fall in the incidence of poverty among the retirement age population over the last two decades.

    Nevertheless, there is some evidence to support concerns about trends towards more marketisation and financialisation of aspects of life, lessening social cohesion and engagement, and promoting disillusion with the system. This is probably not unconnected with the unprecedented falls in living standards experienced by wide sections of the population in the later 2000s and early 2010s, in part due to cost of living factors like higher fuel costs (causing a marked rise in fuel poverty) as well as the increasing precarity of some people’s working lives and housing situations. On a majority of domains of social exclusion, the surveys showed that scores had worsened between 1999 and 2012, while people’s judgements about what things were necessities became more restrictive, reversing a long-term trend towards a more generous set of expectations.

    The authors also note a growing ‘behavioural agenda’ around poverty, but are highly critical about some misuses of this perspective in relation to public understanding, policy agendas and targets. For example, family breakdown, educational failure and serious personal debt may in some cases cause or confound poverty, but very often they are also clearly consequences of poverty. Addictions can be a compounding factor in the poverty and exclusion of some adults, but these only account for a tiny proportion of the total number of adults in poverty.

    Britain has moved forward and then backwards in terms of the adoption of national targets for the tackling of poverty, particularly child poverty, with poverty ‘airbrushed’ out of the national strategy for social mobility. Yet in this respect the devolved administrations, particularly in Scotland, have chosen to follow a different path, reinstating child and other poverty targets in legislation and developing an action programme to achieve these. Recent research-based initiatives by the Joseph Rowntree Foundation under the banner Solve UK Poverty have set out an ambitious and diverse policy agenda which it is argued would significantly reduce poverty in the medium to longer term. Yet in the shorter term the immediate prospect in forecasts by the respected Institute for Fiscal Studies are for a substantial rise in poverty, due in substantial measure to the further imposition of welfare reforms, cuts and the freezing of many benefits.

    Overall, we believe the multi-dimensional perspective of ‘poverty and social exclusion’ has been shown to be justified and successfully implemented through the PSE Survey. In this volume we offer a new picture of the main distinct dimensions of poverty and exclusion, while arguing that it is important to pay attention to these distinct aspects to get a full picture of disadvantage in contemporary UK. For taking this research forward into the future we anticipate building on the kind of survey exemplified by PSE by seeing more use made of longitudinal/panel surveys and of linkage between surveys and administrative data to give stronger insights and evidence on causal processes and trajectories of poverty.

    This first appeared on the Poverty and Social Exclusion site

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    My brother recently applied for Universal Credit, he started growing a beard to show how long it took to for his benefit to arrive. He now looks like Rasputin but without the trappings of the household of a Russian queen at his disposal. Bear in mind that my brother is single, has no dependants and is also not in receipt of housing benefit. He is not a complex case, he is essentially a jobseekers’ allowance claimant.

    In order to distract my sister-in-law (different brother, I am resplendent with brothers) from the painful throes of her labour this week I wittered through small talk in the moments that her pain abated. I asked her when she would be going back to her job as a support worker for care leavers, and if she was going to be OK financially for the period she was on basic statutory maternity pay. She is the definition of a complex case, with variable hours at work, changing childcare costs, changing housing needs and changing family size. When I broached her possible move over to Universal Credit from working and child tax credit her eyes rolled further back in to her head than they had with any of the contractions. At time of writing she is three days into the induction of her labour, so spare a thought.

    Universal Credit

    On the face of it, Universal Credit is a good idea. The benefits system is ridiculously complex, simplifying it is common sense. Except people are not simple, they don’t fit into boxes. My sister-in-law and my brother could not have more different needs, experiences and circumstances. The idea that one (fairly inflexible) thing could simply suit them both is a system designed by someone who has not met a very broad range of people. If the variation in my immediate family is so wide, imagine how many iterations are possible.

    Dame Louise Casey took to the airwaves this week to advise the government to halt on the rollout of Universal Credit. Louise is a woman we can safely say has met a huge variety of people. When talking about vulnerability and homelessness, she knows her onions. She warned that the fast-paced rollout about to commence would increase homelessness and destitution, the likes of which we have not seen for decades. After she was interviewed on the BBC Radio 4 PM programme Deven Ghelani, who worked with Iain Duncan Smith in creating Universal Credit and now works at a place called Policy in Practice, came on and said councils had a role to play in bridging the terrifying gap of destitution. I nearly swerved off the road at the shock of his naivety and ignorance. Local councils cannot in any way, shape or form cope with the levels of homelessness they already face. He went on to say that advice and guidance could be provided by councils, which is funny because I have watched all advice and guidance services in Birmingham close over the last seven years. Citizen’s advice offices boarded up, council homelessness centres reduced down to one. Where previously we had local neighbourhood offices where agencies worked with partners like Women’s Aid and drug services to intervene to stop homelessness occurring, all are now gone! Not for a laugh, not because Birmingham City Council wanted rid of them, but because the government have starved these centres to death.

    I don’t work for a punchy-named think-tank but I have a few pieces of advice about how we can make this policy work in practice, because I am the practice, I am the frontline.

    This policy will only cause destitution while private landlords are seemingly completely unregulated and registered. Under Universal Credit, tenants have to prove that they have a signed tenancy and have a bill in order to receive the housing benefit element of their Universal Credit, which sounds fine when you are in an office in Whitehall. In reality, thousands of people are living in situations where they have very difficult relationships with their landlord and cannot be relying on their good nature to provide them with the documentation that they need. I imagine the good landlords with record-keeping systems will largely stop offering homes to people on Universal Credit as the money is no longer guaranteed to make its way to them. So where will these people live?

    There must be a definitive pathway for those who will inevitably go into arrears with their rent, because the local council’s homelessness duty is simply not going to cut it. The words “intentionally homeless” will be doled out like candy to those who have fallen in to arrears and cannot pay their rent. Not such a problem if you are in a council house and the agencies can talk to each other but that misses hundreds of thousands of people. What are we going to do with all of these intentionally homeless people? The government needs to invest pretty sharpish in decent quality temporary accommodation to deal with this churn, because I can bet you a whole year’s Universal Credit that the B&Bs and Travelodges on the motorways around Birmingham will be brimming with families. At a minimum, Universal Credit should not be rolled out until the Government funds – in every area – independent advice and guidance services so these people have somewhere to go for help.

    The Government has absolutely got to get to the bottom of the issue of split payments. Instead of each person receiving individual benefits, Universal Credit is now all going to be paid into the pocket of one person in a household. All well and good if you are a happy unit, not so good if your old man has a penchant for the horses and a pint of the gold stuff. For victims of domestic violence, how on earth are they going to request in front of their husband to have a split payment in order that they might have a tiny piece of independence, a chance of escape? I can just see it now, loads of abused women disclosing their secret shame at the local Jobcentre. How on earth will they then explain to their controlling partner that he is only getting half the payment because she grassed him up to Julie at the Jobcentre? Remember one in three women suffer domestic abuse in their lives. These are not small insignificant numbers, these are hundreds of thousands of people.

    I could go on and on, these are just a few of the very obvious pitfalls of the new system. They are not new observations, I and many others have been raising these things since Universal Credit was started seven years ago. In seven years the Government still don’t have any answers to these dilemmas.

    So until I have answers, I am firmly with Louise Casey. The Government need to hit pause. The Government want people to fit into boxes. They want to think that taxpayers live in these houses and benefit claimants live in those. Life isn’t like that. We all pay tax, we all get benefits. Even just looking at my family there is no universal truth, we have different needs and different experiences. We are not a homogenous bunch of people who can be helped or incentivised with one thing.

    Universal Credit is not a bad idea, it’s just incredibly naïve. The road to hell is paved with good intentions, which is a natty proverb if you are the person with the good intentions, less fun if you are the one who ends up in hell.

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    Poverty in the UK is a serious problem, and it is a problem that is often ignored or wilfully misrepresented in political debate. Social injustice is wrong, but misrepresenting the nature of social justice is doubly wrong, because it encourages further injustice.

    Of course there are natural and selfish reasons why we may all want to misunderstand the nature of justice, and usually such misunderstandings start by distorting a half-truth rather than deploying a lie. In the UK a common distortion starts with a twin pair of assumptions that are not exactly false, but are highly misleading:

    • Economic development requires freedom of exchange, or what is often called ‘the market,’ the freedom to buy and sell with flexible pricing. For most of us this means the freedom to buy things that others sell us and the freedom to sell our labour, by becoming an employee (or servant) of another person or organisation
    • When we freely enter into contracts with other people or organisations then we are bound by our promises. If we behave properly and follow the agreed rules, even if we end up poorer, it might still be said that we were treated fairly.

    The first assumption is utilitarian. It is claimed the free market exists to serve the overall good; and there are good reasons to believe that markets can sometimes perform a useful social function. The second assumption is deontological. We are free to make our own decisions and promises, but we must accept the results of those decisions, even if other people seem to be doing better than us. In the UK people who believe strongly in these two assumptions, like the philosopher John Stuart Mill, are called liberals (although confusingly the term liberal means something very different in the USA).

    Liberalism is a great philosophy, if you are wealthy, because it offers you a double comfort: Not only are you entitled to whatever you’ve got, but you can also persuade yourself that you are part of a system that is good for everyone (in the long-run).

    However it does not take much imagination to realise that this cannot be the whole story. For injustice is a logical consequence of unrestrained economic freedom, and in every decent society there have always been systems, rules or institutions that are designed to reduce the injustices created by economic freedom.

    Just think about what happens if we simply allowed people absolute economic freedom. First, those people who are more successful will, over time, may use their economic power to guarantee their own future success and so will make it harder for others to compete. This is why democratic governments tend to restrict monopolies or replace monopolies with nationalised industries, like the NHS, which work for everyone’s benefit. It is also why public education and free university education matter, because it reduces the advantage the better-off can buy for their children.

    Second, people who lose out will become more desperate, unable to sell their labour for income or only able to sell it at a very low price. This is why democratic government’s have been forced to both set minimum wages and to create income security systems to redistribute money towards the poorer half of the population.

    There is nothing in a free economic market that ensures that you will get a fair, reasonable or even adequate price for your labour. That’s not how markets work. If you are very poor then you must be prepared to sell your time for next to nothing. Economic freedom has never naturally protected the interests of the poorest, the weakest or those without power. Instead it often releases the very worst in our nature: greed, avarice, pride and the sadistic pleasure of exploitation.

    These statements should not seem controversial or challenging. They represent some of the hard-won lessons of the twentieth-century, a century which proved that the price we can pay for ignoring social injustice is revolution, war, terror and Holocaust. So, it may seem surprising that, in the early years of the twenty-first century, we seem to be in danger of forgetting all these important lessons. Not only do the half-truths of liberalism seem to be back in fashion, but many are even tempted to go a little further and embrace some utterly false beliefs:

    • Poverty is just a matter of perspective, it’s all just relative, and the poorest even benefit from inequality, because inequality is a natural part of a free economic system. What really matters is economic growth, not the distribution of that wealth.
    • People who are not doing as well as you deserve to be poor, just as you deserve to be rich. In fact, economic success means you are a better person and economic failure means you are an inferior person. It is perhaps even dangerous to protect the poorest as this might encourage the wrong kind of people.

    I think it is obvious that these beliefs are false; and I think it is also obvious why they are tempting. This kind of thinking is no longer liberal, it is much closer to fascism or eugenics. It pictures some humans as more valuable, more productive, more equal than other humans. Dog-eat-dog economic freedom is twisted into an engine for human improvement. I think it is this kind of extreme liberalism that is sometimes called neoliberalism.

    It is also fascinating (in a rather horrible way) to see how the rather different idea of meritocracy has increasingly been promoted as if it offers a positive vision for society. This is peculiar in the extreme. Meritocracy means that ‘the best’ people should have the most power (and, it is typically assumed, the most money). In fact the term meritocracy is simply a modernised form of aristocracy – ‘aristos’ being the Greek word for the ‘the best’. The difference is that the best is now presumed to be some cocktail of ‘the clever,’ ‘the powerful’ and ‘the rich’ – rather than landed nobles.

    Old-fashioned liberalism was often combined with a commitment to charitable action: We have other obligations beyond keeping our promises, and any financial success should bring extra social responsibilities, much in the same was that old-fashioned aristocrats used to believe that they had extra responsibilities to the commoners – “noblesse oblige”. It was for this reason that many of the early pioneers of capitalism (Rockefeller, Carnegie, Harkness etc.) actually did spend much of their money on works of public philanthropy.

    However, today’s neoliberals and their meritocratic cousins seem much less interested in social or moral responsibility. Success is not an invitation to exercise social responsibility, it is merely the proclamation of the right of the powerful and rich to seek even higher rewards for themselves, and to look down their noses on those with less money or with different gifts. Liberalism and meritocracy merely justify growing injustice: encouraging the powerful to believe they are entitled to more money; encouraging the wealthy to believe they are entitled to more power. As shallow philosophies go we are scraping the bottom of a very deep barrel.

    How did we get here?

    How have we got here? How have we forgotten the lessons of the past? Why do we even begin to treat these crazy and wicked views as somehow reasonable points of view. Although I am a Christian I do not believe that declining faith or moral standards is the best explanation. In fact countries like the USA, which have a very high rate of Church attendance, also seem to be just as morally confused as the agnostic UK. We will find better explanations I think if we look at the economic, social and political characteristics of our society.

    I also think that, despite the fact that things are currently getting worse, there are several reasons to be hopeful. Social and economic changes are themselves driving us towards a crisis point that might ultimately be very helpful, although how quickly this change will take place is unclear. Although the rise of liberal and meritocratic thinking is a growing threat, I think there remains a stubborn awareness of older truths that hard to dislodge from the human soul:

    Justice lives in poverty.
    She survives.
    She measures
    What is necessary.
    She honours what ought to be honoured.
    She seeks out clean hearts, clean hands.
    She knows what wealth and power
    Grind to dust between them.
    She knows
    Goodness and the laws of heaven.

    Aeschylus: Agamemnon

    In fact, even when our leaders try to exploit liberal and meritocratic prejudices they can only go so far, and often they try to manipulate language and statistics in order to cover their tracks. This tells us that not all hope is lost; there is no need for deception if all truth is gone.

    What we find in practice is that modern politics is a little like street magic. The performer wants us to look in one place, while what is really important is happening somewhere else. In fact I think we can spot at least 10 myths that are commonly exploited to put our moral conscience to sleep:

    1. Inequality is good for the economy
    2. Growth is good for everyone
    3. The welfare state protects the poorest
    4. The rich pay the highest taxes
    5. Only the poor need benefits
    6. Benefits are often claimed fraudulently
    7. People are too dependent on benefits
    8. The benefit system is too expensive
    9. Government has tried to protect the most vulnerable
    10. There is no real poverty in the UK

    I want to use this essay to not only challenge these myths, but more importantly to try and show how the use of these myths performs a useful social function for the political system. Ultimately I believe that, for all the worthy discussion about poverty reduction in the UK (from across the political spectrum) there has been no meaningful commitment to reduce poverty for over 40 years. This means that those of us who care about equality and social justice may need to think differently about our goals and our strategies.

    1. Inequality is not good for the economy

    Liberals will often argue that inequality is a natural part of the economic order and that if we want the benefits of a developing free-market economy then we must accept that inequality will naturally arise. Moreover they also argue that interfering with the labour market will have negative consequences. However, as Figure 1 show, if we look at the growth rate in the UK it has not increased as the UK has become a more unequal country, if anything it has declined.

    Figure 1. UK Economic Growth Rate 1949-2012

    In fact inequality has not benefited the economy and there are many ways of combining economic freedoms with social justice, primarily through redistribution and other social and economic policies.

    2. Growth is not good for everyone

    Another common proposition is that we should not care about equality, just about growth. If an economic policy raises the standard of living of everyone then the fact that some people benefit more is irrelevant. But, as we have seen, the opposite is true – inequality seem to reduce growth. So what we should really pay attention to is who does benefit from economic growth.

    The following data is all taken from the Office for National Statistics, who publish detailed information on the family (household) incomes for every year from 1977 onwards. This allows us to compare how the incomes of different groups changed between 1977 and 2014. We can compare and contrast these incomes more effectively by bring them into line with the values for 2014. Figure 2 shows how incomes had changed – before any redistribution by tax or benefits – between 1977 and 2014. I have adjusted the data from 1977 to bring it in line with the data from 2014 by showing how income distribution for households would look if 1977 had the same average household income as households did in 2014.

    We can see that relatively only the top 20% of families have really benefited from economic change during this period (although there is also a tiny uplift for those in the second decile). So, broadly, we can see:

    • the poor have got poorer
    • the rich have got richer
    • the middle has got a lot poorer

    Figure 2. Comparing Distribution of Original Incomes 1977-2014

    So, during the post-1977 period growth has declined (as per Figure 1) and economy has skewed the benefits of that reduced growth to the better off. This means the poorest are losing twice: lower growth and higher inequality.

    3. The welfare state is not protecting the poorest

    It is often assumed that the welfare state almost automatically benefits the poorest most. However, as we shall see, the reality of the welfare system is not quite what people believe. The welfare state’s primary direct impact comes in three forms:

    • benefits – increased income
    • taxes – reduced income
    • services – increased income for its employees, reduced costs for those with needs

    Now if we compare the incomes after taxes and benefits between 1977 and 2014 as we do in Figure 3 we can see that, rather than increasing the incomes of the poorest, the system’s function has been to increase the incomes of middle-earners.

    Figure 3. Comparing Post-Tax-Benefit Incomes 1977-2014

    This means that we should be very careful to examine two very different kinds of impact on family income. Some of these changes seem to be economic. We can see a significant drop in the incomes of almost all groups, except the wealthiest 20%. However we can also see that tax-benefit policy during this period has been engineered to bring about changes that are just as significant as the economic changes. In fact it looks very much like, as the economy has depressed middle-incomes so the tax-benefit system has been used to reflate them.

    Because the poor were already so poor and the rich were already so rich the changes are best understood using percentages and ratios. So here are some key facts:

    • Before tax and benefits the income of the richest 10% was 18 times higher in 1977 and 27 times higher in 2014.
    • After tax and benefits the income of the richest 10% was 7 times higher in 1977 and 13 times higher in 2014.
    • Economic changes reduced the income of the poorest 10% by 15% between 1997 and 2014
    • Policy changes reduced the income of the poorest 10% by 26%
    • Middle income groups all lost income because of economic changes, the most extreme group being the 4th decile, who saw their income reduce by 29%
    • However middle income groups saw their incomes increase because of policy changes that increased their benefits and reduced their taxes, with the 4th decile benefiting by a 26% increase in their income
    • The rich saw a huge growth in their income of 31%, but a modest reduction by policy of only 8%

    It is these facts that explain the focus by politicians on the ‘squeezed middle.’ However it is not that the middle has been squeezed by the poor or by economic policies that support the welfare state. Instead most of the tax-benefit system is focused on increasing the incomes of those in the middle. In fact as we can see in Figure 4 and Figure 5, between 1977 and 2014 income has been taken off the poorest and redistributed towards the middle.

    Figure 4. Changes in income for families 1977-2014

    Figure 5. Percent changes in income for families 1977-2014

    What is really going on is a fundamental change in the structure of the economy. Growth continues, but the beneficiaries of growth are getting fewer – basically only the top 20%. The welfare system is not primarily being used to benefit the poorest, it is primarily organised to support the middle.

    4. The poor pay the highest taxes

    One of the biggest deceptions of everyday political rhetoric is the use of the term ‘taxpayer.’ The term is often used to imply that there is some group, the better-off, who are somehow contributing the most, and that the poorest are in someway not taxpayers. This deception relies on pretending that the only significant tax is income tax – but this not true. Income tax is the biggest tax the richest pay, but for others indirect taxes, like VAT, are much more important.

    For the following figures I have primarily used the latest ONS data (ONS, 2017). So, if we take all the taxes people pay, and then compare it to their total income then the group that pays the highest rate of tax is the poorest 10% of families – who pay more than 10% more in tax than any other group.

    Figure 6. Overall rate of tax paid by household

    The reason for this is that the UK tax system is regressive – which means it hurts the poorest most – because it relies to such a high degree on indirect taxes, taxes on spending, not on income. Figure 7 compares the detailed breakdown of taxes paid between the poorest 10% and the richest 10%.

    Figure 7. Comparing the different taxes paid

    5. We’re all on benefits

    A similar deception is that only the poor are ‘on benefits.’ Nothing could be further from the truth. Every group benefits from benefits and the poorest do not even benefit the most. In fact it would truer to say that we’re all on benefits and that the primary beneficiary of benefits is the middle-income earner. However this deception is maintained by treating some benefits, like tax credits and pensions, as if they are not really ‘benefits.’ This serves to aid the natural desire of the better-off to see themselves as somehow distinct from those relying on Job Seekers Allowance or Employment and Support Allowance.

    Figure 8. Distribution of benefits across different income groups

    6. Benefit fraud is utterly insignificant

    Another common lie is that benefit fraud is a significant problem. In fact, benefit fraud is very low indeed. It is dwarfed by tax fraud and even more by tax avoidance (the legal but immoral effort to avoid your social responsibilities). The fact that the public seem to believe benefit fraud is so much greater must have something to do with the way in which politicians and the media have exploited an image of some people in society as being somehow particularly unworthy. This problem certainly began before Austerity as it was the new Labour Government who launched the ‘Benefit Thieves’ campaign which pandered to this non-existent social problem.

    Figure 9. Benefit fraud in context

    One very striking statistic is that the poorest not only pay lots of tax, mostly indirect taxes like VAT, but they also pay a significant level of income tax. This is surprising because their incomes are so low they should not be paying any income tax. However, the poor have no accountants, and I suspect that the application of emergency tax rates for short-term work means that the government is actually defrauding the poorest by over-taxing them. In addition the £17 billion of unclaimed benefits could also be treated as a form of government fraud – creating a system so complex – no one knows what they’re entitled to.

    What we must ask is who benefits from this kind of rhetoric. It certainly provides a useful distraction from the real issues, including growing inequality. Perhaps there is a sense in which this is a further price of a declining middle-class. As incomes drop, status is threatened. Perhaps, as well as propping their income through tax and benefit changes politicians are pandering to the need of middle-income earners to feel morally superior to those who are poorer. I suspect the negative skiver, scrounger, fraudster rhetoric is really the mirror image of the as ‘hard-working families’ ‘the squeezed middle’ or ‘alarm-clock Britain’. The rhetorical purpose is to divide us and delude us. Money is transferred from the poor to the middle, but stigma is added to the poor to make the middle feel less bad about this act of theft.

    7. People are not too dependent on benefits

    Another common fallacy is that the benefit system is primarily about supporting people who are out of work and that benefits need to be low in order to discourage people from becoming dependent upon them. But even a cursory glance at benefit spending destroys that myth.

    Figure 10. Different benefits used

    Job Seekers Allowance (the UK’s unemployment benefit) represents 0.7% of total spending. Whereas the four main benefits (nearly 80% of the benefit bill) are not even really directed to address poverty at all:

    • 48.3% on pensions – a basic income for all people of retirement age
    • 12.4% on housing and council tax benefits – compensation for the unequal distribution of property
    • 11.1% on tax credits – compensation for the collapse of middle-income wages
    • 6.2% on child benefit – a basic income for nearly all children

    The poor are in no danger of becoming over-dependent on benefits. Instead the whole of economy is dependent on a significant level of income redistribution and social security simply to function. The shame is that the poorest are treated so poorly by that system – stigmatised and impoverished.

    8. The benefit system is inexpensive

    The UK’s spending on the welfare state is higher than some countries and lower than others. It has remained at a fairly constant level over a long period. There is no reason to think that welfare spending is unsustainable; it is only unsustainable if we refuse to pay for what we think is necessary, and this just requires us to adjust taxation levels. Politicians like to pretend that there is some crisis in order to justify policies they believe will bring them electoral advantage. We should ignore them.

    Figure 11. Government spending over time

    Often it is spending on benefits that is represented as the greatest and most unsustainable cost for the welfare state. What is more it is claimed that the poorest may have become dependent on these benefits and that cuts in services or income are necessary to get people ‘off benefits’ and into work. In fact the truth is much more interesting.

    First of all, as we have already seen in Figure 6, the cost of benefits is hugely exaggerated by ignoring the fact that most benefits are paid straight back in taxes. If we calculate the net or real cost of benefits – after taxes we find that the cost of benefits is very low indeed: £27.8 billion or 1.4% of GDP.

    Figure 12. The real cost of benefits

    Benefits are not even strictly government spending, they are a transfer payment, reducing one person’s income through taxes and increasing another with a benefit. The fact that benefits are presented as government spending is really just a trick of accountancy. If instead we accepted that redistribution was an essential feature of a modern economy we would distinguish it much more clearly from public spending, such as the NHS and education. Currently we’ve got things the wrong way round; we treat redistribution as a somewhat dubious feature of the welfare state, rather than as its primary function.

    9. Government often attacks the most vulnerable

    A further rhetorical trope, that turns out to be a lie, is the idea that government will naturally and quite properly protect those in most need. This line has been particularly important during the Austerity period, although it is not an uncommon lie at the best of times. For instance, I have explored elsewhere, and at some length, how austerity policies targeted those on low incomes, and in particular disabled people with the greatest need. The UK Government’s policies have been so shameful in this regard that the United Nations has openly criticised the UK for failing to meet its human rights obligations:

    “The Committee is seriously concerned about the disproportionate adverse impact that austerity measures, introduced since 2010, are having on the enjoyment of economic, social and cultural rights by disadvantaged and marginalised individuals and groups. The Committee is concerned that the State party has not undertaken a comprehensive assessment of the cumulative impact of such measures on the realisation of economic, social and cultural rights, in a way that is recognised by civil society and national independent monitoring mechanisms (art. 2, para. 1).”

    UN Committee on Economic, Social and Cultural Rights: Concluding observations on the sixth periodic report of the United Kingdom of Great Britain and Northern Ireland. 24 June 2016

    I won’t repeat all of my earlier analysis of the cumulative impact of the cuts here. However I will note, as shown in Figure 13, that one of the features of the welfare state that enables such deception is its complexity.

    Figure 13. The different cuts impacting disabled people

    Complexity allows for various changes to go unnoticed or to be misunderstood:

    • Changes that happen over time, such as the failure to update benefits, take place slowly, but have a very large impact over time
    • Changes in assessment and eligibility can move people out of entitlement, and for new people they will not know they have lost out
    • Technical changes or rationalisations can be presented as modernisations or improvements in targeting, even if they are primarily cuts

    The general rule of thumb in understanding political changes to the welfare state is not to look for fairness or rationality, but to try and identify where short-term political advantage lies. If the primary strategy is to provide tax-cuts to groups who will provide political support then making cuts at any point and by any means can be expected.

    10. Poverty is a significant and growing problem in the UK

    Poverty is not just political, it is also economic. The real situation is something as follows:

    • public and private wage inequality has increased significantly
    • the tax-benefit system has increasingly been used to lift the income of middle-income earners
    • taxes target the poorest and benefits have not risen accordingly

    Over time inequality has increased as:

    • salary differentials have got worse
    • taxes have got more unfair
    • benefits have got worse for the poorest
    • but the system has got more generous in the middle

    On a technical level I think this is also why the Gini Coefficient is a rather inadequate measure of inequality, because it gives too much weight to middle incomes. It makes much more sense to examine the discrepancy between the richest and the poorest, as Figure 14 does.

    Figure 14. How inequality doubled in the UK

    It is also important to ensure that in presenting data about poverty we do not fall into the trap of ignoring taxes. It is the post-tax and post-benefit data that is most important. So today, as Figure 14 shows, the UK has a very high level of inequality and a very high level of poverty. 6.5 million people must live on £51 per week after tax, to pay for all costs. This amount is totally inadequate and it is clear that even a modest tax increase for those on higher incomes could be used to radically increase the lowest incomes.

    Figure 15. Inequality in 2016

    This is why there are now 2,000 food banks in the UK. It is why mortality rates are falling for the first time since the creation of the UK. Poverty in the UK is severe, harmful and unjust – and completely unnecessary.

    Redistribution and public services

    So far I have restricted myself to three main factors in shaping poverty and inequality: income, tax and benefits. But there are other important factors, which are also subject to political influence, that also impact on poverty in the UK.

    Positively the existence of free public services, like health and education, is a great leveller, although in practice there often great distortions in the distribution and quality of those services. Nevertheless universality that takes public services out of the money economy is generally very positive. The fact that social care remains highly means-tested is significantly regressive. The rich look after themselves and make no commitment to the public system, the poor often have to impoverish themselves further to ensure they are entitled to vital services.

    It should also be noted that public services also create jobs, often very well paid jobs, for those with middle-incomes. This is worth considering when we examine the overall redistribution created by the welfare state. The poorest certainly benefit from public services, but society becomes more unequal when pubic services also increase wage differentials. In other words many middle-income earners have their income lifted twice, both through the tax-benefit system and by taking up work in public services. It is the poorest who lose out on both accounts.

    This is not a criticism of public sector workers – far from it – it is just drawing attention to the strange way we think about income and public spending. If the Government increases the salary of a doctor this will be good for the doctor, but it makes no obvious difference to the service I receive and, from the perspective of equality, it is has made a bad problem worse.

    Cost, debt and other complexities

    The data that I have focused on here – incomes, tax and benefits – doesn’t tell us about some other very important facts:

    • Personal debt, which is a cost that has to be served and which is pushed up as incomes drop, is expensive for the poor, but cheap for the rich.
    • Housing costs, which have risen as the social housing has been suppressed and mortgages cheapened, become a bigger burden for the poorest whilst for the homeowner or landlord the costs go down.
    • Growing energy bills, increased through privatisation, hit the poor harder than the rich, because we all need to heat our homes (although now some can’t).
    • Lack of savings, growing job insecurity, lack of community resources, services or support and many other factors worsen the living situation of the poorest disproportionately.

    Real poverty

    There is no excuse, as some in the Government plan, for reducing our focus on the economics of poverty. However we should take a holistic approach and ensure that we also look at the costs people have to pay. Moreover we should also examine the social conditions which make it even harder to bear the costs of poverty. real poverty might best be pictured as having several dimension, as set out in Figure 15.

    Figure 16. Real poverty

    Personally I think we should move towards a more objective understanding of poverty, one which would enable us to eradicate poverty. I would define poverty as follows:

    Poverty is the lack of all the resources necessary to participate as an equality in the life of the community

    There is absolutely no reason why, by this definition, we cannot eradicate poverty from the UK.

    Why does the system not care?

    If we assume that politicians are not naturally unjust, but are primarily motivated by the desire to get re-elected, then there are a number of factors that may help explain recent developments.

    In a two-party system, focused primarily on economic well-being, lifting the income of median-income voters is going to be critical. In addition you must disguise fact that you are doing so is also important (a) because you are failing to address the needs of people in the greatest need (b) benefits are stigmatised and those groups don’t want to be confused with stigmatised groups. Hence systems like tax credits are used to provide a benefit with lower levels of stigma for middle earners.

    Furthermore this explains the increasing use of stigma, sanction, conditionality and control for those in the lowest income groups. Increasing the negative stigma associated with those on the lowest income also increases both a sense of superiority and a sense of insecurity – I don’t want to become like ‘them’. Abusing the poor becomes part of the street magic as it distracts people from noticing that most government policy is about subsidising the middle.

    It is also important to acknowledge the changing structure of our society. If the interests of those who are poorest are unlikely to be represented, if people themselves are unlikely to organise to protect their interests, then exploitation is inevitable. Some of the more obvious social changes include:

    • declining trade union membership
    • declining church attendance
    • increased social atomism
    • declining social fabric in many communities
    • reduced level of political engagement

    Poverty has been privatised. Without the necessary level of social solidarity and connectedness this situation is unlikely to change.

    What next?

    Although the current trend looks very negative I think there are some opportunities for positive change. The decline for middle-income earners which has helped erode our focus on poverty and inequality will increase. Technology and other economic changes is going to see more people, younger people, people in white collar jobs feel that the current system is unsustainable. You can only rob the poor for so long – they’re too poor for the trick to last for ever.

    I think many more people are going to be attracted to the concept of basic income as a solution which universalises income security. In a sense the interests of the middle and the poorest will – if this happens – start to coincide. This should be a good thing.

    I also think that a growing number of us will realise that an economic model which assumes that the only valuable activities are measured by money will collapse. The attractions of family, love, citizenship and community do remain, even in a world impoverished by injustice and shallow thinking. As people begin to reconsider what is of real importance then we can also start to consider how best to build a world where everyone’s gifts matter.

    Meritocracy and neoliberalism will remain a threat to moral sanity. Things will not get better on their own. But we can unite around different values and use the emerging economic crisis as the basis for building something better.

    This was first published by the Centre for Welfare Reform.

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