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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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    Exact figures may be disputed but there is little doubt that social inequality and poverty are growing in the UK. Around four million people suffer from food insecurity, which means being hungry at least some of the time. There are even reports of people being hospitalised for malnutrition and claims of several deaths from starvation.

    As an anthropologist who has worked for several decades on issues of food and food security in both Tanzania and India, I was shocked to discover in 2014 that a significant proportion of the UK population was currently experiencing similar problems to those encountered in much less developed economies. How could this be possible in one of the richest countries in the planet?

    I started to investigate by studying food poverty and forms of food aid at the micro-level in two areas of the UK, one in the north London borough of Barnet and the other in a more rural part of west Wales. Much of my research has taken place in food banks and included interviews with both clients and volunteers, and serving occasionally as a volunteer myself.

    Food poverty needs to be understood in its social context in order for long-term solutions to be found. It is this kind of fine-grained ethnography which enables connections to be made between the state and its policies, the market, and the voluntary sector.

    While wages have risen very little if at all in most sectors and benefit entitlements have often been cut, some people turn to food banks as a coping mechanism. In the UK today, the main food bank charity, the Trussell Trust, has more than 400 such centres and there are likely to be at least as many independent food banks. They rely on long-life food donated by the public in supermarket and school collections.

    Food poverty

    The usual reasons for coming to a food bank include problems with benefits (including sanctions which means no benefits at all for a period of weeks), low-income and debt. Some clients have chronic problems, like this man:

    I used to live in a middle class area of London and cared for my father. But when he died I lost both the flat, which was rented, and my job both at the same time. So I lived in my car for 3 years. Then I got another job, but it didn’t last because I had back problems… I am on pension credit which is paid every two weeks and I don’t have to pay council tax but it’s not enough to live on and pay energy bills, loan from bank, TV licence etc. I come here every Monday and it’s ‘thank goodness for the food bank’.

    Others encounter a sudden emergency with which they cannot cope financially:

    I used to work in administration, specialising in human resources. My problems developed after my husband deserted me and our 3 kids, as a result of which I had a mental breakdown and couldn’t work. So I went on to benefits but these were stopped because I had ticked the wrong box on the form. I have been to the food bank a couple of times and found the people there very friendly. I also had food given to me at Christmas by the food bank.

    Food bank client in north London

    Most food banks are run by volunteers, often out of churches, like this woman:

    I heard about the food bank from my church, which had an item in the newsletter… People (clients) are here because of benefit cuts, sickness leading to loss of work, unemployment, disabilities, domestic violence, bills piling up. There are extremes of people who are so angry and bitter that it is difficult to talk to them, while others are so grateful they burst into tears and hug and kiss you. Often these people live alone, so they also come for company, they have a tea or coffee and feel slightly loved and cared for…

    Volunteer at a north London food bank

    Each food bank has a manager (volunteer or paid) one of whose responsibilities is to keep track of food, clients and volunteers:

    Last year we gave out 1300 food parcels, of which roughly 300 might be to returnees (that is the national average). That means we fed 1000 people in a town with a population of 5,000. The main problems are benefits cuts and changes which account for maybe 60% of the people we see. When their circumstances change, benefits are cut until the new status comes into force. That might take several weeks and meanwhile people have nothing. Another is housing. I am expecting a client just now. She and her partner, plus their children, have just moved out of half-way accommodation. They are lucky – they only spent 8 weeks there before getting re-housed. But others spend many months in such places.

    Welsh food bank manager

    Alongside the problem of food poverty is one of food waste and surplus, which is generated by the food and restaurant industries, and by domestic consumers. While making use of the waste coming from restaurants is difficult, but not impossible, that generated by food retailers can be redistributed provided it is not past its ‘sell-by’ date.

    A number of organisations, including well-established ones like FareShare and Foodcycle and more recent local additions, such as the Felix Project in London, collect food surplus from both wholesalers and retailers such as supermarkets. They use this to supply charities like homeless hostels, women’s refuges, and breakfast clubs which turn it into meals for their clients. Recently, FareShare has made use of an app to develop the FareShare FoodCloud, partnering initially with Tesco (and, more recently, Waitrose) to allow surplus food to be collected daily by different charities in a managed and monitored way.

    It may thus appear that using the considerable surplus generated by the food industry and ensuring that is it channelled to organisations dealing with food poverty constitutes a win-win situation, effectively a problem solved.

    In my forthcoming lecture in memory of the distinguished anthropologist Professor Mary Douglas, I shall be using some of her work and my own to argue against such a view. The late Professor Dame Mary Douglas was a prolific writer on many topics, one of which was food. Like other anthropologists, she was interested in the social and symbolic aspects of food and her work encompasses economics and social policy. Douglas maintained that giving out food was rarely the solution to more fundamental problems of poverty, a lesson which has been re-learned a number of times in contexts ranging from famine in Africa to food insecurity in the USA.

    She argued rather that obtaining food should come from reciprocity either in the form of payment for labour or some other kind of reciprocal exchange. Where food is given out without any commensurate return, it is a form of charity which only alleviates an immediate problem, but not the reasons for its existence. Her argument draws upon classic anthropological work on gift-giving which demonstrates that gifts should not only be received (never look a gift horse…) but also returned.

    It is for this reason that receiving something for nothing creates a highly asymmetrical status between giver and receiver, which is why many people feel that it is stigmatising to go to a food bank. While many clients feel gratitude for the help they receive, most also feel shame, because in accepting such help, they deem themselves to be failures. Such a view is reinforced by much of the media which views clients of food banks and other food aid organisations as ‘scroungers’.

    Most food banks and other food aid organisations recognise that their solutions are imperfect and hope that the need for them will be temporary, but argue that people cannot be left to suffer hunger when it can be alleviated, so ‘in the meantime’, their efforts remain necessary.

    In the 2017 Mary Douglas Memorial lecture, I consider where responsibility for food poverty lies and how more fundamental solutions to it may be found.

    First published on the  British Politics and Policy blog

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    300,000 people have had their benefits suddenly stopped by sanctions in the last 12 months, many of whom have been plunged into poverty, unable to heat their homes or even eat.

    On today’s National Day of Action Against Sanctions, Ruth Patrick highlights the reality of welfare reform as laid out in her new book, For whose benefit? The truth is that our punitive welfare reform agenda leaves people further away rather than closer to the paid labour market.

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    Ruth Patrick

    “While Cameron and Osborne may no longer be in charge, their welfare reform agenda continues apace. This month sees the implementation of another wave of reforms, which will further weaken Britain’s social security system.

    Over recent years, politicians have robustly defended successive rounds of welfare reform. They argue that reform is needed to end supposed cultures of ‘welfare dependency’ and prevent people from being able to ‘choose’ benefits as a ‘lifestyle choice’. In making their case, politicians draw upon simplistic but powerful demarcations between ‘hard working families’ and ‘welfare dependants’, and suggest that welfare reform will help those on out-of-work benefits join the ranks of the hard working majority.

    As David Cameron put it back in 2014:

    “Our long-term economic plan for Britain is not just about doing what we can afford, it is also about doing what is right. Nowhere is that more true than in welfare. For me the moral case for welfare reform is every bit as important as making the numbers add up: building a country where people aren’t trapped in a cycle of dependency but are able to get on, stand on their own two feet and build a better life for themselves and their family.”

    But does Cameron’s moral case stand up? And has welfare reform actually helped people make transitions from ‘welfare’ and into work?

    “The truth is that our punitive welfare reform agenda leaves people further away rather than closer to the paid labour market.”

    Patrick_For whose benefit-webOver the past six years, I have been researching experiences of welfare reform: walking alongside a small group of individuals as they anticipated, experienced and reflected upon changes to their benefits. By returning to the same people several times, I was able to contrast their expectations with what subsequently happened, and to unpick individual journeys through the benefit system against a context of far-reaching welfare state retrenchment.

    The single parents, disabled people and young job seekers I spoke to did not recognise the idea of benefits as a lifestyle choice. Their lived experiences contrasted markedly with the popular stereotypes so often peddled by politicians and replicated and reproduced in the media. What they instead showed was the hard ‘work’ that getting by on benefits demands, and the ways in which welfare reform simply added an additional burden to their already difficult lives.

    One of the individuals I interviewed was Adrian, a young job seeker and care leaver who had a history of offending. Adrian had never worked, but expressed strong aspirations to find employment, aspirations that endured over time despite repeated setbacks. Challenging the popular narrative of ‘inactive’ claimants, Adrian volunteered at a local homeless hostel, enjoying the chance to ‘give something back’ and provide support that he himself had once benefited from.

    “The single parents, disabled people and young job seekers I spoke to did not recognise the idea of benefits as a lifestyle choice.”

    At the time of our first interview, back in 2011, Adrian was on a benefits sanction for failing to apply for a job after a misunderstanding between himself and his Job Centre Plus adviser. Over the following five years, he was subject to repeated sanctions, and these often seemed to be due to poor communication, confusing directions as well – on occasions – as Adrian’s failure to turn up for appointments on time or when unwell.

    dole animators 05

    Image copyright: Dole Animators

    For Adrian, sanctions meant immediate and extreme hardship, and indirectly led to his becoming homeless when he was unable to pay back rental arrears. To survive, Adrian turned to foodbanks and was also caught shoplifting sandwiches for which he received a fine which he was unable to pay because of his sanctions.

    While Adrian continued to seek work, he felt the sanctions made this more difficult:

    “You’d ring them [employers] up and they’d say “oh, come down, we’ll go for an interview”. You’d go for an interview and if it’s a point where you’re being sanctioned, you’re all…skinny and everything, you look proper ill. They look at you and go “nah, you look like a crackhead or something.”

    When I spoke to Adrian last year, he explained the impact sanctions had on his work-search and mental health:

    “[I go to the work programme] more or less every week….Just talk about looking for work, and then they’d put me on some mock interview and [I’d] never get through. They did say why, they said [poor] eye contact, which were pretty good. Cos I don’t make eye contact after the sanctions and that, I became very unsociable, didn’t want to trust…now it’s just lasted, made me unsociable with people and that, made me feel down…”

    Adrian has been ill-served by a punitive welfare reform agenda that is grounded in a baseless rhetoric that suggests that individuals require ‘tough’ measures if they are to be activated off benefits and into employment. Over five years, repeated sanctions left him destitute and – ironically – further away rather than closer to the paid labour market. What Adrian needed – but what was notably absent – was targeted and effective support.

    Any further changes to the social security system should start with a complete rethinking of the assumptions that currently underpin ‘welfare reform’. Unpicking these assumptions requires a recognition of the lived experiences of poverty and out-of-work benefits receipt, experiences that expose the weakness of David Cameron’s moral case for welfare reform.

    First published by the Policy Press

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    The government promised to help disabled people back into work. They’re failing – and now it looks like their Welfare Reform is targeting those who need higher levels of support.

    The Government published its long-awaited ‘Improving Lives: Work, Health and Disability’ Green Paper at the end of October 2016 after originally promising a White Paper in 2015. The White Paper was supposed to define how disabled people would be supported into work and meet the Government’s manifesto pledge of halving the disability employment gap of 34% by 2020 (currently it stands at 32%).

    The employment gap was used to justify further draconian cuts in social security support for disabled people in the Welfare Reform and Work Bill published last summer. In particular, the Bill announced cuts of approximately £1,500 a year in Employment and Support Allowance to half a million people in the Work-Related Activity Group (ESA WRAG) – those people who had been found not fit for work, but who may be in the future – to be introduced in April 2017.

    The 2016 Welfare Reform and Work Act followed the 2012 Welfare Reform Act which Scope estimated by 2018 will have cut nearly £28bn of social security support to 3.7m disabled people. Of course this doesn’t include £4.6bn cuts in social services support since 2010 or the NHS crisis, both of which affect disabled people.

    The Green Paper, the consultation for which closed on 17th February just 6 weeks before the ESA WRAG cuts come into place, makes the bold claim that ‘…employment can…promote recovery.’

    The issue I have with this statement, and the tone of the Green Paper as a whole, is that this implies that disabled people and people with chronic conditions would recover if only they tried a bit harder, or their doctors weren’t such soft touches. It doesn’t mention ‘shirkers’ directly but comments on how some people with the same condition languish in the ESA Support Group whilst others “flourish at work”, making it clear that’s what they’re thinking, ignoring their own rhetoric about “not treating everyone in a one-size-fits-all way”.

    As a former Public Health consultant who researched into the health effects of work and worklessness, I agree that some work is good for health, but I don’t agree with the Government’s flawed thinking underpinning this: that it’s OK for people to return to work when they are still not fit, because it may help. This is not just unsound, it’s dangerous.

    The scapegoating of disabled people, which includes people with physical or mental impairments and long-term health conditions as defined under the 2010 Equality Act, has been a hallmark of this Government and the previous Coalition. But even the conclusion of the United Nations inquiry that the UK Government has been responsible for ‘grave…systematic violations’ of the UN Convention on the Rights of Persons with Disabilities since 2010, has been met with Government stonewalling.

    It is already well established that disabled people are twice as likely to live in poverty as non-disabled people as a result of the extra costs associated with their disability. Currently 4.2 million disabled people live in poverty and I have been informed from unpublished analysis by an Economic and Social Research Council research project that this is getting worse.

    The Government has refused to stop the cuts to ESA WRAG and Universal Credit’s Limited Capacity to Work which come in this April, which will undoubtedly increase the numbers of disabled people living in poverty, threatening their health and well-being. Various discretionary funds may be available, for example the Flexible Support Fund, but there is no guarantee of support and they are quite specific in what they can be used for.

    The timing of these cuts when there has been a negligible reduction in the disability employment gap is quite shocking. The Green Paper rings alarm bells that people in the ESA Support Group are the next to be targeted by Welfare Reform. Linked to this, the new Work Capability Assessment criteria which the Government announced last September (after I committed to scrap the Work Capability Assessment) will be published later this year. These will give a clear indication what the Government’s real agenda is.

    The Green Paper also talks about employers and the need for them to invest more in workplace health and occupational health support. This is, of course, very important; 90% of disability and long-term health conditions are acquired, so it is absolutely right to examine what can be done to reduce the risk of employees falling ill and how employers can make reasoned adjustments to support an employee to stay in work if they become disabled. But Access to Work helped only 36,000 disabled people stay in or access work in 2015 out of the 1.4m disabled people who are fit and able to work.

    Welfare Reform

    To date, the Disability Confident Campaign launched in 2015 has been a dismal failure making a negligible impact on the disability employment gap. Changes in employer attitudes and behaviour needs practical support, including Access to Work. But what is the Government doing to support employers, especially small businesses given that nearly half the workforce is employed by them? How can a small business access affordable, timely occupational health support? With the NHS in crisis and waiting times for non-urgent treatments escalating, how will timely interventions to help people back to work be delivered?

    As always with this Government and the previous Coalition, they are happy to point fingers at everyone else without taking any responsibility themselves. They talk about the impact of work on health and the need for ‘culture change’ and to ‘reinforce health as a work outcome’ but what about the impacts of the social security system on the health of claimants? Their policies have a direct impact on people’s health in the punitive, humiliating way they are too often implemented, but also through the real, enduring poverty and hardship people are forced to live under.

    Labour will hold this Conservative Government to account on all these areas, developing meaningful, alternative, approaches with disabled people, employees, and employers as part of our Disability Equality Roadshow. If this Government is committed to a fairer society, they should stop trying to rebuild the economy off the backs of poor, sick and disabled people.

    Labour believes, like the NHS, our social security system should be there for all of us in our time of need, based on principles of inclusion, support and security for all, assuring us of our dignity.

    First published by Open Democracy

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    Whether e-cigarettes can help address health inequalities will depend on take-up in deprived communities – but cost and ‘faff’ are discouraging deprived smokers from switching, according to new research.

    The study involved community-based research in the North East of England with smokers and quitters over three years from 2012 to 2015. Research participants bought both tobacco and electronic cigarettes largely through informal outlets and personal networks – but for the very poorest, cost was a barrier to any e-cigarette use. Although £10 would buy a starter tank and e-liquid, smokers could get a week’s worth of illicit rolling tobacco for the same money. The poorest could not risk such a large outlay on something that might not work.

    nov-14-ecig-market-pic-for-sha-blog-nov-16
    Figure 1: People bought from informal outlets

    Even those who could afford better tended to buy cheap e-cigarettes (and cheap tobacco if they were still smoking) because addiction was a problem for their moral identity, as was excessive expenditure on the self. Older people were particularly likely to be put off by the association of the e-cigarette with pleasure or play, and avoided aspects of e-cigarette use which they associated with frivolity or self-indulgence: sweet flavours, expensive parts, vaping shops, culture and language.

    Users struggled with the faff factor

    Users struggled with the time, effort and expense involved in finding the ‘right’ e-cigarette and the frequency of product failure i.e. cheaper tank models splitting, leaking, or bubbling if over-tightened or dropped, and problems with batteries running out or failing to charge. Unless users were highly motivated to quit, smoking was easier and cheaper taking into account the cost of e-cigarette replacement and the availability of illicit tobacco.

    This practical problem was also a gender issue. The energy, time and money needed to switch successfully to e-cigarettes were often lacking for older women heavily invested in family care, whose personal health was relatively low in their hierarchy of concerns. Mature women in the study had a relational sense of identity in which care of the self was at the bottom of a hierarchy of concerns. For these women, their own health simply did not seem important enough, in comparison with the many tasks they did for others, for them to put in the effort needed to quit. As a result, whilst they might try an e-cigarette, they quickly became impatient with aspects in which it compared poorly with the ever-reliable, endlessly replaceable cigarette.

    Figures currently show slightly more women than men using e-cigarettes overall. Women are more likely to use disposable or first-generation ‘cigalikes’, but since second-generation devices deliver nicotine more effectively and are more satisfying to users, there is a risk that using less effective models may translate into fewer women ceasing to smoke. Gender is not discussed in the most recent UK e-cigarette evidence review; further research will be needed to establish whether there is a gender differential in the use of e-cigarettes to quit smoking successfully.

    Young men bought into vaping culture

    Smoking cessation conflicted with a local ethic of working-class hedonism which encouraged sociable smoking and drinking, particularly among younger men. This meant that to abstain or quit smoking was to risk being seen as pretentious or insufficiently masculine. However, using an e-cigarette overcame this problem, not least because an interest in gadgets and technology was a legitimate male trait. The e-cigarette was therefore a viable masculine accessory in combining hedonism with technology.

    Local masculinity was performed differently in mature adulthood, at which point smoking cessation could function as part of a narrative of family responsibility or indeed of mastery; older men positioned their e-cigarette use within this functional narrative. Normative masculinity also required that one should give up smoking if suffering serious ill-health such as cancer, stroke or heart attack; not to do so in such circumstances implied weakness or a lack of self-control. Some men with serious health problems who were unable to quit smoking remained dual users of tobacco and e-cigarettes, but deployed e-cigarettes as a badge of moral intent.

    The success of the e-cigarette in addressing health inequalities will partly depend on whether it enables users to overcome locally normative barriers to cessation. These findings suggest that it does have some potential to do this, at least in relation to men. However, the e-cigarette is constantly changing and increasingly regulated; should it become a more medicalized product, it might lose its attractiveness as a masculine accessory. On the other hand, if more reliable and effective models start to dominate the market, this will diminish the trial and error process which discourages older women users in particular.

    Whilst the findings of this study cannot be generalised to deprived areas across the UK or further afield, local meanings of smoking and cessation in relation to gender and age are crucial to e-cigarette take-up, as are place-based smoking and cessation practices more generally. Most importantly, we need to appreciate that local norms can sometimes make giving up tobacco or taking up e-cigarettes more of a risk to moral identity than carrying on smoking.

    The full article is open access and available here:
    Thirlway, Frances (2016). Everyday tactics in local moral worlds: e-cigarette practices in a working-class area of the UK. Social Science & Medicine 170: 106-113.

    About the author

    Frances Thirlway is a Research Associate at Durham University and an associate member of FUSE – the UKCRC Centre for Translational Research in Public Health. Her research interests are in health, class and culture, with a particular interest in smoking cessation (including e-cigarette use) in relation to health inequalities in the north of England and in Scotland. Follow her @fthirlway

     

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    In 1842, the English social reformer Edwin Chadwick documented a 30-year discrepancy between the life expectancy of men in the poorest social classes and the gentry. He also found a North-South health divide with people from all social classes faring better in the rural South than in the industrial North.

    Today, these inequalities persist.People in the most affluent areas of the United Kingdom, such as Kensington and Chelsea, can expect to live 14 years longer than that those in the poorest areas, such as Glasgow or Blackpool. Men and women in the North of England will, on average die two years earlier than those in the South. Scottish people also suffer a health penalty with the highest mortality rates in Western Europe.

    Such geographical inequalities in health exist, to varying degrees, in all high-income countries. People living in more deprived areas fare particularly badly in the casiono capitalism of the United States; where gaps in life expectancy between rich and poor areas of some cities, such as New Orleans, are as large as 25 years. Indeed, the US as a whole has a significant health disadvantage in comparison to other high-income countries with, for example, American men living on average three years less than their counterparts in France and five years less than Swiss men.

    Understanding and reducing these health inequalities remains a major public-policy challenge worldwide and has garnered significant recent political attention. For example, in her opening speech on the steps of 10 Downing Street, the new British Prime Minister Theresa May highlighted the nine-year gap in life expectancy between the richest and the poorest boys in England. It is not only a moral issue though; health inequalities carry significant economic costs to individuals and society (e.g. NHS costs, lost productivity). But the causes of such inequalities are complex and the solutions contested.

    Explaining Health and Place

    In my new book, Health Divides: where you live can kill you published by Policy Press, I show that where you live affects how long you live and that the health of different places is determined both by the population composition (who lives here) and the environmental context (where you live).

    Who lives here? The demographic, health behaviours and socio-economic profile of the people within a place influences its health outcomes. Generally speaking, health deteriorates with age, women live longer than men, and health status also varies by ethnicity. Levels of smoking, alcohol, physical activity, diet, and drugs – all influence the health of populations significantly. The socio-economic status – or social class in “old money” – of people living in a country also matters as those with higher occupational status (e.g. professionals such as teachers or lawyers) have better health outcomes than non-professional workers (e.g. manual workers). So differences in the characteristics of people living in a country,city or neighbourhood will impact on the health of that place.

    However, my book also shows strongly that where you live matters. The economic environment of a country, such as poverty rates, unemployment rates, or wage levels can all influence public health. The social environment, including the services provided within a country to support people in their daily lives such as child care or health care and welfare, can also impact on population level health. The physical environment is also an important determinant with research suggesting that proximity to waste facilities and brownfield or contaminated land, as well as levels of air pollution can negatively affect health. So countries,cities or neighbourhoods with worse economic, social or physical environments will have worse health outcomes.

    Reducing health inequalities

    However, even though both composition and context matter, and can be supported by scientific evidence, politics can matter more than science in determining which strategies policymakers pursue to reduce health divides – or if they even care about inequalities at all. After all, some potential solutions are politically easier to implement within existing systems than others.

    For example, interventions aimed at changing individual health behaviours are far less challenging to prevailing power structures than those that demand extensive investment in improving the social economic environment. Indeed, by blaming people for their own health problems, such interventions let governments and businesses off the hook for the wider economic, social and environmental determinants of health inequalities.

    Such “downstream” approaches only tackle one side of the coin and there is little evidence that lifestyle interventions are effective in reducing health inequalities: more comprehensive measures are needed. As my book shows, most of the health gains over the nineteenth and twentieth centuries were brought about by far-reaching economic, political, and social reforms which improved the wider environment and also significantly improved the financial position of the poorest people.

    It has been clearly demonstrated that more equal societies almost always do better in health terms and the poorest and most vulnerable groups, say in Sweden or Norway, are far healthier and live longer than the equivalent groups in the UK or the US. These countries have done so through the development of a stable, inclusive economy, a supportive welfare system and a high standard of living.

    Conclusion

    So, where you live matters for how long you live – and changing how we live could reduce health inequalties.

    Health Divides: where you live can kill you is available now from Policy Press.

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    More must be done to give the UK’s most vulnerable children a fairer start in life

    UNICEF’s long-running Report Card series provides a regular assessment of how rich countries fare in promoting child well-being. The latest Report Card, Fairness for Children, assesses ‘child well-being gaps’, which measure the distance between the most disadvantaged children and the ‘average’ child in each country. While much of the debate about inequality today focuses on the top 1 per cent, these measures capture the extent to which the most disadvantaged children fall behind the levels of well-being their peers can expect. This focus on so-called ‘bottom-end inequality’ therefore captures the extent to which each country allows their most vulnerable children to fall behind.

    Unicef_report_card

    The Report Card examines four domains of child well-being ­– income, education, health, and life satisfaction – and the UK’s performance can be summed up as ‘could do better’. Overall, the UK is ranked 14th (from best) out of 35 countries (Figure 1). It ranks mid-table in three of the four child well-being domains: 25th out of 37 countries on educational achievement gaps; 19th out of 35 countries on health gaps; 20th out of 35 countries on life satisfaction gaps. The UK, in common with many other countries, has made little progress in reducing gaps in these child well-being domains since the 2000s.

    The UK does rather better in terms of protecting the incomes of the most disadvantaged children, ranking 7th out of 41 countries. But while the gap has narrowed significantly since 2008, this is because the incomes of children at the middle of the income distribution have fallen rather than as a result of a dramatic improvement in the incomes of children at the bottom of the distribution. Hardly, in other words, a good news story.

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    That said, there is a good news story here: the incomes of the UK’s poorest children did not dramatically fall following the recession. Clear contrasts can be drawn here with many other countries hit hard by the economic crisis, particularly those in Southern Europe. This reflects the comparatively strong role social security benefits have played in protecting the incomes of many families with children in the UK. Indeed, across Europe no other country’s social security system does more in reducing the gap between the incomes of the poorest children and the average child (Figure 2).

    However, social security protections for working age people have been the major focal point of the UK’s austerity agenda. Ongoing cuts to social security provision are likely to affect the well-being of the poorest children in the UK in future years, and risk widening inequalities in child well-being still further. Indeed, theResolution Foundation and the Child Poverty Action Group have warned that low income working families face losing relatively large amounts of income because of recent changes to Universal Credit that are about to take effect.

    Unicef_report_cardMoreover, the UK’s social security system has to work harder than those of most neighbours because underlying levels of inequality are comparatively high. While the government’s ‘National Living Wage’ is a step in the right direction here, the Institute for Fiscal Studies (IFS) suggest it will have little impact on poverty or inequality. In fact, after modelling the cumulative impact of recent changes to tax, benefit and labour market policies, the IFS is projecting a rise in relative child poverty from 17 per cent in 2014-15 to 25.7 per cent in 2020-21 and a rise in absolute child poverty from 16.7 to 18.3 per cent over the same period.

    The analysis presented in the UNICEF Report Card suggests the government may struggle to improve child well-being outcomes without addressing rising income differentials. Countries that protect the incomes of the poorest children most strongly tend to have higher levels of overall child well-being. More generally, countries with more equal income distributions also tend to be those that do better in minimising adverse child well-being outcomes.

    Newly released data from the latest (2014) wave of the Health Behaviours in School-Aged Children (HBSC) survey included in the Report Card shows that, across rich countries, children living in less affluent households are more likely to be unsatisfied with their lives than their peers. This confirms patterns found in the 2002, 2006 and 2010 HBSC data. It is hard to imagine a more powerful argument for addressing social inequalities among children than the fact that across all rich countries, and on every occasion this century they have been asked, children from economically disadvantaged households are consistently more likely to have told HBSC researchers that they are unsatisfied with their lives.

    Child well-being gaps are a concern in their own right, but a further reason for policy makers to prioritise reducing them is that smaller gaps tend to benefit all children. Fairness for Children shows that countries with more equal child well-being outcomes tend to also have: fewer children living in poverty; fewer children lacking basic educational skills in reading, maths and science; fewer children reporting ill-health on daily basis; and, fewer children reporting very low levels life satisfaction.

    UNICEF ’s report cards suggest the UK has made progress in addressing overall levels of child well-being since being ranked bottom of the table in the early 2000s. Stephen Crabb used his first speech as Secretary of State for Work and Pensions to pledge ‘a relentless focus on improving life chances’ by mobilising ‘all parts of government to tackle poverty’ and creating ‘a welfare system that does protect the most vulnerable’. If the government is serious about this agenda then it must to do more to close child well-being gaps and give the UK’s most vulnerable children a fairer start in life.

    This article by John Hudson and Stefan Kühner, was first published on the British Politics and Policyblog

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    What’s the problem?

    In his 2015 Budget the Chancellor George Osborne proposed an increased statutory minimum wage rate with a new name, the ‘national living wage’ . Unlike the real Living Wage, his minimum wage rate does not relate to what households need to live decently. The national living wage is a misuse of the idea and name of the real Living Wage; Mr Osborne has stolen the brand name of an established idea known in policy circles for many years. Public discussion of ‘living wages’ shows confusion between Mr Osborne’s minimum wage rate which is not calculated as enough to live on decently, and the real Living Wage which is.

    How are minimum wage rates set?

    The government’s Low Pay Commission  discusses with employers and  employees what pay rates they think business can afford. It then makes recommendations to government which sets the minimum rates employers must pay. Evidence about people’s minimum decent living standards or needs is not part of this process.

    How is the real Living Wage set?

    The real Living Wage is based on what ‘Living’ means. ‘Living’ means freedom to choose the real, socially inclusive life which the public in the UK, not politicians, think is needed for a minimum acceptable standard of living for everybody. That includes not only warm clothing, shoes, adequate bedding and a healthy diet but also spending on things like sports and presents for children as well as normal shopping and other bills. Groups of ordinary people discuss what the minimum standard is with each other and with experts in fields like nutrition, housing and heating until they arrive at agreement. The costs of this minimum acceptable living standard are then calculated for various household types and published as the minimum income standard.

    Household incomes needed to pay for this minimum acceptable standard don’t only come from earnings. They also come from the mixture of tax allowances, child benefits and social security benefits for which households may be eligible. So if government reduces the value of allowances and benefits, then earnings levels have to rise to compensate. In principle, if government raised the levels of allowances and benefits, then the part of household income needed to reach the minimum acceptable standard which comes from earnings could fall, but this hasn’t yet happened.

    The Living Wage is calculated as the hourly rate of earnings which the majority of workers need to earn for a week’s work to reach the minimum income standard or equivalent level in London or in the rest of the UK, taking account of their households’ other income from personal or household allowances and benefits. Because it is part of households’ total income which is needed to afford the minimum acceptable standard agreed by the public for everybody, it is thus completely different from the government’s national living wage which has no connection with minimum living standards.

    Should there be a target?

    Government proposes the national living wage should rise to 60 percent of over-25s’ median hourly earnings. That says nothing about what earnings are needed to reach real Living Wage levels for most households, because it takes no account of other government sources of household income. It risks confusion with the official ‘poverty line’, 60 percent of median household incomes. Both percentages measure income inequalities, not how much is enough. In reality, empirical poverty research  in the UK 2008-15 shows that 60 percent of median household incomes continues to be too low to cover the public’s minimum acceptable living standards for families. Similarly, there is no evidence that 60 percent of median hourly earnings would be high enough to meet them, even with other current income from government sources. At best, statistical indicators of this kind are mileposts but not goalposts, good for showing how far we have got but not for where we need to get to.

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    In recent months, the term “sharing economy” has been used mostly to describe a “peer-to-peer economy“, one involving the sharing of private assets through bartering and the swapping of goods, time, and expertise. Among the most quoted examples are the global rental website Airbnb and Uber, the transport sharing platform. But this is a very narrow definition. The concept can instead be defined to describe anapproach to policy-making, aimed at ensuring the proceeds of economic activity and of growing prosperity are more evenly shared across society. This definition (and goal) used to be central to the post-war construction of managed capitalism, a model in which living standards for all groups rose in line with economic prosperity.

    Yet under market capitalism, the gains from growth have been heavily skewed in favour of a powerful elite: driving the pro-rich, anti-poor trends of the last three decades is the rising concentration of private capital ownership. This, in turn, has been fuelled by rolling privatisation, an antipathy to public ownership and collectivism, and a growing boardroom preference for securing growth through corporate mergers and acquisitions. As the World Bank economist, Branco Milanovic, has argued: ‘If one of the drivers of inequality are capital incomes… this is because they are heavily concentrated. “Deconcentration” of capital incomes, that is much wider ownership, is then a solution. But it is seldom mentioned.’

    5165377895_ccd93e6654_b

    With the exception of the US, few other rich nations operate a model of such intense corporate capitalism, one dominated by the power of the giant private corporation. Co-operatives account for only 2 per cent of the British economy, much lower than, for example, in Germany, Italy and Switzerland, while other alternative business models, from mutuals to partnerships, are greatly under-used. Key sectors – from supermarkets and energy supply to food production and accountancy – are dominated by a handful of companies. Individuals today own 12 per cent of traded shares, down from 54 per cent in 1954. Shares are held much more transiently than in the past, increasingly by global asset management companies and high-frequency traders.

    Outside of the UK, there is much less fixation with private ownership: countries as diverse as Germany and Singapore have higher levels of state ownership. Many rich nations that have gone down the privatisation route are now unwinding their privatisation programmes  in response to the way utilities have been exploited for private gain. Outside of the UK there is also much wider use of social wealth funds – collectively held pools of wealth. Sovereign wealth funds have been established in a diversity of nations from Norway to New Zealand, and in a number of US states, mostly funded from natural resource exploitation. Although such funds are not all used for wider public benefit, the model of collectively-owned wealth offers a potentially powerful economic and social instrument, an alternative to both privatisation and traditional nationalisation.

    Such funds can be used to spread the ownership of capital and its gains more widely, thus offering a direct attack on the roots of inequality. Having failed to establish its own fund from the proceeds of North Sea oil, widely accepted as a major policy error, Britain should seek alternative finance by cancelling the privatisation process and pooling all commercial public assets, from property and land to public companies, into a public ownership fund. Managed independently, such a fund could generate returns to be used for wider public benefit, prevent the shrinking of the nation’s asset-base and ensure that a higher proportion of the gains from economic activity are re-invested for productive use.

    Political leaders, national and global, continue to declare verbal war on inequality. In the UK, an All-Party Parliamentary Group on Inclusive Growth was formed in 2014, while the Conservative Party is still selling – for £10 – its 2010 election poster “All In This Together”. But if the anti-inequality rhetoric and the search for “inclusive growth” is to be given substance, it needs much more than policy tinkering, a nudge in the minimum wage rate here or modest reforms to corporate governance there. Creating a “sharing economy” in which the gains from growth are more evenly shared needs to tackle the source of inequality: the growing concentration of capital ownership and the unyielding power of corporate capitalism.

    First published on the British Politics and Policy blog

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    On Friday, campaigners from Disabled People Against Cuts, Mental Health Resistance Network and Boycott Workfare staged a stormy protest outside City Road Medical Centre in Islington, against the introduction of ‘job coaches’ into GP practices, under the rubric of ‘integration’ and ‘joined up care’.

    In fact, the arrival of job coaches in Islington GP surgeries exposes the toxic reality of government plans to merge health and employment services. In a move that is both unethical and unsafe, health professionals are being tasked to deliver benefit cuts for the Department for Work & Pensions (DWP). This involves  a raft of measures to support the imposition of ‘work cures’, including setting ’employment’ as a clinical outcome and allowing employment coaches to directly update a patient’s medical record.

    Islington GP Pilot

    NHS Islington Clinical Commissioning Group (CCG), who oversee local health care, has accepted DWP funding to ‘drive employment outcomes through strategic health commissioning’, in a move intended to enforce the mantra that ‘work is good for you’, whether it is or not.

    Jobs on prescription‘ targets people with long term mental health conditions and is being piloted in seven Islington GP practices, as part of a £90K collaboration between the council, the Jobcentre, DWP, and Islington CCG. In other words, a partnership between healthcare and the government departments responsible for administering benefits, including the punitive and unaccountable sanctions regime – a system which is known to disproportionately affect people with mental health conditions, as well as disabled people and those with long term health conditions’ please.

    Destroying patient trust

    The first casualty of government efforts to interfere with clinical judgment is trust. The scheme will undermine trust between doctors and patients and could discourage disabled people and people claiming benefits from using healthcare at all, if doing so is seen to be linked to pressure to find paid work or loss of benefits. An activist from Disabled People Against Cuts warns that

    many disabled people already feel they have to watch every word they say when seeing their GP, in case it is used against them at some point to stop their benefits. Placing Jobcentre-funded staff in doctors’ surgeries could destroy the doctor/patient relationship and may lead to some people not accessing vital healthcare when they need it most. Many will feel that the GP surgery is not a safe space to discuss their health concerns if a GP can prescribe job coaching. This pilot will pile pressure on patients in mental distress who are already suffering.”

    Discredited private contractor Maximus

    Employment coaches for the pilot are provided by Remploy (the recently privatised employment service for disabled people). Remploy is owned by Maximus, the private company contracted to carry out Work Capability Assessments (taking over from ATOS). Work Capability Assessments have been independently associated with an increase in suicides, self-reported mental health problems and antidepressant prescribing, and found by a judicial review to ‘disadvantage people with mental health problems, learning disabilities and autism’.

    Evidence that Maximus falsified the results of ‘fit for work’ tests has been raised in parliament and their conduct in both the US and UK has been very widely criticised by claimant and disability rights groups.

    Maximus was also recently accused of trying to bribe doctors away from the NHS with salaries well above average rates to carry out ‘fit for work’ assessments. It is difficult to imagine any organisation less suited to working in partnership with primary care or with a worse record in relation to mental health and disabled people.

    JobcentrePlus Invasion

    The Health and Work Programme for Islington explicitly aims to integrate employment support in the ‘map of medicine’ that doctors are pushed to use to inform their decisions. The programme fully intends to get people into work, whatever their circumstances, and – through the new, improved ‘fit note‘ and ‘fit for work’ programme (also delivered by Maximus) – to keep them working, whether they are sick or not.

    In a move that will worry many GPs, Islington Health and Wellbeing board intend to make “employment status” part of the Patient Held Record. Every health care professional will soon be obliged to prescribe the work cure, whether or not they (or the patient) believe this is in the patient’s best interests. This is the real meaning of the board’s stated intention to “embed employment into the ‘wiring’ of the healthcare system”.

    The Islington pilot is part of DWP efforts to place Jobcentre advisors in libraries, in schools, and even in foodbanks – whose use has skyrocketed in the last six years. The presence of the Jobcentre turns these into places where people are coerced into work, no matter how ill-paid, precarious, or unsuited to their skills and other responsibilities. DPAC and the Mental Health Resistance Network said:

    “At a time when some claimants have been driven to suicide by the constant bullying, assessments, threats and sanctions that now form part of the UK’s benefits system, there must be no place in the NHS for Jobcentre busy-bodies. Disabled people, benefit claimants and supporters can and will defeat this appalling attack on the fundamental principle that healthcare professionals should ‘first do no harm’.”

    These takeover plans do not end with health. The DWP aspires to ‘join up’ all public services to ‘get local people back to work’, including transport and housing. These developments also support the extension of benefit conditionality – the hoops you have to jump through to be eligible for benefits – to a much wider range of people and a much wider range of circumstances.

    Mandatory referral

    To date there has been no consultation with patient or claimant groups. It is unclear whether there are safeguards in place e.g. to ensure patients are told that choosing not to see the job coach will have no impact on either their health care or their benefits. A promise from Richard Watts, leader of Islington council, that the scheme is entirely voluntary is not reassuring, given that the whole idea behind the scheme is to ‘promote the idea of employment for people with health conditions’. Both service users and health professionals have every reason to suspect that patients will feel under pressure to agree to see a job coach and that over time the scheme will become mandatory.

    A spokesperson from MHRN said:

    “our concern is that this scheme will not be voluntary. Over time it will become mandatory and lead to sanctions and loss of benefits, as the doctor becomes part of the DWP scheme to force claimants into low paid or unsuitable jobs that will undermine the patient’s condition.”

    The case for mandatory treatment for people with long term conditions (first flagged up in the Conservative Party Manifesto) is currently being reviewed, including whether benefit entitlements should be linked to ‘accepting appropriate treatments or support’. Such a move would have extremely serious implications: consent is invalidated if it is given under duress, for example if it is linked to loss of benefits or the fear of loss of benefits. Nevertheless, this is precisely the direction that government policy is moving in and represents a serious threat to the independence of health professionals and to the human rights of patients.

    Unemployment labeled a psychological disorder

    The Islington pilot comes at a time when unemployment is being branded as a psychological disorder, for which work is the cure. Welfare-to-work companies bid for lucrative contracts to deliver Entrenched Worklessness Provision to ‘change the hearts and minds’ of unemployed people. There are further plans to locate iCOPE (Camden and Islington Psychological Therapies Service) staff in Islington jobcentres, compromising their clinical judgment by embedding them in a coercive ‘back to work’ environment. Commenting on these developments, Paul Atkinson, a psycho-therapist for thirty years, said:

    While health care professionals see the experience of being in sustainable employment as potentially therapeutic for some patients, it’s naive to believe that welfare-to-work policies are led by the interests of the individual unemployed benefit claimant. I am afraid the DWP is a toxic brand for most claimants, and I think for a growing section of the public”.

    Such plans also mean placing therapeutic services in a setting responsible for administering the benefits system, including sanctions. A member of Boycott Workfare said:

    Support for unemployed people has little to do with helping people apply for jobs or get useful training. Increasingly, it is about making people express a positive attitude to unpaid work and short-term, low wage jobs – under threat of sanctions or other punishments.

    Enforcing the work cure

    Justification of the Islington pilot relies on a ‘work is good for you’ mythology that denies the reality of the labour market: the stark inequalities in pay, conditions, and security that make it entirely misleading to talk about ‘work’ as if everyone benefits from it.

    For many disabled people who do have the capacity to work, gaining a decent quality, fairly paid, stable job does improve their independence and quality of life. And many disabled people do work, and others who can work yearn to have this kind of job.

    But this end of the jobs market is often closed to disabled people, with employment discrimination rife and little or no enforcement of the Equality Act. Cuts to government support, (including the access to work budget), which previously enabled disabled people who can work to gain employment, mean that disabled people have to ‘make do’ with low-paid, short term, low-end jobs for exploitative employers. While the government sinks funds into coercive programmes, funding for Motability and Access to Work has been cut – these are schemes that have provided real practical support to disabled people who wanted to obtain or stay in work. A member of Boycott Workfare said:

    “we’re always receiving complaints from people who are trying to continue with courses that would give them real skills and qualifications, who face pressure from the DWP to abandon them for workfare or farcical ‘training’ from DWP contractors.”

    For growing numbers of people, work does not provide a wage you can live on; for others, it is something feasible on some days, but then not for weeks at a time – a fact that the DWP is determined to ignore. Work is not necessarily ‘good for your mental health‘ either: for many people, especially those in unpaid or low paid, insecure jobs, the workplace is a site of long hours, exploitation, petty tyrannies, bullying and stress.

    Mental health services ‘ruining lives’

    Islington’s decision to invest in job coaches in GP surgeries comes at a time when mental health services have been neglected, marginalised and under-funded for years, when services are so bad that lives have been “put on hold or ruined” and “thousands of tragic and unnecessary deaths” have been caused. It comes at a time when many people are blocked from accessing the services and support they need, including physical health care. People with mental health problems already have a lower life expectancy of nearly 20 years, mainly due to preventable physical illness. Mental Health Resistance Network said:

    Where is the parity of esteem that the government keeps shouting about? How are barriers to accessing healthcare addressing our lower life expectancy?”

    The pilot has been designed without any consultation whatsoever with mental health, disability rights or claimant groups, who are wholly opposed to the scheme and the values underpinning it. DPAC said:

    “patients will simply not engage with the health care system with schemes such as this. They will be too afraid if the result is further pressure, further mental distress and further harm. We can see this scheme, if it is rolled out, having a tragic human cost and driving a patient to suicide if pushed. That is not what a doctor should be involved in. They should support the patient and remember the ethics of why they became a doctor in the first place: to care for the patient and above all else Do No Harm.”

    Fighting back

    Last year, plans to put Improving Access to Psychological Therapies (IAPT) services in 350 JobCentres led to major protests. 400 mental health professionals signed a letter opposing the imposition of ‘back to work’ therapy and describing linking social security benefits to “state therapy” as ‘totally unacceptable’. The protest against job coaches in GP surgeries is attracting even greater support, as growing numbers of health professionals, patients, activists and concerned members of the public come together to protect the fundamental principle of medical care: first do no harm. We will fight any efforts to merge our health services with services responsible for benefit cuts and benefit sanctions. We call on Islington CCG and its partners to immediately terminate this scheme.

    By Lynne Friedli and Robert Stern

    First published by Our NHS

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    A recent study of poverty in the UK has revealed that parents in poverty are going without necessities to provide for their children. Children are at a higher risk of going without essentials than adults. However, among adults, those who live with children have higher poverty rates than those who do not. Indeed, rates of poverty among this sub-group of adults are higher than among children themselves. Living in a workless household increases the risk of child poverty (mirroring official statistics), but a substantial majority of poor children – 60 per cent – live in households in which at least one adult works. These findings pose a challenge to government policy and rhetoric which positions poor families as trapped by a benefits system which does not provide the appropriate incentives for work, and poor parents as lacking the skills to provide for their children.

    Using an individualised poverty measure developed in the UK Poverty and Social Exclusion Study, which takes into account the shared resources within a household (household income), and how resources in the form of ‘socially perceived necessities’ are distributed among household members, we found that 22 per cent of the overall population were in poverty, compared to poverty rates of 27 per cent among children and 32 per cent among adults living with children. These findings have come at a time when the government is seeking to change the way in which child poverty is measured and currently governed by the 2010 Child Poverty Act. The Act was passed with cross-party support in 2010 and introduced several measures of poverty, based on equivalised household income or a combined measure of income and access to essentials.

    familyImage credit: mrhayata CC BY-SA

    Prior to a House of Lords defeat, the present government was proposing to drop these measures in favour of measuring the proportion of children in workless households, and the educational attainment of pupils at age 16. In doing so, the government is acting against the majority of expert advice it has received on the matter. The future of these proposals is currently unclear. Yet changes to the Child Poverty Act have been proposed amongst a raft of austerity policies. Austerity was initially positioned as a necessary response to the financial crisis with the promise that ‘we’re all in this together’ – that is, no particular section of society should suffer more than another. But in reality the proposed austerity measures, many of which have been defeated in the House of Lords or challenged through the courts, have targeted specific groups more than others. Targeted groups have included:

    • Young people, through removing their entitlement to housing benefit and increasing conditionality on income-related benefits;
    • Families, through restrictions on tax credits and Universal Credit limiting them to two children;
    • Working-age adults (including families), through freezing working-age benefits rates for four years, increasing the rate of reduction in tax credits as earnings increase, reducing the income threshold for tax credits, and lowering the benefits cap;
    • Disabled people, through the reduction of Employment and Support Allowance for those in the work-related activity group to Job Seekers’ Allowance rates.

    Redistributive policies are rooted in the idea that structures within society unfairly disadvantage some people and groups. In contrast, individual and cultural explanations of poverty are rooted in the idea that poverty is the result of poor individual choices and behaviours. These may be ‘transmitted’ from one generation to the next resulting in ‘cultures of poverty’.

    In contrast to Labour policies prior to 2010 which were anti-cyclical in nature and favoured (at least in part) redistribution, Coalition and now Conservative policy and rhetoric indicates a preference for individual and cultural explanations of poverty. This can be seen in decreasing social security entitlements and increasing conditionality. It can also be seen in how poor people are described: they live in ‘troubled families’, and may be ‘skivers’ who need motivating to ‘take responsibility’. Extra money is seen as unlikely to help, as ‘feckless’ parents may spend it on drink, drugs and gambling rather than on improving their children’s well-being. As a result, the problem of how to address child poverty is transformed from one best addressed through providing additional resources to poor families, to one best addressed by helping poor parents to overcome personal shortcomings.

    To assess the Conservative approach, we examined access to resources and economising behaviours among adults and children in poor households. We found that very few adults – around 1 per cent – had adequate resources themselves and lived with children who did not have adequate resources. In contrast, we found that 16 per cent of adults went without necessities themselves, but lived with children who did not go without necessities. This suggests that adults living on very limited resources may be sacrificing their own needs in order to provide for their children. Additionally, adults living in households with poor children were much more likely to engage in economising behaviours and many reported that they had:

    • Skimped on food so others would have enough to eat;
    • Bought second-hand clothes instead of new;
    • Continued to wear worn-out clothes;
    • Cut back on visits to the hairdresser or barber;
    • Postponed visits to the dentist;
    • Spent less on hobbies;
    • Cut back on social visits, going to the pub or eating out.

    Perhaps most striking of these was our finding that 69 per cent of adults living with poor children reported skimping on their own food so that others would have enough to eat. While the House of Lords defeat is to be welcomed, the future of the Child Poverty Act remains unclear. The fact that parents are having to make these sacrifices, in many cases despite being in work, challenges both Conservative explanations of poverty and the rationale for proposals to remove income and material deprivation from poverty measures. Indeed, increasing the financial resources available to families to help ensure decent living standards for all is indicated.

    First published on the British Politics and Policy blog

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