I have already commented on the trends and costs of the growing burden of health inequalities in the UK and what this means for growing numbers of the population in particular disadvantaged communities.
The recent report, just published from Prof John Hills team at the LSE on wealth inequalities trends, rebased from official stats, also confirms this widening disparity between those able to leave wealth, in whatever form, and those with no wealth.
However if Austerity continues in this “hair shirt” addiction then the consequences will become ever more real to many more people, not just those at the bottom end but increasingly up the economic ladder in real terms as well. This will cause more pressures on families, communities and wider as well as services, resources and those who seek to be responded to.
So why is this recession different to others?
There are four key differences.
Firstly a diminished safety net for the unemployed. Median earnings benefits and tax credits have fallen in real terms so the outlook for some years to come, amongst a significant part of the population and in pressured areas, is long term.
Secondly new unemployment co-exists with significant structural worklessness in the form of long term sickness absence and disability pension receipt. Govt has sought to seek changes to disability support and pension receipt.
Thirdly the nature of work has changed within Britain during the last 20 years. As we have seen with a low industrial workforce, increases in services but more uncertainty in employment with no hours working, short time working and other peculiarities. So low paid marginal and uncertain employment is more likely for low wage earners than not. All this leads to more negative health impact of unemployment and indeed employment.
Lastly the labour market is becoming more feminised and gender roles are shifting again because of the ability of women mainly to work for low pay and not engaged with their work conditions. Ironically all this at the same time as the Govt currently has hit the family and single women harder in support terms in the total social good aspect.
We cannot think that health is a silo subject on its own but within the Public Health remit particularly, and in Social Care and the NHS, it is a key aspect as is the social well being of the community.
Part of the neo-liberalised agenda is to compensate for these upward pressures by negative changes to financial support, changes to rules which become discriminatory and changes to support inversely to those communities which need it more.
This approach affects not only individuals but communities and their resilience. Social support, as we are seeing, vulnerable groups being marginalised, whether social support or supported housing or for the disabled, and therefore their health and well being suffers.
So if health becomes an issue and health inequalities effect worsens then how should we move forward?
From an economics viewpoint, as even the IMF have stated, in a much different way to what is being implemented now. They have repeated this message in rapid succession surprisingly for such a conservative approach body.
Social good and economic good are compatible not separate as those siren voices would have us believe.
Paul Krugman’s thesis, the Nobel award economist backed up by a host of other key left economists, such as Robert Reich, is that by attacking the social good and reducing the level of real disposable income you weaken overall position in the economy much worse.
So in the UK we have had stagnation and indifferent performance. Cuts in public spending, as a Joseph Rowntree Foundation (JRF) report concluded, found unsurprisingly are affecting not only long term health and well being (from libraries to adult social care etc.) but the very nature of the cuts or austerity those who need those services their health.
So we have widening health inequalities, fuel poverty and absolute poverty, food banks, reduction in pension values, an increase in mental health, more domestic violence, education reductions which affect pupils in disadvantaged areas not being able to access higher education and much more.
Women and single parent families as well as ethnic minorities are particularly hard hit and when we get into young people the levels of youth unemployment, although not the levels of Greece or Spain are over a million.
The effects on physical and mental states which are well known within the work of Marmot over cardiovascular disease, mental health which this government seeks to marginalise or ignore, health behaviours leading to drugs ( recreational and depressives) and alcohol and of course more morbidity and possibly suicides as well.
So instead of austerity, reduction in the mean level of salaries and wages, curtailment of support services and benefits which hit the poorest harder, but not just the poorest either, we should we embarking on a different strategy.
That strategy needs to be based round a growth strategy which will improve well being outlook, tackle health inequalities and pressures in deprived communities. That will activate the economy put people into work and tackle the debt as from a positive position.
It will not need quantative easing either as more positive generation of income will stop the need to add to the £375 billion of artificial stimulus which already has been actioned to an increasingly diminishing effect except to the debt level.
Increase sin salaries/wages, benefits will help and assist at the bottom end so instead of food banks need people will have enough disposal income to purchase in shops.
Getting people back to work will increase well being, as I have stated, but it will do much more than that as it will create jobs, stimulate a positive benefit to all and lower health service and other needs pressures for junk cheap foods.
It really is a no brainer but neo liberalists will not see that as a positive intervention.
As we come up to Control Period 5 (UK Treasury Expenditure profile allocation. PSBR) and the statement of another £11.5 billion reductions for 13/14 provision potential, including even more to Local Government and key services, benefits and much more that the communities and its people rely on.
Such an approach will also have far reaching consequences; not only for Public Health, but Social Care and the NHS which it is already doing so.
As Bill Clinton said “it’s the Economy stupid”
That is certainly correct but unless we have the right global strategy and UK strategy it’s also the health and well being of its people stupid!
The longer we leave positive intervention the worse the scenario gets for increasingly more and more people.
Cllr Mike Roberts v/chair SHA (Local Government) May 2013
NB. Wealth on the UK: Distribution, accumulation and policy (Prof John Hill etc. Centre for Analysis of Social Exclusion)
2. Liverpool Observatory Report February 2012