Inequality, health, education and social security: A story of public services Dr Wanda Wyporska

Context

The UK Cuts to social security, gig economy, education, housing, NHS, and internal migration Marketization of public services and push to the private sector Rising costs and inflation Depression of wages, diversion of profit from labour share, political uncertainty A return to the levels of inequality last seen under Thatcher in the 1980s.

Cuts Local councils – £11.3 billion Over 500,000 council workers have lost jobs Outsourcing Rich have had taxes cut by £9 billion – top tax payers gained £4 billion and large company shareholders gained £5 billion. Women face job losses, cuts in benefits and publics services.

Pay Tracker CEOs in the UK’s top 100 companies now pocket an average of £5.3m* each year, or 386 times that of a worker earning the National Living Wage. Over two thirds (67%) of FTSE 100 CEOs are paid more than 100 times the average UK salary. Ninety per cent of FTSE 100 CEOs are paid at least 100 times more than the National Living Wage. Equality Trust analysis also found that FTSE 100 CEOs are now paid: • 165 times more than a nurse. • 140 times more than a teacher. • 132 times more than a police officer. • 312 times more than a care worker.

Wealth Tracker Richest 1,000 people own more wealth than 40% of households, or 10.2 million families. In the last year alone the combined wealth of Britain’s 1,000 richest people increased by £82.5 billion to £658 billion.

Drivers of inequality Technology: smaller businesses, more higher skilled and fewer lower skilled jobs Childhood: SES, parental income (50% in UK v 15-25% in Nordic countries) as a predictor Education: good early years provision Political systems: proportional representation, increased democracy Globalisation: inequality increasing within countries and decreasing between countries

Percent of all income going to top 1% 1930-2014 USA UK Germany Ireland Australia Sweden Netherlands % of income received by richest 1% Source: World Top Incomes Database

Health

INFANT MORTALITY RANK 1960 OECD (2017), Infant mortality rates (indicator). doi: 10.1787/83dea506-en (Accessed on 19 April 2017)

INFANT MORTALITY RANK 1970

INFANT MORTALITY RANK 1980

INFANT MORTALITY RANK 1990

INFANT MORTALITY RANK 2000

INFANT MORTALITY RANK 2010

INFANT MORTALITY RANK 2014

In the UK, this understanding of health inequalities dates back to 1980, when the Department of Health and Social Security published its Report of the Working Group on Inequalities in Health. The Black Report, as it became known (after its chairman, Sir Douglas Black of the Royal College of Physicians), systematically collated all the available data on socioeconomic status and health outcomes. Men in the lowest socioeconomic group, it turned out, were dying at a rate twice that of men in the highest, and the gap was growing, despite the establishment of the National Health Service. Prime Minister James Callaghan’s Labour government commissioned the Black Report in 1977, but by the time it was published, Prime Minister Margaret Thatcher’s new Conservative government was in power. According to the British Medical Journal, in its 2002 obituary for Black, “The Black report was not to Mrs. Thatcher’s liking and was never printed; instead, 260 photocopies were distributed in a half-hearted fashion on Bank Holiday Monday.” Since then we’ve had other, government-commissioned, UK commissions reporting on health inequalities

Rising levels of income inequality are associated with declining performance on the 2013 UNICEF Index of Child Well-being in 21 wealthy countries. Rising levels of income inequality are associated with declining performance on the 2013 UNICEF Index of Child Well-being in 21 wealthy countries. UK, United Kingdom; US, United States. Kate E. Pickett, and Richard G. Wilkinson Pediatrics 2015;135:S39-S47 ©2015 by American Academy of Pediatrics

Fig 1 Infant mortality rate (95% confidence interval) by socioeconomic classification, 2008-15. Fig 1 Infant mortality rate (95% confidence interval) by socioeconomic classification, 2008-15. Source: Office for National Statistics. NS-SEC=National statistics socioeconomic classification, based on new Standard Occupational Classification (SOC2010) since 2011. Child mortality data and birth statistics used father’s NS-SEC until 2011 and combined parents NS-SEC from 2012. For this analysis we grouped mortality rates for joint registrations by NS-SEC into three groups: professional (1, 1.1, 1.2, 2), intermediate (3,4), and manual (5 and below, including unclassified)2 David Taylor-Robinson, and Ben Barr BMJ 2017;357:bmj.j2258 ©2017 by British Medical Journal Publishing Group

Life expectancy and infant mortality “The LSP’s analysis shows that, of the many factors comprising the Index of Multiple Deprivation, income levels have the most powerful influence over neighbourhood death rates.” Longevity Science Panel – February 2018 From Blackpool to Belgravia 32 years Education and Social Mobility Very strong relationship between high levels of income inequality and low levels of social mobility. Children of highly paid people are more likely to be highly paid and children of low paid people more likely to be low earners. Countries with higher levels of income inequality have lower levels of social mobility The link between inequality and a lack of social mobility exists throughout a person’s life. Such links are stronger than the link between social mobility and poverty. Crisis, debt and inflation Increased inequality can lead to financial crises. High levels of income inequality are associated with economic instability and crises, whereas more equal societies tend to have longer periods of sustained growth. High levels of income inequality lead to higher levels of personal and institutional debt. There is substantial evidence to suggest that increased inequality was at least partially responsible for the increase in debt that precipitated the US financial crisis. Inequality may have played a role in the UK financial crisis by increasing debt and over-consumption, but these effects could also have been small. Increased inequality may increase rates of inflation. Physical health Mental Health Engagement with Politics and Society Income inequality changes the way people interact with other members of their society and engage in society itself. People in European countries with higher levels of inequality are less likely to help each other in acts of altruism. Unequal societies have lower rates of both social and civic participation (including lower engagement with political parties). Higher rates of income inequality are linked to lower levels of voter turnout. Inequality is linked to lower levels of cultural activity. Trust There is a substantial and robust body of research suggesting that countries with higher levels of inequality have lower levels of trust. This lack of trust is associated with a variety of other social issues including happiness, homicides and health. Increased inequality in a nation leads to lower levels of trust. This lack of trust is closely linked to higher homicide rates and worse health.

Mental illness is more common in more unequal societies www.equalitytrust.org.uk Wilkinson & Pickett, The Spirit Level

Gains of the past are being undone 10 year rise in absolute poverty unprecedented since records began Taylor-Robinson D, Whitehead M, Barr B. BMJ 2015

The progress of the 1960s was easier to reverse because we failed to make changes in the structure of institutions.

Education and child poverty

Fragmentation of Education Public v private schools Academisation and marketisation Segregation by economic power and social class Segregation by ethnicity and/or religion Social cohesion agenda / Prevent Strategy

Percentage gap between five-year olds reaching ‘a good level of development’ from deprived and non-deprived areas Social Mobility Commission

Percent of people at the top of professions who went to private schools, in 1987 and in 2016 Social Mobility Commission

Class pay gap A Social Mobility Commission report found that Britain’s traditional professions such as medicine, law, journalism and academia remain dominated by those from advantaged backgrounds - nearly three quarters (73%) of doctors are from professional and managerial backgrounds with less than 6% from working class backgrounds. The class pay gap is £6,800.

Class pay gap The report says those from poorer backgrounds may: be less likely to ask for pay rises, have less access to networks and work opportunities, exclude themselves from promotion for fear of not ‘fitting in’. Other explanations for the ‘class pay gap’ could include conscious or unconscious discrimination or more subtle employment processes which lead to ‘cultural matching’ in the workplace. Nearly half of ethnic minority children live in poverty. Ethnic minority pay gap of 37% in the capital’s public sector.

Social Security and Low Pay: In work poverty

Equality and Human Rights Commission Report Effects between 2021-2022 Extra 1.5 million in poverty Child poverty rate for lone parent households increase from 37% to over 62% Households with 3+ children will lose £5,600 Households with at least one disabled adult and disabled child will lose over £6,500 a year over 13% of their income

Equality and Human Rights Commission Report Bangladeshi households will lose £4,400 a year compared to White households or Mixed (£500-£600) Lone parents will lose average £5,250 ayear one fifth of annual income Women will lose £400 on average whereas Men will lose £30. HoC Library report – women bear 80%

Runnymede Trust and Women’s Budget Group 2016 report: The analysis shows that by 2020: Individuals in the poorest households lose most from tax and benefit changes, but in every income group BME women will lose the greatest proportion of their individual income. Low income black and Asian women will lose around twice as much money as low income white men as a result of tax and benefit changes. Out of all household types, lone mothers are hardest hit by cuts to services and tax and benefits changes followed by lone fathers and single female pensioners (see Figure 2). Among lone mothers, it is again BME women that lose the most.

British Social Attitudes Survey (Survey July-Nov 2016) 81% think income gaps are too large 42% agree that government should redistribute income 28% disagree 48% want taxation increased to allow greater spending 44% want tax and spend levels to stay as they are 83% think the government should spend more on health 71% think the government should spend more on education

British Social Attitudes Survey (Survey July-Nov 2016) The proportion who say most dole claimants are “fiddling” has dropped from 35% in 2014 to 22% in 2016. The proportion who say that social security claimants don’t deserve help has dropped to 21% - a record low

Socio-Economic Duty (Section 1) ‘when making decisions of a strategic nature about how to exercise its functions to have due regard to the desirability of exercising them in a way that is designed to reduce the inequalities of outcome which result from socio-economic disadvantage’.

www.equalitytrust.org.uk @equalitytrust Wanda.Wyporska@equalitytrust.org.uk