Welfare Reform and Health Marlene McMillan Lead Public Health Practitioner Presented by Hazel Henderson, Consultant in Public Health

Welfare Reform and Health UK Government‘s aims to make work pay, simplify the benefits system and make savings of £18bn from the welfare budget. EU research shows that social spending is linked with better health and smaller inequalities There is a clear relationship between the extent of deprivation and the scale of the financial loss. The most deprived wards are hit the hardest. Scottish Government Welfare Reform Committee, 5 th Report, 2014

Income, Welfare and Health “Tax and benefit changes are regressive rather than progressive across most of the income distribution” (IFS) families in bottom 40% incomes drop by over 5% by 2012/13, with drop of 7% for poorest (IFS) Britain's top 1000 saw collective wealth increase by £73billion in year to 2009/10 Poorest households, especially families, will have less resources to pay for energy and food costs

Welfare Reform and Health The worst affected places in Ayrshire and Arran: – Doon Valley & Kilmarnock South wards (£640 per adult of working age per year) – Irvine West & Saltcoats and Stevenston (£650) – Ayr North (£630) & Girvan and South Carrick (£610) The reforms to incapacity benefits are resulting in the biggest financial loses, particularly in more disadvantaged communities. In the absence of a big shift into employment, a key effect of the welfare reforms will be to widen the gaps in income between communities. Scottish Government Welfare Reform Committee, 5 th Report, 2014 Sheffield Hallam estimates based on official data 2014

Income, Welfare and Health In 2012 Scotland’s 100 richest men and women increased their fortunes to £21 billion, up from a combined wealth of £18 billion in 2011 What is poverty? Core definition in UK/Scotland is 60% median contemporary incomes adjusted for household size.

What is poverty? Poverty is caused by interaction of political, social, economic, cultural and environmental factors. Risks and barriers vary over life cycle. It is “anything which leads to people not having enough money. It is not lone parenthood or unemployment... it is the fact that they do not have enough money in those situations... People talk about policies against poverty as if it were a matter of altering the characteristics of the people who are poor... (instead of ) altering the characteristics of the social, economic or geographical environment in which they experience that poverty (Professor John Veit-Wilson)

Public Attitudes in 2014 Complex/contradictory attitudes: Less concern than in the past about inequality and hardening approach to those on benefits, 51% wanted more equal society in 1994 – now 38% Poverty – individualised – ‘failure’ to grasp existing opportunities Strong negative stereotypes prevail/ absence of positive stereotypes Government/ media: reinforce and fuel negative perceptions Society more likely to blame those at the bottom for their situation

Myth: We’ve seen an increasing number of people claiming out-of-work benefits Reality: Out-of-work benefit receipt has been in long-term decline and is half a million lower now than in the aftermath of the last recession. Myth: ‘welfare’ spending goes mostly to those on out of work benefits Reality: Out-of-work benefits account for less than a quarter of welfare spending and just over half of non-pensioner spending. Myth: benefit spending is high because of large families on out of work benefits Reality: Families with more than five children account for 1% of out-of-work benefit claims Myth: the welfare state is supporting households to stay out of work for generations Reality: Only 0.3% of households have two generations that have never worked Myth: Families are better off on benefits than in work Reality: the vast majority of families would be better off in employment Myth: The welfare state enables people to ‘languish’ on benefits for years on end Reality: Most out of work benefit claims are not long term in nature Myths and media portrayals

Welfare Reform: Impact on children Many organisations and leaders within Scotland are expressing serious concern about children being put at risk of poverty by the policy. Decline in child poverty in Scotland has stalled over the last three years Poverty amongst working age adults without children increased over last 10 years Value of out of work benefits has declined significantly in relation to earnings 50% of children in poverty are in working households 30% of poverty pay is in the public sector

Why is this a Public Health issue?

Impact of welfare reforms on health Increased poverty, fuel poverty, food poverty Increases in mental health problems, including depression, suicide and parasuicides and possibly lower levels of wellbeing, delayed recovery Longer-term increase in mortality due to heart disease – commencing 2–3 years after increased unemployment, with effects persisting for years Increased homelessness Benefit payment delays for terminally ill people (policy implementation problems) 1 More domestic violence (perhaps due to increased strain on families and relationships) and possibly more homicides Worse infectious disease rates, such as TB and HIV Fewer road traffic deaths (perhaps due to lower incomes leading to less car use) Increase in unsuitable or dangerous working conditions Increase in child poverty Institute of Health Equity, UCL, 2012

Poverty and food Food banks are a service of last resort for people living in poverty. As the authors of a report commissioned by the Department for Environment, Food and Rural Affairs (DEFRA) on food poverty stated: ‘There is no evidence to support the claim that increased food aid provision is driving demand. All available evidence, both in the UK and internationally, points in the opposite direction. Put simply, there is more need and informal food aid providers are trying to help.’ People on low incomes have traded down and down again to the cheapest food products.

Food bank usage

Poverty and food

Mitigating Actions NHS Ayrshire and Arran has a pivotal role to play as a partner and a service provider in mitigating actions and has done so for many years. long term public health commitment to work in partnership to improve health and tackle inequalities in health taking a neighbourhood approach to public health - focusing on asset based approaches alongside co-production and informed by public health intelligence developing of public health intelligence function to support targeted approach to address inequalities identifying, developing, supporting and leading as appropriate, the role of Public Health in relation to integrated Health and Social Care Partnerships, Community Planning Partnerships and locality planning Deliver effective and efficient services to address communicable disease and environmental hazards, and to prevent disease through immunisation and screening programmes.

Mitigating Actions (NHS and partners) securing personal/household income (links to money advice and employability services) maintaining socioeconomic status, (rehabilitation back to work or to stay in work when off sick) keeping people close to the labour market (referrals to employability support, NHS work placements and volunteering, Modern Apprenticeships) reducing household costs (credit unions, food co-ops, food banks) reducing barriers to services (service design and location, reducing barriers relating to protected characteristics) NHS Ayrshire and Arran representation and partnership working at the National, Regional and Local Authority levels E-learning module being developed for staff with client groups most vulnerable to the negative impacts Crossover with Work, Health and Wellbeing actions underway in Public Health