by Paul Southon
- Public Health Development Manager
- UK Healthy Cities Network Local Coordinator
Welfare reform is a reality. Reviews of the likely health impacts suggest that they will be significant, are starting now and will last for a generation. (1) (2)
Work to quantify the financial implications for local areas shows that the financial impact will be disproportionately felt by the areas with the largest health inequalities. (3) There is also evidence that the impacts on already disadvantaged sections of communities – such as disabled people, black and minority ethnic groups and women – will be disproportionate. (4) (5)
All of this is happening at a time of major reductions in budgets and staffing across the public sector which limits the local ability to respond. This has been described as a perfect storm for local government. It will also have significant impacts across health services.
Over the longer term there is likely to be an increase in mental health problems, non-communicable diseases and related disabilities which will be felt across the health and social care system. Increasing poverty, especially child poverty, will have long term and generational impacts on child development, health outcomes and life expectancy.
GPs are reporting an increase in people with mental health problems. They are also reporting increasing numbers of requests for support with appeals against Work Capability Assessment decisions and the changes to disability benefits.
Currently the most visible part of the welfare reforms is the spare room subsidy or ‘bedroom tax’. Families on housing benefit who are defined as having extra bedrooms suffer a financial penalty. There is a severe shortage of available smaller properties for these families to move into. Their options are to move into the private rented sector, which may be more expensive, or stay where they are with a reduced income. Families are also moving to areas with lower rents, losing their social and support networks.
Councils are already reporting increases in rent arrears.(6)It is likely that this will lead to increased stress and family tensions, which could be exacerbated by the loss of social and support networks. A concern is that these families will resort to using alternative lenders, such as pay day loans, to cover shortfalls. One payday loan company has recently increased its typical APR to 5,835%.
For families experiencing poverty food becomes a major problem, both in access to enough food and in the quality of the food available. The rapid rise in food banks is testament to the difficulty families have in buying food. (7)
They also have to rely on the cheapest food which is often poor in nutrition and high in fats, including trans-fats. With the current food environment eating healthily is not a cheap option.
So, welfare reform is a reality. The evidence suggests that it is likely to have a major negative impact on public health and inequalities. It is now time to ask the key question: What can local areas do about it and what is the role of public health?
Much of the focus in councils has been on setting up the local systems to manage what were previously national benefit systems, the social and crisis fund payments and council tax benefits. Now these are operational the wider impacts of the reforms are being considered.
Many councils are mapping the local impact of welfare reforms to better understand the local challenges. (8) However, the scope to tackle these challenges at a local level is limited.
One of the stated aims of the welfare reforms is to encourage people into work. This is a laudable aim. Supporting someone into good quality work is a major public health win. The main way to reduce the numbers of people reliant on benefits will be to increase local employment.
However, increasing local employment is challenging in the areas where welfare reform will have the largest impact. Many of these areas have poor levels of educational attainment. Much of the available employment is low paid and insecure. A recent report estimates the local financial impact.
For example, Sandwell will lose around £119 million from the economy each year resulting in less money spent within the local economy, affecting local business and resulting in fewer local jobs.
With the limited scope for minimising the impacts of welfare reform at a local level it is essential that the most is made of local resources. This will need joined up working across councils, health, voluntary and community sectors and local businesses.
Public health has a role in raising awareness of the changes and the health impacts across all parts of the council and partners. It can also support the mapping and analysis of local impact, helping identify the local priorities for action and ensuring local plans are evidence based and monitored effectively.
Welfare reform is here, it comes with a real risk of significant negative impacts on health and inequalities at both local and national levels. Public health in councils needs to recognise this and ensure that it is fully involved in local efforts to minimise these impacts. At a regional and national level public health must lobby for changes to policy to protect population health and the disproportionate effects on the most vulnerable.
(1)Institute of Health Equity (2012). The impact of the economic downturn and policy changes on health inequalities in London.
(3) Beatty C, Fothergill S. Hitting the poorest places hardest: the local and regional impact of welfare reform. Centre for Regional Economic and Social Research. 2013
(4) Oxfam GB. (2010) A gender perspective on 21st century welfare reform.
(5) Welsh Government. (2013) Analysing the impact of the UK Government’s welfare reforms in Wales – Stage 3 analysis.
(6) Inside Housing (2013) Rent arrears up in wake of bedroom tax.
(7) Trussel Trust (2013) Increasing numbers turning to food banks since April’s welfare reforms.
Better Health For All 