- Dr John Middleton
- Vice President
- UK Faculty of Public Health
By necessities, I understand not only commodities which are indispensably necessary for the support of life, but whatever the custom of the country renders it indecent for creditable people even of the lowest order, to be without
The UK Faculty of Public Health manifesto calls on all political parties to commit to a living wage strategy over the next five years.
A Wordle illustration of FPH’s manifesto, Start Well, Live Better
From Adam Smith through to Peter Townsend, the Joseph Rowntree foundation and the Living Wage Foundation of the present day, social commentators have recognized the notion of relative poverty. There are some things you cannot do without and still function in the culture of modern society.
I call it the brown bread line. The white breadline represents absolute poverty – just enough to survive on. The Food Banks charity, Trussell trust, in its, latest publication, suggests we have gone below the breadline. Acute hunger has returned to Britain for the first time in the welfare state.
In our open letter to the Prime Minister published by the Lancet in May, the Faculty of Public Health highlighted three key and catastrophic changes which have combined for a perfect storm of food poverty. Food prices up 12% over five years, double figure price rises in energy costs and a fall in wages by over 7% in five years. The result has been that some of the poorest people in our society must pay over one fifth of their disposable income to feed themselves.
Poverty kills. In global terms the difference between rich and poor is obvious. In the UK, the sixth wealthiest nation in the world, the gap in income between rich and poor has been getting bigger at least since the mid-seventies and it has accelerated in our latest period of austerity.
The gap in life expectancy between rich and poor has also grown. The gap in life expectancy between rich and poor grew throughout the 1980s. Large studies from Glasgow and the North of England showed the extent to which poverty and unemployment contributed to the gap. The national Office of Population Censuses and Surveys’ longitudinal study reported in 1984 that unemployment was associated with a 20% higher than national death rates. Whilst the overall life expectancy has improved for rich and for poor to the present day, it has not improved as much for the poor.
A succession of reports from Black, Whitehead, Acheson and Marmot has highlighted the difference in health between rich and poor. It a cradle to grave story, a life course, as Marmot has described it. The babies of poor are more likely to be born small and more likely to be still born or die in the first year of life. They are less likely to be breast-fed, grow up shorter and nowadays, fatter, and loose their teeth earlier.
They will perform less well at school – though not through lack of intellect or ability, They will grow up in overcrowded housing and suffer more infectious illnesses. They are more likely to be victims of accidents or violence. Their chances of a university education are very much less and their chances of satisfying, financially rewarding work are slim. They will drift through short-term, unskilled jobs on the edge of the labour market, in more dirty, dangerous, or boring work.
They will develop diabetes, heart disease, cancers and other long-term conditions at an earlier age. Many will die prematurely; those that are propped up with the techno-fixes of modern medicine simply live more years with a disability and the dependency of long-term medical conditions.
Adam Smith’s realization of the idea of relative poverty has been revived. Creditable people, even of the lowest order, according to the Office of National Statistics, face severe material poverty if they cannot afford to:
- Pay their rent, mortgage, utility bills or loan repayments.
- Keep their home adequately warm,
- Face unexpected financial expenses,
- Eat meat or protein regularly,
- Go on holiday for a week once a year,
- A television set,
- A washing machine,
- A car,
- A telephone.
Poverty contributes materially to the burden of ill health in a number of ways. It is easy to see that poor people cannot afford high quality, energy-efficient, safe household appliances, and safety devices, brown bread is more expensive than white, people who are ill carry a large burden of costs for transport to health facilities.
A recent study of the cost of a healthy diet showed that across a basket of 94 foodstuffs cheaper calories came from cheaper more highly processed foods. When you are poor, it’s calories you are thinking about to survive. Fresh foods and foods higher in nutrients minerals and vitamins were more expensive. When you are making decisions to feed the meter, or feed a family, processed foods are cheaper to cook, but come with the high fat, high transfat, high salt, high sugar cocktail condemning people to early obesity and disease.
Even fast food takeaways are competitive in the fight not to feed the meter. There are also the stress-related aspects of working in a low span of control job, for next to no money. Employees may benefit from a higher income fit to live on, but employers have also benefitted from a more reliable, content, satisfied and efficient workforce when they have implemented the living wage, as a recent publication by Marmot’s team shows.
The Labour government in 1997 addressed poverty through the minimum wage, working families tax credit, Surestart maternity grant and commitment to eradicate child poverty. Most of these have been scrapped or reduced in their scope and ambition. The minimum wage is now so far behind what people need to live creditably, that now rightly there is the call for the living wage.
The problems of poverty have been over-complicated through well meaning campaigns from different pressure groups – food poverty, fuel poverty, housing and other poverty. All are characterised by the poor needing to spend a greater proportion of their disposable income than the rich on each household item. The living wage campaign begins to address this, being based on a complex set of assessments of household makeup and budget items which came from the minimum income standard (MIS) devised by Joseph Rowntree and Loughborough University.
It is always possible to contest those items – people are always free to spend their money in other less ‘sensible ways’ but evidence suggests that as people do get better off they will take decisions for more long-term benefit.
It is said that there is all party support for the move. The prime minister and the mayor of London and the other main political parties support it. The living wage this week has been revised to £9.15 an hour in London and £7.85 an hour in the rest of the UK. It is a measure, which could vastly improve the health of our workforce and their families and improve our workforce efficiency and economy. For all these reasons the FPH manifesto calls on all political parties to commit to a living wage strategy over the next five years.