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Faculty of Public Health campaigns progress – Brexit and funding

Posted in austerity, Brexit, funding, local authorities, PH Spending on February 5, 2018| Leave a Comment »

By John Middleton, FPH President

John Middleton 2 web

I wanted to let you all know about the progress we’ve been making with our two flagship influencing projects and to ask you, our FPH members, for help.

You may recall that in June last year I let you know that we had decided to focus the efforts of our small, but perfectly formed, Policy and Campaigns Team on two vital public health priorities – Brexit and Public Health Funding.

This followed a significant policy consultation and prioritisation process with our members through the first half of 2017.

Before I tell you where we’ve got to with these two campaigns it might be helpful to remind you that these two issues aren’t the only two policy areas FPH is working on. We also have five policy committees and 30 (and growing) Special Interest Groups all developing and shaping policy and making the case for a very broad range of public health issues.

In terms of the Brexit and Public Health Funding projects, since June last year we’ve done a number of things in order to be ready to start campaigning at the beginning of 2018.

We’ve talked with a range of different public health stakeholders – including the Public Health Minister, Steve Brine MP – to find out where they thought we should focus our efforts within these two large policy areas. Through this consultation process we drew up ‘long lists’ of possible policy asks.

We’ve also created two campaign project groups, made up of staff and – for the first time – specialty registrars on placement at FPH. As well as giving us more capacity to deliver both campaigns, we’re keen that these projects provide an opportunity for our public health trainees to learn about, and play a vital part in, campaigning for policy change at a national level.

We’ve also created two Advisory Boards of senior FPH members – one for each campaign – to ensure we’re able to draw from the vast expertise we have on both these issues. I won’t embarrass the Board members by highlighting particular people but trust me when I say that both Boards are packed with very senior, experienced FPH folk.

The Advisory Boards met in November and December and shortlisted three policy asks for each campaign. I’m very pleased to announce they are:

For Brexit:

1. We are calling on the UK Government to introduce a ‘do no harm’ clause into the EU Withdrawal Bill – with the effect that the Government commits to ensure that the Bill’s powers are not used to reverse or amend regulations critical to the health of the population.

2. We are calling on the UK Government to ensure the UK’s future relationship with the European Centre for Disease Prevention and Control – we think it is vital that we can continue to work in close partnership with our European partners to tackle serious cross-border threats to health security, e.g. blood borne viruses, pandemic influenza, viral haemorrhagic fevers, and chemical and radiation incidents. In so doing, we will provide a model for the UK as it considers how to continue to play a significant role in other EU public health agencies.

3. We will be calling on the UK Government to ensure that the impact on the public’s health is a vital determinant in our post-Brexit trade agreements – we will develop with the public health community a set of evidence-based public health principles for negotiating ‘healthy’ trade agreements. We will call on the UK Government to adopt these principles as it negotiates our future trading arrangements.

For the Public Health Funding campaign:

1. We are calling on the UK Government to invest in a public health ‘transformation and innovation fund’ to support the upgrading of prevention and population health services in local authorities – FPH members are telling us that they have gone to heroic lengths to deliver more with less and less but they cannot make the ‘radical upgrade’ in prevention services asked of them without additional dedicated funding. This is needed to enable their teams to make the step change in the types of services they provide and how they provide them. We think this fund will need to be in the region of an extra £1bn per year but the exact figure will be determined during the policy development phase.

2. We are calling on national governments to conduct a review into NHS spending on public health and prevention – our aim is to ensure that the approximately £2 billion spent in England annually on prevention and public health services ‘in the NHS’ is spent appropriately and as effectively as possible. We’ll also be looking at what an increased funding settlement for prevention in the NHS might look like in order to help deliver the radical upgrade. As part of this we will be encouraging STPs to focus more on the prevention agenda.

3. We are calling on Public Health England, and other relevant national bodies, to develop an improved ‘dashboard’ for public health services – we want to ensure updated dashboards include what our members think are the key public health performance metrics and indicators. We hope this dashboard will enable the public health community to agree what a ‘good’ public health service looks like, where it is occurring, and to further encourage the sharing of best practice between different areas and sector-led improvement.

Over December and January both campaign project groups have been pulling together their campaign plans for the first year of what will be three-year long campaigns.

These plans have now been signed-off by our Advisory Boards and, as a consequence, I’m delighted to say that at the end of January the Brexit campaign took its first steps and started to make the case to Peers in the House of Lords for our ‘do no harm’ amendment.

It’s been incredibly exciting to be so closely involved in the journey FPH has been on over the past year to get us to this stage and there’s an awful lot of campaigning activity to follow in 2018 and beyond.

And that’s where you come in!

We’re looking to create informal networks of FPH members who are particularly interested in Brexit or Public Health Funding (or both) who we can involve in each campaign on a regular basis.

The kinds of things we’d be looking for you to help with are:

Asking for your views as we’re developing our policy thinking – i.e. acting as an informal sounding board as we’re testing our draft ideas and thinking, so that we can be confident that what we end up saying in public and to governments is closely informed by what our members think.
Helping us decide which campaign messaging works best – eg. which messages do you think are most inspiring? which messages are likely to play best with local and national decision-makers? which hashtag do you like most? We want to know what you think.
Championing our campaigns on social media – eg. retweeting and commenting positively about tweets FPH sends out and saying supportive things about our campaigns on other social media.
Speaking up at conferences and events you’re attending – to highlight the importance of these issues and our specific asks.
Responding to questionnaires and surveys we will be doing throughout the campaign.
Introducing us to your networks – if you play Canasta with Philip Hammond, table tennis with Jeremy Hunt, or go paint-balling with Jeremy Corbyn then please do let us know.

If you’d like to find out more, then please email our Policy and Campaigns Team via policy@fph.org.uk and tell us which campaign you’d like to get involved in.

Thank you so much in advance for your help and watch this space for future updates on both campaigns. We’ll be updating you very soon on our Brexit activities so far in the Lords.

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We need to reduce the disability poverty gap, but benefit cuts are likely to increase it

Posted in Academic, austerity, disability, Health Inequalities, poverty, Uncategorized on March 6, 2017| Leave a Comment »

By Ben Barr, Senior Lecturer in Applied Public Health Research, University of Liverpool, and Lee Bentley, Research Associate, University of Liverpool

The Chancellor of the Exchequer is due to deliver this year’s Budget on Wednesday. It is imperative that he provides additional financial support for disabled people affected by the planned cuts to Employment Support Allowance (ESA) – or risk further widening the disability–poverty gap.

One in three working age disabled people are living in poverty. Their risk of poverty is one and a half times greater than for people without a disability. The government’s strategy, however, for improving the lives of disabled people, focuses almost exclusively on the disability-employment gap rather than this disability-poverty gap (1). It is true that the high risk of poverty amongst disabled people is largely because they are less likely to be in work and supporting people into employment is an important strategy for reducing poverty. Welfare benefits, however, also play a crucial role in preventing poverty by limiting the loss of income people experience when they can’t work due to disability.

People who have lost their jobs because of a disability are likely to be out of work for longer than people who become unemployed. For this reason, disability benefits have generally been set at a higher level than unemployment benefits. From April, this will no longer be the case. The government is reducing the level of ESA for disabled people who are assessed as being currently unable to work but potentially capable of work at some time in the future. The benefit will be reduced by 30% to £73 a week – the same level as unemployment benefits. But whilst 60% of new claimants of unemployment benefits will move off the benefit within six months, 60% of people on ESA will still be claiming this benefit two years later (2). This means that many people out of work because of a disability will have to survive for long periods of time without an adequate income.

Levels of poverty are already very high amongst people out of work with a disability and have been increasing since 2010, particularly amongst people who have a low level of education – the group most reliant on disability benefits (see Figure 1). Cutting these benefits will exacerbate this adverse trend.

Percentage of people with disability in poverty

FIGURE 1: % of people with a disability in poverty, aged 16-64, between 2007 and 2014, by employment status and educational level

The government argues that reducing these benefit levels will incentivise disabled people to stay in or return to work (3), but there is little evidence to support this assumption (4), and some that suggests it may reduce their employment chances (2). Strategies to reduce the disability-employment gap over recent decades have increasingly focused on more stringent assessment criteria for disability benefits, reduced payment levels and requiring claimants to do more to prepare for work or risk losing their benefits (5, 6, 7). These strategies have had little impact on the employment of people with disabilities (8). It remains to be seen whether the government’s new strategy to halve the disability employment gap will be any more successful (1).

Even if the government’s strategy does improve the employment of disabled people, it is likely this will disproportionally benefit disabled people with greater skills and education (9, 10). The planned cuts in ESA will increase the risk of poverty for the most disadvantaged disabled people who remain out of work, and this may increase the disability-poverty gap.

Increasing poverty amongst people out of work with disabilities will adversely affect their health and increase health inequalities. We know that poverty damages peoples’ health, and adequate welfare benefits for people who can’t work can reduce these effects (11). We have seen that in recent years inequalities in health are increasing (12) in part due to disability benefit reforms (13). The severe cut planned by the government will further exacerbate these inequalities, potentially increasing levels of disability.

1   Great Britain, Department for Work and Pensions, Great Britain, Department of Health. Improving Lives: The Work, Health and Disability Green Paper. 2016 (accessed March 2, 2017).
2   Work and Pensions Committee. Disability employment gap. London: House of Commons, 2017 (accessed March 2, 2017).
3   Kenedy S, Murphy C, Keen K, Bate A. Abolition of the ESA Work- Related Activity Component. House Commons Libr Brief Pap 2017.
4   Barr B, Clayton S, Whitehead M, et al. To what extent have relaxed eligibility requirements and increased generosity of disability benefits acted as disincentives for employment? A systematic review of evidence from countries with well-developed welfare systems. J Epidemiol Community Health 2010; 64: 1106–14.
5   Watts B, Fitzpatrick S, Bramley G, Watkins D. WELFARE SANCTIONS AND CONDITIONALITY IN THE UK. York: Joseph Rowntree Foundation, 2015.
6   Banks J, Emmerson C, Tetlow GC. Effect of Pensions and Disability Benefits on Retirement in the UK. National Bureau of Economic Research, 2014 (accessed Sept 26, 2015).
7   Baumberg B, Warren J, Garthwaite K, Bambra C. Rethinking the Work Capability Assessment. London: Demos, 2015.
8   Mirza-Davies J, Brown J. Key statistics on people with disabilities in employment. House Commons Libr Brief Pap 2016; 7540.
9   Burstrom B, Nylen L, Clayton S, Whitehead M. How equitable is vocational rehabilitation in Sweden? A review of evidence on the implementation of a national policy framework. Disabil Rehabil 2011; 33: 453–66.
10   Clayton S, Bambra C, Gosling R, Povall S, Misso K, Whitehead M. Assembling the evidence jigsaw: insights from a systematic review of UK studies of individual-focused return to work initiatives for disabled and long-term ill people. BMC Public Health 2011; 11: 170.
11   Cooper K, Stewart K. Does money in adulthood affect adult outcomes? York: Joseph Rowntree Foundation, 2015 (accessed July 30, 2015).
12   Barr B, Kinderman P, Whitehead M. Trends in mental health inequalities in England during a period of recession, austerity and welfare reform 2004 to 2013. Soc Sci Med 2015; 147: 324–31.
13   Barr B, Taylor-Robinson D, Stuckler D, Loopstra R, Reeves A, Whitehead M. ‘First, do no harm’: are disability assessments associated with adverse trends in mental health? A longitudinal ecological study. J Epidemiol Community Health 2015; : jech-2015-206209.

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Welfare reform is a reality

Posted in austerity, Health Inequalities, PH Spending, poverty, Urban health on September 30, 2013| 5 Comments »

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.

(8) Sandwell Trends: Welfare Reform Topic Page (2013).

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