GMPA

Poverty as a Health Issue

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By Simon Watts, Public Health Registrar on placement with GMPA

Poverty can cause ill health, but ill health can lead to poverty. We are seeing this more visibly with Covid-19, but this was apparent before the pandemic. As apublic health professional, I am passionate about preventing ill health. This short piece argues that poverty is one of the root causes of ill health and that these two large areas of public policy should not be considered in isolation.

Poverty can cause ill health in several ways. Through my recent research into local welfare assistance I have heard stories of residents living in cold, carpet-less, houses and not being able to afford to eat or pay their bills. These stories have clear links to poor physical and mental health and show the importance of strong welfare support in preventing ill health. Good housing, education and fairly paid jobs are also some of the things that will reduce poverty and protect people’s health longer term. These societal factors have a direct impact on health, but often aren’t talked about in the context of health. Improving health is about the NHS, right? Partly, but the NHS treating illness is only part of the picture. And, treating ill health is usually more expensive than preventing ill health in the first place.

Investing in poverty to improve health

Those on the lowest incomes are more likely to be in poor health and more likely to access emergency healthcare services. This is extremely distressing for the residents it impacts and their families, but it also puts pressure on local health budgets. This has been the case for a long time, but more could be done to change it. Investing what little funds there are available locally to reduce poverty could improve resident’s health and save CCGs and local authorities money in the longer term.

Similarly, we invest in a range of public health advice about how to lead a healthy lifestyle; what to eat, the need to take the right amount of exercise. However, we know that some groups are less able to act on this advice, particularly those on lower incomes who might face additional pressures and stress, so the health gap between low and high income groups widens further (Naidoo & Wills, 2016). Why is that? If your material, basic needs aren’t being fulfilled, why would a balanced diet, or taking regular exercise even be on your mind? Health is not a choice when you are struggling to make your rent or feed your family. Trying to tackle important lifestyle issues without tackling poverty will fail and will leave some lower income groups behind.

If we don’t tackle poverty as one of the underlying causes of poor health, we will continue to pour money into health treatment services without addressing one of the key root causes of that ill health.

There are positive examples of progress though. Across Greater Manchester there are a range of services which work with residents to help improve their circumstances. One of these services, Focused Care, work with residents to support them with underlying challenges in their lives such as housing issues or benefits; when these issues are resolved residents may then have the space and time to focus on their longer term health.

Similarly, my recent work on local welfare provision in Greater Manchester has identified some local authorities which offer strong support for those in financial crisis, helping people get back on their feet and improving their mental and physical health as a result. But access to that support is variable across the city region.

Local authority leadership and governance around poverty mitigation and reduction is needed to improve living conditions, and ultimately health. There are Greater Manchester authorities which have strong structures in place to help reduce poverty, led by elected members, but in some authorities poverty appears to be less engrained in decision making. It is worth looking to Scotland, where action plans on poverty reduction are a mandatory requirement for each local authority, as well as the need to consider inequalities in every policy decision through the Fairer Scotland Duty.

Targeted health interventions can reduce poverty

Poor health can also cause poverty, through no longer be able to work for example. Ideally more ill health would be prevented in the first place, which would reduce financial hardship but, as discussed, preventing ill health is complex. However, the health system can help prevent more severe illness if practitioners know about warning signs and symptoms early enough and work with individuals to manage them.

An example of innovation in this space is a GP pilot in Greater Manchester, funded through the commissioning improvement budget. The pilot involved contacting residents who hadn’t visited their GP for several years, starting with those who had historic risk factors such as high blood pressure or a history of smoking. If those residents didn’t respond, they were followed up, even if that meant multiple phone calls or a home visit.

Traditionally a patient might not have been followed up if they couldn’t be reached three times. Changing that approach meant GP practices persistently seeking out residents who wouldn’t normally engage, helping them proactively manage their health issues, which if left unmanaged could have resulted in a health crisis.  The pilot was disrupted by COVID-19, but this approach is supported elsewhere and could help reduce severe illness and the associated financial hardship.

Conclusions

Simon Watts for GM Poverty Action

Simon Watts

I am convinced that a strategy of proactively supporting the health of our most vulnerable residents will make a positive impact on their health and wealth, when complemented by a wider ranging, local-authority-led poverty mitigation and reduction strategy that targets the underlying causes of poverty. This should be supported by poverty and health being considered in all policy decisions.

The cost of not addressing poverty could be higher from a health and societal perspective than investing in interventions that can reduce poverty. Using elements of the healthcare budget, such as commissioning improvement funds, to support vulnerable groups and poverty reduction could reduce pressure on the healthcare budget longer term.

 

 

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Devolved approaches to social security

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Devolved approaches to social security in the UK – lessons for Greater Manchester

By Graham Whitham

We are pleased to be launching, in partnership with the Sustainable Housing and Urban Studies Unit (SHUSU – University of Salford), a series of short essays exploring approaches to social security at a devolved level in the UK. The aim is to understand what lessons there are for Greater Manchester (GM) from approaches taken in the devolved nations, and to consider what COVID-19 means for the future of local welfare provision.

Dr Mark Simpson (Reflections on Northern Ireland’s mirror image approach to devolved social security) highlights the different payment arrangements for Universal Credit (UC) in Northern Ireland (the only part of the UK where welfare policy is wholly devolved). In contrast to England, UC payments in Northern Ireland are made twice monthly by default and the housing element is paid automatically to landlords.

Despite the different levels of social security powers that exists in Northern Ireland and Scotland, both nations have sought to mitigate against some of the worst aspects of UK policy. Professor Sharon Wright (Social security in Scotland) explains that in 2018/19 the Scottish Government spent approximately £125 million mitigating UK cuts. According to Professor Wright, Scotland’s approach shows the value of listening to those with lived experience of social security and enabling local people to feed into the design of policies and practices.

An approach that responds to the needs of service users was at the heart of the DWP and Oxfam Livelihoods Training Project in Wales. Professor Lisa Scullion (to whom we are grateful for bringing this series of essays together) and Dr Katy Jones (Taking an assets-based approach to Jobcentre Plus support: Lessons from Wales) discuss how the project took a person-centred approach to tackling poverty, embedding understandings of poverty within DWP across Wales. Findings from this project could inform the development of labour market programmes in GM.

Dr Daniel Edmiston, Dr David Robertshaw and Dr Andrea Gibbons explore the impact of COVID-19 on local responses to welfare provision (What can local responses to COVID-19 tell us about the potential and challenges for devolved ‘welfare’?). Whilst recognising the incredible local cross-sector working that has happened during the pandemic, they warn of the risks presented by local welfare support operating in a context of diminishing resources. In this context, increased autonomy that a devolved approach to welfare may bring would need to be accompanied by mechanisms of accountability for local citizens to articulate their needs and preferences about local provision.

There are two aspects to approaching social security policy in GM. The first is to consider what can be done with existing powers. The second is to consider whether GM should seek devolution of aspects of the system and, if it were to do so, what powers it should seek and how it should use those powers. GMPA is currently undertaking research on the first of these considerations, exploring local welfare schemes, with a view to developing policy and a good practice guide for local authorities and their partners. This will be published later in the year.

On the second consideration, these essays encourage further discussion about how devolution of social security system could help strengthen the fight against poverty in GM.

What comes through strongly in the essays is the need to for a person-centred approach to welfare policy that ensures people with experience of using the social security are involved in service design. Also important to recognise is that regardless of the levels of power over the system that exist, what can be done locally, as Dr Mark Simpson says, to support people accessing the welfare system depends on the interaction of available powers, available budget and political will.
                               

To read the essays click here

 

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Focusing on the causes of poverty

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End Child Poverty Campaign, Marcus Rashford and focusing on the causes of poverty

By Graham Whitham

The End Child Poverty Campaign (ECP), of which GMPA is a steering group member, has written to Manchester United footballer Marcus Rashford to congratulate him on drawing attention to the problem of food poverty among families with children. Marcus is backing calls in the National Food Strategy for expansion of free school meals to every child from a household on Universal Credit or equivalent legacy benefit, expanding the school holiday food and activities programme and increasing the value of Healthy Start vouchers.

It’s brilliant that Marcus has been able to generate such positive coverage for the issue of child food poverty and we fully support his call for an extension of free school meals to all children whose families are in receipt of Universal Credit. However, it is important that we don’t see food provision as a solution to poverty, whether that be poverty effecting children or other groups of the population.

It is imperative that the Government puts tackling child poverty at the heart of its post-pandemic economic recovery if we are to see an end to families having to rely on food handouts and vouchers to feed their children.

That is why GMPA supports ECP’s call for Government to set out a comprehensive and ambitious child poverty strategy that looks not just at ensuring children have enough to eat, but tackling the causes of low income and the reason families can’t afford adequate food in the first place. This would include strengthening the social security system by increasing child benefit by £10 a week; and ending the benefit cap, the two-child limit and the five week wait for Universal Credit. As well as taking action to ensure that companies pay a real living wage; addressing high rents and the cost of childcare; and reinvesting in children’s services.

Sian (GMPA’s recently appointed Food Poverty Programme Coordinator) set out GMPA’s response to the National Food Strategy in our last newsletter. Whilst a national conversation about food poverty is welcome (and necessary), the strategy recommendations do not focus enough on fixing these underlying causes of poverty.

GMPA Director Graham Whitham for GM Poverty ActionIn Greater Manchester it is important that we use what resources and powers we do have to support people in a way that prevents and reduces poverty, and that gives people maximum dignity, choice and control in the way support is provided. This should involve identifying opportunities to boost household income by increasing benefit take-up and widespread adoption of the Real Living Wage, as well as providing people with access to money rather than in-kind support such as food parcels and vouchers (see our ‘Cash First’ briefing for further discussion about the benefits of this approach).

Graham Whitham
GMPA Director

 

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Keep the lifeline

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Joseph Rowntree Foundation campaign: Keep the lifeline

By Graham Whitham

Update

Today (September 30th), despite the cancellation of the Autumn Budget, a letter has been sent to the Chancellor, signed by JRF and over 50 other organisations including GMPA. In the letter the signatories urge the Chancellor to “make the temporary £20/week increase to the standard allowance of Universal Credit and Working Tax Credit permanent from April, as well as extend the same uplift to ESA, Income Support and JSA.”

It goes on to say “Falling incomes and rising costs throughout the pandemic have put families under immense financial pressure, but the £20 uplift has been a lifeline that has enabled many of them to keep their heads above water and has stopped us seeing a marked surge in poverty levels. However, if the uplift ends in April 2021, this good work risks being undermined.”

For more details on JRF’s ‘Keeping the lifeline’ campaign please take a look at this blog  from JRF’s Acting Director Helen Barnard. More information about the campaign is available on JRF’s website here.

Please get in touch with us if you would like to support this campaign.


GMPA is supporting the Joseph Rowntree Foundation’s (JRF) call to maintain the £20 uplift for Universal Credit (UC) and legacy benefits introduced during the lockdown. The current indications from Government are that they still consider this to be a temporary measure, and as yet are not persuaded of the need to keep it in the autumn Budget. However, we know that many low incomes families were struggling financially prior to the pandemic and that many will be struggling following the lockdown period as the economic consequences of COVID-19 become clearer. Those needs are not likely to go away anytime soon and the £20 uplift needs to become permanent.

 

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The National Food Strategy

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The National Food Strategy: What does it do for food poverty?
By Sian Mullen

Part one of the National Food Strategy, an independent review supported by a team of experts across the food system, was published last month. It aims to make, “urgent recommendations to support the country through the turbulence caused by the COVID-19 pandemic, and to prepare for the end of the EU exit transition period”.

Initially, the strategy does a good job of steering the conversation towards the relationship between food and economics. It highlights some of the factors that cause food poverty: sudden unemployment, the housing benefit cap, and delay in receiving universal credit. Equally, it recognises that the lack of a “financial buffer”, experienced by those in low paid jobs, means they are less likely to be able to cope with the shock of a loss of income. Thus, it correctly determines that food poverty is not caused by a lack of food, it is caused by a lack of funds to buy it.

However, the strategy recommendations do not focus on fixing these underlying causes of poverty. Aside from a brief note to continue to measure food poverty (an important factor in ensuring the right work is done in the right place), the focus is directed towards free meals and voucher support. It predominantly focuses on children, presumably based on the slightly misleading assertion that, “new food bank users are overwhelmingly children and young people”. A closer look at the statistics relating to this claim reveal that while 21% of users during COVID-19 were families with dependent children and 5% did not have dependent children, the other 74% of respondents ‘preferred not to answer’. It is questionable to draw any conclusions around the age of users from such statistics. Equally, 22% of new food bank users (over the age of 16), were aged between 16-24; a significant, but not overwhelming proportion of the population.

This is not to detract from the importance of ensuring that children have access to nutritious food. However, this singular emphasis on children runs the risk of a strategic focus that concentrates on food handouts and vouchers as opposed to changes in welfare and employment policies to ensure adults have access to a decent and reliable income in order to feed themselves and their children.

One of the key recommendations is an increase in the value of Healthy Start vouchers. Whilst valuing initiatives aimed at ensuring children are nutritionally healthy, there are flaws to this approach. Firstly, if people do not have enough money to provide for their children, then they should receive more money. Cash assistance avoids issues surrounding accessing vouchers, issues around accessing shops where you can spend vouchers, and provides the recipient with dignity and equality when buying products (for an interesting perspective on the relegation of those on benefits to a world outside of money see: Williams (2013)). Critics argue that vouchers are necessary to ensure funds are spent as intended, however evidence suggests that cash schemes are successful in meeting project aims (Bailey (2013); DFID (2017)) and the level of control provided by vouchers is unreasonable and promotes
dependence on handouts,

“One of the principles of universal credit is to encourage personal responsibility.
It’s inconsistent … to say a benefit claimant should be trusted to pay their rent,
but we shouldn’t trust them to buy food…”
(CPAG)

Secondly, the uptake of Healthy Start vouchers is low with the current rate at only 48%. If vouchers are going to be the temporary answer, then there needs to be a focus on maximising take-up through proper promotion of the support that’s available, reducing complexity and stigma and measures to ensure vouchers can be accessed easily.’

Sian Mullen Food Poverty Programme Coordinator for GM Poverty ActionUltimately, if we are going to end food poverty then we need to address the problems that lead to food poverty. What we really need in Greater Manchester is a strategy that focuses on ensuring everyone has access to a decent and reliable income (Caraher & Furey (2017); Garnham (2020); Macleod (2019); Tait (2015)). Yes, we need some short-term fixes to the symptoms, but without a strategy that has a clear long-term goal of a decent and reliable income for all, the problem of food poverty will remain.

Sian Mullen
GMPA Food Poverty Programme Coordinator

 

 

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Food poverty programme

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GMPA’s Food Poverty Programme Update, and Introducing Sian Mullen
By Tom Skinner

Addressing the underlying causes of food poverty has been a major focus of GMPA’s work over the last three years. Many of you have contributed to it, including through the Greater Manchester Food Poverty Alliance project which co-produced the GM Food Poverty Action Plan, published last year.

Since then, we have pushed for many of the actions in the plan to happen. This includes:

  • The GM Combined Authority collating information about poverty levels, access to food, Healthy Start voucher uptake and more, and sharing this with Local Authorities.
  • A greater recognition of the Combined and Local Authorities’ roles in reducing poverty as a means of tackling food poverty, and elected members and officers being tasked with this.
  • Increasingly joined up thinking about food provision during the school holidays. (Although we eventually want to reach a state where the need for charitable food aid is significantly reduced.)
  • More recently we have been very involved in helping to support and shape GM’s response to Covid-19, particularly addressing the extra impact that the pandemic has had on people in poverty.

To build on this work we recently recruited to a new post – Food Poverty Programme Coordinator – that will focus on implementing the action plan and support measures that address the underlying causes of food poverty.  This work will include piloting place-based partnership approaches to reducing food poverty in different localities across Greater Manchester. We were delighted to have appointed Sian Mullen to the role.


Sian Mullen

Sian Mullen Food Poverty Programme Coordinator for GM Poverty ActionSian has worked in the development and humanitarian sectors both in the UK and abroad for many years. She is passionate about working to alleviate poverty to create a more equal society, and is excited to be focusing on reducing food poverty in Greater Manchester.

Sian has lived in Manchester since 2012 when she came to complete her PhD in Humanitarianism.

Prior to joining GMPA she worked as a programme manager with Oxfam, coordinating their poverty alleviation programme across Greater Manchester. She has also been an active volunteer with several charities involved in food provision including during the Covid-19 response.


Tom for GMFPA article for GM Poverty Action

Tom Skinner, GMPA Co-Director

At GMPA we are excited about working with Sian and many of our partners over the coming years as we work towards our vision of a Greater Manchester free from poverty. Linked to this is the need for national action on food poverty. Part one of the National Food Strategy, an independent  review supported by a team of experts across the food  system, was published last month. You can read GMPA’s comments in response to the strategy in a separate article on the news page.

 

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Impact of poverty on BAME communities

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The disproportionate impact of poverty on BAME communities
By Graham Whitham

Many of you will have seen the recent Social Metrics Commission report highlighting the shocking extent to which certain parts of our community are at much greater risk of poverty. The report found that nearly half of BAME UK households live in poverty and many in deep poverty, and BAME families are between two to three times more likely to be experiencing persistent poverty.

The pandemic has highlighted many of the inequalities we were already aware of. The virus has sought out and disproportionately affected some of the most vulnerable in our society. Those who said at the start of the COVID-19 outbreak that the virus was a ‘great leveller’ and that the consequences would be felt by rich and poor alike were talking nonsense.

We invited a number of leading figures from the VCSE sector in Greater Manchester, who have been at the forefront of tackling poverty and inequalities across the city region to provide their comments on the Social Metrics Commission figures and what they mean for the fight against poverty in light of the pandemic.


Miranda Kaunang FareShareGM for GM Poverty Action

Miranda Kaunang,
Head of Development, FareShare GM

“We were in no doubt that thousands of families were struggling to get by before the lockdown, and that hundreds of organisations want to help them. The lockdown, and the Greater Manchester humanitarian response, confirmed that even more. The FareShare GM team has worked very hard to respond to the need for food aid for years.

To see these statistics, and have confirmed once again the scale of the problem, particularly among certain BAME communities, compared to the scale of our response, is daunting. Without further action from government to address the root causes of poverty, the work of FareShare GM will continue to be needed.

One challenge we face is being able to bring more certainty to our attempts to reach those in most need. To do that we need better data and a more tailored reach, and we need to think about how the intelligence we gather can inform policy and practice in a way that reduces the need for food aid. Like many other practical responders, we will keep on providing important support but the systemic landscape has to change. This really matters.”


Elizabeth Dotun for GM Poverty Action

Elizabeth Dotun  
Project Director ,
Rehoboth for families

“The majority of BAME people in the UK are migrants. Many lack the knowledge of how things work in their new environment and need support to help them settle. Many have suffered poverty because they do not understand the system and the operation of the country, they lack awareness of rights and entitlement. Many, for lack of knowledge of housing rights, have endured living in accommodation which are not suitable for living, examples being damp ceilings, condensation and overcrowding.

In situations where BAME people educate themselves on their environment and the system, they quickly realise that the system is rigged, and a lot of things are out of their control. Some service providers at different levels who are biased or prejudiced or are point blank racist have not always given the right advice or support when a member of the BAME community have asked for help.

Those who migrate to Britain without a degree find it hard to get employment of their choice and are often put in the ‘unskilled labour’ bracket. This makes it hard for members of the BAME community to progress.”


Atiha Chaudry for GM Poverty Action

Atiha Chaudry
Chair
GM BAME Network

“These figures show huge disparities for BAME communities and these are figures before COVID -19’s  big hit on BAME communities. It is shocking and frightening to think what the figures in coming years will say about the huge disparities and persistent inequalities in our western, modern and rich society.

The Social Metrics Commission report should be a must-read for all of us concerned with levels of poverty in our country. It headlines some disturbing and worrying figures for 2018-19 levels of poverty showing some shocking facts.

Greater Manchester is home to a significant BAME population with many districts like Manchester approaching fifty percent ethnic diversity. We should be very concerned locally about what this means for us now and as we begin to understand the aftermath and ongoing impact of COVID on our BAME communities. We need some serious action now!”


Charles Kawku-Odoi for GM Poverty Action

Charles Kwaku-Odoi,
Chief Officer,
Caribbean & African
Health Network

“It is shaming that there is growing inequality for BAME households in a rich country like the United Kingdom. There are structural issues including unfair immigration policies that drive BAME households further into poverty depriving hard working people of a level playing field.

Tackling the structural issues driving BAME households into deeper poverty requires a listening exercise for Government to understand the issues with a commitment to right the wrongs. The Government’s commitment to levelling up must be reflected in proportionate investment for communities that have been marginalised for decades and an internal soul searching within institutions like the Home Office that charges BAME households exorbitant fees when they want to remain legally in the UK. Please don’t give with one hand and collect with two hands!

Employers including the NHS also have a crucial responsibility to deal with the race pay gap where there are hardworking BAME people who continued to be under paid and not valued equally like their White counterparts.”


Beatrice Smith for GM Poverty Action

Beatrice Smith,
Facilitator,
Tameside PTC, GMPA

“These findings highlight once again the disparity of outcomes for BAME communities in comparison with the rest of the UK population. The tragedy of Grenfell 3 years ago, coupled with the adverse effect of COVID-19 on BAME people, provide alarming evidence of the failure of systems and institutions for non-white UK residents.

As it stands, BAME communities’ health remains adversely affected by COVID-19; the majority of frontline workers during the pandemic have been those from BAME backgrounds. These findings, therefore, paint a grim picture of the lived experience of BAME people in the UK and deeper work is needed to establish the causes behind these harrowing findings. As Bryan Stevenson, Author of Just Mercy and founder of the Equal Justice Initiative said: “the opposite of poverty is not wealth, it is justice”. Justice work is therefore needed to address the often systemic injustice that exists behind these statistics and to establish long-term and sustainable solutions with and for BAME communities.”

 

 

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