Context: the politics of blame
Increasing employment and pushing ill and disabled people into work are key elements of the UK Government’s public health and welfare “reform” agendas. The arguments presented for this approach are primarily economic and particularly, moralistic. The reasoning presented is not founded on biological, psychological or sociological evidence. The government maintains that work is the most effective way to improve the wellbeing of individuals, their families and their communities. There is a perception that unemployment is harmful to physical and mental health, so the corollary has been assumed – that work is beneficial for health.
However, that does not necessarily follow, and to claim that it does is distinctly unscientific and irrational. As the Conservatives themselves have often pointed out in less appropriate circumstances in order to avoid democratic accountability and responsibility, there is a difference between an association and a causal relationship.
There is a clear ideological context from which the welfare “reforms” proceeded, and the politically-directed media campaigns that have purposefully stigmatised and outgrouped unemployed people demonstrates quite clearly that reducing welfare support is not about a politically calculated extension of social inclusion and social justice policies, Conservative bonhomie, or overall concern for the wellbeing of welfare recipients and people who are disabled.
The government are attempting to entrench neoliberal ideology in our culture by co opting GPs, social workers and other professionals as agents of the state. The idea that “work is a health outcome” has been embedded in policies such as the Orwellian renaming of sick notes (now “fit notes”), which are designed to explore what work a person who is absent from work because of illness may undertake. However, the government intend a much more far-reaching outcome than simply attempting to reduce the sick “role” and recovery time. The government’s “behavioural change” agenda has become a centrally-orchestrated programme for governance. The provision of public goods and crucial support, from housing and discretionary housing payments to employment benefits and disability support is becoming increasingly conditional.
Political rhetoric, aimed at perpetuating an extremely divisive and intentionally misleading “strivers and skivers” dichotomy is designed to undermine public support for the welfare state and the other gains of our post-war settlement – the NHS, legal aid and social housing for example – also betrays the lack of coherence, rationality and empirical support for the Conservative’s “reforms.” Furthermore, the extremely targeted, class-contingent and punitive nature of the Conservative austerity programme indicates that the welfare “reforms” were founded on traditional Tory prejudices, rather than on any genuine causal relationship based on empirical evidence and social or economic necessity.
This explains why the government have persistently ignored the many evidence-based concerns raised by academic researchers, campaigners and opposition MPs that their austerity policies are having an extremely harmful effect, most often on our poorest and most vulnerable citizens.
The Conservatives are ideologically bound to notions of a small state, minimal levels of political responsibility and intervention, minimal levels of government spending, the heavy promotion and administration of privatisation, competition, fiscal austerity, deregulation and free trade in order to enhance the role of the private sector in the economy, all of which are the central strands of the neoliberal hegemony. Conservative ideology runs counter to any notion that all citizens must be treated fairly, which also means that they must be given equal economic opportunities and provided with a adequate minimum standard of living. Neoliberal ideology is incompatible with a human rights-based society.
Democracy exists partly to ensure that the powerful are accountable to the public, and particularly to our most vulnerable citizens. This government have blocked that crucial exchange, and show disdain for human rights, the welfare state and the NHS, all of which provides ordinary people and the most vulnerable citizens basic protection from those in power.
Conservatives despise human rights and rights-based social provision. They absurdly claim that welfare provision causes vulnerability, and a “culture of dependency,” despite the fact that there is absolutely no empirical evidence to support this view. History has consistently taught us otherwise. The Conservative’s policies are expressions of contempt for the lessons and empirical evidence from over a century of social history and administration.
Tory rhetoric is designed to have us believe there would be no poor people if the welfare state didn’t somehow “create” them. If the Conservatives must insist on peddling the myth of meritocracy, then surely they must also concede that whilst a neoliberal system has a few beneficiaries, it also creates situations of insolvency and poverty for many others. That is what a system based on competitive individualism is about: it creates a few “winners” and a lot of others lose.
Conservative cuts are based on nothing more than the ridiculous myth that poverty is somehow a lifestyle choice or a moral failing which people can be punished or starved out of. The new Tory neoliberal “paternalists” really seem to believe that if they make life for poor people insufferable, they will simply be “incentivised” to choose to be wealthier. It’s a thinly disguised revamp of the ill-conceived 1834 Poor Law deterrence principle of “less eligibility” – that was supposedly aimed at “making work pay” too. But it didn’t. It’s not possible to frighten and punish people out of poverty. Only a Conservative government would claim to be making work pay by cutting welfare down to the bare bones, rather than increasing wages. The welfare cuts have actually had the effect of driving down wages too.
Of course, by framing the issue of poverty in terms of personal responsibility and morality, the Conservatives have stifled debate and restricted public discussion in the hope that people won’t recognise the wider structural inequalities and economic failings, for which this government are solely responsible.
Debbie Abrahams said: “The Conservatives point the finger at sick and disabled people for the rise in spending. They are still shamelessly spinning their tired “shirkers” and “strivers” narrative, designed to whip up public support for cuts to the most vulnerable. But this divisive rhetoric can no longer conceal the fact their economic strategy has failed. It is the government’s failure that has led to rising social security costs.
As we saw at the Autumn Statement (2016), borrowing is up, growth is down, deficit targets have been hopelessly missed and wages have flat-lined. At the same time, the government has refused to tackle the driving forces behind increased social security spending, from low pay to high housing costs. Instead, the government is slashing support to those who need it most, exacerbating the financial strain so many are facing this Christmas, and failing its own targets in the process.
[…] Research by the Joseph Rowntree Foundation suggested that we need to be building 80,000 affordable homes a year to meet demand and keep the current spend on housing benefit stable. This government managed a pathetic 30,000 homes last year. It is this refusal to build enough homes that keeps the housing benefit bill growing. People are left struggling to find somewhere affordable to live, and the state is forced to subsidise the sky-high rents charged by private landlords
We could also look at tax credits, which currently make up more than £20bn a year in the spending under the cap. Tax credits top up working people’s pay where it is insufficient. Wages today are lower than they were in 2008, and won’t even return to the levels of 2008 until 2021. A record six million workers are paid less than the living wage. This is why tax credit costs have risen – because the government has had to increase the amount spent on topping wages up.
Labour founded the welfare state to give pensioners and disabled people dignity, to prevent homelessness, children going hungry, and to cover for periods of unemployment or ill-health. It was never designed to be spending tens of billions substituting for low-wage employers or subsidising rip-off landlords.”
Economic productivity is the new health outcome
The claim that “work is good for you” is allegedly based on “scientific evidence” that people in work tend to be healthier than those claiming unemployment and sickness benefits. However, to draw the conclusion that “employment is good for you” from the data is an example of inferring causality inappropriately, from what is only an association. Yet it is being used to prop up Conservative justifications for dismantling the welfare state.
Unemployment has been linked to increased rates of sickness, disability and mental health problems, and to decreased life expectancy. The claim has also been made that it results in an increased use of medication, medical services, and higher hospital admission rates. However, surely it makes much more sense to say that sickness, disability and mental health problems, the use of medication, medical services, and higher hospital admission rates all cause unemployment, rather than the converse. This government seem to have a major problem accepting the fact that sometimes, people really are simply too ill to work.
Most people who are too ill to work are obviously not as healthy as those who can work. That is hardly controversial. However, that doesn’t mean that work itself is good for your health, it just means those who don’t work tend to have worse health than those who do. People don’t work because they have poor health.
Linking ill health with “worklessness” is an ideological preference which ignores other variables. It is much more likely that the “reforms”, which have reduced welfare provision to inadequate levels – leaving people all too often unable to meet their basic needs – is bad for health, rather than being out of work.
But the Conservatives have used this “evidence” of an association between poor health and unemployment to make an inference based on a “causal link” that hasn’t actually been empirically verified. Iain Duncan Smith has made the claim, for example, that “work is good for you.” He has even claimed that work can make people’s health problems “better.” But that isn’t very likely to be true. It’s akin to claiming that chatting and exercise is a cure for multiple sclerosis, lupus, blindness or cancer. Or that a work coach on prescription will cure rheumatoid arthritis, a disc prolapse or schizophrenia.
This is why I visit my doctor when I am ill, and not Iain Duncan Smith or the government.
The claim that work is good for your health is simply a part of Tory justification narratives for cutting support for sick and disabled people, and hounding people who need to claim benefits. Yet this axiom informs current UK policy towards increased benefit conditionality, harsh sanctions, compulsory work experience and the “workfare” or “work-for-benefits” thinking which the Conservatives favour. However, this is an approach that can never work, unless, of course, the aim is to completely dismantle the welfare state. Oh, hang on…
The biopsychosocial model
The biopsychosocial model (BPS) of ill health is not without controversy, although many see it as more pragmatic or humanistic than the medical model of illness, which came to be regarded as reductionist and deterministic. The biopsychosocial model is the conceptual status quo of contemporary psychiatry, and many believe that it has played an important role in combatting psychiatric dogmatism.
The biological component of the model is based on a traditional allopathic (bio-medical) approach to health. The social part of the model investigates how different social factors such as socioeconomic status, culture and poverty impact on health. The psychological component of the biopsychosocial model looks for potential psychological causes for a health problem such as lack of self-control, emotional turmoil, and negative thinking.
Of course a major criticism is that the BPS model has been used to disingenuously trivialise and euphemise serious physical illnesses, implying either a psychosomatic basis or reducing symptoms to nothing more than a presentation of malingering tactics. This ploy has been exploited by medical insurance companies (infamously by Unum Provident in the USA) and government welfare departments keen to limit or deny access to medical, social care and social security payments, and to manufacture ideologically determined outcomes that are not at all in the best interests of patients, invalidating diagnoses, people’s experience and accounts, and the existence of serious medical conditions. (See also: Getting rich on disability denial, and A Tale of two Models by Debbie Jolly.)
Unum was involved in advising the government on making the devastating cuts to disabled people’s support in the UK’s controversial Welfare Reform Bill. (See also: The influence of the private insurance industry on the UK welfare reforms.)
This is a government that tends to emphasise citizen responsibilities over rights, moralising and psychologizing social problems, whilst quietly editing out government responsibilities and democratic obligations towards citizens.
For example, poverty, which is caused by political decisions affecting socioeconomic outcomes, is described by the Conservatives, using elaborate victim-blame narratives, and this is particularly objectionable at a time when inequality has never been greater in the UK.
Poverty may only be properly seen in a structural context, including account of the exclusion and oppression experienced by those living in poverty, the global neoliberal order, the gender order, the disability, racial, sexual and other orders which frame social life and precipitate poverty in complex and diverse ways. It’s down to policy-makers to address the structural origins of poverty, not the poor, who are currently regarded as the “collateral damage” – casualities – of politically imposed structural constraints.
Conservative governments are unhealthy
The effects of loss of income on people who can’t work because of illness is a confounding factor, too. How is it possible to isolate the devastating impacts of the Conservative “reforms” and the steady dismantling of the welfare state on unemployed people from the misleading generalisation that unemployment is bad for health? Surely if the Conservatives genuinely believed their own claims, they would be more inclined to increase rather than radically decrease provision and support for unemployed people.
Of course, not all work is beneficial. The review that led to the widespread folk tale that work is good for you is based on research involving people who had common and minor illnesses, and fulfilling, secure jobs. That doesn’t reflect the experiences of many people.
Not all jobs are rewarding and positive experiences, and some work can cause serious risks to health.
Doctor Frank Scheer, a neuroscientist at Harvard Medical School and Brigham and Women’s Hospital in Boston, says:
“There is strong evidence that shift work is related to a number of serious health conditions, like cardiovascular disease, diabetes, and obesity.
These differences we’re seeing can’t just be explained by lifestyle or socioeconomic status.”
Shift work and poor quality working environments and employment conditions are also linked to stomach problems and ulcers, hypertension, depression, musculoskeletal disorders, chronic infections, diabetes, general health complaints, all-cause mortality and an increased risk of accidents or injury. Long working hours are equally linked with a detrimental impact on health, according to medical research – see: The impact of overtime and long work hours on occupational injuries and illnesses: new evidence from the United States.
There is a growing and potentially corrosive problem of low paid, poor quality, precarious and temporary work which threatens levels of social inclusion and, ultimately, the health of the workforce.
Research shows unambiguously that the psychosocial quality of bad jobs is worse than unemployment. Peter Butterworth examined the mental health implications of those moving from unemployment into employment and found that:
“Those who moved into optimal jobs showed significant improvement in mental health compared to those who remained unemployed. Those respondents who moved into poor-quality jobs showed a significant worsening in their mental health compared to those who remained unemployed.”
Overall, unemployed respondents had poorer mental health than those who were employed. However the mental health of those who were unemployed was comparable or superior to those in jobs of the poorest psychosocial quality. (See: The psychosocial quality of work determines whether employment has benefits for mental health: results from a longitudinal national household panel survey.)
More recently, in a letter to the Guardian, the UK’s leading bodies representing psychologists, psychotherapists, psychoanalysts, and counsellors called on the Government “to immediately suspend the benefits sanctions system. It fails to get people back to work and damages their mental health.
Findings from the National Audit Office (NAO) show limited evidence that the sanctions system actually works, or is cost effective.
But, even more worrying, we see evidence from NHS Health Scotland, the Centre for Welfare Conditionality hosted by the University of York, and others, which links sanctions to destitution, disempowerment, and increased rates of mental health problems. This is also emphasised in the recent Public Accounts Committee report, which states that the unexplained variations in the use of benefits sanctions are unacceptable and must be addressed.”
The impact of poverty on health
The largest study of poverty conducted in the UK has laid out the dire extent of British material deprivation – and seriously undercut the government’s claim to be lifting people out of poverty through work.
The Poverty and Social Exclusion in the UK (PSE) project details how, over recent years, the percentage of households living below society’s minimum standard of living has increased from 14% to 33% – despite the fact that the economy has increased in size over the same period. The study found that low wages are a central cause of widespread deprivation. For many people, full-time work is not enough to lift them out of poverty; almost half of the working poor work 40 hours a week or more. And one in six adults in paid work (17%) is poor, suffering low income and unable to afford basic necessities.
Commenting on the study’s findings, Professor Jonathan Bradshaw of the University of York said they showed many parents who work full time still have to make huge sacrifices to try and protect their children from deprivation.
“We already know from DWP data that the majority of children with incomes below the the relative income poverty threshold have a working parent. The PSE survey shows that the majority of deprived children, those lacking two or more socially perceived necessities, and very deprived children (lacking five or more socially perceived necessities) have a working parent.
We found that 65% of the deprived and 58% of the very deprived children had a working parent, and 50% of the deprived and 35% of the very deprived had at least one parent working full-time. Child poverty is not being driven by skivers, but is the consequence of strivers working for low earnings while in-work benefits are being dissipated by government austerity measures.”
Responding to the findings, Clare Bambra, a professor at Durham University, said that the research was a shameful picture of “the devastating and far-reaching human costs of inequality and poverty in the UK today.”
“It’s shameful for a rich country like ours to be tolerating such levels of poverty especially amongst our children and young people. The mantra that work sets people free from poverty has been shown to be a grand old lie.
We will be living with the long term consequences of this social neglect for decades to come – there are clear links between poverty and reduced life expectancy and higher rates of ill health, especially concentrated in deprived areas and the north.
These findings show us the true cost of austerity.”
Public health experts from Durham University have denounced the impact of Margaret Thatcher’s policies on the wellbeing of the British public in a comprehensive study which examines social inequality in the 1980s.
The study, which looked at over 70 existing research papers, concludes that as a result of unnecessary unemployment, welfare cuts and damaging housing policies, the former prime minister’s legacy includes the unnecessary and unjust premature death of many British citizens, together with a substantial and continuing burden of suffering and loss of wellbeing.
The research shows that there was a massive increase in income inequality under Baroness Thatcher – the richest 0.01 per cent of society had 28 times the mean national average income in 1978 but 70 times the average in 1990, and UK poverty rates went up from 6.7 per cent in 1975 to 12 per cent in 1985.
Baroness Thatcher’s governments wilfully engineered an economic catastrophe across large parts of Britain by dismantling traditional industries such as coal and steel in order to undermine the power of working class organisations, say the researchers. They suggest this ultimately fed through into growing regional disparities in health standards and life expectancy, as well as greatly increased inequalities between the richest and poorest in society.
Professor Clare Bambra from the Wolfson Research Institute for Health and Wellbeing at Durham University, co-author of the research report, commented:
“Our paper shows the importance of politics and of the decisions of governments and politicians in driving health inequalities and population health. Advancements in public health will be limited if governments continue to pursue neoliberal economic policies – such as the current welfare state cuts being carried out under the guise of austerity.”
Thatcher’s policies have been condemned for causing “unjust premature deaths.” Cameron’s policies are even more class-contingent and cruel.
I think there is a growing body of empirical evidence which indicates clearly that Conservative governments are much worse for public health, prosperity and wellbeing than unemployment.
Pictures courtesy of Robert Livingstone
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