Category: Food Poverty

Select committee to investigate link between ‘survival sex’ and Universal Credit

amber rudd

In February, Amber Rudd finally conceded that the increased use of food banks is partly down to problems in rolling out Universal Credit, following a long line of Conservative ministers who have persistently and loudly denied their is any link between welfare cuts and people needing food banks to make ends meet.

The work and pensions secretary said she was “absolutely clear there were challenges with the initial roll-out” of the benefit and that the difficulty in accessing money was “one of the causes” of the rise.

But she also said that the government had “made changes to help tackle food insecurity”.

Although it seemed like a “promising” acknowledgement, little has changed. Many people are still notable to meet their fundamental survival needs. Universal Credit has been plagued with multiple problems since its inception in 2010. Eight years later, and those problems remain, with a wake of often devastating consequences in those communities where this flagship failure has been rolled out. The Labour party has called for ministers to halt the roll-out “as a matter of urgency”.

Austerity has caused a surge in “survival crime” – where absolute poverty has driven people to shoplift food and to prostitution. 

Frank Field raised the issue of “survival sex” in parliament last October, telling the then work and pensions secretary, Esther McVey, that some women in his Birkenhead constituency were “were taking to the red light district for the very first time” because of Universal Credit.

Relentlessly hard-faced McVey replied that job centre work coaches would be able to help the women off the streets, adding that “in the meantime” Field could “tell these ladies that now we’ve got record job vacancies – 830,000 and perhaps there are other jobs on offer”.

Now, the Commons Work and Pensions Select Committee have launched an inquiry into a possible link between Universal Credit and so-called “survival sex”, after evidence has emerged that problems with the UK Government’s flagship welfare reform have resulted in some women so impoverished by universal credit or sanctions that they have turned to prostitution to pay rent, feed their families, and generally meet the costs of basic survival needs.

The Committee has opened this phase in its ongoing Universal Credit inquiry in response to reports from charities and support organisations that increasing numbers of people—overwhelmingly women—have been pushed into “survival sex” as a direct result of welfare policy ‘changes’ (cuts).

In his recent report on extreme poverty in the UK, the UN Special Rapporteur, Professor Philip Alston, described meeting people who:

Depend on food banks and charities for their next meal, who are sleeping on friends’ couches because they are homeless and don’t have a safe place for their children to sleep, who have sold sex for money or shelter.

Through its work on different elements and consequences of Universal Credit over the last two years, the Work and Pensions Select Committee has identified a number of features of the policy that may contribute to those claiming social security having difficulty meeting survival needs.

  • The wait for a first Universal Credit payment, which is a minimum of five weeks but can be a lot longer;
  • The accumulation of debt: for example, as a result of third-party deductions to benefits or taking out an Advance Payment at the start of a claim;
  • Sanctions, which are applied at a higher rate under Universal Credit than under the system it replaces.

New Universal Credit claimants are made to wait at least five weeks before receiving an initial payment, although recent changes to the payment system mean people can ask for advances to help tide them over while they await their first payment. However, the advances must be repaid over time, which traps people in a cycle of debt.

Frank Field MP, Chair of the Committee, said: “We have heard sufficient evidence, and are sufficiently worried, to launch this inquiry to begin to establish what lies behind the shocking reports of people being forced to exchange sex to meet survival needs.

“This is an investigation, and we do not yet know what we will uncover.

“But if the evidence points to a direct link between this kind of survival sex and the administrative failures of Universal Credit, Ministers cannot fail to act.”

Niki Adams, a spokeswoman for the English Collective of Prostitutes, a self-help organisation for sex workers, said there had been an increase in prostitution in the UK as a result of rising poverty and cuts to single-parent benefits.

The devastating impact of benefit cuts and sanctions on women’s incomes began before Universal Credit, which for many women, especially lone parents, she said, had the effect of making an already precarious financial situation worse.

“If you are on benefits it is already a very low level of income. If your income is then reduced, that’s when you find women going back into prostitution, or going into it for the first time,” she added.

The Select Committee wants to hear from Universal Credit claimants who have “had to exchange sex for basic living essentials, like food or somewhere to live”.

They say: “We understand that telling your story might be difficult.

“You can ask for your evidence to be anonymous (we’ll publish your story, but not your name or any personal details about you) or confidential (we’ll read your story but we won’t publish it).”

The Committee will also hear oral evidence in Parliament later in this inquiry.

 The deadline for submitting evidence is Monday 29 April 2019.

Terms of reference: Universal Credit and Survival Sex.

Evidence may be submitted through the Committee’s website.

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I don’t make any money from my work. I’m disabled through illness and on a very low income. But you can make a donation to help me continue to research and write free, informative, insightful and independent articles, and to provide support to others going through Universal Credit, PIP and ESA assessment, mandatory review and appeal. The smallest amount is much appreciated – thank you.

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The UK in 2019: Dickensian levels of poverty, malnutrition, scurvy and rickets

 Tories and their tall stories

The government have claimed over the last few successive years that the numbers of people in work has reached ‘record levels’. The Conservatives claim that work has ‘many benefits’. One of those claims, for example, is that “work is a health outcome”. So we should reasonably expect that the general health of the population has improved since around 2015, when the claimed employment ‘boom’ began, if the government’s claim were true.

However, that has certainly not happened. In fact public health  has generally has got worse In 2014, the government tried to claim that a substantial drop in food sales was because of ‘market competition’, rather than the growth in absolute poverty. Public spending in food stores fell for the first time on record in July of that year, which put the the UK’s alleged recovery in doubt. Such a worrying, unprecedented record fall in food sales indicated then that many citizens evidently had not felt the benefit of the so-called recovery.

It remains the case that what the government is telling us is nothing like the lived experiences of many citizens. The claimed economic ‘benefits’ of a Conservative government are not reaching the majority of citizens. In fact many citizens have been pushed into absolute poverty, while the wealthiest citizens have enjoyed a substantial boost to their own disposable income. This shift in public funds is intentional, as the government’s policies have been fundamentally designed to move public wealth from the public domain to the private one.

Cameron’s one moment of truth was when he made a slip, declaring that the Conservatives were “raising more money for the rich”. The Conservatives only ever tell the truth in error, it seems.

Reported cases of malnutrition caused by food poverty have significantly risen

The number of people who are so malnourished they have to go to hospital has more than tripled in the last ten years, and is continuing to rise. In 2017,  8,417 patients were treated for malnutrition. By then, the cases of malnutrition had risen by approximately 400% compared to the number of cases during the global recession in 2008.

Of those admitted in 2017, 143 were under the age of nine and another 238 were aged between ten and 19. Shocking statistics also showed that the number of people in hospital with scurvy, a serious deficiency illness arising because of a lack of vitamin C, has doubled in the same period from 61 to 128 cases.

The shameful figures lay bare the true human cost of cuts in wages and social security in a context of ever-rising food prices and the general costs of living.

These rising figures for hospital admissions because of malnutrition in England by NHS Digital show just the tip of the ­iceberg, as GPs say they have been treating ­thousands more less serious cases of malnutrition, without referring them to our already over-burdened hospitals.

Last year, shadow health secretary Jonathan Ashworth said: “It’s absolutely shameful that malnutrition and scurvy admissions to hospital have risen so ­dramatically after eight years of Conservative rule.

“As the sixth largest economy in the world, surely we are better than this.

“But this is the consequence of eight years of cuts to public services, the cost of living rising and falling real wages hacking away at the social fabric of our society.

“Labour in government will lead an all-out assault on the unacceptable health ­inequalities facing our society.”

Dianne Jeffrey, Chairman of the Malnutrition Taskforce, said: “I find these figures incredibly concerning. We already know up to 1.3 million of our older friends, relatives and neighbours are malnourished or at risk.”

Increasingly, children are also at risk.

Additionally, the Lancashire Evening Post reports that doctors at hospitals in Preston and Chorley, Lancashire, have seen a sharp increase in malnutrition over the last three years. They say they are seeing patients with rickets and scurvy.  Patients were admitted to hospital with malnutrition around 70 times at the Lancashire Teaching Hospitals NHS Foundation Trust in the 12 months up to March 2018, according to NHS Digital data. 

This was an increase of around 75 per cent from the same period two years ago, when there were 40 recorded cases. The county’s NHS Foundation Trust also saw cases of rickets and scurvy during 2017-18.

Natalie Thomas, the community assistant at the Salvation Army which runs the food bank in Preston, says she is not shocked that hospitals in the county have seen people suffering from scurvy and rickets. “It’s scary, it really is but I’m really not all that shocked knowing what we see in here,” she said.

“It’s like we are going backwards in time. It’s quite believable with the amount of bags [of food] we are giving out at the moment.

“It’s not getting any better. Since July when Universal Credit came in we’ve been giving out approximately 1,000 bags of food a month. Since then we have not had any quieter months during the year because people are now getting monthly benefit payments rather than fortnightly payments.

“It’s not surprising for us. The Lancashire Teaching Hospitals NHS Foundation Trust is also collecting food for us.” 

Food banks rarely give out fresh fruit and vegetables, however, since they are perishable foods. Because of storage issues, the food bank in Preston does not hand out fresh fruit and vegetables on a regular basis.

Major Alex Cadogan said: “We are not medical professionals but in our food parcels we try and give out a healthy diet but we can only give what we are given. 

“When we are sometimes in receipt of fresh fruit and vegetables we distribute it as rapidly as we can. We do hand out tinned fruit and vegetables regularly.” 

Vitamin C is needed by humans every day to prevent scurvy, as the body cannot store it. It is a water soluble vitamin, and it is easily destroyed by canning processes and by over-cooking. It’s found most in a range of fresh fruit and vegetables. Vitamin D, which is fat soluble, can be stored in the body. It is found in milk, cheese, yogurt, egg yolks, oily fish such as tuna, salmon, sardines and mackerel. Lack of vitamin D causes rickets and other bone disorders. Lack of calcium and vitamin D can also affect the development of children’s teeth and cause osteoporosis later in life.

Hard Times

Scurvy and rickets were rife in Preston – and most other industrial towns and cities – during the Victoria era. And it was Preston’s heavy industry that formed the inspiration for one of Charles Dickens’ best-known books. The author, famed for his books about the impoverished working classes in Victorian England, spent three months in Preston. His time in the city is widely believed to have inspired his novel Hard Times, about people living in extreme poverty. 

These are the socioeconomic conditions that the Conservative government have recreated through their policies, which have reduced and stagnated wages and cut social security support radically, while the cost of living has dramatically increased, causing severe hardship for many families both in work and out. Meanwhile the very wealthy are rewarded with generous tax cuts from the public purse. 

Across England, the number of cases of malnutrition increased by a further 18 %, from 7,855 cases in 2015-16 to 9,307 cases in 2017-18. The Joseph Rowntree Foundation warned that over 1.5 million households across the country are regularly left struggling to afford basic survival essentials such as food.

Chris Goulden, from the organisation, said: “Living in poverty can severely restrict a family’s ability to put food on the table and lead a healthy life.

“The poorest fifth of households spend twice as much of their income on food and fuel compared with those in the richest fifth, meaning those on the lowest incomes are most vulnerable to price rises, inflation and the benefits squeeze.”

Public Health England recommends that people follow its Eatwell Guide to make sure they are eating a healthy, balanced diet. However, a 2018 report by independent think tank the Food Foundation found more than one in four households would need to spend more than a quarter of their disposable income after housing costs to meet the guide’s recommendations. For parents in the bottom 20 per cent of earners, the cost would be 42 per cent of their income.

The Food Foundation have warned that the figures were signs of a “broken food system”. Executive director Anna Taylor said: “Although cases of rickets, scurvy and malnutrition are caused by a complicated range of factors, they are not conditions that we should have to be talking about anymore in a country as wealthy as the UK.

“Nearly four million children in the UK live in households for whom a healthy diet is unaffordable. We need industry and government to take action now to ensure that everyone has access to enough nutritious food.”

A spokesperson from the Department of Work and Pensions claims there are now fewer households with low incomes.

“We know there’s more to do to ensure that every family has access to nutritious, healthy food”, she said.

“Malnutrition is a complex issue and most patients diagnosed in England have other serious health and social problems.

“For people that need extra support with their living costs we spend £90 billion a year on working-age benefits and will be spending £28 billion more by 2022 than we do now.”

However, while malnutrition may sometimes be caused by relatively rare illnesses that cause absorption problems in the stomach, the most common cause of malnutrition, scurvy and rickets is vitamin and mineral deficiency, which is due to a lack of access to adequate, fresh and varied food, due to absolute poverty.  This is why the number of reported cases of malnutrition is rising. 

Meanwhile charities, food banks and campaigners have continually warned that many households simply cannot afford a healthy diet, and have called for government action to increase access to nutritious food.

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A disabled man with an inoperable brain tumour has been left without social security support

Karl Riley, who is recovering from double brain surgery, says he's been struggling to pay bills after his benefits were suspended three months (Photo: Karl Riley)

Karl Riley, who is recovering from double brain surgery, says he’s been struggling to pay bills after his benefits were suspended three months (Photo: Karl Riley) 

A man who has an inoperable brain tumour has condemned the government after his benefit support was stopped, leaving both his partner and himself with just £5 a week to feed themselves.

Karl Riley says that he’s been living below the bread line since his Employment and Support Allowance (ESA) and housing benefit were taken away three months ago when he moved in with his partner, whose income is just a few hundred pounds a month.

Karl, who is 32, says that he has a tumour that is embedded in his brain stem. This has caused him to suffer severe neurological symptoms, such as permanent limited mobility, double vision, memory loss, confusion, extreme anxiety, depression, nausea, insomnia, tinnitus and facial paralysis. 

Despite his health problems, Karl manages a few hours of self-employed work each week. He manages a band part-time, but isn’t capable of working full-time. He says he risks losing his house now that his benefits have  been stopped. 

Karl has also been waiting seven months for NHS physiotherapy treatment. 

He told i News: “I feel like I’m getting no help from either the government or the NHS. My partner and I can’t feed ourselves and pay other living expenses on just £5 a week. Who can survive on that? I understand now why so many people are going to food banks. This government leaves people to starve.”

Karl found out by accident about his non-cancerous tumour when he had a brain scan as part of a medical trial in 2012. At the time he had no symptoms and he was told that doctors would take a ‘wait and see’ approach.

He continued to work for nearly five years but early last year took a turn for the worse, becoming symptomatic. A scan showed the lump had grown to four times its original size. “I was fine at first. They said it wasn’t appearing to grow much and I carried on managing my five bands.” he explained. “But then the neurological symptoms started.” 

Karl had emergency brain surgery last March to drain a build up of fluid, followed by a second operation in July, when doctors told him the tumour was too embedded in his brain, making it inoperable. 

Karl said: “I was bad after the second operation. It caused me a lot more problems and I had to relearn how to walk.” He then had to undergo six weeks of radiotherapy in a bid to reduce the mass, and says he was vomiting every day and continues to feel the side-effects. 

Karl, who then lived with his partner Samantha Neale, 27, had some savings to fall back on at the time, but when they ran out of money, each of them were forced to move back  with their parents.

Karl had been struggling with his mobility. So in December, he made a claim for ESA. He was awarded £73.10 a week, which is the Support Group level of award, for those who cannot work because of illness or disability, plus he was awarded a basic award of £54 a week when he claimed Personal Independence Payment (PIP), which replaces Disability Living Allowance. Then in March, Karl and Samantha decided to live together again, renting the cheapest place they could find for £425 a month. However, Samantha became ill herself and was unable to work.  She currently receives statutory sick pay.

Karl said: “We wanted to live together again, I was stuck in my parents’ tiny box room which wasn’t ideal for me with mobility problems. My partner is essentially my carer, and she’s had a lot of problems in the past, then there was my illness on top of them and she just couldn’t cope anymore.” 

Karl had declared the move as a change of circumstances, and says the that government asked to look at Samantha’s payslips and took one that showed a higher than normal payment to be their regular income. 

Karl explained: “Samantha is getting £380 a month in sick pay, but for one month in May she was paid nearly £600 because her April payment was under at £280 due to a processing problem.

“But despite explaining this the benefits people decided her regular income is £600. Our council tax reduction has stopped too and we can’t claim housing benefit.” So Samantha’s back payment – money she was owed – was taken as her income as well.

Once Karl’s ESA was stopped, he was told to claim working tax credits, but his award didn’t include the disability element.

This means that he now has to pay for his rent in full and has no council tax reduction. Karl says that after paying their rent and bills, there’s now so little left that he’s had to resort to setting up a GoFundMe appeal, because he feels so desperate. 

“It’s disgraceful, it feels like begging, but I had no other option or we will lose the roof over our heads,” he said.

I’ve worked hard all my life, and I can’t help having a brain tumour. The government also make it all so complicated with form after form to fill in, which is hard because I suffer short-term memory problems. It feels like a slap in the face.

He added: “I would love to be able to work more but I desperately need physiotherapy and occupational therapy. I don’t blame Breightmet Health Centre for that, I blame the government for the cuts and leaving NHS resources so stretched.” (Breightmet is an area of Bolton.)

A Department for Work and Pensions spokesperson said: “We’re committed to ensuring that people with health conditions get the support they’re entitled to. Decisions for ESA are made following consideration of all the information provided by the claimant, including supporting evidence from their GP or medical specialist. Anyone who is unhappy with a decision can appeal.

“People with long-term health conditions may also be eligible for support through other benefits such as PIP.” 

It takes months to get a tribunal date, and before people can appeal, they have to go through a mandatory review first, where the government decides whether their original decision was correct. The mandatory review has no time limit, and an average of six weeks is usual for people to wait for the second decision.

Meanwhile, people are left without an adequate income to meet their basic living needs, and an average of nine months wait for their appeal to be heard.

To donate to Karl Riley’s fund, click here.


I don’t make any money from my work. I’m disabled through illness and on a very low income. But you can make a donation to help me continue to research and write free, informative, insightful and independent articles, and to provide support to others. I co-run a group that supports disabled and ill people going through ESA and PIP claims, assessments and appeals.

Any donation is very much appreciated – thank you.

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Malnutrition, austerity and eugenics.

Minnes

Earlier this year, I reported that figures released by The Office of National Statistics (ONS) showed 391 people died from malnutrition in 2015. There were 746 hospital admissions for malnutrition in just 12 months. The statistics also showed two people in the UK are admitted to hospital with the condition every day in what campaigners have called a “national scandal.” 

Official figures more recently from the Department of Health reveal that people with malnutrition accounted for 184,528 of days in hospital beds taken up in England taken up last year, a huge rise on 65,048 in 2006-07. The sharp increase is adding to the pressures on hospitals, which are already struggling with record levels of overcrowding and limited resources because of underfunding.

 

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Critics and campaigners have said the upward trend is a result of austerity and rising absolute poverty, deep cutbacks in recent years to meals on wheels services for the elderly and inadequate social care support, especially for older people. 

Theresa May has made it clear there will be no end to Tory austerity, she said:“What I’m clear about is we’re going to continue as we have done in Government over the last six years – ensuring that we’re a country that can live within our means.” 

The figures once again directly contradict the glib claim from government ministers that the rise in the use of food banks is linked to the fact that there are now more of them. Ludicrously, millionaire David Freud has claimed that people use food banks just because they provide a  “free good”.  However, research shows that people turn to charity food as a last resort following a crisis such as the loss of a job, the delays and problems accessing social security benefits, and through benefit sanctions. 

People may only be referred to a food bank by a professional such as a social worker or GP. If someone turns up without a voucher, food bank staff put them in touch with relevant local agencies who can assess whether they need a voucher and signpost them to the right services. The number of people receiving emergency food is disproportionate to the number of new food banks opening: following the welfare “reforms”, by 2013, numbers helped by food banks increased by 170% whilst there was only a 76% increase in new food banks opening. 

Over 50% of children living in poverty in the UK are from working households and many of the people helped by food banks are in work, with the rising cost of living combined with no rise in low wages causing many to hit a crisis where they can’t afford to met basic needs such as eating.

Jonathan Ashworth, the shadow health secretary, unearthed the latest figures in a response to a recent parliamentary question submitted to the health minister Nicola Blackwood. He said: 

“These figures paint a grim picture of Britain under the Conservatives. Real poverty is causing vulnerable people, particularly the elderly, to go hungry and undernourished so much so that they end up in hospitalOur research reveals a shocking picture of levels of malnutrition in 21st-century England and the impact it has on our NHS. This is unacceptable in modern Britain.”

In a very wealthy first-world  democracy, it is completely unacceptable that anyone is left hungry, malnourished and in absolute poverty.

The Department of Health figures showed that the number of “bed days” accounted for by someone with a primary or secondary diagnosis of malnutrition rose from 128,361 in 2010-11, the year the coalition came to power, to 184,528 last year – a 61% rise over five years.

The National Institute for Health and Care Excellence classes someone as malnourished if they have a body mass index of less than 18.5, have suffered the unintentional loss of more than 10% of their weight over the last three to six months, or if they have a BMI under 20 and have unintentionally seen their weight drop by more than 5% over the previous three to six months.

The worrying decision by the chancellor, Philip Hammond, not to fund the NHS or social care with any more money in his autumn statement last week will only worsen this already unacceptable situation.

Ashworth said: “The reality is the government have failed this week to both give the NHS and social care the extra investment it needs while also failing to invest in prevention initiatives to foster healthier lifestyles. The cuts to public health budgets along with an emaciated obesity strategy are both utterly misguided.” 

Figures are not available for exactly how many patients accounted for the 184,528 bed days last year, but information supplied to Ashworth by the House of Commons library shows that 57% of the patients were women and that 42% were over-65s.

Worryingly, four out of five people who needed inpatient hospital care because of malnutrition were admitted as an emergency, which suggests their health had deteriorated significantly in the days before they were taken in.

Not enough health and social care professionals have the time or knowledge to correctly identify malnutrition.

Stephen Dalton, the chief executive of the NHS Confederation, which represents hospitals, said: “Our members take malnutrition seriously. Good nutrition is a fundamental human right our citizens can expect, and vulnerable, particularly older, people are most at risk of serious consequences if denied basic compassionate care. At a time of unprecedented demand on health and social care we need to be alert and will take seriously any reliable evidence of basic care not being delivered.”

Time and time again, when challenged and confronted with overwhelming empirical evidence of the harm that their class-contingent austerity policies and welfare “reforms” are inflicting on citizens, the government simply deny any “causal link”. They say that the increase in absolute poverty, malnutrition and hunger, deaths and distress are unrelated to their policies, which they claim to be “working”.

With no sign that the government are going to emerge from behind their basic defence mechanism of collective denial – nor are the Conservatives remotely interested in investigating a clear correlation between their blatant attacks on the poorest citizens via their draconian policies and the terrible hardships people are suffering –  we do have to wonder what the real intention is underpinning such clearly targeted austerity.

Conservative ideology seems to be founded on the hypothesis of an inborn and “natural order” – a society that is based on a human hierarchy of worth. The Conservatives feel justified that they are part of a superior class in society and therefore they have an entitlement to hold power. Their policies don’t include the majority of us in their design or aims. The government are not democratic, they are authoritarians. Conservative policies act upon ordinary citizens and have become increasingly detached from citizen needs.

I was accused of the terrible crime of being an “interfering do-gooder” recently by someone with social Darwinist ideals. I couldn’t understand his ferocity. Then I made a connection, the proverbial penny dropped. Again. I suddenly felt very weary, disgusted and shocked – the recognition froze me. Again

Historically, eugenicists thought that misguided “do-gooders”, by giving poor people help and support, were allowing them to survive “unnaturally”, and were consequently interfering in human “natural selection”, a benign force which they thought was “deselecting” the people with the “weakest” genes and the “moral defectives”.  The Conservatives moralise about people who are poor and their punitive anti-welfare policies indicate plainly that they think that poor people have moral deficits.

The Conservative message that poverty is caused by character or behavioural “defects” and not socioeconomic and political circumstances should have been ringing alarm bells very loudly everywhere. The problem with authoritarian governments is they usually have sufficient power, one way or another, to mute the alarm. The first base of power over public perceptions that all authoritarians build is invariably facilitated by the corporate mass media. 

Austerity, “the national debt”, “a country living within its means”, “hardworking families”, the scrounger/striver rhetoric, “hard choices” and the “culture of entitlement” has all been a smokescreen for eugenic policies.

We cannot find any comfort in the belief that the government are simply neglectful policy makers. The persistent and loud denial regarding the increasingly precarious existence of the poorest citizens – especially disabled people – and the loud refusal to investigate the correlation between austerity policies and social outcomes that are damaging and harmful, and to consider the empirical evidence of humanitarian harm presented by citizens, academics, charities and campaigners, indicates a government that is not ignorant of the consequences, yet has no intention of changing their policies. The Conservatives are appallingly unconcerned about the terrible harm they are inflicting on invididuals and on our society.

 “Eugenic goals are most likely to be attained under another name than eugenics.” – Frederick Osborn

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The art of character divination

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Numbers of cases of malnutrition continue to soar in the UK

Minnes

The Office of National Statistics (ONS) have released figures that show 391 people died from malnutrition in 2015. There were 746 hospital admissions for malnutrition in just 12 months. The statistics also show two people in the UK are admitted to hospital with the condition every day in what campaigners have called a “national scandal.” 

Health minister Nicola Blackwood confirmed the numbers in a written answer in Parliament.

More than six people a month perish from starvation in England, which is one of the richest nations in the world.  The UK’s biggest food bank network, the Trussell Trust, provided more than a million three-day food packages over the past year, including 415,866 to children.What is worrying is that people may only have this support for a maximum of three days and have to be referred by a professional, such as a doctor or social worker.

Chairman Chris Mould said: It’s a scandal that people living in the sixth largest economy in the world are going hungry, which is why we’re working to engage the public, other charities and politicians from all parties to find solutions to the underlying causes of food poverty.

Our food banks support many thousands of people in various states of hunger.

Some people have been missing meals for days at a time; others have been unable to afford certain food groups or have sacrificed quality for long periods of time to keep costs down.

This, no doubt, has a negative effect on their health – and for people at the extreme end of the scale it will lead to malnutrition.

Every day we meet families across the UK who are struggling to put enough nutritious food on the table and hear from parents who go without food so their children have enough to eat.”

A Department for Work and Pensions spokeswoman said: “We now have record numbers of people in work and wages rising faster than inflation. 

But we need to go further, which is why we’ve committed to increase the National Living Wage, we’re taking the lowest paid out of income tax and our welfare reforms are ensuring it always pays to work.”

However it seems that “making work pay” is a euphemism for punishing those out of work or those in part-time or low-paid work with absolute poverty. In December 2015, I wrote about research from the Child Poverty Action Group, Oxfam, Church of England and the Trussell Trust which found that failures in the social safety net itself are most often the trigger for food bank referrals.

The report said that while money is tight for many reasons, including bereavement, relationship breakdown, illness or job loss, issues such as sanctions, delays in benefits decisions or payments or being declared “fit for work” led people to turn to food banks for support.

  • Around a third of foodbank users in the sample were waiting for a decision on their benefits – and struggling in the meantime
  • Between 20 and 30% more had their household benefits reduced or stopped because of a sanction

Other factors included loss of income due to the “bedroom tax” or the benefit cap. For between half and two-thirds of the people included in this research, the immediate income crisis was linked to the operation of the benefits system (with problems including waiting for benefit payments, sanctions, or reduction in disability benefits) or tax credit payments.

Amongst this group of people are many that are actually in low-paid work, claiming top-up benefits. The remaining number of people needing support from food banks to meet their most basic need are certainly in work, making a complete mockery of the Department for Work and Pension’s statement.

The research used 40 in-depth interviews with food bank users, data from over 900 users at three food banks around the country, and detailed analysis of nearly 200 clients accessing one food bank in Tower Hamlets. Another academic study said the government’s welfare reformsincluding benefit sanctions and the bedroom tax, are a central factor in the explosion in the numbers of impoverished people turning to charity food banks

The study, part of a three-year investigation into emergency food provision, was carried out by Hannah Lambie-Mumford, a Sheffield University researcher who co-authored a recently published government report into the extent of food aid in the UK.

That report concluded there was insufficient evidence to demonstrate a clear causal link between welfare reform and food bank demand in the UK. This is because the government has refused to make that information available by ensuring the reason for food bank referrals are no longer recorded. But Lambie-Mumford’s study says the rise in demand for charity food is a clear signal “of the inadequacy of both social security provision and the processes by which it is delivered”.

In 2015, more than 2,000 cases of patients with malnutrition were recorded by 43 hospital trusts in a single year.

There were 193 “episodes” of malnutrition in 12 months at Salford Royal NHS Foundation Trust alone, according to new figures.

Freedom of Information (FOI) figures show a rise of 259 between the 43 trusts compared with three years previously.

With the more recent introduction of more stringent in-work conditionality, including the extension of sanctions to those in part-time and low-paid work, the Conservative’s coercive psychopolitical approach to poverty will invariably make it even more difficult for many more to meet their basic survival needs.

At the same time, in 2014,  Community Links published a study called Just about Surviving which revealed that far from encouraging people on benefits to move into work, the draconian welfare cuts have pushed many further from employment. The report said that the state has reduced welfare support to the point where it barely enables people to survive.

Overwhelmingly, the reforms have made people “feel insecure and vulnerable to even small fluctuations in their small income or circumstance; continuing to erode their resilience.”

Furthermore, by forcing people into stressful situations where day-to-day survival becomes a pressing priority, the “reforms” (that are, in reality, simply cuts to people’s benefits), which were hailed by the Conservatives as a system of help and incentives – to “nudge” people into changing their behaviour so that they try harder to find work – are in fact eroding people’s motivation. In other words, the reforms have deincentivised and hindered people looking for employment, achieving the very opposite to the intent claimed by the Tories, to justify their draconian policies.

The report states that people are caught between trying to escape welfare reform through poor employment alternatives and feeling trapped in poverty. They move in and out of low paid work and are extremely susceptible to financial shocks and unprepared for the future.

In 2014, Oxfam’s director of campaigns and policy, Ben Phillips, said: “Britain is becoming a deeply divided nation, with a wealthy elite who are seeing their incomes spiral up, while millions of families are struggling to make ends meet.”

“It’s deeply worrying that these extreme levels of wealth inequality exist in Britain today, where just a handful of people have more money than millions struggling to survive on the breadline.”

Diseases associated with malnutrition, which were very common in the Victorian era in the UK, became rare with the advent of our welfare state and universal healthcare, but they are now making a reappearance because of the rise of numbers of people living in absolute poverty.

NHS statistics indicate that the number of cases of gout and scarlet fever have almost doubled within five years, with a rise in other illnesses such as scurvy, cholera, whooping cough and general malnutrition. People are more susceptible to infectious illness if they are under-nourished.

In 2013/14, more than 86,000 hospital admissions involved patients who were diagnosed with gout – an increase of 78 per cent in five years, and of 16 per cent on the year before. Causes of gout include a lack of vitamin C in the diet of people who are susceptible.

The figures from the Health and Social Care Information Centre (HSCIC) show a 71 per cent increase in hospital admissions among patients suffering from malnutrition – from 3,900 admissions in 2009-10 to 6,690 admissions in 2013-14.

Cases of scarlet fever admitted to hospital doubled, from 403 to 845, while the number of hospital patients found to be suffering from scurvy also rose, with 72 cases in 2009/10 rising to 94 cases last year.

The figures also show a steep rise in cases diagnosed with cholera, a water-borne disease which was extremely prevalent in the 19th century, causing nearly 40,000 deaths.

The new in-work conditionality regime may eventually apply to around one million more people.

The quantity of food being bought in food stores is also decreasing. It doesn’t take a genius to work out that repressed, stagnant wages and RISING living costs will result in reduced sale volumes. Survation’s research in March 2014 indicates that only four out of every ten of UK workers believe that the country’s economy is recovering.

But we know that the bulk of the Tory austerity cuts were aimed at those least able to afford any cut to their income.

We really must challenge the Conservative’s use of words such as “encourage” and “support” and generally deceptive language use in the context of what are, after all, extremely punitive, coercive  policies. The government intends to continue formulating policies which will punish sick and disabled people, unemployed people, the poorest paid, and part-time workers.

Meanwhile, the collective bargaining traditionally afforded us by trade unions has been systematically undermined by successive Conservative governments, showing clearly how the social risks of the labour market are being personalised and redefined as being solely the economic responsibility of individuals rather than the government and profit-driven big business employers.

 

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Related

Welfare sanctions cannot possibly incentivise people to work

The Coalition are creating poverty via their policies

Welfare sanctions make vulnerable reliant on food banks, says YMCA

Study finds Need For Food Banks IS Caused By Welfare Cuts

It’s absolute poverty, not “market competition” that has led to a drop in food sales.

Welfare reforms, food banks, malnutrition and the return of Victorian diseases are not coincidental, Mr Cameron

The politics of punishment and blame: in-work conditionality

 

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The Minnesota Starvation Experiment provided empirical evidence that demonstrates clearly why welfare sanctions can’t possibly work as an “incentive” to “make work pay”

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“Behavioural theory is a powerful tool for the government communicator, but you don’t need to be an experienced social scientist to apply it successfully to your work.”

Alex Aiken
Executive Director of
Government Communications (Source).

 

Introduction

The Conservatives have always used emotive and morally-laden narratives that revolve around notions of “national decline” and a “broken society” to demarcate “us and them”, using overly simplistic binary schema. Conservative rhetoric reflexively defines what the nation is and who it excludes, always creating categories of others.

David Cameron’s government have purposefully manufactured a minimal group paradigm which is founded on a false dichotomy. People who “work hard” are deemed “responsible” citizens and the rest are stigmatized, labelled as “scroungers” and outgrouped (inaccurately) as irresponsible economic free riders. This prejudiced distinction requires a single snapshot of just one frozen point in time, and an assumption that people who claim welfare support are the same people year after year, but longitudinal studies indicate that over the course of their lives, most people move in and out of employment. Most people claiming welfare support have worked and made responsible contributions to society.

The Conservatives also claim that welfare provision itself is problematic, because it creates “a culture of dependency.” Yet there has never been evidence to support this claim. In fact, a recent international study of social safety nets from the Massachusetts Institute of Technology (MIT) and Harvard economists refutes the Conservative “scrounger” stereotype and dependency rhetoric. Abhijit Banerjee, Rema Hanna, Gabriel Kreindler, and Benjamin Olken re-analyzed data from seven randomized experiments evaluating cash programmes in poor countries and found “no systematic evidence that cash transfer programmes discourage work.”

The phrase “welfare dependencywas designed to intentionally divert attention from political prejudice, discrimation via policies and to disperse public sympathies towards the poorest citizens.

The Conservatives have always constructed discourses and shaped institutions which isolate some social groups from health, social and political resources, with justification narratives based on a process of class-contingent personalisations of social problems, such as poverty, using quack psychology and pseudoscience. However, it is social conditions which lead to deprivation of opportunities, and that outcome is a direct consequence of inadequate and biased political decision-making and policy.

Conditionality

One of the uniquely important features of Britain’s welfare state is the National Insurance system, based on the principle that people establish a right to benefits by making regular contributions into a fund throughout their working lives. The contribution principle has been a part of the welfare state since its inception. A system of social security where claims are, in principle, based on entitlements established by past contributions expresses an important moral rule about how a benefits system should operate, based on reciprocity and collective responsibility, and it is a rule which attracts widespread public commitment. National Insurance is felt intuitively by most people to be a fair way of organising welfare.

The Conservative-led welfare “reforms” had the stated aim of ensuring that benefit claimants – redefined as an outgroup of free-riders – are entitled to a minimum income provided that they uphold responsibilities, which entail being pushed into any available work. The  Government claim that sanctions “incentivise” people to look for employment.

Conditionality for social security has been around as long as the welfare state. Eligibility criteria have always been an intrinsic part of the social security system. For example, to qualify for jobseekers allowance, a person has to be out of work, able to work, and seeking employment.

But in recent years conditionality has become conflated with severe financial penalities (sanctions), and has mutated into an ever more stringent, complex, demanding set of often arbitrary requirements, involving frequent and rigidly imposed jobcentre appointments, meeting job application targets, providing evidence of job searches and mandatory participation in workfare schemes. The emphasis of welfare provision has shifted from providing support for people seeking employment to increasing conditionality of conduct, enforcing particular patterns of behaviour and monitoring claimant compliance.

Sanctions are “penalties that reduce or terminate welfare benefits in cases where claimants are deemed to be out of compliance with  requirements.” They are, in many respects, the neoliberal-paternalist tool of discipline par excellence – the threat that puts a big stick behind coercive welfare programme rules and “incentivises” citizen compliance with a heavily monitoring and supervisory administration. The Conservatives have broadened the scope of behaviours that are subject to sanction, and have widened the application of sanctions to include previously protected social groups, such as sick and disabled people, pregnant women and lone parents.

The new paternalists often present their position as striking a moderate, reasonable middle ground between rigid anti-paternalism on the one hand and an overly intrusive “hard” paternalism on the other. But the claim to moderation is difficult to sustain, especially when we consider the behavioural modification technique utilised here – punishment – and the consequences of sanctioning welfare recipients, many of whom are already struggling to meet their basic needs.

Nudge permits policy-makers to indulge their ideological impulses whilst presenting them as “objective science.” From the perspective of libertarian paternalists, the problems of neoliberalism don’t lie in the market, or in growing inequality and social stratification: neoliberalism isn’t flawed, nor are governments – we are. Governments don’t make mistakes – only citizens do.

Work programme providers are sanctioning twice as many people as they are signposting into employment (David Etherington, Anne Daguerre, 2015), emphasising the distorted priorities of “welfare to work” services, and indicating a significant gap between claimant obligations and employment outcomes.

Ethical considerations of injustice and the adverse consequences of welfare sanctions have been raised by politicians, charities, campaigners and academics. Professor David Stuckler of Oxford University’s Department of Sociology, amongst others, has found clear evidence of a link between people seeking food aid and unemployment, welfare sanctions and budget cuts, although the government has, on the whole, tried to deny a direct “causal link” between the harsh welfare “reforms” and food deprivation. However, a clear correlation has been established.

The current government demand an empirical rigour from those presenting legitimate criticism of their policy, yet they curiously fail in meeting the same exacting standards that they demand of others. Often, the claim that “no causal link has been established” is used as a way of ensuring that established, defined correlative relationships, (which often do imply causality,) are not investigated further. Qualitative evidence – case studies, for example – is very often rather undemocratically dismissed as “anecdotal,” which of course stifles further opportunities for important research and inquiry regarding the consequences and impacts of government policy. This also undermines the process of a genuine evidence-based policy-making, leaving a space for a rather less democratic ideology-based political decision-making.

Further concerns have arisen that food banks have become an institutional part of our steadily diminishing welfare state, normalising food insecurity and deprivation amongst people both in and out of work.

There is no evidence that keeping benefits at below subsistence level “incentivises” people to work. In fact research indicates it is likely to have the opposite effect. In 2010/2011 there 61,468 people were given 3 days emergency food and support by the Trussell Trust and this rose to 913,138 people in 2013-2014.

At least four million people in the UK do not have access to a healthy diet; nearly 13 million people live below the poverty line, and it is becoming increasingly difficult for them to afford food. More than half a million children in the UK are now living in families who are unable to provide a minimally acceptable, nutritious diet. (Source: Welfare Reform, Work First Policies And Benefit Conditionality: Reinforcing Poverty And Social Exclusion? Centre for Enterprise and Economic Development Research, 2015.)

There is plenty of evidence that sanctions don’t help people to find work, and that the punitive application of severe financial penalities is having an extremely detrimental, sometimes catastrophic impact on people’s lives. We can see from a growing body of research how sanctions are not working in the way the government claim they intended.

Sanctions, under which people lose benefit payments for between four weeks and three years for “non-compliance”, have come under fire for being unfair, punitive, failing to increase job prospects, and causing hunger, debt and ill-health among jobseekers. And sometimes they result in death.

I want to discuss two further considerations to add to growing criticism of the extended use of sanctioning which are related to why sanctions don’t work. One is that imposing such severe financial penalities on people who need social security support to meet their basic needs cannot possibly bring about positive “behaviour change” or “incentivise” people to find employment, as claimed. This is because of the evidenced and documented broad-ranging negative impacts of financial insecurity and deprivation – particularly food poverty – on human physical health, motivation, behaviour and mental health.

The second related consideration is that “behavioural theories” on which the government rests the case for extending and increasing benefit sanctions, are simply inadequate and flawed, having been imported from a limited behavioural economics model (otherwise known as libertarian paternalism) which is itself ideologically premised.

At best, the new “behavioural science” is merely a set of theoretical propositions, at a broadly experimental stage, and therefore profoundly limited in terms of scope and academic rigour, as a mechanism of explanation, and in terms of capacity for generating comprehensive, coherent accounts and understanding about human motivation and behaviour.

Furthermore, in relying upon a pseudo-positivistic experimental approach to human cognition, behavioural economists have made some highly questionable ontological and epistemologial assumptions: in the pursuit of methodological individualism, citizens are consequently isolated from the broader structural political, economic, sociocultural and established reciprocal contexts that invariably influence and shape an individuals’s experiences, meanings, motivations, behaviours and attitudes, causing a problematic duality between context and cognition. The libertarian paternalist approach also places unfair and unreasonable responsibility on citizens for circumstances which lie outside of their control, such as the socioeconomic consequences of political decision-making.

Yet many libertarian paternalists reapply the context they evade in explanations of human behaviours to justify the application of their theory, claiming that their collective “behavioural theories” can be used to serve social, and not necessarily individual ends, by simply acting upon the individual to make them more “responsible.” (See, for example: Personal Responsibility and Changing Behaviour: the state of knowledge and its implications for public policy, David Halpern, Clive Bates, Geoff Mulgan and Stephen Aldridge, 2004.)

In other words, there is a relationship between the world that a person inhabits and that person’s actions. Any theory of behaviour and cognition that ignores context can at best be regarded as very limited and partial. Yet the libertarian paternalists overstep their narrow conceptual bounds, with the difficulty of reconciling individual and social interests glossed over somewhat.

The ideological premise on which the government’s “behavioural theories” and assumptions about unemployed and sick and disabled people rests is also fundamentally flawed. Neoliberalism and social Conservatism are not working to extend wealth and opportunity to a majority of citizens. The shift away from a collective rights-based democratic society to a state-imposed moral paternalism, comprised almost entirely of unfunded, unsupported, decontextualised “responsible” individuals is simply an ideological edit of reality, hidden in plain sight within the tyranny of decision-makers shaping our “best interests”, to justify authoritarian socioeconomic policies that generate and perpetuate inequality and poverty. Libertarian paternalists don’t have much of a vocabulary for discussing any sort of collective, democratic, or autonomous and deliberative decision-making.

The Conservatives and a largely complicit media convey the message that poor people suffer from some sort of character flaw – a poverty of aspiration, a deviance from the decent, hard-working norm. That’s untrue, of course: poor people simply suffer from material poverty which may steal motivation and aspiration from any and every person that is reduced to struggling for basic survival.

It’s not a coincidence that those countries with institutions designed to alleviate poverty and inequality – such as a robust welfare state, a strong role for collective bargaining, a stronger tax and transfer system, have lower levels of income inequality and poverty.

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The Minnesota Starvation Experiment volunteers

1. “Starved people can’t be taught democracy.” Ancel Keys

Imposing punishment in the form of financial sanctions on people who already have only very limited resources for meeting their basic survival needs is not only irrational, it is absurdly and spectacularly cruel. There is a body of evidence from a landmark study that describes in detail the negative impacts of food deprivation on physical and psychological health, including an account of the detrimental effects of hunger on motivation and behaviour.

During World War Two, many conscientious objectors wanted to contribute to the war effort meaningfully, and according to their beliefs. In the US, 36 conscientious objectors volunteered for medical research as an alternative to military service. The research was designed to explore the effects of hunger, to provide postwar rehabilitation for the many Europeans who had suffered near starvation and malnutrition during the war.

A high proportion of the volunteers were members of the historic peace churches (Brethren, Quakers, and Mennonites). The subjects, all healthy males, participated in a study of human semistarvation conducted by Ancel Keys and his colleagues at the University of Minnesota. The Minnesota Starvation Experiment, as it was later known, was a grueling six month study designed to gain insight into the physical and psychological effects of food deprivation. Those selected to participate in the experiment were a highly motivated and well-educated group; all had completed some college coursework, 18 had graduated, and a few had already begun graduate-level coursework.

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The Minnesota laboratory

During the experiment, the participants were subjected to semistarvation, most lost 25% of their body weight in total. Extensive tests were given to the participants throughout the experiment. Body weight, size, and strength were recorded, and basic functions were tracked using X-rays, electrocardiograms, blood samples, and metabolic studies. Psychomotor and endurance tests were given, as the men walked on the laboratory treadmills, and participants received intelligence and personality tests from a team of psychologists.

The men ate meals twice a day. Typical meals consisted of cabbage, turnips and half a glass of milk. On another day, it might be rye bread and some beans. Keys designed the meals to be carbohydrate rich and protein poor, simulating what people in Europe might be eating, with an emphasis on potatoes, cabbage, macaroni and whole wheat bread (all in meagre proportions). Despite the reduction in food, Keys insisted that the men try to maintain their active lifestyle, including the 22 miles of walking each week.

The negative effects of the reduced food intake quickly became apparent. The men rapidly showed a remarkable decline in strength and energy. Keys charted a 21 per cent reduction in their physical strength, as measured by their performance, using a variety of methods, including a back lift dynamometer. The men complained that they felt old and constantly tired.

There were marked psychological effects, too. They developed a profound mental apathy. The men had strong political opinions, but as the grip of hunger tightened, political affairs and world events faded into irrelevance for them. Even sex and romance lost their appeal. Food became their overwhelming priority. The men obsessively read cookbooks, staring at pictures of food with almost pornographic obsession. One participant managed to collect over a 100 cookbooks with pictures over the course of the experiment.

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Some subjects diluted their food with water to make the meagre proportions seem like more. Others would savour each little bite and hold it in their mouth as long as possible. Eating became ritualised and took a long time.

One of the volunteers recalled memorising the location of all of the lifts in the university buildings because he struggled climbing stairs, and even experienced difficulty opening doors, he felt so weak. The researchers recognised that “energy is a commodity to be hoarded – living and eating quarters should be arranged conveniently” in a subsequent leaflet designed to help in accommodating the increasing weakness and lethargy in people needing aid and support to recover from semistarvation.

Within just a few weeks of the study, the psychological stress that affected all of the subjects became too much for one of the men,  Franklin Watkins. He had a breakdown after having vivid, disturbing dreams of cannibalism in which he was eating the flesh of an old man. He had to leave the experiment. Two more subjects also suffered severe psychological distress and episodes of psychosis during the semistarvation period, resulting in brief stays in the psychiatric ward of the Minnesota university hospital. One of the men had also reported stealing scraps of food from bins.

Amongst the conclusions from the study was the confirmation that prolonged semistarvation produces significant increases in depression, hysteria and hypochondriasis, which was measured using the Minnesota Multiphasic Personality Inventory. Most volunteers experienced periods of severe emotional distress and depression. There were extreme reactions to the psychological effects during the experiment including self-mutilation (one subject amputated three fingers of his hand with an axe, though the subject was unsure if he had done so intentionally or accidentally.)

The men also became uncharacteristically irritable, introverted and argumentative towards each other, they became less sociable, experiencing an increasing need for privacy and quiet – noise of all kinds seemed to be very distracting and bothersome and especially so during mealtimes. The men became increasingly apathetic and frequently depressed.

The volunteers reported decreased tolerance for cold temperatures, and requested additional blankets, even in the middle of summer. They experienced dizziness, extreme tiredness, muscle soreness, hair loss, reduced coordination, and ringing in their ears. They were forced to withdraw from their university classes because they simply didn’t have the energy or motivation to attend and to concentrate. Other recorded problems were anemia, profound fatigue, apathy, extreme weakness, irritability, neurological deficits, and lower extremity fluid retention, slowed heart rate amongst other symptoms.

The Minnesota Experiment also focused study on attitudes, cognitive and social functioning and the behaviour patterns of those who have experienced semistarvation. The experiment illuminated a loss of ambition, self-discipline, motivation and willpower amongst the men once food deprivation commenced. There was a flattening of affect, and in the absence of all other emotions, Doctor Keys observed the resignation and submission that hunger very often manifests.

The understanding that food deprivation dramatically alters emotions, motivation, personality, and that nutrition directly and predictably affects the mind as well as the body is one of the legacies of the experiment.

In the last months of the experiment, the volunteers were fed back to health. Different groups were presented with different foods and calorie allowances. But it was months, even years – long after the men had returned home – before they had all fully recovered. Keys published his full report about the experiment in 1950. It was a substantial two-volume work titled The Biology of Human Starvation. To this day, it remains the most comprehensive scientific examination of the physical and psychological effects of hunger.

Keys emphasised the dramatic effect that semistarvation had on motivation, mental attitude and personality, and he concluded that democracy and nation building would not be possible in a population that did not have access to sufficient food.

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Further study of the impact of food deprivation and starvation on
psychological and cognitive deterioration – The Psychological Effects of Starvation in the Holocaust

Cognitive function deficits and demotivation associated with food deprivation: Blood glucose influences memory and attention in young adults

Nutritional deficiencies and detrimental consequences for mental health: Nutrition and mental health

A comprehensive study of the detrimental impacts of food insecurity on the development, behaviour, mental health and wellbeing, learning, educational attainment, citizenship and physical health of children in America: Child Food Insecurity: The Economic Impact on our Nation

The effects of breakfast on cognitive performance, academic performance and in-class behaviour in adolescents

Comprehensive computerized assessment of cognitive sequelae of a complete 12-16 hour fast

The Minnesota food deprivation experiment also established a link between food insecurity and deprivation and later unhealthful eating practice, eating disorders and obesity – Journal of the American Dietetic Association

2. Abraham Maslow and the hierarchy of human needs

“It is quite true that man lives by bread alone – when there is no bread.”

Maslow was humanist psychologist. He proposed his classical theory of motivation and the hierarchical nature of human needs in 1943. His critical insights have been translated into an iconic pyramid diagram, which depicts the full spectrum of needs, ranging from physical to psychosocial. Maslow believed that people possess a set of simple motivation systems that are unrelated to the punishments and rewards that behaviourists proposed, or the complexities of unconscious desires proposed by the psychoanalysts.

Maslow said basically that the imperative to fulfil basic needs will become stronger the longer the duration that they are denied. For example, the longer a person goes without food, the more hungry and preoccupied with food they will become.

So, a person must satisfy lower level basic biological needs before progressing on to meet higher level personal growth needs. A pressing need would have to be satisfied before someone would give their attention to the next highest need. If a person has not managed to meet their basic physical needs, it’s highly unlikely that they will be motivated to fulfil higher level psychosocial ones.

Maslow recognised that although every human is capable and has the desire to move up the hierarchy of needs to fulfil their potential, progress is often disrupted by a failure to meet lower level needs. Life experiences, including the loss of a job, loss of a home, poverty, illness, for example, may cause an individual to become trapped at the lower needs levels of the hierarchy.

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Maslow’s hierarchy of human needs

Some theorists have claimed that whilst Maslow’s hierarchy makes sense – it’s founded on an intuitive truth – it lacks scientific support. However, Maslow’s theory has certainly been verified by the findings of the Minnesota Experiment and other studies of the effects of food deprivation. Abraham Maslow’s humanist account of motivation also highlights the same connection between fundamental motives and immediate situational threats.

The experiment highlighted a striking sense of immediacy and fixation that arises when there are barriers to fulfiling basic physical needs – human motivation is frozen to meet survival needs, which take precedence over all other needs. This is observed and reflected in both the researcher’s and the subject’s accounts throughout the study. If a person is starving, the desire to obtain food will trump all other goals and dominate the person’s thought processes. This idea of cognitive priority is also clearly expressed in Maslow’s needs hierarchy. 

In a nutshell, this means that if people can’t meet their basic survival needs, it is extremely unlikely that they will have either the capability or motivation to meet higher level psychosocial needs, including social obligations and responsibilities to seek employment.


Conclusions: the poverty of reponsibility and the politics of blame

American Conservative academic, Lawrence Mead, argued in 2010 that the government needed to “enforce values that have broken down” such as the “work ethic”, with an expensive, intrusive bureaucracy that “helped and hassled” people back to work. Mead was a Conservative political “scientist” who said that poverty was largely due to a breakdown of public authority. Poverty reflected disorder more than denials of opportunity. He felt that the poor were “too free,” rather than not free enough.

He believed that benefits should be “mean and conditional,” forcing recipients to take any available jobs. Calling himself a “new paternalist”, his proposal is that people must be taught to blame themselves for their hardships and accept that they deserve them. He believed that workfare should be an onerous threat, so that people opt out of the social security system altogether. (See: Guardian, June 16, 2010). Mead provided the theoretical basis for the American welfare reforms of the 1990s, which required adult recipients of welfare to work as a condition of aid.

The consequences of the US reforms have been dire for many families, both in and out of work, many are now facing destitution as a consequence of the US welfare safety net being cut away. Mead also considerably influenced the UK Conservative-led welfare reforms.

The extremely conditional welfare approach that Mead advocated rests on the assumption that the problems it seeks to address are fundamentally behavioural in nature (rather than structural) and are therefore amenable to remedy through paternalist punishment, or, to borrow from the libertarian paternalist bland lexicon, through manipulation of  “cognitive biases“, in this case, one specifically known as loss aversion.

A paper, written in 2010 – Applying behavioural economics to welfare to work contained outlines of the pseudopsychological justification  for increasing the use of sanctions. The “research” was sponsored by Steve Moore, Business Development Director of esg , a key welfare to work consortium, which was  established by two Tory donors with close ties to ministers. The Government’s Behavioural Insights Team (the “Nudge” Unit) provided a tenuous theoretical framework and a psychobabbled rationale for increasing and extending the use of benefit sanctions, transforming welfare provision into a system of directed political prejudice, discrimination and punishment.

The following year, in June, the government announced that it would toughen the sanctions regime, making it much more difficult for claimants to temporarily sign off benefits to avoid being forced into unpaid work. Perhaps the woefully under-recognised and under-acknowledged cognitive bias called “vested interests escaped the attention of libertarian paternalists, when esg were awarded two extremely lucrative government contracts with Iain Duncan Smith’s Department for Work and Pensions in 2011, totalling £73million.

So, the paper provides a justification narrative for welfare sanctions and mandatory work fare, and it also preempts an opportunity for work fare providers to make lots of profit and to subsidise private businesses with free labor at the expense of the UK’s poorest citizens and taxpayers. Yet the government’s own research also showed that the scheme does not help unemployed people to find paid employment once they have finished the four weeks of mandatory work “experience”. It also has no positive effect in helping people “off benefits” and into employment in the long term.

The libertarian paternalist justification narrative is basically a pseudoscientific attempt to pathologise and homogenise the psychology of unemployed people, justifying the need for a very lucrative “remedy,” which is costing the poorest citizens their autonomy, health and wellbeing. It’s also costing the public purse far more than it would to simply provide social security for people needing support in meeting their basic needs.

Furthermore, as I have previously pointed out, it flies in the face of established empirical evidence.

From the document in 2010, on page 18: The most obvious policy implication arising from loss aversion is that if policy-makers can clearly convey the losses that certain behaviour will incur, it may encourage people not to do it.” This of course assumes that being without a job is because of nothing more complex than opting for a “lifestyle choice.” 

And page 46: “Given that, for most people, losses are more important than comparable gains, it is important that potential losses are defined and made explicit to jobseekers (e.g.the sanctions regime).”

The recommendation on page 46: We believe the regime is currently too complex and, despite people’s tendency towards loss aversion, the lack of clarity around the sanctions regime can make it ineffective. Complexity prevents claimants from fully appreciating the financial losses they face if they do not comply with the conditions of their benefit.”

The Conservatives subsequently “simplified” sanctions by extending their use to previously protected groups, such as sick and disabled people and lone parents, increasing their severity and increasing the frequency of their use from 2012.

Of course there is a problem in assuming that punishing people will make them behave more “rationally,” and that is aside from the ethical dilemmas presented with neoliberal paternalists and businesses deciding what is “rational” and in other people’s “best interests.”

Deprivation substantially increases the risk of mental illnesses, including schizophrenia, depression, anxiety and substance addiction. Poverty can act as both a causal factor (e.g. stress resulting from poverty triggering depression) and a consequence of mental illness (e.g. schizophrenic symptoms leading to decreased socioeconomic status and prospects).

Poverty is a significant risk factor in a wide range of psychological illnesses. Researchers recently reviewed evidence for the effects of socioeconomic status on three categories: schizophrenia, mood and anxiety disorders and substance abuse. Whilst not a comprehensive list of conditions associated with poverty, the issues raised in these three areas can be generalised, and have clear relevance for policy-makers.

The researchers concluded: “Fundamentally, poverty is an economic issue, not a psychological one. Understanding the psychological processes associated with poverty can improve the efficacy of economically focused reform, but is not a panacea. The proposals suggested here would supplement a focused economic strategy aimed at reducing poverty.” (Source: A review of psychological research into the causes and consequences of poverty, Ben Fell, Miles Hewstone, 2015.)

The Conservative shift in emphasis from structural to psychological explanations of poverty has far-reaching consequences. The recent partisan reconceptualision of poverty makes it much more difficult to define and measure. Such a conceptual change disconnects poverty from more than a century of detailed empirical and theoretical research, and we are witnessing an increasingly experimental approach to policy-making, as opposed to an evidence-based one, aimed solely at changing the behaviour of individuals, (to meet the demands of policy-makers) without their consent.

At least the Treasury is benefiting from the new conditionality and sanctions regime. Earlier this year, the Work and Pensions select committee heard independent estimates (committee member Debbie Abrahams MP said the DWP will not give or does not have figures) that since late 2012 sanctions had resulted in at least £275m being withheld from benefit claimants (the comparable figure for 2010 was £50m).

Many people in work are still living in poverty and reliant on in-work benefits, which undermines the libertarian paternalist case for increasing benefit conditionality somewhat, although those in low-paid work are still likely to be less poor than those reliant on out-of-work benefits. The Conservative “making work pay” slogan is a cryptographic reference to the punitive paternalist 1834 Poor Law principle of less eligibility.

But part of the government’s Universal Credit legislation is founded on the idea that working people in receipt of in-work benefits may face punitive benefits sanctions if they are deemed not to be trying hard enough to find higher paid work. It’s not as if the Conservatives have ever valued legitimate collective wage bargaining. In fact their legislative track record consistently demonstrates that they hate it, prioritising the authority of the state above all else.

Workplace disagreements about wages and conditions are now typically resolved neither by collective bargaining nor litigation but are left to management prerogative. Conservative aspirations are clear. They want cheap labor and low cost workers, unable to withdraw their labor, unprotected by either trade unions or employment rights and threatened with destitution via benefit sanction cuts if they refuse to accept low paid, low standard work. This is thought to “increase economic competiveness.” Similarly, desperation and the “deterrent” effect of the 1834 Poor Law amendment served to drive down wages. In the Conservative’s view, trade unions distort the free labor market, which runs counter to New Right and neoliberal dogma.

Since 2010, the decline in UK wage levels has been amongst the very worst in Europe. The fall in earnings under the Coalition is the biggest in any parliament since 1880, according to analysis by the House of Commons Library, and at a time when the cost of living has spiralled upwards.

 

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There has been a powerful shift back from progressive notions of collective social justice and equality to increasingly absurd, unfair and enforced individual responsibilities without concomitant rights, the underpinning Conservative view is that that socioeconomic inequality resulting from the free market is necessary and not something that the state need or should do anything about. Inequality in the UK is now greater than in any other European Union country, including the US. Yet the subsequent growing poverty and uncertainties of the labor market are irrationally held to be the responsibility of the individual.

In fact the state is forcefully redistributing the risks and burdens of job-market instability from the state to unemployed individuals. The “problem” of an entirely politically-defined  “welfare dependency” is presented with a “solution” in terms of a one-way transition into low-waged, poor quality work, which does not alleviate poverty.

Any analysis of the British economy over the past 40 years shows how the decline of union power since the early 1980s has coincided with the fall in the proportion of GDP that goes to wages, and the rise of private business profits. Boardroom pay has sky-rocketed whilst wages have been held down, as chief executives and directors no longer fear the effect of their pay rises on their staff. It’s a neoliberal myth that if firms are profitable, they are more likely to employ more workers, or that falling profitability is likely to reduce the demand for labor. One problem is that the government and employers have come to see the workforce as a disposable cost rather than an asset.

Wage repression has nothing whatsoever to do with workers, and threatening to punish low paid workers for their employer’s profit motive and the vagaries of an unregulated (liberalised) labor market by removing the in-work benefits that ensure exploited workers don’t face destitution is not only absurd, it is extremely cruel. The steady erosion of the post-war welfare state, and the increasing use of punitive approaches has served to further facilitate private sector wage repression. Ninetheenth century notions of punitive deterrence have replaced civilised notions of citizen rights and entitlement, once again penalising people for the manifested symptoms but sidestepping the root causes of poverty.

Libertarian paternalist nudges may only work by stigmatising particular behaviours. The new “behavioural science” reflects an ideological and cultural rejuvenation of the Conservative’s ancient moral and prejudiced critique of the poor, polished by nothing more than pseudoscientific attempts at erecting a stage of credibility, using a kind of linguistic alchemy, based on purposefully manufactured semantic shifts and bland, meaningless acronyms.

What was once summarily dismissed from Victorian moralists such as Samuel Smiles, and Herbert Spencer, who is best known for the expression, and sociopolitical application of the social Darwinist phrase survival of the fittest, is now being recodified into the bland terminology and inane managementspeak acronyms emanating from the behavioural economics “insights” team – the Nudge Unit at the heart of the Cabinet Office.

This was the race to the bottom situation for many people in Victorian England, where conditions in the workhouses became appalling because conditions for unskilled workers were also appalling. It established a kind of market competition situation of the conditions of poverty, where “making work pay” invariably means never-ending reductions in the standard of living for unemployed people and those in low paid work. Benefit sanctions amount to cutting unemployment benefits, reducing choices by forcing people into any available low paid employment and have exactly the same effect: they drive down wages and devalue labour.

Narratives are representations of connected events and characters that have an identifiable structure, and contain implicit or explicit messages about social norms, and the topic being addressed as such may impact attitudes and behaviour. One way to shift perceptons and “change behaviours”, according to the new economolgists, is through intensive social norms media campaigns. Media narratives are being nudged, too.

From MINDSPACE: Influencing behaviour through public policy,  David Halpern et al (2010):

“Framing is crucial when attempting to engage the public with behaviour change.”

“There are ways in which governments can boost their authority, and minimise psychological reactance in the public.”

Sometimes campaigns can increase perceptions of undesirable behaviour.”

Research shows that public ideas about poverty and unemployment depend heavily on how the issues are framed. When news media presentations frame poverty, for example, in terms of general outcome, people tend to believe that society collectively shares the responsibility for poverty. When poverty is framed as particular instances of individual poor people, responsibility is assigned to those individuals. In 1986, The General Social Survey documented how various descriptions of poor families influence the amount of assistance that people think they ought to have. Political framing is a powerful tool of social control. It agendarises issues (according to a dominant and Conservative economic, moral and social system that values thrift and moderation in all things, but mostly for the poorest people) and establishes the operational parameters of public debate.

The most controversial government policies are, to a large extent, reliant on dominant media narratives and images for garnering public endorsement. Prevailing patterns have emerged that systematically and intentionally stigmatise and scapegoat unemployed citizens, framing inequality and poverty as “causally linked” with degrees of personal responsibility, which is then used as a means of securing public acceptance for “rolling back the state.” News media define political issues for much of the public, and set simplistic access levels, often reducing  complex issues to basic dichotomies – and establishing default settings, to borrow from the lexicon of libertarian paternalists. Default settings allow policy-makers to shift the goalposts, and align public attitudes and behaviours with new policy objectives and outcomes. And ideology.

For example, one established default setting, is that hard work, regardless of how appropriate or rewarding, is the only means of escaping poverty. A variety of methods have been used to establish this, although the new paternalists tend to rely heavily on notions of political authority to manipulate social norms, the mainstream media has played a significant role in extending and propping up definitions of an ingroup of “hardworking families,” whilst othering, pathologising and outgrouping categories of persons previously considered exempt from employment, such as sick and disabled people and lone parents.

The perpetual circulation of media images and discourse relating to characters pre-figured as welfare dependents, and accounts of the notion of a spiralling culture of dependency this past five years closely correspond with New Right narratives.

The marked shift from the principle of welfare provision on the basis of need to one that revisits ninteenth century notions of “deservingness” as a key moral criterion for the allocation of societal goods, with deservingness defined primarily in relation to preparedness to make societal contribution via paid work is likely to widen inequality. In fact behaviour theory approaches to policy simply prop up old Conservative prejudices about the nature of poverty, and provide pseudoscientific justification narratives for austerity, neoliberal and Conservative ideology. As such, nudge is revealed for what it is: an insidious form of behaviourism, social engineering, and the targeted and class-contingent restriction of citizen autonomy.

There are many examples on record of sanctions being applied unfairly, and of the devastating impact that sanctions are having on people who need to claim social security. Dr David Webster of Glasgow University has argued that benefit claimants are being subjected to an “amateurish, secret penal system which is more severe than the mainstream judicial system,” and that “the number of financial penalties (sanctions) imposed on benefit claimants by the Department of Work and Pensions now exceeds the number of fines imposed by the courts.

Furthermore, decisions on the “guilt” of noncompliance” are made in secret by officials who have no independent responsibility to act lawfully. Professor Michael Adler has raised concern that benefit sanctions are incompatable with the rule of law.

There is no doubt that sanctions are regressive, taking income that is designed to meet basic needs from families and individuals who are already very resource-constrained, is particularly draconian. But even by the proclaimed standards of the Department of Work and Pensions sanctions are being applied unfairly, it’s a policy that has been based on discretionary arbitrary judgments, and the injustice and adverse consequences of welfare sanctions make their continued use untenable. As well as having clearly detrimental material and biological impacts, sanctions have unsurprisingly been associated with negative physical and mental health outcomes, increased stress and reduced emotional wellbeing recently, once again. (Dorsett, 2008; Goodwin, 2008; Griggs and Evans, 2010).

There has been a wealth of evidence that refutes the Conservative claim that benefit sanctions “incentivise” people and “help” them into employment. There is a distinction between compliance with welfare conditionality rules, off-flow  measurement and employment. Furthermore, there is no evidence that applying behaviourist principles to the treatment of people claiming social security, any subsequent behaviour change and positive employment outcomes are in any way correlated.

Sanctions don’t work, and the politics of punishment has no place in a so-called civilised society

The Conservative government have taken what can, at best, be described as an ambivalent attitude to evidence gathering and presentation to support their claims to date. There is no evidence that welfare sanctions improve employment outcomes. There is no evidence that sanctions “change behaviours.” 

There is, in any case, a substantial difference between people conforming with welfare conditionality and rules, and gaining appropriate employment. And a further distinction between compliance and conversion. One difficulty is that since 2011, Job Centre Plus’s (JCP) primary key performance indicator has been off-flow from benefit at the 13th, 26th, 39th and 52nd weeks of claims. Previously JCP’s performance had been measured against a range of performance indicators, including off-flows from benefit into employment.

Indeed, when asked for evidence by the Work and Pensions Committee, one minister, in her determination to defend the Conservative sanction regime, regrettably provided misleading information on the destinations of JSA, Income Support and Employment Support Allowance claimants from 2011, that pre-dated the new sanctions regime introduced in 2012, in an attempt to challenge the findings of the University of Oxford/LSHTM study on the effects of sanctions on getting JSA claimants off-flow. (Fewer than 20 per cent of this group of people who were no longer in receipt of JSA were recorded as finding employment.) Source: Benefit sanctions policy beyond the Oakley Review – Work and Pensions.

National Assistance Scales were originally based on specialist calculation of the cost of a “basket of essential goods” necessary to sustain life that were devised by Seebohm Rowntree for Sir William Beveridge when he founded the Welfare State in the 1940s. Rowntree fixed his primary poverty threshold, in his pioneering study of poverty in York (1901), as the income required to purchase only physical necessities. The scales were devised to determine levels of support for unemployed people, sick and disabled people, and those who had retired or were widowed.

Rowntree’s research helped to advance our understanding of poverty. For example, he discovered that it was caused by structural factors –  resulting from unemployment and low wages, in 1899 – and not behavioural factors. Rowntree and Laver cited full employment policies, rises in real wages and the expansion of social welfare programmes as the key factors behind the significant fall in poverty by the 1950s. They could also demonstrate that, while 60% of poverty in 1936 was caused by low wages or unemployment, the corresponding figure by 1950 was only 1 per cent. But we have witnessed a regression since Thatcher’s New Right era, and continue to do so because of an incoherent Conservative anti-welfare ideology, scapegoating narratives and neoliberal approaches to dismantling the post-war settlement.

Yet Rowntree’s basic approach to defining and addressing poverty remains unchallenged, both in terms of its empirical basis and in terms of positive social outcomes. There is categorically no doubt that human beings have to meet physical needs, having access to fundamental necessities such as food, fuel, clothing and shelter, for survival.

There is a weight of empirical evidence confirming that food deprivation is profoundly psychologically harmful as much as it is physiologically damaging. If people can’t meet their basic survival needs, it is extremely unlikely that they will either have the capability or motivation to meet higher level psychosocial needs, including social obligations and responsibilities to find work and meet conditionality requirements.

There is a clear relationship between human needs, human rights, and social justice. Needs are an important concept that guide empowerment based practices and the concept is intrinsic to social justice. Furthermore, the meeting of physiological and safety needs of citizens ought to be the very foundation of economic justice as well as the development of a democratic society.

An elitist, technocratic government that believes citizens are not reliably competent thinkers will treat those citizens differently to one that respects their reflective autonomy. Especially a government that has decided in the face of a history of contradictory evidence, that the “faulty behaviour” and decision-making of  individuals is the cause of social problems, such as inequality, poverty and unemployment.

Sanctioning  people who need financial support to meet their basic needs is cruel and can never work to “incentivise” people to “change their behaviours.” One reason is that poverty is not caused by the behaviour of poor people. Another is that sanctions work to demotivate and damage people, creating further perverse barriers to choices and opportunities, as well as stifling human potential.

Earlier this year, the Work and Pensions Select Committee heard evidence of a social security system that is built upon fear and intimidation. The Committee heard how sanctions can devastate claimant health and wellbeing. They impoverish already poor people and drive them to food banks. They can leave claimants even further away from work. Jobcentres routinely harrass vulnerable jobseekers, “tripping them up” so they can stop their benefits and hit management-imposed sanctions targets (or as the Department for Work and Pensions would have it, “expectations”).

Conservative claims about welfare sanctions are incommensurable with reality, evidence, academic frameworks and commonly accepted wisdom. It’s inconceivable that this government have failed to comprehend that imposing punishment in the form of financial sanctions on people who already have very limited resources for meeting their basic survival needs is not only irrational, it is absurdly and spectacularly cruel.

Sanctions are callous, dysfunctional and regressive, founded entirely on traditional Conservative prejudices about poor people and ideological assumptions. It is absolutely unacceptable that a government treats some people, including some of the UK’s most vulnerable citizens, in such horrifically cruel and dispensible way, in what was once a civilised first-world liberal democracy.

 
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NHS hospital to offer food parcels to patients at risk of malnutrition – Rachel Pugh

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This article was written by and first published in the Guardian today.

A central food collection point will sit by the canteen at Tameside hospital.

A central food collection point will sit by the canteen at Tameside hospital. Photograph: Christopher Thomond for the Guardian

Emergency staff at a hospital are being asked to offer food boxes discreetly to patients they believe may benefit as they are discharged amid rising concerns among doctors of malnourishment.

Tameside hospital in Greater Manchester is also planning to open a permanent food bank collection centre inside the hospital next month to help the nutrition of both patients and locals in the area.

News of the move came after it was announced on Wednesday by the work and pensions secretary Iain Duncan Smith that job advisers have been posted in a food bank in Manchester as part of a trial set to be rolled out across the UK.

Bosses at Tameside hospital said they had made the decision after doctors and nurses became worried about what they said was a significant rise in patients showing signs of malnourishment, and also staff living locally becoming worried about some neighbours. Staff have been given training to spot malnourishment.

Tameside hospital’s chief executive, Karen James, said: “I was talking to an old lady recovering on a ward, who was in financial difficulties and chose to feed her dog first after paying the bills, whilst she went without. It’s heartrending.”

Elsewhere, the Queen Elizabeth hospital in Birmingham opened a food and clothing bank on its main premises earlier this month, and a spokeswoman said on Wednesday that they had been inundated with donations. In the summer the Royal Victoria Infirmary in Newcastle began offering parcels to parents using its neonatal care unit.

Malnutrition affects three million people in the UK and costs the NHS an estimated £5bn a year.

Malnourished surgical patients have complication and mortality rates three to four times higher than normally nourished patients, with longer hospital admissions. Similar findings have been described in medical patients, and particularly the elderly.

Tameside hospital was placed in special measures in summer 2013 after a review by the NHS England medical director, Sir Bruce Keogh. It was taken out of special measures in September this year.

A spokeswoman for Birmingham’s Queen Elizabeth hospital said its scheme was part of a wider community initiative that involves using hospital land for community orchards, gardens and beekeeping. Twice a month, the hospital hosts a farmer’s market, one of the largest in Birmingham. “Food banks are about more than food,” said the hospital. “People who are referred to them are also offered practical and emotional support by signposting other agencies, whether that is financial advice or counselling services or in some cases help with clothing.”

Speaking earlier on Wednesday, Duncan Smith told the Work and Pensions Committee that people who turn to charities for help when they cannot afford to eat will be given advice on claiming benefits and finding work while they pick up emergency food parcels.

“I am trialling at the moment a job adviser situating themselves in the food bank for the time that the food bank is open, and we are already getting very strong feedback about that,” he said. “If this works and if the other food banks are willing to encompass this and we think it works, we think we would like to roll this out across the whole of the UK.”

Robert Devereux, the permanent secretary to the Department for Work and Pensions, who appeared alongside Duncan Smith at the hearing, said two advisers had been working one day a week at the Lalley Welcome Centre in Manchester.

Duncan Smith said: “They are to provide support to people who come in, and that can include people saying: ‘I haven’t had my payment’,” giving the example of a claimant whose money was delayed because officials had not seen the right documents.”

 

Welfare reforms, food banks, malnutrition and the return of Victorian diseases are not coincidental, Mr Cameron

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The coalition will leave more debt than all Labour governments since 1900. The current government is now responsible for £517 billion of the trillion-plus-pound UK public debt, compared to £472 billion accrued during the 33 years Labour led the country since the turn of the twentieth century.

And the figures look even worse when you adjust for inflation. When you do that, the Coalition’s share jumps to nearly half of the total debt.

But the Coalition don’t meet any public needs, they simply serve the wants of a powerful, wealthy elite. Labour invested in public services, the Tories have bled them dry. So, what have they done with the money? Because the public have seen only austerity cuts. And the most vulnerable citizens bear the brunt of the cuts.

Oxfam’s director of campaigns and policy, Ben Phillips, said: “Britain is becoming a deeply divided nation, with a wealthy elite who are seeing their incomes spiral up, while millions of families are struggling to make ends meet.”

“It’s deeply worrying that these extreme levels of wealth inequality exist in Britain today, where just a handful of people have more money than millions struggling to survive on the breadline.”

Diseases associated with malnutrition, which were very common in the Victorian era in the UK, became rare with the advent of our welfare state and universal healthcare, but they are now making a reappearance because of the rise of numbers of people living in absolute poverty.

NHS statistics indicate that the number of cases of gout and scarlet fever have almost doubled within five years, with a rise in other illnesses such as scurvy, cholera, whooping cough and general malnutrition. People are more susceptible to infectious illness if they are under-nourished.

In 2013/14, more than 86,000 hospital admissions involved patients who were diagnosed with gout – an increase of 78 per cent in five years, and of 16 per cent on the year before. Causes of gout include a lack of vitamin C in the diet of people who are susceptible.

The figures from the Health and Social Care Information Centre (HSCIC) show a 71 per cent increase in hospital admissions among patients suffering from malnutrition – from 3,900 admissions in 2009-10 to 6,690 admissions in 2013-14.

Cases of scarlet fever admitted to hospital doubled, from 403 to 845, while the number of hospital patients found to be suffering from scurvy also rose, with 72 cases in 2009/10 rising to 94 cases last year.

The figures also show a steep rise in cases diagnosed with cholera, a water-borne disease which was extremely prevalent in the 19th century, causing nearly 40,000 deaths.

While total numbers remain low, the 22 cases last year compare with just 4 in 2009/10, the statistics show.

Dr Theresa Lamagni, Public Health England’s head of streptococcal infection surveillance, said the total number of notifications of scarlet fever this year has already reached 12,580 cases – the highest since 1970.

Cases of measles in hospital rose, from 160 to 205 cases, with a small rise in admissions for whooping cough, from 285 to 289 cases over the five years examined.

The figures on malnutrition follow a series of scandals of care of the elderly, with doctors, remarkably, forced to prescribe patients with drinking water or put them on drips to make sure they do not become severely dehydrated.

Charities have warned that too many patients are being found to be malnourished after being admitted to hospitals from care homes, as well as from their own homes.

However, Labour have said the figures a national scandal.

Luciana Berger MP, Labour’s Shadow Public Health Minister, said: “This shouldn’t be happening in 21st century Britain and the Government’s response is hopelessly complacent.

“People are living under greater pressure and struggling with the cost of living”.

“Hundreds of thousands are forced to turn to food banks and sadly it’s unsurprising people are eating less, and eating less healthily too”.

“David Cameron needs to listen to what the experts are saying and tackle the cost of living crisis that is driving people into food poverty.”

Cases of malnutrition have been steadily increasing since the 2010 general election.

In 2009/10 there were 3,899 hospital admissions for this, in 2010/11 there were 4,660, in 2011/12 there were 5,396 then in 2012/13 this had risen again to 5,594.

People unable to feed themselves adequately needing hospital admission saw a significant rise to 6,686,  where malnutrition was the primary or secondary diagnosis during 2013/14.This is a rise of 71 per cent from 3,899 in the year up to April 2010.

Chris Mould, chief executive of the Trussell Trust which runs a nationwide network of food banks, said: “This shows increases in diseases related to poverty and that’s alarming.

“Our food banks see tens of thousands of people who have been going hungry, missing meals and cutting back on the quality of the food they buy.

“We know quite a large proportion of the population are struggling to get nutritious food on the table. And at the extreme end of that you get people who are malnourished”.

“We don’t believe anyone should have to go hungry in the UK”.

“The scale of the increases we’re seeing must be further investigated to find out why this is happening”.

Scurvy is a disease associated with pirates stuck at sea for long periods – has increased by 31 per cent in England since 2010. This is caused by a lack of vitamin C and is usually due to an inadequate diet without enough fresh fruit and vegetables.

Figures from January this year from the NHS indicate that there were 833 hospital admissions for children suffering from Rickets – a condition which is caused by a lack of Vitamin D, from 2012-13. Ten years ago, the figure was just 190.

The disease, which causes softening of the bones and permanent deformities, was common in 19th century Britain but was almost eradicated by improvements in nutrition. The body produces vitamin D when it is exposed to the sun, but it’s clear that adequate diet plays an important role, too, since the decline of Rickets happened at a time when we saw an improvement in the diets of the nation as a whole.

It is thought that malnutrition is the main cause, children are most at risk if their diet doesn’t include sufficient levels of vitamin D.

Low incomes, unemployment and benefit delays have combined to trigger increased demand for food banks among the UK’s poorest families, according to a report commissioned by the government and released earlier this year,

The report directly contradicts the claim from a government minister that the rise in the use of food banks is linked to the fact that there are now more of them. It says people turn to charity food as a last resort following a crisis such as the loss of a job, or problems accessing social security benefits, or through benefit sanctions.

The review emerged as the government comes under pressure from church leaders and charities to address increasing prevalence of food poverty caused by welfare cuts. The End Hunger Fast campaign called for a national day of fasting on 4 April to highlight the issue.

The report was written by  food policy experts from the University of Warwick, and it was passed to ministers in June 2013 but had remained undisclosed until February 2014, creating reasonable speculation that the government suppressed its findings.

Examining the effect of welfare changes on food bank use was not a specific part of its remit, and the report is understood to have undergone a number of revisions since early summer, ordered by the Department for Food and Agriculture and the Department for Work and Pensions (DWP).

The researchers found that a combination of rising food prices, ever-shrinking incomes, low pay, increasing personal debt, and benefit payment problems meant an increasing number of families could not afford to buy sufficient food.

In a letter to the British Medical Journal, a group of doctors and senior academics from the Medical Research Council and two leading universities said that the effect of Government policies on vulnerable people’s ability to afford food needed to be “urgently” monitored.

The group of academics and professionals said that the surge in the number of people requiring emergency food aid, a decrease in the amount of calories consumed by British families, and a doubling of the number of malnutrition cases seen at English hospitals represent “all the signs of a public health emergency that could go unrecognised until it is too late to take preventative action”.

The health specialists also said:“Access to an adequate food supply is the most basic of human needs and rights”.

The authors of the letter, who include Dr David Taylor-Robinson and Professor Margaret Whitehead of Liverpool University’s Department of Public Health, say that they have serious concerns that malnutrition can have a long-lasting impact on health, particularly among children.

Tory ministers have repeatedly insisted that there is no “robust link” between the welfare reforms and rising food bank use, whilst welfare minister Lord Freud claimed the rise in food bank use was because there were more food banks and because the food was free.

It ought to be noted, not least by the government, that people may only access food banks when they are referred by a professional agency, such as social services, the DWP or a Doctor. In particular, vouchers for emergency food parcels tend to be given by benefits officials.

In all but exceptional cases, Trussell Trust food banks will only issue a food parcel to someone with a voucher from an accredited agency. Claimants are limited to emergency aid on three occasions only. This indicates that need, rather than availability, is the key reason for the increased use of food banks since 2010.

Together with the pressure created by rising prices and falling wages, there has been a marked increase in demand for emergency food aid since the welfare reforms came into effect. And this is affecting both people in and out of work.

More than half of people who have visited a food bank since April were referred because of social security problems.

The Government claimed the rapid increase in malnutrition cases “could be partly due to better diagnosis”.

I don’t imagine that it’s likely that Doctors have suddenly become better at diagnosis since 2010.

I do, however, think there is much scope for improvement in the capacity of Tory ministers for understanding correlation, basic cause and effect and simple connections.

However, Tory skills in mendacity, creating diversions and ad hominem are second to none.

 

See also:

Poverty

 An email to authoritarian Tory MPs Charlie Elphicke, Priti Patel and Conor Burns

Quantitative Data on Poverty from the Joseph Rowntree Foundation.

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Pictures courtesy of Robert Livingstone