Category: Psychologists against austerity

Psychologists Against Austerity: mobilising psychology for social change

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Source: PSYCHOLOGISTS FOR SOCIAL CHANGE

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Psychologists Against Austerity are changing our name to reflect the full range of work that we do. We’re now Psychologists for Social Change!

Psychologists for Social Change is a network of applied psychologists, academics, therapists, psychology graduates and others who are interested in applying psychology to policy and political action.  We believe that people’s social, political and material contexts are central to their experiences as individuals.  We aim to encourage more psychologists to draw on our shared experience and knowledge to engage in public and policy debates.

The group started in 2014, when members of the London Community Psychology Network came together to address growing concerns about austerity policies. This lead to a number of meetings in London, and a workshop at the Community Psychology Section Festival. This lead to the development of the briefing paper on the Psychological Impact of Austerity. The briefing paper was launched at the House of Lords in March 2015, followed swifly by our first Week of Action. 

Since then, we have spread through the country with a number of local groups, and many more events, actions and publications.

Our central aims have remained the same since those first early meetings. They are: 

Mobilising Psychologists

One of our central missions has always been to encourage more psychologists to become involed in political and social action. To this end we have developed training for Clinical Psychology Trainees, spoken at conferences, and provided supervision for policy placements. 

Mobilising Psychological Knowledge

We also aim to disseminate psychological knowledge and research in ways that are relevant to current policy concerns. We understand that one of the resources that psychologists have is an understanding of communication and persuasion. This was the impetus for our briefing papers on the Psychological Impact of Austerity and Improving Discussion on Inequality.

Influencing Public and Policy Debates

Drawing on both these resources, of people and knowledge, we aim to move psychologically informed discussion into the public sphere. This has included examining specific policies for their psychological impact, as well as responding to specific policy announcements and media reports.

Campaigns and Actions

Psychologists Against Austerity (PAA) is an ongoing campaign highlighting the costs to mental health of austerity policies. This focusses both on the breadth and depth of cuts to public services and the austerity narrative which has been used to justify these cuts. 

As applied psychologists in the UK we believe it is our public and professional duty to be speaking out against the further implementation of austerity policies. From professional experience and our knowledge of empirical psychological evidence, we know that cuts have been toxic for people’s wellbeing and mental health.

Recent scientific evidence continues to demonstrate links between austerity policies and the nation’s worsening mental health and increasing mental health inequalities.

Responding to this, this campaign aims to mobilise psychologists and psychological knowledge to make a case against further austerity policies.

Publications 

Please visit the Psychologists for social change site for more details.

You can read and download Psychologists Against Austerity: mobilising psychology for social change, published as free content in Critical and Radical Social Work, Volume 4, Number 3, November 2016, pp. 409-413(5) here

Join your local group

Click through the ‘groups’ menu on here to find the group meeting nearest to you. 

If you don’t see a group near you, and you want to start one, click here.

You can also subscribe to our mailing list here.

 

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Critique of the ‘Origins of Happiness’ study. Psychologists Against Austerity respond

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Clinical psychologists have widely criticised Labour peer and economist, Richard Layard, over research he led that claims failed relationships and physical and mental illness were bigger causes of misery than poverty. 

“Happiness scholars” and authors of the study report, Andrew Clark, Sarah Fleche, Richard Layard, Nattavudh Powdthavee and George Ward say:

“Understanding the key determinants of people’s life satisfaction will suggest policies for how best to reduce misery and promote wellbeing. This column discusses evidence from survey data on Australia, Britain, Germany, and the US which indicate that the things that matter most are people’s social relationships and their mental and physical health; and that the best predictor of an adult’s life satisfaction is their emotional health as a child.”

In the their study, the Origins of Happiness, the authors call for a new focus for public policy: not ‘wealth creation’ but ‘wellbeing creation.'”

The authors say: “Most human misery is due not to economic factors but to failed relationships and physical and mental illness. Eliminating depression and anxiety would reduce misery by 20% while eliminating poverty would reduce it by 5%. And on top of that, reducing mental illness would involve no net cost to the public purse.” 

So the authors propose the delivery of more Cognitive Behavioural Therapy (CBT), whilst income redistribution and social justice perspectives are considered trivial and insignificant because they are deemed too costly. Layard in particular enthusiastically endorses CBT, which he regards as the modern evidence-based psychological therapy of choice. Layard was one of the key signatories of The Depression Report, and one of the main campaigners, along with David Clark, for the Increasing Access to Psychological Therapies (IAPT) programme, which has entailed the mass provision of CBT.

CBT is a cheap, short-term, goal-oriented treatment that practitioners claim takes a “hands-on, practical approach to problem-solving.” Its goal is to change patterns of thinking or behaviour that are claimed to be behind people’s difficulties, and so change the way they feel about their circumstances. However, I have critiqued this approach more than once. 

I’ve also critiqued the use of quantitative methodology and survey methods more generally in policy-making, as such methods frequently fail to pay due regard to authenticity, reliability and validity, inclusion and full participation: quantitative methods tend to be used non-prefiguratively. (See for example: The importance of citizen’s qualitative accounts in democratic inclusion and political participation.)

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Happiness is a neoliberal warm gun: depopulating policy

CBT is of course premised on the assumption that interpreting situations “negatively” is a bad thing, and that thinking positively about bad events is beneficial.

The onus is on the individual to adapt by perceiving their circumstances in a stoical and purely “rational” way. CBT is primarily about self-governance techniques.

So we need to ask what are the circumstances that the authors are expecting people to accept stoically. Socioeconomic inequality? Absolute poverty? Sanctions? Work fare? Being forced to accept very poorly paid work, abysmal working conditions and no security? The loss of social support, public services and essential safety nets? Starvation and destitution? Political authoritarianism? The end of democracy?

It’s all very well challenging people’s thoughts but for whom is CBT being used, and for what purpose? It seems to me that this is about helping those people on the wrong side of draconian government policy to accommodate that, and to mute negative responses to negative situations. CBT in this context is not based on a genuinely liberational approach, nor is it based on any sort of democratic dialogue. It’s all about modifying and controlling behaviour, particularly when it’s aimed at such narrow, politically defined and specific economic outcomes, which extend and perpetuate inequality. In this context, CBT becomes state “therapy” used only as an ideological prop for neoliberalism.

CBT is too often founded on blunt oversimplifications of what causes human distress – for example, it is currently assumed that the causes of unemployment are psychological rather than sociopolitical, and that particular assumption authorises intrusive state interventions that encode a Conservative moral framework, which places responsibility on the individual, who is characterised as “faulty” in some way. The deeply flawed political/economic system that entrenches inequality isn’t challenged at all: its victims are discredited and stigmatised instead.

Yet historically (and empirically), it has been widely accepted that poverty significantly increases the risk of mental health problems and can be both a causal factor and a consequence of mental ill health. Mental health is shaped by the wide-ranging characteristics and circumstances (including inequalities) of the social, economic and physical environments in which people live. Successfully supporting the mental health and wellbeing of people living in poverty, and reducing the number of people with mental health problems experiencing poverty, requires engagement with this complexity. (See: Elliott, I. (June 2016) Poverty and Mental Health: A review to inform the Joseph Rowntree Foundation’s Anti-Poverty Strategy. London: Mental Health Foundation).

In the social sciences there is a longstanding and unresolved debate over the primacy of structure or agency in shaping human behaviour. Structure is the recurrent patterned social, economic and political arrangements which influence or limit the choices and opportunities available to citizens. Agency is the capacity of individuals to act autonomously and independently of “outside forces” to make their own free choices. 

Layard et al. dismiss the importance of context on human behaviours, cognitions, perceptions, attitudes and states of mind, and the study is premised and proceeds as if this controversy has been resolved. It hasn’t. 

Such an approach crucially overlooks conflict, the impacts of political decision-making, economic arrangements, social structure, prevailing cultural norms and ideologies, for example.

Rather predictably, Layard’s approach to research (for he’s an economist, not a psychologist, hence his approach shares more in common with the behavioural economists from the cost-cutting, antidemocratic Nudge Unit) conflates human needs and wellbeing with narrow ideological (antiwelfarist, “small state” neoliberal) outcomes, by removing any consideration of the complex interactions, constraints and impacts of the economic, social, cultural and political context on human happiness. Layard’s neuroliberal approach therefore may be read as an endorsement of existing socioeconomic inequalities. 

Furthermore, definitions of “happiness” are culturally specific. They are susceptible to culturally (and politically defined) dominant moral judgements. The happiness imperative may be regarded as an artifact of modern history, not as an inherent feature of the human condition. Across cultures and time, happiness has most frequently been defined as “good luck” and arising because of favourable external conditions. Some definitions place notions of a virtuous life and “hard work” as essential and central qualities of happiness. It’s worth noting that from 1997 to 2001, Layard was an adviser to New Labour and one of the key architects of the “New Deal” and “Welfare to Work” policies. He certainly has clearly defined ideological inclinations.

In those countries with a dominant ideology that is founded on competitive individualism, such as the US and the UK, the definitions of happiness and wellbeing based on chance and context were replaced by definitions focused on favourable internal feelings and states. In other words, happiness came to be regarded as an inner state that we have some personal control over. The significant rise in the availability and popularity of “self help” literature in the western world is a testament of this view that the happiness of citizens is a personal responsibility, and not a political one.

A central theme in this individualist approach is a relentless optimism about the capacity of individuals to improve their own mental health, and accept things as they are in order to bask in earned and fully deserved human happiness and fulfilment. The starting point of the self help perspective, (dating back to Samuel Smiles and his moralising, conservative disquisitions on Thrift and Self help: the austerity ideologue of mid Victorian laissez faire) is that the world is basically okay, the problems arising at an individual level are simply because of how we choose to perceive it – this is reflected in an emphasis on the necessity of changing the way you see and think about the world, particularly in neoliberal economies. It’s very clear why CBT is so appealing to the UK Conservative government. It doesn’t challenge the status quo at all. 

Establishing happiness as a metric is only meant to serve a political end. Indeed, it may even be regarded as a form of political gaslighting. I’m not alone in my concern that “happiness” research could be used to advance authoritarian aims. Studies show that in European elections since 1970, the subjective “life satisfaction” of citizens is the best predictor of whether the government gets re-elected  – this apparently is much more important than economic growth, social conditions, unemployment or inflation.

CBT is the modern descendant of the discredited, ever so quantitative behaviourist tradition, spearheaded by B.F. Skinner, who views persons as nothing more than empty and simple mediators between behaviour and the environment. Integral to this perspective of behaviourism is the concept of behaviour modification through rewards or “consequences.” This has been politically translated into a reductionist economic language of incentives and outcomes. (Stimulus => response.)

This is paralleled with the growth of nudge, which is a technocratic behaviourist solution and ideological prop in the form of behavioural economics, which is also all about generating public policies that aim to quantifiably change the perceptions and behaviours of citizens, aligning them with narrow neoliberal outcomes.

Even the likes of Oliver James (author of Affluenza and The Selfish Capitalist, among other works) critique the symptoms of neoliberal policies rather than the disease: neoliberalism itself.

This is precisely why independent research findings consistently highlight the value of adopting less idiomatic and more value neutral historical, political, cultural and linguistic perspective in the study of public happiness.

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I think it’s fair to say that mental illness is not caused by just one thing. Poverty can be one factor or trigger that interacts with a complexity of other events, such as adverse life events, genetic predisposition, poor physical health or substance abuse. But so far, the strongest evidence suggests that poverty can lead to mental illness, especially disorders such as depression.

Living in poverty causes chronic distress and struggle. Failure to meet basic human needs certainly has an impact on human and social potential – Abraham Maslow explored how our cognitive priorities are reduced when our physiological needs are not met or our survival is threatened. Struggle and distress may have an ultimate biological impact on brain function. According to one controversial hypothesis, schizophrenia is the result of chronic experience of social adversity and defeat, which disturbs the dopamine level and function in the brain, for example.

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A report published by the World Health Organization this year strongly suggests that poor individuals are twice as affected by mental health conditions compared to rich individuals. The report concludes: “Whilst the relationship between poverty and mental health is complicated, individual measures taken to reduce global poverty are likely to have positive impacts on mental health issues in underprivileged populations.”

Regardless, a society may be judged on how it treats its most disadvantaged citizens. The harrowing problems of poverty, as described in Charles Dickens’ David Copperfield, and social rehabilitation, or lack of it, as portrayed by Victor Hugo in Les Misérables, sadly remain as pressing today.

The statement from Psychologists Against Austerity

The Origins of happiness study overlooked the social and political context of mental health, say campaign group Psychologists Against Austerity. This lets politicians and the architects of austerity off the hook.

The London School of Economics (LSE) study, led by Layard, was published in early December. The report claims that eliminating depression and anxiety would be a cheap way to reduce misery by 20 per cent, while eliminating poverty would be more difficult – and, besides, it would only reduce unhappiness by 5 per cent.

Psychologists against austerity (PAA) have condemned the stark and simplistic dichotomy presented in the report between income and mental illness as predictors of life satisfaction.

In a response published online, the group, which is made up of practising mental health professionals, highlighted the fact “some media reports have gone further, apparently taking the results to imply that there is no causal relationship between poverty and mental illness”, and blamed the researchers for not making the complex relationship between poverty and mental health clearer. According to the psychologists, the two things “are related in a complex variety of ways, with both causally influencing the other”.

The group of psychologists said it was easy for the researchers to downplay the link in their findings, because the relationship is not as simple as happiness being dependent on income alone.

“Living in poverty is more stressful, with fewer buffers, so challenges are more likely to be catastrophic,” their statement said. “People living in poverty have less agency and control over their lives, and live with lower status, often accompanied by stigma, powerlessness and shame.”

Layard’s emphasised that as UK average incomes have increased, the country has not got happier. But PAA point out that in addition to becoming richer, Britain has also become a profoundly more unequal society since the 1980s.

The original study states that relative poverty is more important than absolute poverty in mental health terms, but does discuss this in detail.

Decades of previous research supports PAA’s statement, and many individual psychologists and academics agree with the anti-austerity group’s statement. 

The study “lets politicians off the hook, it lets austerity off the hook” by treating mental illness as if it exists in a void and is not intrinsically linked to societal factors, director of clinical psychology at Canterbury Christ Church University, Dr Anne Cooke, told the Guardian:

“It says that all that doesn’t matter, making a better society doesn’t matter, just offering technical treatments,” she said. “I am one of the people that offers technical treatments and I think they can be extremely helpful to some people but that argument is being stretched beyond the point at which it applies.”

Dr Peter Kinderman, president of the British Psychological Society, has said he welcomed Lord Layard’s call for a focus on national wellbeing through investment in mental health services. But he added, speaking to the Guardian, that he had misgivings about how the study had treated mental illness as a distinct variable from human misery.

Layard’s work has previously led to David Cameron’s adoption of national “wellbeing” statistics, and he was also a driving force behind the adoption of the Improving Access to Psychological Therapies to increase access to “talking therapies” on the NHS.

That latter policy was particularly controversial because it established finding work as an outcome of psychological treatment, which critics said may not be a suitable outcome for some and encouraged a policy of forcing people into work which may not be appropriate for them. PAA and other campaign groups have previously called aspects of the scheme’s implementation “profoundly disturbing”, attacking 2015 plans by then-chancellor George Osborne to link welfare and therapy by placing IAPT therapists in job centres. Layard, who is an economist rather than a psychologist, is now calling for a “new role for the state” that “swaps wealth creation for wellbeing creation” through targeted mental health interventions.

The LSE study has worried psychologists because Layard is highly influential with policymakers. The Labour peer’s recommendations previously led David Cameron to adopt national wellbeing statistics, and Lord Layard was also a driving force behind the Improving Access to Psychological Therapies (IAPT) scheme to increase access to “talking therapies” on the NHS.

Dr Jay Watts, a clinical psychologist, told the Guardian Layard’s call “negates decades worth of data linking mental health to poverty”.

“It’s ripe for misuse … in the current political climate,” she added.

Dr Anne Cooke said there were better ways to improve wellbeing than by focusing on isolated mental health interventions. Policy should take a more holistic public health approach, she proposed.

“Cholera wasn’t eradicated by developing new treatments, it was eradicated by improving drains back in pre-Victorian times.

What [Layard] neglects is the people at the bottom of the pile who are really, really struggling, and in current circumstances there are a lot of them. People who you see at food banks for example, who are in incredible distress and certainly would – most of them or a lot of them – meet the criteria for an anxiety disorder or depression,” she said.

But it’s largely a response to their circumstances. If we do something about that, rates of mental illness in the population are going to come down a lot more effectively than providing a lot more therapy.”

Meanwhile, PAA suggested that rather than doing nothing to help the most disadvantaged people, the study could actually contribute to perpetuating poverty.

“Discussions of mental health that leave out a thorough analysis of poverty and income inequality may be used uphold policies that maintain disadvantage and oppression in society,” the group said.

You can read PAA’s full response here

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Adults in the poorest fifth are much more likely to be at risk of developing a mental illness as those on average incomes: around 24% compared with 14%.

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Related

The Psychological Impact of Austerity – Psychologists Against Austerity

Psychologists Against Austerity: mental health experts issue a rallying call against coalition policies 

The power of positive thinking is really political gaslighting

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Psychologists Against Austerity and People’s Assembly Protest

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The People’s Assembly are organising a march on Saturday 16th April (next weekend) from 1pm in London, calling for health, homes, jobs and education. It will start at the junction between Gower Street and Euston Road, marching towards Trafalgar Square.

Some of us from Psychologists Against Austerity will be joining the march. If you would like to come along and march with us, we will be meeting outside the Prince of Wales Feathers pub, next to Warren Street station at 12.30pm. This is around the corner from where the march is starting and we will walk over to join them at 12.45pm.

For those of our members in regional groups outside of London, the People’s Assembly are organising coaches from across the country. To see if there is one near to you, have a look at their website: http://www.thepeoplesassembly.org.uk

It would be great to get as many of us there as possible. We are getting a small number of t-shirts printed to see what they look like. If you would like one, bring £10 with you on the day, first come first served! If you have any questions or want to know where we are on the day, feel free to tweet us at @commpsychUK

If you can’t make it to the march, it could be a great opportunity to have a conversation with someone new about the impact of austerity. Our second briefing paper, ‘Improving Public Discussion about Inequality’ might be able to help. Have a read for some ideas about how to communicate the impact of austerity in engaging ways and reach beyond those marching with us on the 16th:  https://psychagainstausterity.wordpress.com/briefing-paper-preaching-to-the-non-converted/

With best wishes,

Psychologists Against Austerity.
@commpsychuk
www.psychagainstausterity.wordpress.com
https://www.facebook.com/Psychologists-Against-Austerity

Man walks into Ashton Under Lyne Jobcentre, gets sanctioned goes home and commits suicide. Another day outside the Jobcentre.

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Source: Man walks into Ashton Under Lyne Jobcentre, gets sanctioned goes home and commits suicide. Another day outside the Jobcentre.

More: Sanctions are founded on Tory psychobabble. You can’t “incentivise” people by starving them

Benefit Sanctions can’t possibly ‘incentivise’ people to work – here’s why

 

Conservative governments are bad for your health

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proper Blond 

Context: the politics of blame

Increasing employment and pushing ill and disabled people into work are key elements of the UK Government’s public health and welfare “reform” agendas. The arguments presented for this approach are primarily economic and particularly, moralistic. The reasoning presented is not founded on biological, psychological or sociological evidence. The government maintains that work is the most effective way to improve the wellbeing of individuals, their families and their communities. There is a perception that unemployment is harmful to physical and mental health, so the corollary has been assumed – that work is beneficial for health. 

However, that does not necessarily follow, and to claim that it does is distinctly unscientific and irrational. As the Conservatives themselves have often pointed out in less appropriate circumstances in order to avoid democratic accountability and responsibility, there is a difference between an association and a causal relationship.

There is a clear ideological context from which the welfare “reforms” proceeded, and the politically-directed media campaigns that have purposefully stigmatised and outgrouped unemployed people demonstrates quite clearly that reducing welfare support is not about a politically calculated extension of social inclusion and social justice policies, Conservative bonhomie, or overall concern for the wellbeing of welfare recipients and people who are disabled.

The government are attempting to entrench neoliberal ideology in our culture by co opting GPs, social workers and other professionals as agents of the state. The idea that “work is a health outcome” has been embedded in policies such as the Orwellian renaming of sick notes (now “fit notes”), which are designed to explore what work a person who is absent from work because of illness may undertake.  However, the government intend a much more far-reaching outcome than simply attempting to reduce the sick “role” and recovery time. The government’s “behavioural change” agenda has become a centrally-orchestrated programme for governance. The provision of public goods and crucial support, from housing and discretionary housing payments to employment benefits and disability support is becoming increasingly conditional. 

Political rhetoric, aimed at perpetuating an extremely divisive and intentionally misleading “strivers and skivers” dichotomy is designed to undermine public support for the welfare state and the other gains of our post-war settlement – the NHS, legal aid and social housing for example – also betrays the lack of coherence, rationality and empirical support for the Conservative’s “reforms.” Furthermore, the extremely targeted, class-contingent and punitive nature of the Conservative austerity programme indicates that the welfare “reforms” were founded on traditional Tory prejudices, rather than on any genuine causal relationship based on empirical evidence and social or economic necessity.

This explains why the government have persistently ignored the many evidence-based concerns raised by academic researchers, campaigners and opposition MPs that their austerity policies are having an extremely harmful effect, most often on our poorest and most vulnerable citizens.

The Conservatives are ideologically bound to notions of a small state, minimal levels of political responsibility and intervention, minimal levels of government spending, the heavy promotion and administration of privatisation, competition, fiscal austerity, deregulation and free trade in order to enhance the role of the private sector in the economy, all of which are the central strands of the neoliberal hegemony. Conservative ideology runs counter to any notion that all citizens must be treated fairly, which also means that they must be given equal economic opportunities and provided with a adequate minimum standard of living. Neoliberal ideology is incompatible with a human rights-based society.

Democracy exists partly to ensure that the powerful are accountable to the public, and particularly to our most vulnerable citizens. This government have blocked that crucial exchange, and show disdain for human rights, the welfare state and the NHS, all of which provides ordinary people and the most vulnerable citizens basic protection from those in power.

Conservatives despise human rights and rights-based social provision. They absurdly claim that welfare provision causes vulnerability, and a “culture of dependency,” despite the fact that there is absolutely no empirical evidence to support this view. History has consistently taught us otherwise. The Conservative’s policies are expressions of contempt for the lessons and empirical evidence from over a century of social history and administration.

Tory rhetoric is designed to have us believe there would be no poor people if the welfare state didn’t somehow “create” them. If the Conservatives must insist on peddling the myth of meritocracy, then surely they must also concede that whilst a neoliberal system has a few beneficiaries, it also creates situations of insolvency and poverty for many others. That is what a system based on competitive individualism is about: it creates a few “winners” and a lot of others lose.

Conservative cuts are based on nothing more than the ridiculous myth that poverty is somehow a lifestyle choice or a moral failing which people can be punished or starved out of. The new Tory neoliberal “paternalists” really seem to believe that if they make life for poor people insufferable, they will simply be “incentivised” to choose to be wealthier. It’s a thinly disguised revamp of the ill-conceived 1834 Poor Law deterrence principle of “less eligibility” – that was supposedly aimed at “making work pay” too. But it didn’t. It’s not possible to frighten and punish people out of poverty. Only a Conservative government would claim to be making work pay by cutting welfare down to the bare bones, rather than increasing wages. The welfare cuts have actually had the effect of driving down wages too.

Of course, by framing the issue of poverty in terms of personal responsibility and morality, the Conservatives have stifled debate and restricted public discussion in the hope that people won’t recognise the wider structural inequalities and economic failings, for which this government are solely responsible.

Debbie Abrahams said: “The Conservatives point the finger at sick and disabled people for the rise in spending. They are still shamelessly spinning their tired “shirkers” and “strivers” narrative, designed to whip up public support for cuts to the most vulnerable. But this divisive rhetoric can no longer conceal the fact their economic strategy has failed. It is the government’s failure that has led to rising social security costs. 

As we saw at the Autumn Statement (2016), borrowing is up, growth is down, deficit targets have been hopelessly missed and wages have flat-lined. At the same time, the government has refused to tackle the driving forces behind increased social security spending, from low pay to high housing costs. Instead, the government is slashing support to those who need it most, exacerbating the financial strain so many are facing this Christmas, and failing its own targets in the process.   

[…] Research by the Joseph Rowntree Foundation suggested that we need to be building 80,000 affordable homes a year to meet demand and keep the current spend on housing benefit stable. This government managed a pathetic 30,000 homes last year. It is this refusal to build enough homes that keeps the housing benefit bill growing. People are left struggling to find somewhere affordable to live, and the state is forced to subsidise the sky-high rents charged by private landlords 

We could also look at tax credits, which currently make up more than £20bn a year in the spending under the cap. Tax credits top up working people’s pay where it is insufficient. Wages today are lower than they were in 2008, and won’t even return to the levels of 2008 until 2021. A record six million workers are paid less than the living wage. This is why tax credit costs have risen – because the government has had to increase the amount spent on topping wages up. 

Labour founded the welfare state to give pensioners and disabled people dignity, to prevent homelessness, children going hungry, and to cover for periods of unemployment or ill-health. It was never designed to be spending tens of billions substituting for low-wage employers or subsidising rip-off landlords.”

Economic productivity is the new health outcome

The claim that “work is good for you” is allegedly based on “scientific evidence” that people in work tend to be healthier than those claiming unemployment and sickness benefits. However, to draw the conclusion that “employment is good for you” from the data is an example of inferring causality inappropriately, from what is only an association. Yet it is being used to prop up Conservative justifications for dismantling the welfare state.

Unemployment has been linked to increased rates of sickness, disability and mental health problems, and to decreased life expectancy. The claim has also been made that it results in an increased use of medication, medical services, and higher hospital admission rates. However, surely it makes much more sense to say that sickness, disability and mental health problems, the use of medication, medical services, and higher hospital admission rates all cause unemployment, rather than the converse. This government seem to have a major problem accepting the fact that sometimes, people really are simply too ill to work.

Most people who are too ill to work are obviously not as healthy as those who can work. That is hardly controversial. However, that doesn’t mean that work itself is good for your health, it just means those who don’t work tend to have worse health than those who do. People don’t work because they have poor health.

Linking ill health with “worklessness” is an ideological preference which ignores other variables. It is much more likely that the “reforms”, which have reduced welfare provision to inadequate levels – leaving people all too often unable to meet their basic needs – is bad for health, rather than being out of work. 

But the Conservatives have used this “evidence” of an association between poor health and unemployment to make an inference based on a “causal link” that hasn’t actually been empirically verified. Iain Duncan Smith has made the claim, for example, that “work is good for you.” He has even claimed that work can make people’s health problems “better.” But that isn’t very likely to be true. It’s akin to claiming that chatting and exercise is a cure for multiple sclerosis, lupus, blindness or cancer. Or that a work coach on prescription will cure rheumatoid arthritis, a disc prolapse or schizophrenia.

This is why I visit my doctor when I am ill, and not Iain Duncan Smith or the government.

The claim that work is good for your health is simply a part of Tory justification narratives for cutting support for sick and disabled people, and hounding people who need to claim benefits. Yet this axiom informs current UK policy towards increased benefit conditionality, harsh sanctions, compulsory work experience and the “workfare” or “work-for-benefits” thinking which the Conservatives favour. However, this is an approach that can never work, unless, of course, the aim is to completely dismantle the welfare state. Oh, hang on…

The biopsychosocial model

The biopsychosocial model (BPS) of ill health is not without controversy, although many see it as more pragmatic or humanistic than the medical model of illness, which came to be regarded as reductionist and deterministic. The biopsychosocial model is the conceptual status quo of contemporary psychiatry, and many believe that it has played an important role in combatting psychiatric dogmatism.

The biological component of the model is based on a traditional allopathic (bio-medical) approach to health. The social part of the model investigates how different social factors such as socioeconomic status, culture and poverty impact on health. The psychological component of the biopsychosocial model looks for potential psychological causes for a health problem such as lack of self-control, emotional turmoil, and negative thinking.

Of course a major criticism is that the BPS model has been used to disingenuously trivialise and euphemise serious physical illnesses, implying either a psychosomatic basis or reducing symptoms to nothing more than a presentation of malingering tactics. This ploy has been exploited by medical insurance companies (infamously by Unum Provident in the USA) and government welfare departments keen to limit or deny access to medical, social care and social security payments, and to manufacture ideologically determined outcomes that are not at all in the best interests of patients, invalidating diagnoses, people’s experience and accounts, and the existence of serious medical conditions. (See also: Getting rich on disability denial, and  A Tale of two Models by Debbie Jolly.)

Unum was involved in advising the government on making the devastating cuts to disabled people’s support in the UK’s controversial Welfare Reform Bill. (See also: The influence of the private insurance industry on the UK welfare reforms.)

This is a government that tends to emphasise citizen responsibilities over rights, moralising and psychologizing social problems, whilst quietly editing out government responsibilities and democratic obligations towards citizens.

For example, poverty, which is caused by political decisions affecting socioeconomic outcomes, is described by the Conservatives, using elaborate victim-blame narratives, and this is particularly objectionable at a time when inequality has never been greater in the UK.

Poverty may only be properly seen in a structural context, including account of the exclusion and oppression experienced by those living in poverty, the global neoliberal order, the gender order, the disability, racial, sexual and other orders which frame social life and precipitate poverty in complex and diverse ways. It’s down to policy-makers to address the structural origins of poverty, not the poor, who are currently regarded as the “collateral damage” – casualities – of politically imposed structural constraints.

Conservative governments are unhealthy

The effects of loss of income on people who can’t work because of illness is a confounding factor, too. How is it possible to isolate the devastating impacts of the Conservative “reforms” and the steady dismantling of the welfare state on unemployed people from the misleading generalisation that unemployment is bad for health? Surely if the Conservatives genuinely believed their own claims, they would be more inclined to increase rather than radically decrease provision and support for unemployed people.

Of course, not all work is beneficial. The review that led to the widespread folk tale that work is good for you is based on research involving people who had common and minor illnesses, and fulfilling, secure jobs. That doesn’t reflect the experiences of many people.

Not all jobs are rewarding and positive experiences, and some work can cause serious risks to health.

Doctor Frank Scheer, a neuroscientist at Harvard Medical School and Brigham and Women’s Hospital in Boston, says:

“There is strong evidence that shift work is related to a number of serious health conditions, like cardiovascular disease, diabetes, and obesity.

These differences we’re seeing can’t just be explained by lifestyle or socioeconomic status.”

Shift work and poor quality working environments and employment conditions are also linked to stomach problems and ulcers, hypertension, depression, musculoskeletal disorders, chronic infections, diabetes, general health complaints, all-cause mortality and an increased risk of accidents or injury. Long working hours are equally linked with a detrimental impact on health, according to medical research – see: The impact of overtime and long work hours on occupational injuries and illnesses: new evidence from the United States.

There is a growing and potentially corrosive problem of low paid, poor quality, precarious and temporary work which threatens levels of social inclusion and, ultimately, the health of the workforce.

Research shows unambiguously that the psychosocial quality of bad jobs is worse than unemployment. Peter Butterworth examined the mental health implications of those moving from unemployment into employment and found that:

“Those who moved into optimal jobs showed significant improvement in mental health compared to those who remained unemployed. Those respondents who moved into poor-quality jobs showed a significant worsening in their mental health compared to those who remained unemployed.”

Overall, unemployed respondents had poorer mental health than those who were employed. However the mental health of those who were unemployed was comparable or superior to those in jobs of the poorest psychosocial quality. (See: The psychosocial quality of work determines whether employment has benefits for mental health: results from a longitudinal national household panel survey.)

More recently, in a letter to the Guardian, the UK’s leading bodies representing psychologists, psychotherapists, psychoanalysts, and counsellors called on the Government “to immediately suspend the benefits sanctions system. It fails to get people back to work and damages their mental health.

Findings from the National Audit Office (NAO) show limited evidence that the sanctions system actually works, or is cost effective.

But, even more worrying, we see evidence from NHS Health Scotland, the Centre for Welfare Conditionality hosted by the University of York, and others, which links sanctions to destitution, disempowerment, and increased rates of mental health problems. This is also emphasised in the recent Public Accounts Committee report, which states that the unexplained variations in the use of benefits sanctions are unacceptable and must be addressed.”

The impact of poverty on health

The largest study of poverty conducted in the UK has laid out the dire extent of British material deprivation – and seriously undercut the government’s claim to be lifting people out of poverty through work.

The Poverty and Social Exclusion in the UK (PSE) project details how, over recent years, the percentage of households living below society’s minimum standard of living has increased from 14% to 33% – despite the fact that the economy has increased in size over the same period. The study found that low wages are a central cause of widespread deprivation. For many people, full-time work is not enough to lift them out of poverty; almost half of the working poor work 40 hours a week or more. And one in six adults in paid work (17%) is poor, suffering low income and unable to afford basic necessities.

Commenting on the study’s findings, Professor Jonathan Bradshaw of the University of York said they showed many parents who work full time still have to make huge sacrifices to try and protect their children from deprivation.

“We already know from DWP data that the majority of children with incomes below the the relative income poverty threshold have a working parent. The PSE survey shows that the majority of deprived children, those lacking two or more socially perceived necessities, and very deprived children (lacking five or more socially perceived necessities) have a working parent.

We found that 65% of the deprived and 58% of the very deprived children had a working parent, and 50% of the deprived and 35% of the very deprived had at least one parent working full-time. Child poverty is not being driven by skivers, but is the consequence of strivers working for low earnings while in-work benefits are being dissipated by government austerity measures.”

Responding to the findings, Clare Bambra, a professor at Durham University, said that the research was a shameful picture of “the devastating and far-reaching human costs of inequality and poverty in the UK today.”

She said:

“It’s shameful for a rich country like ours to be tolerating such levels of poverty especially amongst our children and young people. The mantra that work sets people free from poverty has been shown to be a grand old lie.

We will be living with the long term consequences of this social neglect for decades to come – there are clear links between poverty and reduced life expectancy and higher rates of ill health, especially concentrated in deprived areas and the north.

These findings show us the true cost of austerity.”

Public health experts from Durham University have denounced the impact of Margaret Thatcher’s policies on the wellbeing of the British public in a comprehensive study which examines social inequality in the 1980s.

The study, which looked at over 70 existing research papers, concludes that as a result of unnecessary unemployment, welfare cuts and damaging housing policies, the former prime minister’s legacy includes the unnecessary and unjust premature death of many British citizens, together with a substantial and continuing burden of suffering and loss of wellbeing.

The research shows that there was a massive increase in income inequality under Baroness Thatcher – the richest 0.01 per cent of society had 28 times the mean national average income in 1978 but 70 times the average in 1990, and UK poverty rates went up from 6.7 per cent in 1975 to 12 per cent in 1985.

Baroness Thatcher’s governments wilfully engineered an economic catastrophe across large parts of Britain by dismantling traditional industries such as coal and steel in order to undermine the power of working class organisations, say the researchers. They suggest this ultimately fed through into growing regional disparities in health standards and life expectancy, as well as greatly increased inequalities between the richest and poorest in society.

Professor Clare Bambra from the Wolfson Research Institute for Health and Wellbeing at Durham University, co-author of the research report, commented:

“Our paper shows the importance of politics and of the decisions of governments and politicians in driving health inequalities and population health. Advancements in public health will be limited if governments continue to pursue neoliberal economic policies – such as the current welfare state cuts being carried out under the guise of austerity.”

Thatcher’s policies  have been condemned for causing “unjust premature deaths.” Cameron’s policies are even more class-contingent and cruel.

I think there is a growing body of empirical evidence which indicates clearly that Conservative governments are much worse for public health, prosperity and wellbeing than unemployment.

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Pictures courtesy of Robert Livingstone

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