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'Is poverty the health crisis driving a breakdown in social cohesion?'

Jen Watson
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There is clear evidence that cohesion in society is unravelling. An ever-increasing population feel isolated and excluded by deep social inequalities.

Living in poverty, they are excluded from education, housing, culture and healthcare. As a result they feel peripheral, marginalised and desperate.

”The most vulnerable – children and older people – are suffering”

In 2019, 46% of the UK’s most vulnerable – children and older people – live in poverty, despite the fact that the UK has the fifth largest economy in the world. It is surprising then that a rise in employment is no longer reducing poverty.

Universal Credit may lead to a fall in benefits in real terms and rising rents as well as reduced help for low-income households have a further detrimental impact. It has created new phenomenon – the “working poor”.

The gaps in, and misdistribution of, wealth promote an unequal, unhealthy (both physically and mentally) and potentially violent society.

Nearly one quarter of adults in the poorest fifth of the population experience depression and anxiety, many have problem debt and 70% of people in work are not contributing to a pension.

The inequality in the UK has been described as “grotesque”, stemming from a variety of political and economic factors. This is before the potential impact of universal credit is fully realised.

The continued rise in employment is no longer reducing poverty. One in eight workers – 4.7 million people – live in poverty. State support for low-income families through benefits and tax credits is falling in real terms with no child benefit for more than two children. The most vulnerable – children and older people – are suffering.

Therefore, more than ever, we need to align services appropriately so that they can both provide help to and empower those most vulnerable.

A multitude of inequalities occur throughout our society. Pockets of often intense deprivation exist alongside pockets of extraordinary wealth, which can occur even in the smallest of boroughs. These phenomena can be observed most markedly in large metropolitan cities such as London and Manchester.

Rates of deprivation can be identified and measured within local authorities using the lower super output area (LSOA) tool. The LSOA is made up of a number of indices such as crime and deprivation relating to employment, health, disability and the environment.

Ongoing cuts – 49% in real terms – to social services, policing, education, libraries, community centres and youth groups have led to changes in the British social landscape and contradict our core national values.

In 2018, London experienced one of its highest number of killings in a decade. One third involved victims aged between 16 and 24 years old.

The cuts to Public Health England’s funding have affected their ability to provide comprehensive health education and promotion. This will affect smoking cessation, high alcohol consumption, obesity and services related to sexual health – all of which will seriously affect UK adult and child health and add to the NHS burden.

Another population affected will be those diagnosed and treated for cancer. The research shows that many people with cancer experience serious financial concerns and loss of income related to their diagnosis.

While the UK is at the forefront of potentially ‘game-changing’ innovations such as personalised molecular treatments, the reality for some patients accessing this expensive and pioneering treatment is that they rely on food banks and struggle to manage the costs of transport and parking to attend for treatment and care.

There is much written on regional inequalities, in particular, the so-called “North-South” divide. On average those living in the less deprived areas live longer than those living in the more deprived areas. Between the most and least deprived areas, the absolute difference in life expectancy is nine years for males and seven years for females.

Not surprisingly, healthy life expectancy (years in good health) was the highest in the least deprived area (70.6 years) and lowest in the most deprived (51.9 years). With an incredible gap of almost 20 years in the male population, this mirrors the female population, respectively 71.3 years and 52.2 years. These shocking gaps risk widening.

These societal changes are insidious and are as yet not prioritised by the government. Ironically the NHS has been ‘protected’ from the same levels of austerity, and yet will continue to bear the incongruous brunt of these cuts, affecting efficiencies such as social care and care home provision, which will continue to directly affect acute care provision.

It is this imbalance, which illustrates the intrinsic reliance and interdependencies associated with health and social care.

Action needs to be taken across the health service economy to readily identify patients experiencing poverty and tailor services more suitable to their specific needs.

Jennifer Watson is director of nursing and Freedom to Speak up Guardian, King’s College Hospital Foundation Trust

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