Austerity: who pays the price?
What effect have the Government's austerity measures had on people's health? For doctors working in deprived areas, the answers are of great concern
What does austerity mean to you? Big cuts in public spending, perhaps. A tactic to balance the books in an economic crisis?
Or a welfare state so trimmed that its benefits no longer cover living costs?
For Doncaster GP Dean Eggitt, austerity has meant asking a new kind of question, a sort he might never have expected to ask.
‘Some people have cut back on food when they have problems with their finances. Now when I see a patient with persistent ill health, I will enquire about their diet,’ the chair of the town’s local medical committee says.
‘I had never seen it before but some patients are not eating properly.
‘They don’t present as hungry,’ he adds. ‘It requires some digging, perhaps because they’re embarrassed. They come for something else; they want you to write a letter about their benefits.’
Dr Eggitt quizzed one man about his diet because his leg wound was failing to heal. ‘He wasn’t eating properly and needed good nutrition for the wound to heal itself. I’ve had to start referring patients to food banks. It is becoming so much part of my job.’
This practice of food bank referrals is but one of the upshots of austerity and the consequent cuts and changes to social security payments that have been integral to its agenda.
Many more negative effects are flagged up in a new report from the BMA’s board of science, published earlier this week.
According to Health in all policies: health, austerity and welfare reform, these parallel political agendas have over the past decade damaged the nation’s health and widened the divide between people who can afford to live healthily and those who cannot.
They are agendas that have increased child poverty, hit the most fragile the hardest, and pushed up the prevalence of mental illness.
A most ‘notable impact’ during the austerity years, according to the report, is the first rise in suicide rates in the UK since the 1980s. This worrying trend began in 2008 and continued until 2013. In some areas, such as the Lake District area of Cumbria and the seaside town of Torbay, rates are rising still, prompting doctors and public health officials to redouble their efforts at suicide prevention.
The effects of austerity and recession traced in this review of more than 100 reports and papers are too many to list. Cuts in pension credits and social care have been linked to rising mortality among elderly pensioners.
Patients with multiple sclerosis have reported deterioration in their health as their social security benefits became subject to extra conditions. One in three councils in England have closed day services for adults with learning disabilities, according to research in the briefing.
The BMA briefing concludes, however, in the light of its evidence, that ministers should, from now on, ensure they check thoroughly how austerity-type measures might harm citizens’ health — and ideally before they are implemented.
‘There should be a mandatory requirement for all Government departments and public bodies to adopt a ‘health in all policies” approach’, it recommends. With this, the impact of all new policies would be assessed for their potential impact on health.
Without any adequate pre-emptive checks introduced before austerity became policy, it has fallen to scholars and welfare charities to count the cost of the cuts. And while it is still ‘too early’ to assess the full impact of austerity, according to the BMA’s review, there are already a ‘broad range of negative indicators of significant concern’.
According to one measure that stands out in the report, the proportion of households with insufficient income to live healthy lives has risen from nearly 20 per cent to just under 25 per cent during the austerity years.
Such trends will harm the nation’s health in the absence of ‘strong social support systems’, the report warns. But under austerity, by definition and in practice, such systems are suffering and are already stressed.
Austerity is defined in the BMA briefing as an effort by governments to cut deficits by freezing or slashing spending. Such an agenda began in the UK with the coalition Government’s cost-cutting ‘emergency budget’ of 2010 and continues today.
While the NHS faces its own financial crisis, with growing demand and an expectation to find £22bn in ‘efficiency savings’, other areas impinging on health spending, such as social care funding or other local government services, are also under big financial pressure.
As a result, essential public support scaffolds have been radically reduced and shifted, the briefing points out.
The spending capacity of councils has not just been severely slashed. Public funding for town halls is now shared out differently. On the whole, rundown areas have less to spend than the relatively wealthy, according to analysis by JRF(Joseph Rowntree Foundation), an anti-poverty charity.
This growing inequality in funding is due to a range of cuts and changes to the assortment of grants and resources given by the Government to town halls.
‘Public services play a much more important role in the lives of people on low incomes,’ the JRF study says.
Then there are the so-called improvements to social security, steamrolled out by the former chancellor George Osborne for reasons of ‘fairness’ as well as austerity. ‘A fair welfare system is fair to those who need it and fair to those who pay for it too,’ Mr Osborne told a Conservative Party conference three years ago.
This intricate web of restrictions, caps and rule changes to benefits have collectively cut billions from the bill but corroded — and in many cases dissolved completely — the principle that payments should cover basic living costs, such as rent.
And if new prime minister Theresa May sticks to her predecessor’s manifesto commitment, a hefty £12bn more will be taken away from welfare budgets by the time her party’s five-year parliamentary term is up.
Research pinpointed in the report also shows that those hardest hit by these so-called ‘welfare reforms’ tend to live in areas already well known for deprivation.
A study this year by researchers at Sheffield Hallam University identified that towns such as Blackpool, old industrial districts such as Blackburn in England and Merthyr Tydfil in Wales, as well as London boroughs with high housing costs, were the areas where residents had suffered the largest losses of income.
‘As a general rule,’ the paper by Christina Beatty and Steve Fothergill says, ‘the more deprived the local authority the greater the financial loss’.
And, according to the evidence sifted in the BMA’s review, Dr Eggitt is not alone in finding that some of his patients are failing to eat properly.
An ‘unprecedented’ rise in the use of food banks since austerity measures were introduced was recorded in a 2015 paper from the BMJ, cited in the BMA report. This increase, researchers have shown, is associated with cuts to both public spending by councils and welfare spending by Whitehall. This trend corresponds strongly, it adds, with a rise in hospital admissions for malnutrition.
In all, austerity-led changes of the past decade have stirred up a ‘perfect storm’, according to BMA public health committee chair Iain Kennedy.
‘The Government in England shifts responsibility for providing services from the centre to local level, and then cuts funding for local authorities.’
Since 2010, discounts for people who struggle to pay council tax and a crisis loan fund, both previously run from Whitehall, have seen budgets cut before being passed down to councils.
‘Austerity damages health,’ Dr Kennedy adds. It had resulted in cuts to child welfare programmes, support for older people and unemployment benefits. All were ‘bad for health and bad for health inequalities,’ Dr Kennedy says.
A similar point was raised at the BMA’s special representative meeting in May by Professor Sir Michael Marmot, director of the Institute of Health Equity and president of the World Medical Association.
Research from across the globe has linked high public spending on social welfare to better health, he says.
‘All a politician has to do is to stand up and say “get the welfare bill down”,’ he adds. ‘Where on earth did the idea come from? It is Government policy to increase inequality and to make things harder for families with children.’
In light of this evidence, there’s one question worth asking again.
What does austerity mean to you?
Tell the BMA about your experiences of austerity by contacting Keith Cooper