Transcript Document

Making a bad situation worse?
The impact of welfare reform and
the economic recession on health
and health inequalities in Scotland
Gerry McCartney
Consultant in Public Health
Head of Public Health Observatory
January 2014
Aims
1. Provide a background picture of health in Scotland
2. Describe the changes in economic context and welfare
policy over time
3. Summarise the evidence on the likely impacts
Historical international trends in life expectancy
Life
at birth
birth (years)
(years)
Life expectancy
expectancy at
90
80
70
60
50
40
30
20
10
0
1751
1801
1851
1901
1951
2001
Year
Data extracted from the Human Mortality Database for all available nations: Australia, Austria, Belgium, Belarus, Bulgaria, Canada, Chile,
Czech Republic, Denmark, East Germany, England & Wales, Estonia, Finland, France, Germany, Hungary, Ireland, Iceland, Israel, Italy,
Japan, Latvia, Lithuania, Luxembourg, Netherlands, New Zealand, Northern Ireland, Norway, Poland, Portugal, Russia, Scotland, Slovakia,
Slovenia, Spain, Sweden, Switzerland, Taiwan, West Germany, Ukraine & USA.
Life expectancy at birth (years)
Higher overall mortality than comparable nations
85
80
75
70
65
60
1971
1976
1981
1986
1991
1996
2001
2006
Year
Data extracted from the Human Mortality Database for: Australia, Austria, Belgium, Canada, Chile, Denmark, England & Wales,
Finland, France, Germany, Ireland, Iceland, Israel, Italy, Japan, Luxembourg, Netherlands, New Zealand, Northern Ireland, Norway,
Portugal, Spain, Sweden, Switzerland, Taiwan & West Germany.
Life expectancy at birth (years)
Higher overall mortality than comparable nations
85
80
Scotland
75
70
65
60
1971
1976
1981
1986
1991
1996
2001
2006
Year
Data extracted from the Human Mortality Database for: Australia, Austria, Belgium, Canada, Chile, Denmark, England & Wales,
Finland, France, Germany, Ireland, Iceland, Israel, Italy, Japan, Luxembourg, Netherlands, New Zealand, Northern Ireland, Norway,
Portugal, Scotland, Spain, Sweden, Switzerland, Taiwan & West Germany.
Life expectancy drops by 2.0 years for males and 1.2 years for females for
each station on the railway line between Jordanhill and Bridgeton
Male life expectancy
75.8 years
Hillhead
St George’s
Cross
Buchanan
Street
Jordanhill
Hyndland
Partick
Exhibition
Centre
Charing
Cross
Anderston
QUEEN
STREET
Argyll St.
Govan
Ibrox
Cessnock
CENTRAL
St Enoch
Bridgeton
Male life expectancy
61.9 years
McCartney G. Illustrating Glasgow’s health inequalities. JECH 2010; doi 10.1136/jech.2010.120451 .
Trends in
mortality
inequalities in
Scotland
1981-2010
(sources: NRS and Scottish
Government)
Inequalities in male mortality (early 2000s, all ages)
Sources: Mackenbach (2008) and Popham (2010)
Inequalities in female mortality (early 2000s, all ages)
Sources: Mackenbach (2008) and Popham (2010)
All-cause age-standardised mortality (men, 15-44y) in
Scotland compared to 16 other European countries
Source: Whyte B, Ajetunmobi T. Still “the sick man of Europe”? Scottish mortality in a European context1950 – 2010:
an analysis of comparative mortality trends.
All-cause age-standardised mortality (women, 15-44y)
in Scotland compared to 16 other European countries
Source: Whyte B, Ajetunmobi T. Still “the sick man of Europe”? Scottish mortality in a European context1950 – 2010:
an analysis of comparative mortality trends.
1. Summary of Scottish mortality epidemiology
• Health in Scotland is improving, but remains worse than in
the rest of west and central Europe
• Health inequalities in Scotland are wider than the rest of
west and central Europe, and on many measures are
getting worse
• There has been little or no improvement in mortality for
young adults for 30 years
2. Changes in economic context and welfare
policy
Timeline of selected welfare changes (from 1975)
SDA – Severe Disablement Allowance
IS – Income Support
DLA – Disability Living Allowance
AA – Attendance Allowance
IB – Incapacity Benefit
JSA – Job Seekers Allowance
ESA – Employment and Support Allowance
WCA – Work Capability Assessments
CPI – Consumer Price Inflation
UC – Universal Credit
PIP – Personal Independence Payments
Timeline of selected welfare changes (from 1975)
Decreasing universality
Increasing conditionality
Increasing stigma
Increased privatisation
Equivalised real average weekly household incomes, after housing costs, by
income deciles for Scotland 1994-2010 (£)
Source: NHSHS analysis of IFS data derived from FRS – published as part of the third annual Monitoring and
Evaluation Scotland’s Alcohol Strategy (MESAS) report.
Note: The shaded area represents years of economic downturn.
Trends in economic growth (Gross Value Added) and income
inequality (Gini coefficient) (Sources: IFS and SG)
2. Changes in economic context and welfare
policy
• 30 years of welfare change have reduced universalism,
increased conditionality, increased stigma and privatised
the process
• No increase in income for poorest for 10 years
• Recession has reduced middle/high income groups most
• Income inequality is higher now than 30 years ago, but
has declined in the last 2 years
• Note – various policies are expected to exacerbate income
inequalities in the next few years
3. What are the likely impacts of recession?
• Some aspects get better and other worse; some
contradictory impacts in short-term v long-term
• The impacts are dependent on the policy response and
social protection available1,2
• Moving into unemployment increases mortality by 63%3
• Suicide has increased,2 and mental health worsened, in
many countries4
• Short-term decreases in substance misuse
1. Suhrcke M, Stuckler D. Will the recession be bad for our health? It depends. Social Science and Medicine 2012; 74: 647-53.
2. Stuckler D, Basu S, Suhrcke M, Coutts A, McKee M. The public health effect of economic crises and alternative policy responses
in Europe: and empirical analysis. Lancet 2009; 374(9686): 315-23.
3. Roelfs D, Shor E, Davidson K, Schwartz J. Losing life and livelihood: a systematic review and meta-analysis of unemployment and
all-cause mortality. Social Science and Medicine 2011; 72: 840-54.
4. Katikireddi SV, Niedzwiedz CL, Popham F. Trends in population mental health before and after the 2008 recession: a repeat crosssectional analysis of the 1991-2010 Health Surveys of England. BMJ Open 2012; 2(5).
What are the likely impacts of welfare changes?
Some similar and some contradictory to predicted recession
impacts:
• Increases in cardiovascular, respiratory and obesityrelated illness
• Worse mental health
• Higher winter mortality
• Increased substance misuse
• Increased unprotected sex and associated STIs
• Increased health inequalities
Compounding factors
• Differential impacts across population groups – young
adults particularly badly affected
• Many losing multiple sources of income
• Some particularly badly affected (e.g. those sanctioned
from JSA)
• Rising energy prices affecting those in worst housing
• Regional differences in availability of work (almost 5 times
as many jobseekers in Glasgow than available jobs)
• Increasing stigmatisation
• Cuts to public services reducing available support
Summary
• Economic recession is likely to be bad for health –
especially when accompanied by neoliberal policy
responses
• The changes to welfare policy predate the 2010 coalition,
but have intensified the drive away from universalism and
towards conditionality and privatisation
• These changes to welfare are likely to compound the
problem
• It is too early to detect much change in the routine
administrate health data
A copy of the baseline
report containing most of
this material is available at:
www.scotpho.org.uk
under the ‘reports and
publications’ tab.
Thanks
[email protected]