Benefits and Health

Clare BambraProfessor of Public Health Policy

Socialist Health Association Labour Party Conference 2011

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Overview

• Incapacity Benefit replaced with Employment Support Allowance• Workfare – compulsory training to receive benefits, time limits, lower

benefit rates• Re-categorisation from deserving to undeserving poor• Why? Media and Policy versus research evidence• Ill health matters • Conclusion

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Incapacity Benefit ReformEmployment and Support Allowance

Two-tier system of benefits:

1. Those judged unable to work or with limited work capacity due to the severity of their physical or mental condition will receive a higher level of benefit with no conditionality.

2. Those who are deemed ‘sick but able to work’ will only receive an additional Employment Support premium if they participate in employability initiatives.

Failure to participate results in the removal of the Employment Support component and only entitled to basic Employment and Support Allowance (paid at the same rate as unemployment benefit – Jobseeker’s Allowance). Since 2010, receipt of Employment and Support Allowance for the ‘work-related activity’ group is limited to a maximum of 1 year.

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Benefit Levels £115 UK Poverty Line

£91.40 Incapacity Benefit (long-term rate)

£91.40 Employment and Support Allowance (Work-related activity)

£96.85 Employment and Support Allowance (Support Premium)

£65.45 Employment and Support Allowance (Basic Allowance)

£65.45 Job Seekers Allowance

£65.45 Income Support

Welfare Reform bill will reduce benefits for a lot of people – European wide studies of benefit rates, unemployment and health have shown that better benefits = less poor health amongst the workless.

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From deserving to undeserving

• Workfare? Compulsory training to get element of benefit, coercion not voluntary

• People in receipt of benefits due to ill health or disability have historically been viewed and treated as more ‘deserving’ or morally worthy than those in receipt of other types of benefit

• Now they have joined other benefit recipients as undeserving and subject to coercion.

Why?

Because the legitimacy of the ill health of IB recipients has been undermined

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The shirking classes: Just 1 in 14 incapacity claimants is unfit to work (Daily Mail, 27 Jul 2011)

GOVERNMENT MUST END THE INCAPACITY BENEFITS SCANDAL (Daily Express, 22 Apr 2011)

100,000 addicts on state benefits (The Sun, 9 Nov 2010)

Just one in six incapacity benefit claimants 'is genuine' as tough new test reveals TWO MILLION could be cheating (Daily Mail, 20 Oct 2009)

Too fat to workAlmost two thousand people who are too fat to work have been paid a total of £4.4 million in benefit (The Times, 19 Nov 2007)

Media representation - Scroungers

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Policy view – employability

• Welfare to Work - Intense focus on IB in recent years (passive to active to activation) but has been almost exclusively on employability not health (except CMP and reform of fit note following Carol Black report)

• Supply side interventions: Education, training and work placement schemes; Vocational advice and support services; Vocational rehabilitation; In-work Benefits.

• Demand side interventions: Financial incentives for employers; Employment rights legislation; Accessibility interventions.

• Limited effectiveness in achieving return to work outcomes (Bambra, 2006)

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Research evidence – structural unemployment and ill health • Hidden unemployment

Beatty and Fothergill thesis (2002) - regional differences in IB rates conceal ‘hidden unemployment’ in the former industrial areas that some have not recovered from the fallout of deindustrialisation. Many on IB not find work even without health issues (low skills etc).

• Health as the key reason for job loss Survey of c.3500 IB population found that 70% lost last job due to ill-health, 70%

health limited work ability, and over 90% said ill-health was the main barrier to work (Beatty and Fothergill, 2010).

• Epidemiological insights Marmot et al – Whitehall data those with pre-existing ‘poor health’ twice as likely as

those with ‘very good health’ to take short-term sick leave (1-7 days) and six times as likely to take long term sick leave (>21 days).

Higher association between IB claims and morbidity (r=0.98 p<0.01, census LLTI; r=0.97 p<0.01, census not good health) and mortality (r=0.80 p<0.01, Vital Statistics) than unemployment (r=0.72 p<0.01, 2001 census) (Bambra & Norman, 2006).

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Health matters: IB survey

• In 2009, we began a longitudinal survey of the health of long-term IB recipients in the Job Centre Plus (JCP) South of Tyne region (covering South Tyneside, Sunderland, and County Durham)

• Participants were recruited at voluntary IB ‘Choices’ events run by the South of the Tyne JCP

• Between September 2009 and June 2010, JCP invited all eligible long-term IB recipients (IB receipt of over 3 years) in the region to 28 of these events

• Of the 8858 individuals invited to the events, 1429 attended (16%) of which 229 participated in the health survey.

• We interviewed 16% of attendees amounting to 2.6% of the total eligible IB population.

∂IB cohort Regional National

Tenure – renting 60% 34% 30%

Tenure – social housing 85% 67% 60%

No access to vehicle 42% 34% 25%

Household where no-one worked 65% 24% 19%

Results• 50% male and 50% female, mean age of 49 (19 to 63)• Average time on IB was 9 years

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Former occupations of participants-by skill

Majority previously worked in semi skilled (32%) or unskilled (33%) jobs.

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IB cohort National

% Smokers 36% 21%

Weekly alcohol consumption (units)

Men 22 Men 17

Women 14 Women 9

Smoking and Drinking

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Primary health problems

• 50% Musculoskeletal as primary problem

• Mental health was the primary health issue for 24%

• 80% had seen a health professional in the 30 days prior to interview

• Co-morbidity: almost 60% had 3 health problems or more

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EQ5D EQ5D-VAS HADS-A HADS-D SF8-MCS SF8-PCS

Our Survey 41 46.45 10.54 8.85000000000001 36.9 33.2

UK Population Norm 86 82.48 6.14 3.68 52.1 50.9

5

15

25

35

45

55

65

75

85

Validated health measures

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Conclusions• Health of IB population much worse than general population• They have complex health and social needs – much more deprived and

living in poverty• Moved from deserving to undeserving• Previous policies have focused on improving the skills and

employability of the IB population, current work programmes have little by way of attention to health improvement

• Improving health and creating jobs are essential parts of moving people back to work – not reducing benefits, stigmatising and forced training.