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Factors Affecting Health
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Diet
According to the Scottish Health Survey 2010 "much of Scotland's poor health record can be attributed to its unhealthy eating habits...excess consumption of saturated fat, salt and sugar, and low consumption of fruit and vegetables are all risk factors associated with 1 or more of cardiovascular disease, cancer, hyptertension, type 2 diabetes and obesity."
Social class and diet
Fruit and vegetable consumption is higher among managerial and professional households. Consumption of fruit and vegetables decreases as household income decreases. Fruit and vegetable consumption is highest in the highest income quintile.
Scottish Health Survey 2008
There is also a significant link between household income and children's consumption of fruit and vegetables. As with income the link between fruit and vegetable consumption and the Scottish Index of Multiple Deprivation (SIMD) is evident.
Scottish Health Survey 2010
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Disadvantaged groups in society are more likely to eat more unhealthy food than others.
Look at 2.3.1 Socio-economic differences in diet in the Growing Up in Scotland report below:
Growing Up in Scotland 2009
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Intakes of Non-Milk Extrinsic Sugars (NMES) - sugars added to food and drink, table sugar and those present in fruit juices - were higher in those living in less affluent areas. More high sugar foods such as soft drinks are consumed in less affluent areas.
See chart 3.9 Percentage contribution of food groups to NMES by Scottish Index of Multiple Deprivation quintile in children in Scotland, 2006 for more details:
Food and Drink in Scotland: Key Facts 2010
However, children from all socio-economic backgrounds are suffering the effects of unhealthy diets. Some children have even been diagnosed with suffering from the 17th Century disease rickets, which is caused by low levels of vitamin D.
The Middle Class Myth of Heathly Eating
Poor not the only ones with poor diet
Middle class children suffering from rickets
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However, there does not appear to be a link between income and obesity in England.
Obesity is associated with chronic conditions such as type II diabetes, coronary heart disease and some cancers. Obese women are almost 13 times more likely to develop type II diabetes than non-obese women, whilst obese men are nearly 5 times more likely to develop the disease.
England
The groups with the lowest levels of obesity are poor men and rich women. While women in higher household income quintiles have lower levels than those in the poorest, this is reversed for men. Men in the richest fifth household income quintile have higher percentages of obesity than those in the poorest.
When looking at social class and obesity there is very little difference in the percentages of men from social classes I-IIINM and those from social classes IIIM-V who are obese. The differences are more pronounced between women of different social classes with about a 5 percentage point difference. However, there is no obvious link between social class and obesity. Figures can be found on The Poverty Site:
The Poverty Site - Obesity
Scotland
Using the Scottish Index of Multiple Deprivation, among women, higher levels of raised waist-hip ratio (WHR) and waist circumference (WC) - waist-based measures of obesity- are associated with increasing area deprivation. For example, the prevalence of raised WHR rose steadily and significantly from 36.0% in women living in the least deprived areas to 51.4% in those living in the most deprived areas. Similarly, the prevalence of raised WHR was 53.4% among women in the 15% most deprived areas compared with 39.3% of women in the rest of Scotland. Among men, those in the least deprived group were least likely to have raised WHR.
Table 7.8 Raised waist-hip ratio and raised waist circumference 2008/9 by Scottish Index of Multiple Deprivation and sex
Premature Death - The Poverty Site
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Child Obesity in Scotland
The prevalence of overweight and obesity did not vary significantly by socio-economic classification. Boys in the lowest income households were more likely to be obese than boys in all other income households. There was no clear pattern for girls.
Table 8.4 Children's body mass index (BMI), and prevalence of overweight and obesity in children 2008/09 by Socio-economic classification and sex
Area deprivation was significantly associated with obesity in children by the Scottish Index of Multiple Deprivation. Children in the most deprived quintile were more likely to be obese than those in the least.
Boys and girls in the most deprived 15% of areas had a higher prevalence of obesity, unhealthy weight and overweight including obesity than children in the rest of Scotland. However, while these findings follow the pattern that would be predicted, the differences are not statistically significant.
Table 8.6 Children's body mass index (BMI), and prevalence of overweight and obesity in children in 2008/09 by SIMD and sex
However, for both boys and girls, parental BMI was found to be significantly associated with child obesity. Children had significantly higher odds of being obese if they had a parent who was obese.
Gender and Diet
The diets of men tend to be poorer than those of women. For example, in 2008/09 men's diets exceeded the recommended percentage of total fat. For example, the total energy derived from total fats (35.5%) in men's diets exceeded recommended levels by 0.5% whereas the percentage for women was 34.7. Men also consume more saturated fat than women. Saturated fat makes up 13.0% of food energy in men's diets compared to only 12.6% for women.
Low consumption of fruit and vegetables is a risk factor for cardiovascular disease and other illnesses. The World Health Organisation (WHO) recommends eating at least 5 varied portions of fruit and vegetables a day. Men are less likely to eat the recommended daily intake of fruit and vegetables than women. For example, only 20% of males in Scotland in 2010 met the daily intake compared to 23% of women.
Smoking
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Cigarette smoke contains about 4000 different chemicals which damage the cells and systems of the human body. These include at least 80 chemicals that can cause cancer. From US studies, compared with nonsmokers smoking is estimated to increase the risk of men developing lung disease by more than 22 times and women developing lung cancer by 12 times. According to the World Health Organisation (WHO), cigarette smoking in adults causes heart disease and stroke.
Smoking and Social Class
Smoking kills regardless of class
Smoking Statistics by Socio-economic group
Smoking and Gender
According to the Scottish Health Survey 2010 smoking rates were almost identical between men (26%) and women (25%) although female smokers smoked fewer cigarettes per day than male smokers (13.1 compared to 14.8 respectively).
Physical Exercise
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The health benefits of a physically active lifestyle are well documented and there is abundant evidence that regular activity is related to a reduced incidence of chronic conditions such as cardiovascular disease, obesity and type 2 diabetes. Increased physical activity and the associated increases in physical fitness can reduce the risk of illness and premature death in overweight and obese people regardless of weight loss.
According to recommendations on physical activity adults aged 19-64 should engage in at least moderate activity for a minimum of 150 minutes a week. In 2010 39% of adults met the physical activity recommendations. The proportions of adults with low activity levels who took part in less than 30 minutes a week remained steady - 31% in 2010 and 2008 and 32% in 2009.
Physical Exercise and Social Class
Those living in the most deprived quintile were least likely to have met the activity recommendations (38% of men and 28% of women). However, among men there was no clear relationship between Scottish Index of Multiple Deprivation (SIMD) quintile and meeting the recommendations as the proportion was highest for those in the 3rd quintile (51%) and similar in the remaining quintiles (at between 44-46%). This absence of any significant social class gradient can be attributed to a number of factors such as relatively high levels of activity in manual occupations and the tendency for more deprived groups not to have access to cars, thus tend to walk more. For women, a clearer pattern was evident: at 39%, those in the least deprived quintile were the most likely to have met the recommendations, the proportions then dropped and levelled off in the middle quintiles to around 32% before dropping to 28% in the most deprived quintile. (Scotland, 2008)
Proportions of those meeting physical activity recommendations declined with lowering income. For example, 50% of men and 40% of women in the highest income quintile households met the recommendations compared with 35% of men and 28% of women in the lowest income quintile. (Scotland 2008)
Physical Exercise and Gender
Men are more likely than women to meet the physical activity recommendations every year. In 2010 45% of men and 33% of women met the recommendations.
Alcohol
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After smoking, drinking is the second biggest risk factor for cancers of the mouth and throat. People who develop cirrhosis of the liver - often caused by too much alcohol- can develop liver cancer. Women who drink more than 3 units a day increase their risk of breast cancer. Too much alcohol is likely to be a cause of heart disease and stroke. A 20 year study found Scottish men who drank more than 5 units a day were twice as likely to die from a stroke compared to non-drinkers.
Alcohol and Social Class
According to the Scottish Health Survey 2010, adults in more socio-economically disadvantaged groups tended to be more likely to be non-drinkers or ex-drinkers than their more advantaged counterparts, and were less likely to drink outwith the recommended limits. For example, 60% of men in the highest income households drank outwith the guidelines compared with 43-44% in the three lowest income groups. 46%-49% of women in the two highest income groups drank outwith the guidelines compared with 29% in the lowest income group.
Similar patterns were evident with area deprivation. For men, the prevalence of drinking outwith the guidelines was highest among those living in the least deprived areas (54%) and lowest in the most deprived areas (45%). The figures for the intervening quintiles ranged between 47% and 49%. Among women, 44% of those in the least deprived quintile drank outwith the guidelines compared with 34% in the two most deprived quintiles.
Women: the hidden risks of drinking
Wealthy Areas Head Alcohol Tables
Alcohol and Gender
Mean weekly alcohol consumption among adult males was 16.0 units and women mean weekly consumption was 7.6 units in Scotland in 2010. Twenty-two percent of men and 18% of women drank in excess of recommended weekly limits. Forty-three percent of men compared to 33% of women drank more than the recommended regular daily amount (4 units for men and 3 units for women) while 26% of men compared to 16% of women drank more than twice the recommended daily limit.
Gender
Women live longer than males. Based on statistics covering 2008-2010, life expectancy is 75.8 years for men compared to 80.4 years for women in Scotland. One advantage women have over men is they tend to develop cardiovascular disease (like heart attack and stroke) later than men. For example, in the age group 45-54, 2,739 men died of coronary heart disease in the UK in 2008 compared to only 590 females. In the age group 55-64 1,742 women died of coronary heart disease compared to 6,317 males.
Risk factors for coronary heart disease include smoking, poor diet, and being over-weight or obese. See above.
Factors Affecting Income and Wealth
Education
What will determine if they go to university? Their postcode
How much is your qualification worth? average wages compared
The UK's best paid jobs
Income
Income Inequalities - The Poverty Site
Unemployment
Middle classes hit hard by recession
Middle class unemployment nearly three times higher than last year
Download Jobseekers Allowance Claims by occupation
Ethnicity
Due to higher levels of unemployment and low pay, ethnic minorities suffer from income and wealth inequality. For example, the unemployment rate for Black and Asian workers rose from 10.2% in October-December 2007 to 13% in the same period in 2010, a figure nearly twice as high as Whites. The unemployment rate for young Blacks and Asians rose from 20.1% in 2007 to 30.5% in 2010 while the rate for young Whites is 16.4%.
Around two-fifths of people from ethnic minorities live in low-income households, twice the rate for Whites. There are big differences within this according to ethnic group. For example, 20% of Whites live in low-income households compared to 30% of Indians and Black Caribbeans, 50% of Black Africans, 60% of Pakistanis and 70% of Bangladeshis. Low pay is one factor which contributes to low incomes. Low pay is much more prevalent among most minority ethnic groups. For example, up to half of Bangladeshi workers, a third of Pakistanis and a quarter of black Africans were paid less than £6.50 per hour in 2006 compared with a fifth of the other ethnic groups.
As some ethnic groups are disproportionately represented in sectors where a high proportion of employees are low paid this can explain to some extent the reason why so many ethnic minorities suffer from low pay and subsequently from low income. For example, about 1/4 of employed Ethnic Minorities work in the 'Distribution, Hotel and Restaurant' industry sectors. Twenty-five percent of Pakistani men primarily work as taxi drivers in Britain.
A 2010 report by the Equality and Human Rights Commission (Is Britain Fair?) revealed Black and Asian groups earn less than White British people with the same qualification level. Also, Black male graduates earn 24% less than White British male graduates.
Furthermore, 60% of Black and Asian households do not have any savings. This compares to only 33% of White households that have no savings. In 2009 the average White household had £221,000 in assets compared to only £76,000 in Black Caribbean households, £21,000 in Bangladeshi households and £15,000 in African households.
Low income and ethnicity
Britons from ethnic minorities believe top professions closed to them
Half of young black people unemployed, says report
A bleak future for black and minority ethnic British workers says TUC conference
Download How_fair_is_britain_ch11
Download Assets, Equality and Ethnicity
Case Study - Social and Economic Inequalites and The Elderly
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Ageism
One social factor pressure groups and charities representing The Elderly frequently raise concern about is age discrimination. An Age Concern study, Still Hungry to be Heard, reports malnutrition affects people in later life more than anyone else. The report posits people are admitted to hospital with malnourishment and nothing is done about it or people become malnourished in hospital because they did not get food they could eat or they did not get help to eat the food provided. For example, malnutrition affects 23% of people under 65. However, this increases to 32% for those aged 65+. The difference is even more pronounced when looking at the 80+ age group. Those who are aged 80+ who are admitted to hospital are twice as likely to become malnourished as those under aged 50.
Download Age Concern Still Hungry To Be Heard
An investigation has found elderly patients are being condemned to an early death by hospitals making secret use of "do not resuscitate" orders. The orders record an advance decision that a patient's life should not be saved if their heart stops. The investigation found these orders are being routinely applied without the knowledge of the patient or their relatives. A charity for the elderly said this practice was 'euthanasia by the backdoor' with the notices being placed on the files of patients simply because they were old and frail.
Elderly patients are being condemned to an early death by hospitals
Sub-standard Housing
Another social factor where some elderly people experience inequality is housing. Nearly 1 in 3 of the oldest households in England (where the oldest person is aged 75+) live in housing which has failed the official decent homes standard. One in eight of those 75+ housholds live in housing which fail the decent homes standard because of sub-standard heating and insulation. Across Britain 10% of households headed by an individual aged 60-69 and 7% of households headed by an individual aged 70+ reported sub-standard housing (leaks, dampness, etc) in 2004-06. Those that live in poor housing face multiple knock on effects to their health and well being.
Ill Health
Ill health and death rates increase in the older population in cold weather. There is a strong relationship between poor insulatation and heating of houses, low indoor temperatures and excess winter deaths. While deaths from hypothermia are rare, cold weather and poor heating can contribute to the deaths caused by circulatory diseases and repiratory diseases. There were 24,430 excess winter deaths of people aged 65+ in the UK in 2010/11. The average daily excess winter deaths of people aged over 65 is 202 - that is over 8 per hour.
The proportion of people with a Limiting Long-term Illness (LLTI) or disability increases with age. Eleven per cent of men and 12% of women aged 16-24 reported a LLTI condition compared to 48% of men and 55% of women aged 75+.
Heart and circulatory diseases are the largest causes of mortality in adults over 65 in England and Wales. Nearly 21% of men aged 65-74 and 28% aged 75+ report ever having had ischemic heart disease. For women the figures are 10.0% and just over 19%. Elderly women and men have slightly higher obesity levels. Thirty-four percent of women aged 65+ are obese whereas only 28.1% of women aged 16-64 are reported as being obese. Thirty-one percent of men aged 65+ are classed as obese whereas only 26.6% of men aged 16-64 are. A large number of later in life men and women do not meet the recommended physical activity levels. Male proportions meeting the physical activity levels fell from 66% of those aged 16-24 to 10% aged 75+. Forty-five percent of women aged 35-44 met the recommended levels but this dropped off to only 7% of women aged 75 and over.
Poverty
Many elderly people suffer from economic inequalities. A large number of elderly people live below the poverty line. For example, according to Later Life UK 1.8m pensioners (16%) live below the poverty line (a weekly income of £124 for single pensioners and £214 for a couple). Of these, 1 million (8%) live in severe poverty (below the 50% median line). Eight percent of pensioners are in persistent poverty (below the poverty line for at least 3 out of the last 4 years in the UK).
Download Later_Life_UK_factsheet[1]
Fuel Poverty
Furthermore, figures for the UK in 2011 show 4.8 million people aged 60+ living in fuel poverty. Fuel poverty is defined as when a household needs to spend more than 10% of its income on fuel to maintain an adequate level of warmth and to meet its other energy needs, e.g. lighting and cooking. Thirty-six percent of people aged 60+ in Great Britain sometimes stay or live in just one heated room of their home to save money. People in later life in the UK are more likely to worry about the cost of heating in the winter than in comparable European countries. They are also more likely to turn off heating, wear outdoor clothing inside and go to bed early to save on heating costs. Read about the physical effects of the cold in the health inequalities section above.
Download Fuel Poverty - state of the nations 2011
Wealth Inequalities
Wealth is accumulated (and used througout the lifecycle) and age differences need to be seen in this context. The pattern of wealth and age is 'hump-shaped' as people accumulate wealth during the working years and draw on it in as they get older as pensioners. This notwithstanding, pensioners risk losing all their assets, including their homes under the current care home system. Pensioners must fund the cost of care themselves, unless they have less than £23,250 in assets including their homes. At least 20,000 people a year have to sell their house to pay for care.
20 000 a year sell homes to fund care
Twenty-eight per cent of pensioner couples have less than £1,500 in savings. For single male and single female pensioners the figure is 40. Over a quarter (26%) of single female pensioners have no savings at all. For single male pensioners it os 28% and for pensioner couples it is 17%.
However ...
It would appear the work place is becoming less ageist. There has been a trend of people leaving the workplace later. For men, the estimate of average age of withdrawal increased from 63.8 years in 2004 to 64.5 in 2009. For women, it increased from 61.2 years in 2004 to 62.0 years in 2009. Also, the unemployment rate for people aged 50+ is lower than the 16-24 age group. For example, 4.8% of people aged 50+ are unemployed compared to 22.3% in the 16-24 year group.
Almost a half (44%) of all retired households occupy dwellings with 2 or more bedrooms than is required. Whereas, female-headed households with children are more likely to reside in over-crowded or sub-standard housing.
By the time people enter later life they have accumulated wealth through years of income/saving and the purchase of property. For example, elderly people tend to have a higher than average wealth. The median wealth for Great Britain overall is £204,504. While the median wealth for 16-24 year olds is £12,900, £65,900 for those aged 25-34 years and £174,900 for 35-44 year olds, the median wealth for 55-64 year olds is £416,100 and £306,000 for 65-74 year olds.
Download How_fair_is_britain_ch12[1]
Women are much more likely to be low paid than men throughout their working lives. This often translates into lower income in retirement as well. Women, particularly those who have been lone parents, are susceptible to poverty in later life as they are less likely to have been able to build up savings and pensions. For example, 10% of male employees earn less than 60% of the median hourly wage compared to 17% of women in the UK.
Case Study - Early Childhood Education and Care
Download European Commission Communication on Early Childhood Education and Care
'Postcode lottery' over childcare in Scotland
The Principles of the Welfare State
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Following the creation of a welfare state in the 1940s UK citizens became entitled to a safety net from 'the cradle to the grave'. The problems of want, disease, ignorance, squalor and idleness (the 5 giants identfied by Beveridge) would be tackled through a system of social insurance and health care.
The idea of universalism is one of the founding principles of the Welfare State. The state would look after each individual from the 'cradle to the grave'. Should a person fall out of work, be sick, become old, or require housing then that citizen would have the right to state help.
The Welfare State would be funded through National Insurance Contributions from the working population. This was a form of social insurance, based on the same principle as car or home insurance. So long as there were more paying in than claiming out, the state could provide welfare services. Individuals who needed social security benefits would receive them as a matter of right because he or she would have contributed to the national insurance fund. The principle of flat-rate contributions underpinned the original concept of the Welfare State.
The Welfare State was based on collectivist principles. The collectivist approach means the state (the government, local authorities) - rather than the individual or the private sector - has responsibility for the welfare of its citizens. In contrast, individualists argue it is down to each person to look after their health and welfare, and that of their family. Individualists prefer private providers of services such as health and education. They believe competition between service providers saves money and is more efficient.
Are the founding principles of the Welfare State still being met?
The principle of universalism has come under threat. Instead of universal benefits there has been an expansion of means-tested benefits. A means test is where all the factors in an applicant's financial circumstance are taken into account when deciding whether a person qualifies for a benefit. For example, working and child tax credits are means-tested. They are awarded on an annual basis after an assessment of income with more benefit going to those on the lowest incomes.
However, under Labour tax credits were near universal benefits. They were targeted at all but the richest 10% of families with children. For example, in 2010, 5.7 million families with 10.1 million children between them received tax credits. The Labour government liked to call this 'progressive universalism'.
Another universal benefit which will end soon is child benefit. The Coalition Government will stop paying child benefit to everyone from January 2013. Child benefit was created in 1942 in recognition of the fact women (no matter what their social class) had little or no money to call their own when bringing up children. Beveridge thought it was an absolute necessity to provide women with a source of funds. Today, child benefit totals £20.30 a week for the first child then £13.40 for each subsequent child. Under the Coalition government's welfare reforms, child benefit will be phased out when someone in a household has an income of more than £50 000. The benefit will fall by 1% for every £100 earned over £50 000. Therefore, those earning more than £60 000 will lose the entirety of their benefit.
Facing a child benefits dilemma
However, the Coalition government plans to scrap the means-tested Pension Credit introduced by Labour. Pension Credit is a means-tested top-up scheme for over 60s on low-incomes. The Coalition government intends to introduce a flat-rate universal retirement pension worth around £140 a week. The universal flat-rate would benefit women and carers who are disadvantaged by the current system as many do not clock up enough national insurance contributions to qualify for the full state pension.
The contributory principle has also been undermined by changes made to benefits for those unable to work due to illness or disability. Incapacity Benefit took on an element of means-testing and was reformed when Labour was in government into a more work-focused benefit with rates and penalties designed to keep people looking for work. For example, the Employment and Support Allowance (ESA) requires individuals to undergo a Work Capability Assessment to show their illness/disability does limit their ability to work. They are required to take part in work-focused interviews with a personal adviser. Making ESA a discretionary payment the state will only pay after a series of means-tests is not consistent with the social insurance principle.
Furthermore, controversial Coalition government welfare reforms will time restrict the payment of contributory Employment and Support Allowance. Currently there are two types of ESA: contributions-based ESA and income-based ESA. Individuals who have paid enough National Insurance Contributions (NIC) qualify for contributions-based ESA. Those who have not paid enough NIC receive income-based ESA. This is means-tested and takes into account household income, pension, and any savings of £6000 or more. From October 2013 new claimants will only be able to receive contributory ESA for a maximum of 12 months. (Income-based ESA will be replaced by Universal Credit). Again, this is not consistent with the principle of social insurance.
However, the SNP government in Scotland has adopted a collectivist approach consistent with the original principles of the welfare state. Legislation has been introduced to ensure young people get access to healthy and nutritious food at school, encouraging healthy eating habits from a young age. Local authorities have been enabled to provide free school lunches to all P1-P3 pupils.
The introduction of a cap on benefits appears to conflict with the collectivist principle of the welfare state. The Welfare Reform Act 2012, introduced by the Coalition government, which received Royal Assent (was passed) on 8 March 2012 caps the total amount of benefit that can be claimed in a year. This means an individual is only entitled to state help providing it costs under £26 000 a year.
However, the abolition of prescription charges in Scotland is in-line with the collectivist approach, which has been pursued by the SNP government. The Scottish government has gradually reduced prescription fees from £6.85 per item in 2007 to £3 in 2010-11, and was free from April 2011. According to the SNP government, the policy has restored the NHS to its founding principles - healthcare that is free at the point of delivery and based on clinical need, not the ability to pay.
The Coalition government's controversial Health and Social Care Bill, which gained Royal Assent in March 2012, has been widely criticised and opened up the government to claims it is going to privatise the NHS. The reforms are more in tune with an individualist approach (preferring the involvement of the private sector in delivering services) rather than a collectivist one.
A concern is all hospitals will become Foundation Trusts further down the line. These will effectively be commerical bodies whose main objective will be to make a profit. At the moment, 3.5% of elective operations (such as hip and knee replacements) are done by the private sector. In other areas of health care, especially mental health, the role of other providers is much more pronounced. In total, £1 of every £20 spent in the NHS goes to a non-NHS provider. The reforms will expand this.
The reforms remove the cap on private patients being treated by NHS foundation hospitals. NHS foundation hospitals in England will be free to use almost half their hospital beds and theatre time for private patients. The worry is waiting lists will get longer if more capacity is used for private patients. If hospitals are in financial dificulty they may make up the deficit by taking on more private patients.This could lead to hospitals competing for patients from other areas, which may result in local hospitals shutting down. The treatment of chronic and complex conditions may be given a reduced priority as they are often more expensive.
However, there are no such plans to move towards privatisation of the Health Service in Scotland. Nicola Sturgeon, the Health Minister in Scotland, said "the NHS in Scotland will remain a public service, paid for by the public and accountable to the public. There will be no privatisation of the NHS in Scotland." Although, she is worried the Scottish Budget could be hit by the reforms. She argues if up to 49% of beds in each hospital in England are taken up by private patients, hospitals will get more of their money from private patients. This could lead the UK government to reduce the amount of public finance available for health, including in Scotland.
No privatisation of the NHS in Scotland says Sturgeon: 'not now, not ever'
To what extent have recent governments effectively met the health and welfare needs of UK citizens?
Income (Want)
Between 1998/99 and 2008/09 child poverty declined across the UK. Before housing costs, 26% of children in England and 28% of children in Scotland lived in relative poverty in 1998/99. A decade later this had reduced to 22% and 21% respectively. Support for families introduced by the Labour government in the form of tax credits contributed to the reduction in children living in poverty. For example, the child tax credit is paid on top of Child Benefit and to the main carer in the family. It is made up of a number of elements including a family element, a baby element, a child element and a disabled child element. Currently the family element is worth £545 per annum to families who qualify.
However, in 2009/10 the poverty rate for working age adults without dependent children has increased. Twenty percent of working age adults without dependent children are in poverty - this is the highest since 1997 and an increase of 5% in a decade. This group tends to be in deeper poverty than other population groups with more than half of working age adults without children who are in poverty having incomes below 40% of the median.
Health (Disease)
There has been a significant improvement in health in some areas since the Labour government launched its programme to tackle health inequalities following the Acheson Report. There has been an improvement in infant mortality rates. Infant mortality rates have reduced from 5.6 per 1000 births in 1995-1997 to 4.7 per 1000 births in 2005-07. The Labour government introduced improved access to ante-natal and post-natal care through creating more accessible primary care, for example, with walk-in centres and the expansion of Sure Start.
However, while health improved in some areas overall, the differences in health between different groups subbornly remained. Levels of infant mortality still vary according to social class. At 4.8 deaths per 1000 births, the rate of mortality was 1/3 higher among infants whose parents were from from manual occupational classes compared to 3.6 per 1000 deaths from non-manual classes. Overall, 1300 infant deaths were registered in non-manual classes and 1200 in manual classes in 2009.
Tackling Inequalities in Child Health Presentation
Education (Ignorance)
The introduction of Education Maintenance Allowance (EMA) has had a significant impact. This allowance helps young people aged 16-19 from low-income families stay on at school or attend college after compulsory education. In the academic year 2010-11, 34, 780 school pupils and college students received EMA payments in Scotland. Following the initial Scottish pilot and review in East Ayrshire, it was found participation rates increased by 7% overall but by 9% among young people from low income families. The SNP government in Scotland has decided to retain the EMA but the coalition government scrapped the scheme in England in January 2011.
However, despite a number of Scottish Government initiatives some groups of young people continue to under-achieve in education, such as Looked After Children. For example, the Education (Additional Support for Learning) (Scotland) Act 2004 began in 2005. Its aim was to create a stronger, better system for supporting children's learning, including looked after children. However, the average tariff score (for qualifications gained) for looked after children who left school during 2009/10 was only 67 compared to 372 for all school leavers.
Housing (Squalor)
The SNP government has introduced a number of schemes to help people get on the property ladder. One such scheme under the Low-cost Initiative for First Time Buyers (LIFT) is the New Supply Shared Equity (NSSE) scheme. It is aimed at helping people on low incomes who want to own their own home but who cannot afford to pay full price. Under a shared equity scheme the buyer pays for a majority share in the property (usually 60%-80%) and the Scottish Government pays the rest. Between 2005/06 and 2009/10 LIFT provided a total of 7,268 properties. Over this five year period around 16% of households housed through LIFT were local authority or registered social landlords (RSL) tenants, which freed up 1,130 homes for new lets.
However, the Scottish Government has been criticised for reducing funding for social housing. Housing charities condemned government plans to reduce spending in affordable housing by 50% over 2 years saying the government would be unable to meet its flagship manifesto commitment of 30,000 new socially rented homes over 5 years. As of October 2011 over 120,000 households across Scotland had been waiting on local authority housing lists for a year and over 81,000 of these had been stuck on waiting lists for over 2 years.
Employment (Idleness)
The introduction of the National Minimum Wage (NMW) was successful in getting people into work. Labour introduced the NMW in 1999; it is the hourly rate below which adult workers in most sectors of the British economy must not be paid. One of its aims was to improve incentives for people to actively seek paid work in the labour market thus improving employment levels. Since the introduction of the NMW employment has grown. Despite the recession employment was still much higher in September 2010 than in March 1999 prior to the introduction of the NMW. The number of employee jobs has increased by 1.1 million and the number of employees has risen by 1.4 million.
However, Labour's New Deal programmes for helping people into work were limited in their success. The New Deal programmes targeted different groups of people such as the New Deal for Young People and the New Deal 25-Plus. They provided employment subsidies and training grants for employers who took on previously unemployed people. Job seekers had to fulfil certain criteria, e.g. attend training, or their benefits were cut. In 2007, ten years after Labour was elected, youth unemployment was higher than when Labour was elected (up by 18,000) and higher still since the New Deal for Young People started (up 70,000).
Who should be responsible for health and welfare provision?
Collectivists argue the state should be responsible for the health and welfare of its citizens. The creation of a welfare state is a way in which the state can provide a guaranteed minimum standard of life and insurance against the hazards of poverty, illness and social deprivation. For example, the welfare state in Britain was based on the principles of universalism with flat-rate contributions giving 'cradle-to-the-grave' coverage. Collectivists stress the importance of fairness and equality in society.
Individualists argue it is down to each person to look after their health and welfare, and that of their family. Individualists prefer private providers of services such as health and education. They believe competition between service providers saves money and is more efficient. Individualists stress the importance of self-reliance and the need to avoid a 'dependency culture'.
Whilst a collectivist approach to health and welfare provision would be more closely associated with a socialist/social democratic party and a more right-wing/right-of-centre party with the individualistic approach, Britain's Welfare State has remained intact regardless of whether it has been a Labour government or a Conservative government in power. A raft of benefits and services are still provided on a collectivist basis such as the NHS, Statutory Maternity Pay, Statutory Paternity Pay and Statutory Sick Pay.
The Labour government (1997-2010) did reform the welfare state pursuing a 'third way' approach to the provision of health and welfare. In 2005 David Blunkett, the then Labour government's Work and Pensions Secretary said " ... The welfare state of the 21st Century ... [It] must embody the mutual acceptance of self responsibility and the acceptance of responsibility for the well-being of others..."
David Blunkett on the welfare state
The 'third way' approach to health and welfare meant individuals had to take responsibility to help themselves or lose out on help from the government. It was a 'tough love' approach adopted from America. Individuals would no longer be able to access certain benefits without giving something in return. For example, Labour's 'Welfare-to-Work' programme gave further support to people to get back into work, for example, training and work experience, but if they failed to accept the help or to actively seek work their benefits were cut.
However, the coalition government has radically reformed the welfare state placing even greater responsibility on the individual to look after themselves financially. Changes made under the Welfare Reform Act 2012 will mean even if people are in work they will have to try to increase their earnings and/or their hours until they move off benefits altogether (35 hours a week on the National Minimum Wage). Claimants will be required to regularly demonstrate the actions they have taken to improve their prospects of moving into better paid work or face a sliding scale of cuts to their benefit.
When in power the Labour government played a key role in protecting children from the worst excesses of poverty. It retained Child Benefit as a universal benefit and introduced tax credits - which were near universal. for example, the family element of Child Tax Credit was not withdrawn until the annual family pre-tax income exceeded £50,000.
However, the coalition government is further reducing universal benefits in favour of means-tested ones and decreasing the income levels at which certain benefits can be accessed. This will increase the onus on parents to support their families without government assistance. Child benefit will cease to be a universal benefit from January 2013. Also, the income limit to qualify for child tax credit is being cut. Child tax credits will be removed from any family with one child who earn more than £26,000 - down from the current £40,000 level.
David Cameron's 'Big Society' emphasises the role of individuals and communities in mending 'Broken Britain'. Cameron believes Britain needs people to take more responsibility and government action can only ever be part of the answer to solving society's problems. The 'Big Society' is the government's vision of a society where individuals and communities have more power and responsibility and use it to create better neighbourhoods and local services. Labour leader, Ed Miliband, has said Cameron is undermining the concept of the Big Society due to spending cuts. Various charity figures have suggested the scale of local authority cuts could kill off the idea before it gets started - by destroying existing voluntary groups.
Big Society is my mission, says David Cameron
However, the SNP government in Scotland has used a collectivist approach to help tackle social and economic problems north of the border. The introduction of free school lunches for P1-P3 and the abolition of prescription charges demonstrates the SNP (which is a social democratic party) still believes the state has a key role to play in the provision of health and welfare services.
Overall, the major political parties and most UK citizens believe in a mix of collectivism and individualism - that health and welfare provision is the responsibility of both the government and the individual. However, the balance between what the state should do and what should be left to the individual is likely to vary depending on the party in power.