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Reduce poverty, protect the NHS, improve lives

In this blog, Chris Birt explores how the cost of living crisis is impacting on people’s physical and mental health and how that is piling pressure on the already struggling Scottish NHS.

Written by:
Chris Birt
Date published:

We know that poverty does not just mean a shortage of money, it has long lasting impacts on people’s health; both physical and mental. And that plays out in the shocking disparity between the healthy life expectancy of someone born in one of our wealthiest communities and someone born in our poorest – 25 years. For women, that means if you are born in a wealthy community you can expect around 72 years of healthy life vs 47 in our poorest communities. To have that 25 years of good quality of life snatched away from so many people is a gross failure of our society.

Is it any wonder that our NHS is under pressure where people in our least well-off communities face health problems from such a young age?

The cost of living crisis has also come along and added to the pressure on our people and public services. In Poverty in Scotland 2022 we detailed how the rising cost of living had degraded people’s physical and mental health so in our latest survey we sought to understand:

  1. Whether there had been any change over the winter;
  2. Which elements of the current crisis were causing the most concern; and
  3. Whether this had driven demand on already under pressure NHS services.

This underlines just how important it is that the Scottish Government’s poverty reduction ambitions are met. You can reform NHS services as much as you want but if you fail to drive down demand through reducing poverty you are tying one hand behind your back.

Fortunately, things like the Scottish Child Payment are starting to help and the Scottish Government’s commitment to introducing a Minimum Income Guarantee can start to build greater security for households and reduce that demand. The UK Government also have an important tool at their disposal via the Universal Credit system, where our Essentials Guarantee would, again, provide the security which far too many people lack.

Mental ill-health and the rising cost of living go hand-in-hand

While around half of all people have noted a somewhat or very negative impact on their mental health from the cost of living crisis (a similar proportion to last year), for families on low incomes this is even higher – i.e. 7 in 10, which is a jump of 10 percentage points since last year. For families with children, the situation is even worse, and has gotten worse. In particular for single parent and large families with 8 in 10 now reporting that they have experienced a somewhat or very negative impact on their mental health due to rising costs (up from 7 in 10 and 6 in 10 respectively).

To help us understand this more, we also asked people who reported their mental health had been negatively affected what factors contributed to that. The key aspects were uncertainty about when things will improve, worrying about their long-term future and wages not keeping up with price rises. However, we found that for people who had experienced a negative impact on their mental health in low income and very financially insecure households worrying about affording the essentials is the top reason given. Compared to all people who have seen a negative impact on their mental health they were also much more likely to give other reasons for negative impact on their mental health, such as being unable to meet children’s needs and isolation from friends and family.

It’s not just mental health, the cost of living crisis is worsening physical health too

Again the impact on the whole population is striking, with around a third of people still reporting that their physical health has declined somewhat during the crisis. There are also households whose physical health is more likely to have been impacted – such as families with children, especially around a half of larger families and families with children where someone is disabled. But it is single parent households that again stand out. Single parents experienced multiple shocks during the Covid-19 pandemic as childcare facilities and schools closed, making access to work even harder. And they have also borne the brunt of this crisis, nearly two thirds of single parents (63%) reported a somewhat or very negative impact on their physical health – a sizable jump from the around half we saw in our previous survey.

This crisis has forced people to reduce and cut back on the very essentials and it is not surprising that this has serious knock-on effects to people’s health. For example, 7 in 10 people who had accessed a foodbank or who had skipped or cut down the size of meals to make ends meet reported a negative impact on their physical health due to the crisis.

Once again the NHS is having to pick up the slack for government failures elsewhere

In light of the huge wave in mental and physical ill-health caused by the cost of living crisis we sought to understand what impact this might have on demand for NHS services. Our findings are sobering and concerning.

We asked people who had reported any negative impact on their physical or mental health2 which services they had sought to use. As might be expected, the bulk of the additional demand has fallen on GPs with nearly 3 in 10 people whose health had deteriorated seeking support from their GP for either their physical and/or mental health. Just less than 1 in 10 people had accessed hospital services (either A&E or other services) for their physical health and over 1 in 20 had accessed acute mental health services (either within hospital or community settings). Once again, the Scottish Government’s “priority families” show higher rates of necessity for NHS services, such as families with 3 or more children (9 in 20) or families with children where someone is disabled (nearly 1 in 2).

Clearly that is putting additional pressure on NHS services that are already facing extreme pressure caused by a mix of the Covid-19 pandemic, acute workforce shortage and continuing demographic changes. On top of that, however, 12% of people whose mental or physical health has been negatively impacted by the crisis were put off accessing NHS services because of warnings of long waiting times and/or pressure on the NHS and 8% wanted to access a service but they weren’t eligible, couldn’t get an appointment or the service wasn’t available in their area. As a result, 1 in 6 people who have seen a decline in their physical or mental health because of the crisis have an unmet health need – potentially storing up problems for them, and the NHS, for the future. Once more the figures are even more concerning for families who are most at risk of poverty. One in four single parent families and parents of families where someone is disabled, who reported a negative health effect of the Cost of Living crisis, have wanted to access a service but have been unable to or were put off accessing services due to warnings of long waiting times and/or pressure on the NHS. Highlighting the additional barriers that single parents often face (such as lack of childcare and transport options) in accessing services.

An avoidable crisis with long-term impacts that must not be repeated

The cost of living crisis, as highlighted by both Poverty in Scotland 2022 and our recent update on the winter, has unleashed a wave of hardship over Scotland. The Government support available may have stopped things being even worse but it is hard to conclude anything other than that both the UK and Scottish Governments have failed in their responsibilities to protect people from this crisis.

But those failures have not just been made in the last few months. As we highlighted in our recent report on very deep poverty, the conditions which have made this spike in inflation a crisis have had a long period of gestation. The withering of social security support for single people and disabled people in particular has exposed people to destitution in a way that is completely unacceptable in a society as wealthy as our own.

More recent decisions, such as the imposition of the two-child cap, have put larger families at high risk of poverty and single parents have borne the brunt of policies such as the benefit cap.

But the UK Government has a large part of the solution at its fingertips. The Universal Credit system is inadequate to meet even the basic needs of most households and by providing our Essentials Guarantee the UK Government could ensure that all those in receipt of Universal Credit can at least affords life’s essentials.

The Scottish Government also has a massive role to play. By meeting the legally binding child poverty reduction targets, not only would the lives of those children be improved but we could chip away at the awful health inequalities that exist in our society. Neither individuals, nor parents, nor the NHS, nor our economy can expect to flourish while poverty is so high.

The new First Minister has asked to be judged on his record of reducing poverty and clearly we welcome this. As the first part of that he needs to raise the Scottish Child Payment to meet the interim child poverty targets, recommit to a Minimum Income Guarantee and re-energise the national mission to reduce child poverty with a particular focus on how childcare, housing, employment support and a fairer economy.