Thea Joshi hears from Ed Davie, Policy & Public Affairs Lead, about the cost-of-living crisis and the toxic impact poverty has on mental health. He shares some of the evidence on the links between poverty and poor mental health, and on the rising levels of poverty we’re facing in the UK. Ed highlights the tangible actions Government should take to address poverty, as well as what we can do at a local level.
Listen to the episode on Spotify or Apple Podcasts. The full transcript is available below.
Show notes
- Read our briefing on poverty, inequality and mental health
- Check out our report which shows the mental health inequality between children from the poorest and wealthiest homes
- Learn more about the impact of inequality on mental health
- Our jargon-busting guide to Integrated Care Systems
- Our briefing on building mentally healthier Integrated Care Systems
- If you’re struggling with finances and your mental health , you might want to check out Mental Health and Money Advice or Citizens Advice
- If you need support with your mental health, we have a list of helplines and sources of support
Music by scottholmesmusic.com
Transcript
Alethea Joshi (AJ): I’m here today with Ed Davie, who is our Policy and Public Affairs lead at the Centre. Welcome, Ed.
Ed Davie (ED): Thanks very much. Hi!
AJ: We want to focus today on the cost of living crisis. A key part of our work at the Centre is highlighting those links between poverty, inequality and discrimination and the impact they have on mental health. So I really wanted to get you on today, to dive a bit deeper into this. So obviously, we’re all too aware at the moment that we are experiencing a cost of living crisis in the UK, with both really high energy prices, but also food and other essential costs rising really rapidly. And we know that it’s having a huge knock on effect on people’s lives and on their wellbeing. I just wondered if you could set that in a bit of context for us?
ED: Yeah, sure. I mean, obviously, as you’ve pointed out, there is this acute issue at the moment around the cost of living crisis. But for many millions of people in the UK, unfortunately, this is nothing new. And that everyday has been a cost of living crisis for a long time, many years, because of very high rates of poverty. There are different ways of measuring or recording poverty, which is a bit confusing, but the Government tends to like using absolute poverty, which means that you lack financial resources, to such an extent, that you lack the kind of the basics of everyday life; food hygiene, a warm, safe home. And there are very high levels of absolute poverty and there have been for a considerable number of years.
But there’s also a measure called relative poverty, which is where a household has less than 60% of the average income, which I personally and a lot of experts think is a better measure, because not only is not having enough financial resources in itself important and of course that is, but it’s also having less than your peers, less than your neighbours. So if you have less than 60% of the average, that in itself, that inequality has an impact on your health and your confidence and how you view yourself and are seen in your community, which is really important, as well. So this has been going on for a long time, for a lot of families and individuals. Obviously, it’s become worse recently, because of inflation, the high costs of goods like fuel, heating, and food, and clothing and everything else, the basics of life often for people. So this has become a problem for a larger group of people.
But unfortunately, it’s something that’s been around to some extent, forever, in a way, it has had periods where it’s less bad and at the moment, we’re in a period where it is worse for those reasons.
AJ: Thank you, that’s super helpful context. And to kind of be reminded that this is this is actually not a new phenomenon for the people who are feeling it the most. I wonder if you could kind of give us a little bit of the data on that in terms of the numbers that we’re looking at?
ED: Yes. So currently, about 11 million people in the UK, live in absolute poverty. So as I say, that’s experiencing a situation where you don’t have enough money even for the basics of a decent home, food, heating, clothing and hygiene products. So the population is of the UK 60 million. So obviously, that’s one one in six people currently living in absolute poverty. And unfortunately, economic experts predict this is going to rise to 14 million by the year 2023-24. So that’s about 21%, so that’s over one in five people. Unfortunately, this is even worse for children, and a third of children will be living in absolute poverty by 2023-24. So if you think about a classroom of 30 children, 10 of those children will be in absolute poverty, living in conditions where their families are unable to afford even the basics of life in a decent manner. And as I say, there’s a different measure, which I think is important, which is relative poverty, which will encompass many more numbers than that.
So as I say, absolute poverty, one in three children, relative poverty, nearly half of children will live in relative poverty, which is absolutely shocking. And the important thing is that obviously, that’s terrible in itself. But we are a mental health charity. So what does it mean for mental health? We know from our research and others, that poverty is absolutely terrible. It’s toxic for people’s mental health and wellbeing, especially for children. So you can understand why the most basic thing is that you can’t afford the things that keep people mentally and physically healthy like a healthy diet. So the NHS recommended diet costs over 75% of the disposable income of the poorest fifth. So that’s unaffordable to buy, you know, fruit, vegetables and all the rest of it that people need to stay healthy physically and mentally. Warm homes are really important for people’s physical and mental health. If you are cold all the time, that’s detrimental to your health. If you live in poverty, you might be in a difficult insecure housing situation where you’re having to move all the time. So you’re breaking your community ties and your support networks around you. Lots of people are living in inadequate housing with damp, not enough room to do their homework, to study, to sleep well. All of this has a knock on effect. And if you’re living in really crowded, unsafe conditions at home, it has an impact on domestic violence, and community violence, which also has an impact on you. And you’re less likely to be able to afford things like you know, gym memberships, and all of that.
And then you know, the worst thing for me is the research we’ve recently done on the effects of poverty, financial inequality, and mental health is that a very large study in Scotland, which backs up other existing evidence showed that children in the poorest fifth of communities are 12 times more likely to experience three or more adverse childhood events. So adverse childhood events are things like sexual, physical, emotional abuse, neglect, having a parent with a drug or alcohol problem, or serious mental illness, or experiencing bullying or being bereaved. All of those things are categorised as an adverse childhood event or ace in the jargon. And as I say, if you are a child in the poorest fifth of the community, you’re 12 times more likely to experience three or more adverse childhood events by the time you’re eight years old, which is awful in itself. But also, we know that experiencing multiple adverse childhood events like that is really terrible for your mental health and massively increases your risk of depression, psychosis, suicide, becoming an intravenous drug user. Every terrible outcome there is, is worsened by experiencing adverse childhood events, which as I say, are worsened by experiencing child poverty. And that’s not only terrible for those children, obviously, most importantly, and their families and communities, but that has massive knock on effects for the whole of our society.
Because those children are less likely to do well in school, they’re more likely to become offenders, they’re more likely to end up in hospital and prison, and on benefits. So there’s an enormous financial as well as moral costs of the whole of society, by not supporting these children, to have access to the resources, they need to live a safe and happy childhood that enables them to develop into safe, happy and healthy adults who, which is important in itself morally, but also, because sometimes you have to make the economic as well as the moral case for investment in this area.
AJ: Yeah. And I think, you know, just to kind of speak to what you were saying initially about child poverty, we have to just highlight that to be living in one of the richest countries in the world. And having a third of children living in absolute poverty is an absolute outrage. You know, and this is where we talk about when we’re talking about social justice, this is what we mean that we believe it is absolutely unacceptable, that that should be the case in 2022, in the UK. This is not okay. And that, as you’ve said, leading on from that, you know, we know you mentioned the data in Scotland, we know from our own research that children growing up in the poorest 20% of households are four times more likely to have a mental health difficulty than those growing up in the wealthiest 80% of households. You know, this is unacceptable. And obviously, we do a lot of work around children’s mental health, which is really critical for all children. But this has to be a part of the conversation that we’re having when we’re talking about the mental health of children. Because if you’ve got a third of a classroom, facing absolute poverty, then before we can talk about anything else, we have to talk about the fact that they may not be going home to warm houses, getting enough food to grow and develop, and you know, having basics like, you know, shoes and clothes that fit. I mean, this has to be part of our conversation about children’s mental health. So, thank you for highlighting that. You mentioned obviously, there about our recent briefing, which focuses on poverty and inequality. And I’m wondering if you could just tell us a little bit more about what we were focusing on there.
ED: Yeah, so the policy briefing is a kind of, you know, what they jargon they call it like a literature review, looking at all the best scientific evidence around and bring it all together in one short and hopefully readable and accessible document with lots of nice graphics that illustrate the points we’re trying to make. And it’s fascinating and a bit depressing, but important that we know what the issues are in order to come up with solutions. And there are suggested solutions in the policy briefing based on what’s happened elsewhere in the world and in this country in terms of making intervention. So as I say, you can very clearly make the link between especially childhood poverty, traumatic experiences that are made more likely, and then poor mental health and other outcomes later in life is very clear. The posh public health word is aetiology, between the kind of causation, the poverty, and how that turns into a disease or set of symptoms, in this case, mental illness, it’s very, very, very clear link, absolutely solid. And the interesting thing is, if you’re thinking about inequalities, these these disadvantages around poverty do not fall equally across the community.
So, whilst it’s absolutely true, that white British people can and do experience poverty, and it’s important that it’s acknowledged, and we do something about it, it is more likely that certain racialised groups like Black Caribbeans, for example, or British people of Bangladeshi heritage, are much more likely to live in poverty through no fault of their own because of structural racism and historic reasons. And that in itself, as well as experiencing racism directly, which we know is really bad for people’s mental health. But that combination of experiencing discrimination directly and its effects on your income and wealth levels, has this amplifying effect, making mental health outcomes. One of the reasons that mental health outcomes are poor in say, the Black Caribbean community in this country is because of that we call it intersectionality, where different disadvantages intersect with each other. So it’s kind of important to hold that in your head as well. And the other thing that you find in that policy briefing, which is not new, but it’s bringing together the evidence again, is how health outcomes deteriorate, not just mental health outcomes, by the way, but every single health outcome that we are aware of, except one, which is sports injuries, which goes the other way round.
All the health outcomes bar sports injuries, like suicide, sections under the Mental Health Act, depression rates, psychosis, all the rest of it, there’s a gradient. So the wealthiest 10% of the population will experience the smallest amount of any poor health outcome, then the next 10% will experience a slightly higher level, and on and on it goes deteriorating all the way down the wealth or the deprivation level until the most deprived 10% of the community experiences the worst health outcomes in every health outcome, except sports injuries. And that’s, that’s interesting, because not only does it tell us that being poor in a society is really bad for you for the reasons that that we’ve discussed, and it is in the policy briefing. But also, this gradient means that it’s important to try to shift the inequality so not only do we want to increase the incomes and reduce the costs of the poorest, that’s really important, but we also need to equalise it across the gradient where we can.
So Michael Marmot, who is a famous epidemiologist, who runs the Whitehall studies, which are a famous study done since the 1960s, where they’ve tracked the health of British Civil Servants across the civil service grades. So you can see very clearly, everyone from doorkeepers and cleaners in the Civil Service up to mandarins, who run Government Departments. And what that told us was that health outcomes, like I say, worsen on your status and your income. And therefore what he talks about is social transfers, he calls it, which basically means taxing wealth, and the wealthiest, a bit more to a reasonable degree, and increasing the incomes of the poorest through increasing the minimum wage, and increasing things like tax credits, and social security payments. So that the rich get a little bit less rich, they’re still very comfortably off, and the poorest get less poor. And then you flatten the gradient, and even rich people do better in a more equal society because even wealthy people they don’t want to walk out on the on the broken pavement, with homeless people sleeping on the pavement and rubbish strewn everywhere because their local council has no money. That doesn’t suit anybody, that’s not good for anybody. All people, including wealthier people benefit from living in a more economically, equal society. And that’s what Michael Marmot and other experts suggest is the solution. There are policy solutions to these problems. And, we’re not taking them and I’ll give you just another couple of examples. There’s been a good study done that found that for every $1 extra of the minimum wage that a US state pays, which works out depending on the state about 8%. So an 8% increase in the minimum wage, there abouts, decreases the suicide rate in that state by over 5%. Right. So an extra dollar an hour, minimum wage, decreases the suicide rate by 5%. That’s certainly the correlation. The equivalent of that, in England alone would be hundreds of lives saved by increasing people on the lowest income when they’re in work. So they’re doing the right thing, they’re gonna work, but at the moment, they’ve been paid poverty wages, if we increase the minimum wage, we will improve people’s mental health to such an extent that we would save hundreds of lives in England alone, among other benefits, if that study is true. And there are lots of other studies that I could talk about.
One of my favourite studies is the “Great Smoky Mountain” cohort study, with a group of children in North Carolina. About 20% of them were Native American children living on Native American reserved land. At about the age of eight, a casino was set up on the Native American land, which gave an increase in income to the Native American families of about 15%. It lifted a large group of these children out of poverty, because their incomes increased. And their psychiatric assessment scores which were being done every year anyway, as part of the cohort. So they massively improved. And they massively improved, over and above, the non Native-American families who didn’t get the increase in income. So it’s a natural experiment where we can see very clearly that that quite modest improvement in income for families, massively improved psychiatric assessment scores. So again, more evidence that if we took the policy decision to increase the incomes of the poorest, we would benefit large numbers of people’s health and mental health, especially children, we would create a more equal society, especially if it was funded from a social transfer from the wealthiest, which would have very profound health and social benefits for the whole community, and not just the poorest.
AJ: So you talked there about the policy actions that can be taken. Obviously, you’ve mentioned some there. But I guess, speaking into this current situation, with the cost of living and thinking of the briefing that we did, I mean, could you talk us through a few of the actions that we highlighted that would make a real, tangible difference to the incomes and the situations of the poorest in our country?
ED: Yeah, I mean, on one level, the solution is quite straight forward, right? You, you increase the incomes of the poorest, and you reduce, especially the poorest, everybody would be good, but, you increase the incomes and you reduce costs. Now, that sounds simple, obviously, it’s more complicated in execution, but it doesn’t necessarily have to be so. So increasing incomes, let’s look at that. The obvious one is the minimum wage, right? Everybody wants, good work is good for nearly everybody. And we’re at a point in this country where we’re nearly at zero unemployment. So a lot of people are in work. But there’s a growing group of economically inactive people who are, are not well, either physically, like long COVID is a thing and mentally, as well. But a lot of these people with the right support, and Centre for Mental Health has an excellent IPS supported employment scheme. For example, to name one. With the right support, many of these people could get back into training and into work, into the right work where they were treated decently and paid well. But we do need an increase in the minimum wage. The Living Wage foundation every year calculates the minimum that should be required to live a decent life that increases every year, depending on inflation. And you know, many experts argue that the National Minimum Wage should actually be the Living Wage Foundation Wage, at least. So that’s a relatively straightforward thing to do. It does have costs for employers. But one could easily argue that there’s no reason why the taxpayer should be subsidising big business and other employees to pay people poverty wages that then the taxpayer has to sort out through housing benefit and tax credits and all the rest of it. Why should we, for example, be paying BP, who just recorded multibillion pound excess profits for the quarter, why should we be paying them to pay below a decent wage to people who work in their petrol forecourts for example. And then the taxpayer picks up the tab for the gap through having to pay tax credits and housing benefits. So I think it’s unjustifiable, right? So we could increase people’s incomes like that.
We could make sure that our social security system is fair. For example, at the moment, there’s a two child cap on child benefit. So, you get paid some child benefit for Child 1 and Child 2, if you have the temerity to have a third child, you get you get nothing, you get no child benefit for that third or subsequent child. Which, you know, obviously, has an effect impoverishing people and people from some racialised communities who often might have larger size families, so it discriminates against them on that basis. And it discriminates against children just for being born in slightly larger families. There’s also a cap on the total amount of benefits that families can receive. And this discriminates against, particularly London families where housing costs are higher. But it is a flat cap across the whole country, so if you happen to live in London, you will be discriminated against that. So we need a better minimum wage, we need a better social security system that doesn’t discriminate against people. So that’s that’s the increasing income bit. And then reducing costs is things like, I, for example, because I’m relatively well off, invested money on solar panels on our roof, and insulation and double glazing a few years ago, and now my energy bill is frankly, even in a household of five people, is actually smaller than it’s ever been, despite the rising costs, because I was I was in a position to be able to invest in those measures. And I took advantage of when there was a subsidy, a feed in tariff from the Government that encouraged things like solar panels. Now, if we helped families that couldn’t afford insulation, and domestic solar production, for example, to take advantage of those schemes, we would massively reduce people’s energy bills. And it would reduce pollution, and it will reduce our reliance on Saudi-Arabian and Russia and oil and gas, for example. And these are all things that we need to do anyway, if we’re serious about tackling climate change, but it will have the bonus of reducing costs for families, reducing demand for energy. And again, investing in renewables more generally, like there’s virtually a ban on onshore wind, for example, which is 10 times cheaper than oil and gas. But one person, only one single person can put in an objection to a planning application for a wind turbine, and it will not go through. So it’s a virtual ban on the cheapest and cleanest form of energy that we have. If we invested in things like that, removed those kinds of barriers, we would reduce costs to families.
We need to build more social housing, housing is a huge, huge problem for people, it’s the biggest cost that they have usually, in their lives. We don’t have enough supply. If you sort out people’s housing situation, then many of their other problems are minimised. You need a stable home, to get a decent education, you need a decent home to be able to do your homework and to work and you know, it has many other benefits. Free childcare is another huge problem in this country, that would be a way of reducing people’s costs and supporting them to have better outcomes, especially in childhood. So there’s loads and loads of things that you can do. Finland, they have a housing-first response to homelessness, they’ve massively reduced homelessness, where if someone presents homeless, they’re automatically given a small, modest, decent little home, and they’re given counselling for what other problems they may have. And 80% of people are still in stable housing after a decent period of time. So, there are policy responses, there are solutions to these problems. We just need to actively choose to take them.
AJ: Yeah, and thank you for flagging up about housing first, because it’s an area that we have also produced work in and very much supported. And that there is, as you say, there is evidence that it can have a really transformative impact on people’s lives. And also for flagging up the the links here with climate change. And I think quite often we think of mental health and climate change and poverty as quite separate things, different kinds of causes. But actually, we know how interrelated they are. We know the unequal impact of climate change on the poorest households, both in the UK and especially globally. And it’s something that we will be sharing more on in coming months. But I guess I’m conscious, as you said earlier, that the picture is quite bleak. I think it’s good, where our own mental health allows that we don’t look away from this. But yeah, it is, it’s a tricky situation. It’s not a cheery story. And I guess, when we’re talking about what needs to be done, at a large level, it’s easier to feel powerless. And so I guess I just wondered if you could maybe highlight a few of the things that you know, maybe the things we can be doing at an individual or local level, that can be mitigating some of the impact of what we’re seeing at the moment with cost of living.
ED: Sure, well, yeah. No the worst thing in any of these challenges is to think that they’re hopeless, and there’s nothing that can be done. Because if we give up on trying to sort out our environmental challenges, or our social challenges, like the one we’re talking about, then they definitely will get worse, there’s no doubt about that. But if we take action individually, and in our communities, and at a national and international level, all of these things are perfectly solvable. As I say, there’s plenty of policy solutions out there, that would make a very significant improvement in all of these things. So we should inform ourselves, you know, people listening to the podcast or reading the briefing are doing that – Well done. Excellent work! And once we know what the problem is, and what the solutions are, then we can lobby our members of parliament and our counsellors and other people in positions of power, you know, to make changes. So apart from national Government, which is really important, and it has a lot of the tools, there are other levels of being able to intervene and do things. So there’s these new statutory (since July) integrated care systems. 42 across England, where it brings together National Health Service institutions, Local Government and others to make decisions about health and social care, and related stuff in an area. They have integrated care partnerships and integrated care boards, sorry, there’s loads of jargon in this world. But there are a means by which local people, local residents, and patients and constituents can kind of voice their concerns. And I would urge people to, you know, have a look at the map see what their integrated care services, what their local authority is, and see there will be mechanisms where you can influence the decision making.
AJ: And I should say, on that point, that we do have a really helpful jargon busting guide to integrated care boards and the like, which I will link to.
ED: Yes! And we also have a great policy briefing on mentally healthier integrated care systems, which has some really nice evidence based tips on what integrated care systems can do to deal with poverty, among other things to improve health. So for example, you know, those integrated care systems, NHS Trusts and local authorities can get living wage foundation accreditation, stop paying their cleaners and security guards and caterers and all the rest of it poverty wages, a really important thing to do. So if you work for those organisations or if you live in one, if you’re in England, then you know that’s one simple policy that you can advocate for.
Also, using another bit of jargon, I’m afraid. Social value procurement for these large institutions, which basically just means buying and hiring more stuff and people locally. So I’ll give you one example in my neighbourhood, the local Mental Health Trust, South London and Maudsley, supports a social enterprise called Recover, which is a painting and decorating organisation, staffed by mental health service users who are recovering from illnesses, and they’re trained on how to do painting and decorating. And then the local authority hires that social enterprise to paint and decorate its buildings like the dementia care centre around the corner from me. So, the council gets a service from these painters and decorators, the people who work for the service get paid a decent wage, they’re with their peers, it’s aiding their recovery, and hopefully, they’ll get better and be less reliant on expensive public services. So everybody is a winner. I think if more institutions like the NHS and local authorities and Universities and others, they call them anchor institutions, because they can’t move very easily. They’re rooted in their communities. If more institutions like that, took that kind of approach, to hire and buy locally, we’d see real progress. And there are, you know, massive vacancies of job roles in the NHS and local authorities. Now, obviously, you’re not going to fill every single one with vulnerable people in your community. But I’m sure we’ve more job flexibility, better support for people into these roles, better training, and a more creative approach to using public money in this sort of way, we could get many more vulnerable people into decent work, lifting them out of poverty, giving them purpose and dignity. And, you know, that’s that’s what all of us should be doing, not just treating people when they become unwell. But using that economic weight to improve the circumstances of people’s lives, which makes it much less likely that they become patients and if they do become patients that they recover better. So you know, people should and can advocate for those approaches in their local communities. And then there are other smaller things that are equally important.
You know, like, in the environmental movement, they say “think globally, act locally”. And the same is true of any other social issue or problem. So my mum, for example, is in a financial position where she can donate quite a decent bit of money every month to her local food bank. So if that’s an option for you, then at least you’re doing something useful and purposeful, if you can afford it yourself. Other people volunteer to do stuff, to give advice in libraries, or their Citizens Advice Bureau, or through other mechanisms. Maybe their local schools or other institutions might have opportunities to volunteer to support underprivileged people in their community, there’s usually something going on in your local community where you can get involved, if you’ve got the opportunity to do that. And you’ve got the time to do it. And like I say, the worst thing is to feel hopeless and powerless. And there’s nothing you can do. I think it was Maya Angelou said something about, you know, the greatest trick the devil ever played was to convince people that they had no power, right? We all have some power and agency. It’s easier when you have resources, like someone like me, but everybody has agency and how we choose to use it, we can make a significant difference in our communities and beyond.
AJ: Thank you! That’s a super encouraging note to sort of draw to the close on. And yeah, just to know that there are things we can do in the midst of such a challenging time. But I guess I’m really conscious that there may be people listening for who this is a very real concern, they’re seeing the impacts the cost of living on their mental health already. So I guess I just thought it’d be helpful to say, where would you suggest people go to access support if they are in that situation.
ED: So the important thing to remember is that there’s always hope and there’s always support available and not to despair. I mean, I know that’s easier said than done. But whatever hole that you feel that you are in financially and otherwise, you know, there is always support and help and things definitely can get better. If you feel concerned about your health in any way and you’re concerned about that, then do go to your GP, or I’m sure you’re gonna put some chat lines in the chat, do access the support that is available to you. And then in terms of financial stuff, there’s a number of websites, where you can access information about what benefits and social security you are entitled to. And if you know when people are entitled, a lot of benefits go unclaimed by people who are legitimately entitled to those benefits, everything from Healthy Start vouchers, which are like free vouchers for food and milk and other useful stuff to new parents and carers. And something like 40% of these Healthy Start vouchers are unclaimed. And that’s before you get into other benefits. So do make sure you’re claiming the full entitlement to benefits. If you’ve got young children, you may be entitled to significant amounts of free nursery provision for two and three year olds who are eligible. And again, about 30% of families who are eligible don’t access that free childcare. And those children are then getting fed and educated. And you’re getting free childcare so you can do other things, so make sure you’re you’re checking out these sort of websites, see what provision is available and what you’re entitled to. And then there’s various sort of websites like the money saving expert, they’ve got a free email every week, that has various kind of money saving ideas in it, and all kinds of useful stuff that can save you significant amounts of money. And then, you know, there’s often places that have their own Citizens Advice Bureau, your local council will often have money advice services available, your local library can often put you in touch (technology is an issue) often librarians are trained to support you to access that kind of thing. So there is there is a lot of help and support out there. And as I say, easier said than done, but don’t despair. There are there are ways even if you’re in massive amounts of debt and you’re really struggling there are there are ways to get out of these situations. There is hope and there is support and it’s important that people access that you can get out of the situation with the right support.
AJ: Well, I think that’s a great note to end on. Thank you so much for chatting with me today, for imparting your knowledge and for giving us a fresh perspective on the reality of the situation but also on what can be done. I will stick a lot of stuff in the show notes that you’ve mentioned, lots of helpful links, as well as links like you said at the end, to signposting to more support but I wanted to say thank you so much for coming in today!
ED: Thanks a lot for having me.
