Health inequalities: Deprivation and poverty and COVID-19

Defining poverty: Relative and absolute low income

• An individual is in relative low income (or relative poverty) if they are living in a household with income below 60 per cent of median household income in that year. This measure essentially looks at inequality between low- and middle-income households.
• An individual is in absolute low income (or absolute poverty) if they are living in households with income below 60 per cent of the 2010/11 median, uprated for inflation.

A House of Commons briefing paper published on 31 March 2021, reports that poverty is set to increase over the coming years. How much this increase will be depends on whether the £20 benefits uplift to Universal Credit and Working Tax Credit is withdrawn, as planned, in September 2021, at the same time as the Coronavirus Job Retention Scheme is withdrawn.

The Joseph Rowntree Foundation, quoted in the paper, estimates that this will pull 500,000 extra people, including 200,000 children into poverty.

The briefing paper says that income loss has rapidly exacerbated insecurity and vulnerabilities. It highlights the following:

• the inability to build and draw on financial safety nets - low-paid work, zero hours contracts, mixed self-employment/salaried work, and/or work in unpredictable sectors left people financially exposed under COVID-19
• working without full time, reliable salaries - including key workers such as teaching assistants, social care professionals, and family support workers.
• working in sectors that could not ‘move remote’ when COVID-19 hit for example, manual labour and personal services
• caring responsibilities which limited income potential and raised outgoings -particularly but not only for women and single parents.
• health and mental health challenges – 70 per cent were experiencing chronic health issues prior to COVID-19; 65 per cent long-term mental health issues
• domestic violence and abuse - several had recently fled partners who had become abusive, and were unexpectedly now raising children alone.

Whitehead et al (2021) report that during 2020, food poverty increased, with free school meals—an essential nutritional boost for many low-income families—having to be replaced by emergency measures to prevent children going hungry during school closures.

Local authorities and the voluntary sector up and down the country played an important role in making sure food reached children during this time. Most are looking at the longer term need for their residents.

On food poverty, Build back Fairer notes that “During March to August 2020, four million people in households with children experienced food insecurity – 14 per cent of households – up from 12 per cent before the pandemic. In September 2020, the prevalence of food insecurity in black and mixed ethnicity households with children was nearly 50 per cent higher than in white ethnicity households with children. Households with either an adult or child with a long-term health problem or disability were also at much higher risk.”

Financial insecurity exacerbates peoples’ anxiety and affects their physical symptoms, while a significant health problem can create financial insecurity. Poverty means  people may find it harder to access services because they can’t afford to travel to appointments, or their working hours and lack of job security makes it difficult to attend medical appointments. Tackling the day to day need for housing, food and warmth means that health comes a long way second for people experiencing poverty.

From the early days of 2020, local authorities have been supporting their most vulnerable residents in a variety of ways: food parcels and vouchers; advice about self-isolation; regular calls to those on their own to reduce loneliness and to provide a connection.

Those whose employers will not fund time off work for self-isolation are a risk to the wider population because they cannot afford to not work. Accessing the payment of £500 has not been easy because it requires people to be on a particular combination of benefits to qualify for it.

It has become clear that without adequate financial support to isolate at home, many people will avoid taking a test, even if they have symptoms or not stay at home for the full period of self-isolation.

A recent report from the Trades Union Congress highlights concern that those in insecure employment are more likely to be on low pay and without access to sick pay.

This makes people reluctant to take a COVID test as a positive result will mean they have to self-isolate when they can’t afford to be away from work. It also means they are more likely to work when ill and so risk spreading coronavirus.

Analysis by Trade Unions Congress (TUC) found that women, disabled workers and those in minority ethnic groups more likely to be working in insecure jobs. Black and minority ethnic women face the most precarity, being twice as likely as white workers to be employed in insecure jobs.

Amongst other recommendations, the TUC report - ‘COVID -19 and insecure work’ calls for a reform to sick pay, specifically to:

• abolish the earnings threshold for statutory sick pay, extending coverage to almost two million workers–for all absences
• remove the waiting period for sick pay
• increase sick pay to the equivalent of a week’s pay at the real living wage
• provide additional funds to ensure employers can afford to pay sick pay.

Case study: HertsHelp

Local authorities are using some of the COVID funds to help financially support residents. In Hertfordshire, ‘HertsHelp’ is a network of community organisations linking people into direct support through a website, phone number and email service, seven days a week. The network supports individuals with accessing essential items such as food, medicine and financial support. The county’s health protection board has invested an additional £2 million in enabling discretionary payments to support self-isolation, administered by the 10 district and borough councils through their benefits systems.