MRC/CSO Social and Public Health Sciences Unit

By Olivia Hamilton, Research Associate, Inequalities in health programme.

In collaboration with The Poverty Alliance, our team have been running a project to explore ways in which income related policies might be able to reduce health inequalities. This is particularly important given the current cost-of-living crisis and persistently high child poverty rates. In the UK and Ireland this idea is gaining momentum. In 2022 the Welsh Government launched a basic income pilot for care leavers and in the same year, the Irish Government launched one for artists and creative arts workers. In Scotland, the Government has committed to exploring the feasibility of a Scottish Minimum Income Guarantee – a policy that would set a minimum level of income below which nobody in Scotland should fall.

These kinds of income policies represent a radical departure from the current social security system in the UK and have the potential to impact people’s health, in either a positive or a negative way. When considering changes to the social security system, as well as talking to policy makers, it is vital to consult with people who have lived experience of income insecurity, to ask for their preferences on the kinds of income policies that they would like to see explored.

Following on from this research project, we will simulate the health impacts of different kinds of income policies, using computer modelling. To help us decide on the kinds of policies that we should test, we worked with the Poverty Alliance to run a series of workshops with people who have had experience of income insecurity, policy makers, academic researchers and third sector advocates. In the first set of workshops, we met with a group of people with experience of income insecurity and separately, with civil servants from the Scottish and Welsh Governments and academic and third sector advocates with an interest in health, economic justice and the social security system.

“I shop in the evenings, when the food is reduced”

Participants told us that income can have an impact on their physical and mental health. They highlighted three main ways that having an increased and more regular income might improve their lives:

1. By contributing to essential, everyday costs, such as food, transport, bills and rent.
2. By giving them more choice and control over their lives. This included being able to take time to care for family members or friends, being able to say “no” to unsuitable shifts or jobs, and being able to make healthier lifestyle choices like buying fresh organic ingredients, or go to the gym.
3. By supporting people to get into more secure, better paid work that matched their interests and skills.

“With stigma comes self-stigmatisation”

People with lived experience of income insecurity told us that the inefficiency, complexity and inflexibility of the current benefits system was a source of stress and anxiety, which make both mental and physical health problems worse. Over time, negative perceptions of people who claim benefits, especially in the media, also have an impact and can leave people feeling ashamed and embarrassed.

Next, to gather public and stakeholder preferences for the kinds of income policies that we should investigate through our modelling work, we ran three focus groups with people with lived experience of income insecurity and two workshops with people from the private sector, third sector, healthcare practice, and other advocacy groups. One of these workshops took place at the Poverty Alliance’s annual conference, which this year focused on a potential Minimum Income Guarantee for Scotland.

We asked participants what kinds of policies they thought we should model, and what aspects of policy design (like who would be eligible, or whether there would be any conditions attached) were the most important to get right.

What kinds of policies were public and stakeholder groups interested in?

• Most people showed a preference for adjusting and extending existing social security schemes like Universal Credit, or the Scottish Child Payment.
• Many public contributors were interested in understanding the impacts of adjustments to Universal Credit (e.g. removing the 5-week wait, 2-child limit, reducing the taper rate), and extensions of the Scottish Child Payment (beyond families in receipt of Universal Credit, and to children up to age 18).
• Public contributors were also interested in financial support to meet the cost of essentials including food, transport, childcare, and utilities. Suggestions for policies in this area included introducing social tariffs for utilities and communications, and free or discounted transport.
• Policies that support entry into employment through skills development and training were widely discussed. Issues with social security payments and limited free childcare presented barriers to securing and remaining in good work.

“People work for bonuses…my partner can earn three bonuses a month and he’ll not get it. He’s saying, like I’m getting an extra £450 and I’m saying, right, you need to give me £300 of that because it’s getting taken out of my universal credit.”

In general, participants agreed:

• On the importance of considering the level (£) of support carefully. There was agreement that having only enough income to meet essential costs would not be sufficient to live a healthy and dignified life.
• That the level (£) of support should be tailored to individual needs and circumstances. In particular, people noted that the cost of living was much higher for disabled people.
• That increases in the level (£) of support should reflect inflation and increases in the cost of living. People also suggested that payments could increase in the winter months to contribute to additional energy costs.
• On groups who required additional support, including priority family groups, disabled people, low income households, people either out of work or in low paid or insecure work, and people in the UK asylum system.

“If the focus here is on the eradication of poverty, then surely there should be no conditions on the eradication of poverty?”

Perspectives between public and stakeholder groups differed when it came to:

• Universality – the idea that everyone (even people who are relatively well off) would receive income support. Several third sector representatives were in favour of this approach, but universality was largely described as wasteful or unnecessary by public groups.
• Conditionality – whereby certain rules or conditions must be kept in order to receive income support, like needing to be in work or actively looking for work. This was seen as unnecessary or unfair by stakeholders and most members of the public, but for some public participants, certain conditions were seen as potentially useful for supporting transitions into work.

What are the next steps for this research?

We will now present findings from the workshops and focus groups to the members of our research team who will build the policy models. Based on the preferences of members of public and stakeholder groups, they will decide on which income policies they are going to model and decide the best way to do this. Eventually, we hope that their models will tell us how these income policies impact physical and mental health and generate evidence that can shape social security policy in Scotland.

We would like to thank everyone who contributed to this work. The diverse range of knowledge, experiences and perspectives that participants brought to the workshops and focus groups will help to set the direction of our research and to build evidence around policy options that aim to reduce health inequalities.

This work is funded by a 12-month development grant from the National Institute of Health and Care Research (NIHR): ​Evaluating a ‘Minimum Income Guarantee’ and modelling major income supplementation policies: A development award.

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First published: 12 January 2024