Available Open Access under CC-BY-NC licence. How has austerity impacted on health and wellbeing in the UK? Health in Hard Times explores its repercussions for social inequalities in health.
The result of five years of research, the book draws on a case study of Stockton-on-Tees in the north-east of England, home to some of the starkest health divides. By placing individual and local experiences in the context of national budget cuts and welfare reforms, it provides a holistic perspective on countrywide inequalities.
Edited by a leading expert, this is an important book for anyone seeking to understand one of today’s most significant determinants of health.
This chapter examines health inequality — its definition, measurement and theory — and then examines the role of welfare states in determining overall population health outcomes. The main studies in the comparative epidemiological literature on European health inequalities are then summarised, with a focus on the relative performance of the Nordic welfare states. The effects on health inequalities of changes to the Nordic welfare state are also examined. The chapter then uses the theories of health inequalities to examine why it is that the highly decommodifying Nordic welfare states do not have the smallest health inequalities in Europe. It concludes by reflecting on how any further changes to the Nordic welfare model may impact on health inequalities in the future.
This introductory chapter provides the academic and policy/political context of the project. It starts by outlining geographical inequalities in health and some of the debates from the wider academic literature that are important foundations for the following chapters. It then outlines the financial crisis and the austerity measures that have been undertaken in the UK, and provides an overview of the wider literature on the effects of recessions, austerity and welfare cuts on health and health inequalities. The Leverhulme study is then introduced and situated it within this body of work, providing an introduction to the case study method, the case study location (Stockton-on-Tees) and the project as a whole. It concludes by providing an overview of the main chapters in this edited collection, highlighting their themes and connections.
People in the North of England live two years less than those in the South of England and boys born in the most deprived neighbourhoods of England can expect to live nine years less than those born in the most affluent wards (ONS, 2015). For baby girls, the gap is seven years. In our case study town of Stockton-on-Tees in the North East of England, the gaps in life expectancy are even greater – some of the largest in the world – as there is a 15-year gap in life expectancy between men living in the most affluent suburbs such as Hartburn and those living in the most deprived such as Town Centre ward (PHE, 2017). For women the gap is 11 years.
In this concluding chapter, I bring together the main themes of the previous chapters highlighting the key contributions which the Stockton-on-Tees project has made to the wider social science and health inequalities literature; specifically, our understanding of geographical inequalities in health during austerity. The following three key contributions that the research project has made are discussed: (1) The value of taking a case study, mixed methods approach to the exploration of place-based health inequalities; (2) The contribution made by the project to understanding health inequalities and the relationship between health and place by localising the study of health inequalities; and (3) what the project found in terms of the effects of austerity on health inequalities. The chapter concludes by outlining the research, policy and practice implications of the project emphasising how our case study shows the need to integrate political economy perspectives into geographical research; the importance of universal social policy safety nets especially for women, those with disabilities and health conditions, and older people; and for practitioners to look beyond health behaviours when designing public health interventions.
Our project has contributed to the literature methodologically by resurrecting the case study approach in UK social science. The case study approach has a long tradition in UK social research, arguably dating back to the work of Charles Booth in the late 19th century (1889–97). Other prominent early research in this tradition includes Joseph Rowntree’s studies of poverty in York in the early 20th century (1901) as well as the Marienthal town study in Austria (Jahoda et al., 1971 ).
Evidence-based policy (EBP), along with the ‘systematic review’, has recently emerged as a prominent strand within social science and public policy research. A number of articles have heralded this emergence but the vast majority are theoretical and concerned with how EBP research could be practised. This article reflects on the author’s experiences of identifying and reviewing evidence on the effectiveness of labour market interventions aimed at people with a disability or a chronic illness, to demonstrate some of the methodological challenges and practical problems that arise from the actual conduct of EBP research.
The main focus of recent debates around disability, chronic illness and work has centred on access to paid work. Over the past two decades, this has also been at the heart of the social policy agenda in Britain with concerted efforts to maximise labour market participation. However, what is not discussed to the same extent is what happens after people enter employment and the challenges they may face in retaining it. This chapter explores these issues using evidence collected through a mixed methods evaluation of an in work support service. The service was available to assist employees and employers with job retention. Usually these problems were health related, but many individuals were also experiencing wider socio-economic difficulties, such as debt, which led to the creation of new health problems and the exacerbation of existing conditions. The chapter draws on a survey and a series of qualitative interviews undertaken with service users and the practitioners who delivered the service.
This chapter examines the effects of austerity on geographical health inequalities by focusing on the North–South health divide in England and health inequalities between local neighbourhoods. It first explains the importance of geography for health by presenting the two case studies involving the North–South divide and local inequalities. It then considers the austerity and welfare reforms that have been introduced in England since 2010 and how these policies are affecting these spatial health divides. It also reviews evidence from previous international research into welfare retrenchment, as well as qualitative data about the lived experiences of people at the sharp end of austerity. The chapter concludes by highlighting the uneven consequences of austerity measures for health across localities and across different sociodemographic groups, thus exacerbating existing health inequalities.
Partnership working has been a central feature of New Labour's approach to the delivery of health and social policy since 1997. A number of partnership-based initiatives have centred on reducing health inequalities and improving health. This article reports on the findings from a systematic review of the impact of partnership working on public health, and considers whether these partnerships have delivered better health outcomes for local/target populations. It finds that there is little evidence that partnerships have produced better health outcomes for local/target populations or reduced health inequalities.