As a recent BBC Panorama investigation highlighted, “the rich live longer and the poor die younger”. The presenters visited Stockton-on-Tees in County Durham, where some people can only expect to live to 69 and where wealthier people only a couple of miles away live on average about 18 years longer. In England, the difference in life expectancy between the most and least deprived areas is around nine years for men and seven for women. Life expectancy is one measure, but the impact of poverty on well-being and quality of life can also be severe.
According to the Joseph Rowntree Foundation 13.5m people in the UK live in poverty and this number is expected to grow. Poverty is the gap between resources and needs, and it is deepened not only by a lack of resources – most obviously income – but also by the cost of obtaining minimum needs. Alleviating poverty requires improving income as well as reducing the costs of meeting basic needs. Below are just some of the impacts that living in poverty is having on people’s lives.
Poor quality and insecure housing
As one report highlights, “the numerous definitions of poverty and material deprivation cannot be entirely separated from housing circumstances”. According to housing charity Shelter, poor housing conditions increase the risk of severe ill-health or disability by up to 25% during childhood and early adulthood. The decline in the social housing stock has been well documented – there are long waiting lists for a shrinking number of properties.
With the number of private renters in poverty doubling to 4.4m since 2002-03, private renting is regarded by some as the “new home of poverty”. There are growing concerns about the condition of properties within the private rented sector, as well as the lack of security of tenure and how this can impact on health and well-being. For many people, prohibitive housing costs combined with poor standards of accommodation affects physical and mental health, keeping them trapped.
Cold homes and expensive warmth
Living in a cold or damp home has significant implications for health and well-being. When winter comes, cold is the tipping point toward a rise in unplanned hospital admissions and deaths. Being in fuel poverty means not being able to afford to adequately heat your home, or spending so much on bills that other aspects of household budgets suffer. This is partly a result of high energy prices combined with low incomes, but is also inextricably related to the quality of housing.
In the UK, a legacy of poor quality housing that is expensive to improve means people often pay for “expensive warmth”, another way of saying heat is leaking out of the walls. More money is helpful, and benefits such as the winter fuel payment provide some assistance, but this money is of limited use if it is insufficient to pay for improvements that could lift a household out of fuel poverty, such as insulation or a more modern boiler.
The World Health Organisation estimates that ambient air pollution accounts for 25% of all deaths and disease from lung cancer worldwide, as well as 17% from acute lower respiratory infection and 16% from stroke. In the UK, the annual mortality burden due to outdoor air pollution is equivalent to 40,000 deaths. Recent research has highlighted the risk to the development of the foetus and found that children remain susceptible to harmful effects of air pollution on their neurodevelopment and long-term cognitive health.
Deprived communities tend to live in poorer quality environments and research suggests they experience higher air pollution levels and poor indoor air quality is associated with inadequate housing standards. It has been estimated that two-thirds of carcinogenic chemicals emitted into the air are released in the 10% most deprived council wards in the UK. A recent study in London brought the issue home, reporting that tens of thousands of the city’s poorest children are “facing a cocktail of health risks including air pollution, obesity and poverty”. It found that 85% of schools most affected by air pollution have pupils from deprived neighbours.
With most air pollution in Greater Manchester and other major cities attributable to road traffic, it is worth noting that, with lower levels of car ownership, poorer communities are less likely to be contributing to the air pollution they suffer from.
The Food Foundation characterises food insecurity as ranging from worrying about the ability to obtain food (mild food insecurity) to experiencing hunger (severe food insecurity). In 2012, they estimated that 28% of adults had skimped on their own food in the previous year so that others in their households could eat. They reported that in 2014 as many as 8.4m people in the UK faced not having enough food to eat.
The Joseph Rountree Foundation defines a destitute individual as someone lacking two or more of the following things over the past month: shelter, food, heating, lighting, clothing and basic toiletries. It found that lack of food was the most common of these – with over 60% of the 1.5m destitute in the UK not getting enough to eat. Uptake of food banks is now the highest it has ever been.
Our relationship with food is about more than distribution and access, since it is not only a physiological requirement but one bound up with our practices and cultures. So the lack of food has the potential to have a profound impact on our psychological well-being. Access is as much about quality, in terms of access to a healthy and culturally appropriate diet, as it is about quantity.
Restrictive benefits and insecure work
In recent years, there has been a series of changes to the benefits system including the “benefit cap”, the roll out of Universal Credit, and the increasingly punitive sanctions regime. It has been suggested that due to a combination of welfare reforms households could be about £40 per week worse off than they would otherwise be by 2020.
Reductions in benefits have obvious financial implications for many households. But there are also significant mental health implications, including increases in stress, anxiety and even suicide rates as a result of some welfare reforms. People in poverty are also more likely to experience insecure work – for example, zero-hours contracts. Some people on these contracts are pushed into this through changes in benefits and the “work first” approach that dominates the UK’s employment support system. But research shows that poor working conditions are also linked to significant health disparities.
So while poverty’s association with poor physical and mental health outcomes, lower nutritional quality, more basic housing conditions and poorer educational outcomes can all affect overall life expectancy, its impact on the quality of those years is also hugely important.