Kayleigh Garthwaite

‘The language of shirkers and scroungers?’ Talking about illness, disability and coalition welfare reform

Following establishment of the Conservative‐Liberal Democrat coalition, welfare benefits and those who receive them have become of increased significance, with the government and the media alike lamenting the amount of people receiving benefits and what could, and indeed should, be done about it. With a recent White Paper outlining a new Universal Credit, an integrated working age credit that will replace a range of benefits including the Employment Support Allowance for ill and disabled recipients, it means that once again sickness‐related benefits are back in the spotlight. This piece critically reflects upon the way people receiving sickness‐related benefits such as Incapacity Benefit and Employment Support Allowance can be labelled, portrayed and discussed within a wider rhetoric that encompasses governmental, public and media attitudes. Unfortunately, the impacts of such rhetoric could be counter‐productive with regards to employer responses to ill and disabled individuals. Yet policy remains centred largely on the supply rather than the demand side of labour. As a consequence, policies that target and highlight the functional limitations of individuals with perceived impairments are prioritised and supported at the expense of those which draw attention to and seek to resolve the stark inequalities of the social organisation of work.

A labour of Sisyphus? Public policy and health inequalities research from the Black and Acheson Reports to the Marmot Review

Objectives To explore similarities and differences in policy content and the political context of the three main English government reports on health inequalities: the Black Report (1980), the Acheson Enquiry (1998), and the Marmot Review (2010). Methods Thematic policy and context analysis of the Black Report (1980), the Acheson Enquiry (1998), and the Marmot Review (2010) in terms of: (i) underpinning theoretical principles; (ii) policy recommendations; (iii) the political contexts in which each was released; and (iv) their actual or potential influence on research and policy. Results There were great similarities and very few differences in terms of both the theoretical principles guiding the recommendations of these reports and the focus of the recommendations themselves. However, there were clear differences in terms of the political contexts of each report, as well as their subsequent impacts on research and policy. Conclusion The paper calls into question the progress of health inequalities research, the use of evidence and of the links between research, politics and policy.

Prospective pilot evaluation of the effectiveness and cost-utility of a ‘health first’ case management service for long-term Incapacity Benefit recipients

BACKGROUND In line with the NICE guidance, an NHS-commissioned case management intervention was provided for individuals receiving Incapacity Benefit payments for ≥3 years in the North East of England. The intervention aimed to improve the health of the participants. METHODS A total of 131 participants receiving the intervention were compared over 9 months with a (non-equivalent) comparison group of 229 receiving Incapacity Benefit payments and usual care. Health was measured using EQ-5D, EQ-VAS, SF-8, HADS and the Nordic Musculoskeletal questionnaire. Socio-demographic and health behaviour data were also collected. Fixed-effects linear models with correlated errors were used to compare health changes between groups over time. A preliminary cost-utility analysis was also conducted. RESULTS The comparison group measures of health were stable over time. Starting from comparatively poor initial levels, case-management group generic (EQ5D, EQ-VAS) and mental health (HADS-A, HADS-D and SF8-MCS) measures improved within 6 months to similar levels found in the comparison group. Musculoskeletal (Nordic 2) and health behaviours did not improve. Tentative estimates of cost-utility suggest an intervention cost in the region of £16 700-£23 500 per QALY. CONCLUSIONS Case management interventions may improve the health of Incapacity Benefit recipients. Further research is required to help confirm these pilot findings.

ALL THINGS BEING EQUAL: DOES IT MATTER FOR EQUITY HOW YOU ORGANIZE AND PAY FOR HEALTH CARE? A REVIEW OF THE INTERNATIONAL EVIDENCE

Over the last 25 years, the health care systems of most high-income countries have experienced extensive—usually market-based—organizational and financial reforms. The impact of these system changes on health equity has been hotly debated. Examining evidence from systematic reviews of the effects of health care system organizational and financial reforms will add empirical information to this debate, identify any evidence gaps, and help policy development. Systematic review methodology was used to locate and evaluate published systematic reviews of quantitative intervention studies (experimental and observational) of the effects on equity in health care access and/or health status of health care system organizational and financial reforms (system financing, funding allocations, direct purchasing arrangements, organization of service provision, and health and social care system integration) in high-income countries. Nine systematic reviews were identified. Private insurance and out-of-pocket payments as well as the marketization and privatization of services have either negative or inconclusive equity effects. The evidence base on the health equity effects of managed care programs or integrated partnerships between health and social services is inconclusive. There were no relevant studies located that related to resource allocation reforms. The systematic review-level evidence base suggests that financial and organizational health care system reforms have had either inconclusive or negative impacts on health equity both in terms of access relative to need and in terms of health outcomes.

Stigma, shame and 'people like us': an ethnographic study of foodbank use in the UK

Foodbanks and other charitable activities are fast becoming an established part of austerity Britain. This paper is based on ethnographic research undertaken over a two-year period in North East England, exploring the lived experiences of health inequalities for residents in the most and least affluent areas. Findings show how the majority of foodbank users experienced stigma, fear, and embarrassment, which was at times aggravated by representations in ‘poverty porn’ television shows. Stigma could be overcome once people recognised that ‘other people like us’ were receiving a food parcel. Finally, the practice of ‘Othering’ was evident across the research sites.

Go slow: an umbrella review of the effects of 20 mph zones and limits on health and health inequalities

BACKGROUND Transport is an important determinant of health and there is a well-established association between socio-economic status (SES) and risk of road accidents. Effective traffic calming interventions such as 20 mph zones and limits may therefore improve health and reduce health inequalities. METHODS Systematic review methodology was used to identify systematic reviews of the effects of 20 mph zones (including speed limits and road humps) and 20 mph limits on health and SES inequalities in health amongst adults and children. RESULTS Five systematic reviews were included. Overall, they provide convincing evidence that these measures are effective in reducing accidents and injuries, traffic speed and volume, as well as improving perceptions of safety in two of the studies. There was also evidence that such interventions are potentially cost-effective. There was no evidence of the effects on SES inequalities in these outcomes. CONCLUSION Twenty mile per hour zones and limits are effective means of improving public health via reduced accidents and injuries. Whilst there was no direct evidence on the effects of interventions on health inequalities, targeting such interventions in deprived areas may be beneficial. Further controlled evaluations that specifically examine SES effects are required.

Desperately seeking reductions in health inequalities: perspectives of UK researchers on past, present and future directions in health inequalities research.

Abstract Following government commitments to reducing health inequalities from 1997 onwards, the UK has been recognised as a global leader in health inequalities research and policy. Yet health inequalities have continued to widen by most measures, prompting calls for new research agendas and advocacy to facilitate greater public support for the upstream policies that evidence suggests are required. However, there is currently no agreement as to what new research might involve or precisely what public health egalitarians ought to be advocating. This article presents an analysis of discussions among 52 researchers to consider the feasibility that research‐informed advocacy around particular solutions to health inequalities may emerge in the UK. The data indicate there is a consensus that more should be been done to learn from post‐1997 efforts to reduce health inequalities, and an obvious desire to provide clearer policy guidance in future. However, discussions as to where researchers should now focus their efforts and with whom researchers ought to be engaging reveal three distinct ways of approaching health inequalities, each of which has its own epistemological foundations. Such differences imply that a consensus on reducing health inequalities is unlikely to materialise. Instead, progress seems most likely if all three approaches are simultaneously enabled.

Shifting the Goalposts: A Longitudinal Mixed-Methods Study of the Health of Long-Term Incapacity Benefit Recipients during a Period of Substantial Change to the UK Social Security System

The UK social security safety net for those who are out of work due to ill health or disability has experienced significant change, most notably the abolition of Incapacity Benefit (IB) and the introduction of Employment and Support Allowance (ESA). These changes have been underpinned by the assumption that many recipients are not sufficiently sick or disabled to ‘deserve’ welfare benefits – claims that have been made in the absence of empirical data on the health of recipients. Employing a unique longitudinal and mixed-methods approach, this paper explores the health of a cohort of 229 long-term IB recipients in the North East of England over an eighteen-month period, during a time of significant changes to the UK welfare state. In-depth interviews with twenty-five of the survey cohort are also presented to illustrate the lived experiences of recipients. Contributing to debates surrounding the conceptualisation of work-readiness for sick and disabled people, findings indicate IB recipients had significantly worse health than the general population, with little change in their health state over the eighteen-month study period. Qualitative data reinforced the constancy of ill health for IB recipients. Finally, the paper discusses the implications for social policy, noting how the changing nature of administrative definitions and redefinitions of illness and capacity to work can impact upon the lives of sick and disabled people.

The perfect fit? Being both volunteer and ethnographer in a UK foodbank

Purpose – The purpose of this paper is to explore both volunteer and ethnographer in a Trussell Trust foodbank in Stockton-on-Tees, North East England during a period of welfare reform and austerity. It shows how ethnographic researchers can develop a more effective qualitative understanding of foodbank use through volunteering. Design/methodology/approach – The methodological design was ethnographic both in terms of data collection and analysis. Volunteering and participant observation began in November 2013 and is ongoing. The data presented are derived from field notes of participant observations. Findings – Tensions are present when considering how best to write up ethnographic research when the researcher adopts a “volunteer ethnographer” role. The negotiation of relationships, practices, and emotions requires the researcher to appreciate the complex and “politicized” discourse surrounding foodbank use in order to report how the foodbank operates in an objective yet truly reflective way. Originality/...

‘The unwilling and the unwell’? Exploring stakeholders’ perceptions of working with long term sickness benefits recipients

This paper draws on qualitative research with Incapacity Benefit (IB) stakeholders in the North East of England, UK. Stakeholders’ experiences of working with long-term sickness benefits recipients reveal multiple barriers that both sick and disabled people, and themselves as practitioners, clearly face. Reflections on what ongoing welfare reform could mean for future practice for both stakeholders and recipients will be explored. The findings suggests that whilst stakeholders recognise the complex barriers faced by those receiving sickness benefits, a wider moral dialogue between ‘deserving’ and ‘undeserving’ is being created and sustained as a result of negative stereotyping of sickness benefits recipients.