An important step towards reducing health inequalities (SHAAP)

1. What do you see as being the key elements of a Minimum Income Guarantee? Scottish Health Action on Alcohol Problems (SHAAP) views a Minimum Income Guarantee (MIG) as an important step towards addressing the structural inequalities and poverty that contribute to health inequalities in Scotland. 2. What do you see as the main benefits, challenges and risks of a Minimum Income Guarantee in Scotland? One of the main benefits that SHAAP sees from a MIG in Scotland is the potential for the policy to help reduce health inequalities over the long-term. As there has been less focus on the social determinants of health in policy-making in favour of clinical factors in the past (Smith, Hill & Bambra 2016: 269) we view a MIG as an important step forward in this respect. In relation to alcohol policy specifically, SHAAP considers the introduction of a MIG as a compliment to other policies aimed at limiting the availability, attractiveness and affordability of alcohol. We view a particular benefit in the potential of the policy to help address some of the structural causes of the unequal burden of alcohol harm in society, such as poverty and inequality. In the long run we would hope that policies aimed at addressing these root causes would move Scotland closer to a nation in which we work to prevent, rather than simply treat ill health, including alcohol problems. One challenge that SHAAP sees for a MIG in Scotland is the need to avoid stigmatisation of those who receive it. Unlike a Universal Basic Income (UBI), a MIG is targeted, and as such the system of delivery will need to be designed to reduce rather than exacerbate stigma. It is also SHAAP’s view that the system for delivery for a MIG should be straightforward and transparent, and not increase stress and anxiety for those receiving it, as has been the case for Universal Credit. References: Smith, Katherine, E., Sarah Hill, Clare Bambra. 2016. “Chapter 1: Background and introduction: UK experiences of health inequalities”. In: Health Inequalities: critical perspectives, Katherine E. Smith, Sarah Hill and Clare Bambra (eds.). Oxford University Press: Oxford

Why the contribution is important

It has long been accepted that poverty causes ill health, but research over the last decade has shown that relative inequality is also linked to a social gradient in health (Marmot 2020; Marmot 2010). Relative inequality has increased in Scotland since the 1980s, alongside a rise in mortality inequalities by area of deprivation (Smith, Hill & Bambra 2016: 7). Even before the COVID-19 pandemic hit, the Joseph Rowntree Foundation (JRF) cautioned that poverty was on the rise in Scotland (Congreve 2019). If Scotland is to achieve a recovery from the COVID-19 pandemic that builds a “fairer future”, strengthens our health services and helps our population become healthier and more resilient, it is essential that root causes of ill-health in society, such as poverty and inequality (cf. Marmot 2015; Smith, Hill & Bambra eds. 2016; Baum 2019) are addressed. In SHAAP’s own area of work, the effect of health inequalities on alcohol-related hospital admissions and alcohol-specific deaths is extremely clear (cf. SHAAP 2018). Though you are more likely to drink more than the recommended weekly amount if you live in one of Scotland’s least deprived areas, you are over four times more likely to die an alcohol-specific death if you live in one of Scotland’s most deprived areas (NRS 2021). This figure is a stark reminder of the extent to which alcohol harms are exacerbated and compounded by socio-economic factors, and represents only the tragic end point of a journey during which an individual – as well as those close to them – can experience multiple harms from alcohol during their lifetime. This is not a problem that can be fixed by defaulting to the rhetoric of “personal responsibility” and “healthy choices” in policy-making. As Marmot has so eloquently put it, “[…] it is poverty that leads to unhealthy choices […] [P]oor health […] results from the restricted options available to those on low incomes, as well as the direct health impacts associated with the stresses and poor conditions which result from poverty” (Marmot 2020: 35). Instituting a MIG that factors in the minimum income needed for healthy living is therefore an essential step if we are to reduce health inequalities and make it easier for people to be healthy – moving closer to our goal of preventing, rather than simply treating ill health. References: Baum, Fran. 2019. Governing for Health: Advancing Health and Equity through Policy and Advocacy. Oxford University Press: Oxford Congreve, Emma. 2019. Poverty in Scotland 2019. Joseph Rowntree Foundation: York Marmot, Michael. 2010. Fair Society Healthy Lives: Strategic Review of Health Inequalities in England Post-2010. Marmot, Michael. 2020. Health Equity in England: The Marmot Review 10 Years On. National Records of Scotland (NRS). 2021. Alcohol-specific deaths: 2020 Scottish Health Action on Alcohol Problems (SHAAP). 2018. Dying for a drink: circumstances of, and contributory factors to, alcohol deaths in Scotland: results of a rapid literature review and qualitative research study. Smith, Katherine, E., Sarah Hill, Clare Bambra (eds.). 2016. Health Inequalities: critical perspectives. Oxford University Press: Oxford Smith, Katherine, E., Sarah Hill, Clare Bambra. 2016. “Chapter 1: Background and introduction: UK experiences of health inequalities”. In: Health Inequalities: critical perspectives, Katherine E. Smith, Sarah Hill and Clare Bambra (eds.). Oxford University Press: Oxford

by SHAAP on September 15, 2021 at 12:44PM

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