Tag Archives: healthcare

Health inequalities and ethnic minority communities: breaking down the barriers

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Almost from the start of the coronavirus (COVID-19) pandemic, its unequal impact on ethnic minorities has been clear. But the health inequalities experienced by Black, Asian and Minority Ethnic (BAME) communities predate the pandemic. As the Local Government Association has observed:

“…the truth is these inequalities were already having an impact on the health and wellbeing of ethnic minority communities before COVID-19 hit – it is just that the pandemic has shone a light on them like nothing before.”

Recently, the Centre for Ageing Better hosted a webinar titled “Ethnic health inequalities in later life,” based on the report of the same name, published in November 2021.

The report mainly looked at the period from 1993 to 2017, although the webinar was able to offer more recent information regarding the COVID-19 pandemic, which of course greatly affected health inequalities.

Widening inequalities

Dr. Sarah Stopforth, one of the researchers for this study, explained that  ethnic inequalities have been found to widen more after the age of 30, and by the age of 40 have established themselves. One of the study’s main findings was that poor health for White British women in their 80s was the equivalent to the poor health of African and Caribbean women in their 70s, and the equivalent to Pakistani and Bangladeshi women in their 50s.

While there were similar results for men from these same ethnic groups, it is clear that women across all ethnicities have poorer health than their male counterparts. Why is this happening?

The reasons are complex, but Sara suggested that  health inequalities are usually tied to the socio-economic inequalities present in our society. However, she also said that this tends to ignore the underlying causes of these health outcomes.

The role of the NHS

Dr. Habib Naqvi from NHS England talked about the role of the NHS in tackling health inequalities. He asserted that our healthcare system should be well equipped to respond to these inequalities, given the UK’s long history of migration by people from Afro-Caribbean communities. So why has it not been able to?

A lot of this, he explained, was due to the fragmentation of the NHS. The many areas of the sector are not working co-operatively to reach a collective and consistent goal, which then affects the ability to tackle issues such as inequalities in the sector.

In addition, Dr Naqvi pointed to mortality rates for ethnic minority groups – living longer does not always mean living in a healthy way. One of the features of “long Covid,” is its tendency to exacerbate long-standing health complications or to weaken COVID-19 patients’ health even after the illness. Again, ethnic minority communities have been disproportionately affected by this condition.

Another impact of  the COVID-19 pandemic has been a heightened feeling of isolation and fear for many ethnic minority groups, something highlighted in a report from the University of Manchester. Many were unable to communicate with healthcare staff due to language barriers or health conditions affecting their communication skills, and were often having to be admitted alone due to Covid restrictions. The inability of patients from ethnic minority backgrounds  speak for themselves raises concerns about their healthcare. Research has found evidence that ethnic minority patients – especially women – are not having their illnesses taken seriously.  

Vaccine hesitancy

Linked to this is the controversial issue of vaccine hesitancy, which has become a particular concern among ethnic minority groups. One of the reasons that many members of ethnic minorities may feel hesitant or scared to take the vaccination is because of the lack of communication and information, linked with their previous healthcare experiences.

It was suggested during the webinar that even throughout the pandemic, the healthcare sector has not effectively protected ethnic minorities, despite these health inequalities long being known.  Health professionals have attempted to reach out to communities and help them with any fears regarding COVID-19 or the vaccination process, but this can be difficult with social distancing restrictions. As a result, people within BAME communities may have to rely on family and friends to get information regarding vaccination, which may not calm their fears.

Data, care and trust

One of the key points driven home by Dr. Naqvi was the need for better data in order to better understand health inequalities among ethnic minority communities. Birth to end-of-life care was also mentioned, including tackling racial bias that can be found even in antenatal care. Finally, the concept of earning trust was highlighted. Dr. Naqvi said that the NHS must work to earn trust from BAME communities, particularly among the elderly, given the long-standing disparities in treatment and discrimination many have faced over the years.

Final thoughts

The webinar offered useful insights into how deeply healthcare inequalities lie. Our previous blog post on the future of public health offered a reminder that access to efficient, well-supported and high quality healthcare is vital for everyone. This webinar underlined that message, but highlighted its special significance for those experiencing longstanding health inequalities.

Photo by Hush Naidoo Jade Photography on Unsplash

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The future of public health: lessons from the pandemic

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The Coronavirus pandemic (COVID-19) has impacted all sectors of our society, but none more-so than public health services.

Last month, The Health Foundation hosted a webinar discussing the lessons from the pandemic and the future role of public health. The webinar drew on the findings from The Kings Fund report “Directors of public health and the COVID-19 pandemic”.  It considered the issues facing public health as a result of COVID-19, and proposed steps to rebuild the healthcare sector and begin tackling the problems left as we slowly move out of the pandemic.

Lack of resources

One of the main themes of the webinar was raised by Shilpa Ross of The Kings Fund, who explained that a lack of resources and shortages in public health existed long before the COVID-19 pandemic. The impact of longer term reductions to the public health grant meant that health services were not ready for the pandemic, nor for how long it has lasted. This has had a knock-on effect elsewhere in the NHS. A Care Quality Commission report noted that in July 2021, almost 300,000 people were waiting more than 52 weeks to begin hospital treatment.

On top of this, public health has faced staff shortages. Because so many healthcare services are “fishing in the same pond for recruits,” Shilpa explained that it has been especially hard to fill vacancies. In addition, many healthcare workers have experienced short and long-term effects of the virus, and the additional workloads have left many stressed and burnt out. The disruption to education could further delay the training and employment of potential new healthcare workers.

While the NHS has in some cases set up drop-in sessions for support and made efforts to provide even basic support, such as bottled water to aid hydration, these cannot fill the hole created by healthcare staff shortages.

Widening inequalities

Professor Kevin Fenton of Public Health England argued that “inequalities have defined the pandemic,” and would be the legacy of the last year and a half. A 2020 report by the Institute of Health Equity, commissioned by The Health Foundation, found that in England members of Black, Asian and minority ethnic groups (BAME) were more likely to be affected by COVID-19. The report attributed this partly to people in these groups living in more deprived areas, working in occupations with a higher exposure risk to the virus (such as healthcare or customer service roles), and in some cases living with multiple generations in their home (complicating self-isolation). The authors contended that while inequalities in social and economic conditions were present before the pandemic, they contributed to the unequal death toll resulting from COVID-19.

These inequalities have widened, partly due to the shortage of resources and staff. It has only grown more difficult to address the ever increasing numbers of people needing treatment, both urgent and non-urgent. As a result, the most vulnerable in society have fallen by the wayside.

Changing how public health works

The webinar also discussed how public health can move forward as the country slowly returns to a new form of normal. In addition to the restructuring of Public Health England, a new tax – the Health and Social Care Levy – will put an additional £12 billion into health and social care over the next three years. However, money alone is not enough – the webinar participants agreed that the infrastructures and inner workings of public health must evolve as we move towards a more efficient system of working.

Professor Fenton stressed the importance of engaging with local communities, and that the response towards the pandemic going forward must be grounded in their experiences, and what they need from both the public health system and also local authorities. He noted that while there may be pressure to go back to the way things operated before the pandemic, we must move forward: by understanding what worked and what didn’t, progress and better services can be achieved. Shilpa Ross added that a more targeted and tailored approach to health inequalities has provided more significant results in terms of vaccination and testing rates. This has in turn raised levels of trust within communities that public health teams may not have engaged with before the pandemic. All of this, however, takes up precious time.

Professor Jim McManus, Director of Public Health for Hertfordshire County Council, highlighted the importance of prevention not only for COVID-19 moving forward but other health conditions.  He stated that they must be tackled at a place where they can stop others continuing to be affected, in addition to treating those who are currently being affected.  Robin Tuddenham, Accountable Officer for NHS Calderdale Clinical Commissioning Group, agreed, and stressed that problems like homelessness and poverty should not be seen as separate from health but rather as important factors in the prevention of ill health.

Concluding thoughts

Highlighting the underlying issues and difficulties affecting public health before the pandemic is one step towards addressing them.

The webinar demonstrated that the pandemic has shifted how public health is perceived and valued. It has reminded all of us how important access to efficient, well-supported and high quality healthcare really is. Those working in decision-making roles in the healthcare sector are clearly looking towards the next steps for public health and how to give people the highest quality and most efficient care possible. With this in mind, the pandemic may have created a stepping stone towards a better healthcare system.

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How have health librarians been responding to the Covid-19 pandemic?

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The impact of the coronavirus pandemic over the past 18 months has highlighted the vital role of information and knowledge services in supporting health and social care, public health, and medicine.

Last month’s Annual CILIPS Conference included a presentation about #HealthLibrariansAddValue – a joint advocacy campaign between CILIPS and NHS Education for Scotland (NES) which aims to showcase the skills of health librarians and demonstrate the crucial role of health libraries.

Library and knowledge services in the health sector have faced increased pressures and a multitude of challenges throughout the pandemic as they have continued to develop and deliver vital services and resources to colleagues under unprecedented restrictions and changed working practices. With the demand for trustworthy and reliable health information higher than ever, it is clear that well-resourced, coordinated and accessible knowledge services are essential.

Supporting the frontline

Throughout the pandemic, the work of health librarians has been vital in supporting frontline workers including doctors, nurses, pharmacists, and social workers. Hospital library services have been directly involved in medical decision-making, providing evidence and resources to support patient care and the training of medical staff. As the information needs of the medical workforce have changed through the course of the pandemic, health libraries have had to be fast and flexible to provide time sensitive and urgent information to those on the frontline.

A project undertaken by the NHS Borders Library Service saw the creation of a new outreach service for local GPs, which involved the delivery of targeted current awareness bulletins, resource lists, and Covid-19 research updates, all of which directly informed the provision of primary patient care and helped to keep GPs up to date on emerging knowledge about the coronavirus.

Health Education England’s (HEE) Library and Knowledge team adapted their services to meet changing workplace needs, ensuring 24/7 access to digital knowledge resources, gathering evidence on how to keep staff safe while working, and developing training programmes to support virtual working practices for healthcare staff.

Supporting decision-making across sectors

Health librarians have played a major role in informing the UK’s pandemic response at a national level, aiding public health decision-making and facilitating partnership working across sectors.

Librarians from Public Health Scotland’s (PHS) knowledge services have worked closely with PHS colleagues to coordinate Scotland’s response to the pandemic. Their work included the creation of daily Covid-19 updates for PHS’ guidance teams, distributing the latest and most relevant research on key topics, and adapting these updates in line with PHS’ changing priorities (for example as their focus shifted from virus transmission to vaccine efficacy). Librarians at PHS have also been involved in creating evidence summaries to support specific Covid-19 research projects, such as an investigation into the relationship between Covid-19 and vitamin D. The evidence gathered by knowledge services helped PHS to formulate their response on the issue and make national recommendations relating to vitamin D intake.

On 12 July 2021, PHS launched their Covid-19 research repository, which is managed and maintained by the library team and collects, preserves, and provides access to Scottish Covid-19 research. This project aims to support policymakers, researchers, and the public by bringing together Scotland’s Covid-19 research in one place and making it easily accessible for all who need it. It is also aimed at reducing duplication of effort, which health librarians had recognised as a concern during the pandemic.

Similarly, Public Health England (PHE)’s library aimed to tackle the duplication of effort across England by creating their ‘Finding the evidence: Coronavirus’ page which gathers emerging key research and evidence related to Covid-19 and makes it accessible in one place. Many resources on the site are freely available and include a wide range of resources including training materials, and search and fact checking guidance.

Health libraries have also been informing decision-making across the social care and third sectors, with NES librarians facilitating digital access to research and evidence via the Knowledge Network and Social Services Knowledge Scotland (SSKS), and providing training and webinars to help users make the most of such services. NES librarians have been involved in partnership working with organisations such as the Care Inspectorate, SCVO, and Alliance.

Keeping the public informed

A key challenge for health librarians during the pandemic has been in dealing with the information overload and spread of harmful misinformation around Covid-19.

Library and information professionals have had a key role to play in providing trustworthy information to patients and the public, helping people to make informed choices about their health and wellbeing. As previously mentioned, librarians have helped agencies like PHS to deliver clear, meaningful, and authoritative guidance to the public, as well as making up-to-date and reliable Covid-19 research centralised and widely accessible to the public.

The World Health Organization (WHO) emphasises the importance of health literacy in enabling  populations to “play an active role in improving their own health, engage successfully with community action for health, and push governments to meet their responsibilities in addressing health and health equity”. Health librarians have been at the forefront of efforts to promote and improve health literacy during the pandemic.

NES’ knowledge services have been delivering training and webinars to health and social care staff on how to improve people’s health literacy, and health librarians working with HEE have created targeted Covid-19 resources for specific groups such as older people and children and young people.

Final thoughts

Clearly, the work of health librarians has been crucial to the UK’s pandemic response and recovery so far, and advocacy campaigns like #HealthLibrariansAddValue are central to highlighting this important work and demonstrating its impact.

Looking forward, it is clear that innovative and high-quality knowledge services will be essential in a post-pandemic world as they continue to aid recovery, promote health literacy and support the health and social care workforce. As set out in HEE’s Knowledge for Healthcare framework, investment is required at a national and local level to build expertise and support the digital knowledge infrastructure which will be required.

Further reading: more on health from The Knowledge Exchange blog

The year of living differently: reviewing The Knowledge Exchange blog in 2020

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2020 has been a year like no other. A microscopic virus – 10,000 times smaller than the width of a human hair – has dominated, disrupted and redefined the way we live and work.

Although the pandemic is primarily a public health emergency, its effects have been felt in all areas of public and social policy, from economic development and employment to transport and the environment. Throughout this year, our blog has reflected on the impacts of the coronavirus and the restrictions introduced to prevent its spread.

The COVID-19 knock-on

While the coronavirus pandemic has dominated the news headlines, it has also obscured the knock-on effects on the NHS. In October, we reported on the impacts of delays to preventative healthcare measures, such as screening and routine medical care in the form of pre-planned operations for long-term chronic and non-urgent conditions.

As the blog post noted, the impacts have been wide-ranging, including not only delays in care for case of physical ill health, but also for those seeking treatment for mental health conditions:

“Research suggests that incidence of mental illness during the coronavirus pandemic increased. However, the numbers of people accessing services and being referred for treatment have not increased proportionate to this.”

The ‘hidden epidemic’

Long before the coronavirus pandemic, domestic violence had become known as a ‘hidden epidemic’ in the UK. In September, our blog highlighted the unintended consequences of quarantine for domestic abuse victims.

After the UK entered lockdown in March, calls and online enquiries to the UK’s National Domestic Abuse line increased by 25%. Three-quarters of victims told a BBC investigation that lockdown had made it harder for them to escape their abusers and in many cases had intensified the abuse they received.

Despite additional government funding, the local authorities and charities which support victims of domestic violence have been struggling with the financial fallout from the pandemic. Even so,  important partnerships have been formed between local government, educational institutions and third sector bodies to provide safe spaces for women and their children fleeing violence. Among these was an initiative at the University of Cambridge:

“St Catherine’s College formed a partnership with Cambridge Women’s Aid to provide over 1000 nights of secure supported accommodation during the lockdown period.“

‘Same storm, different boats’

As the recent Marmot review has stressed, the coronavirus pandemic has exposed and deepened many of the deep-rooted inequalities in our society, including gender, ethnicity and income.  It has also shone a light on more recent inequalities, such as the growth of precarious employment among sections of the population.

In July, we looked at the uneven economic impact of the pandemic, focusing on the heavy price being paid by young people, women, disabled people and Black and Minority Ethnic (BAME) communities.

Women often work in the frontline of care services and have had to juggle childcare during lockdown. BAME communities are over-represented in key-worker jobs, and so were particularly vulnerable to coronavirus.

And although there has been much talk about ‘building back better’, our blog post drew attention to the observations of Dr Sally Witcher, CEO of Inclusion Scotland during a Poverty Alliance webinar:

“She asks whether indeed we should want to build back, when the old normal didn’t work for a large proportion of people, particularly those with disabilities. Dr Witcher also questions ‘who’ is doing the building, and whether the people designing this new future will have the knowledge and lived experience of what really needs to change.”

The impacts of a pandemic

Many other aspects of the impact of COVID-19 have been covered in our blog:

  • How housing providers have embraced the fluidity of an emergency situation, including tackling homelessness, engaging effectively with tenants and addressing mental ill health.
  • Digital healthcare solutions for those with coronavirus and for the continuity of care and day-to-day running of the NHS.
  • Creating and managing a COVID-secure workplace.
  • How COVID-19 is changing public transport, including an acceleration towards contactless payment and mobile ticketing.
  • The additional challenges of the pandemic facing autistic children and young people.
  • The impact of the coronavirus restrictions on the arts.
  • The role of green new deals in tackling climate change and economic inequality as part of the post-Covid recovery.

Beyond the virus

Although the pandemic has been at the forefront of all our minds this year, The Knowledge Exchange blog has also taken the time to focus on other important issues in public and social policy:

We’ve also taken advantage of the ‘new normal’ experience of remote working to join a number of webinars, and to report back on the observations and ideas emerging from them. Most recently, our blogs have focused on a series of webinars organised by Partners in Planning, which included contributions on how the planning system can help address climate change.

Final thoughts

The health, economic and social impacts of the pandemic are likely to be long-lasting – restrictions on travel, work and socialising will continue into the spring, and insolvencies and unemployment numbers are likely to rise. And the continuing uncertainty over the UK’s new trading relationship with the European Union will generate additional challenges.   

But, as a frequently difficult, often challenging and sometimes distressing year draws to a close, there is cause for optimism about 2021. Vaccines to prevent the spread of the virus have been developed with lightning speed. Across the UK people are already being vaccinated, with greater numbers set to receive the jab in the coming months.

Here at The Knowledge Exchange, we’ll continue to highlight the key issues facing public and social policy and practice as we move towards the post-Covid era.

Season’s greetings

It’s with even greater meaning than ever before that we wish all our readers a happy Christmas, and a healthy, prosperous and happy new year.

Best wishes from everyone at The Knowledge Exchange: Morwen, Christine, Heather, Donna, Rebecca, Scott, Hannah and James.

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Knowledge from a distance: recent webinars on public and social policy

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During the national lockdown, it’s been impossible for most of us to attend conferences and seminars. But many organisations have been harnessing the power of technology to help people share their knowledge, ideas and experience in virtual seminars.

In the past few weeks, the research officers at The Knowledge Exchange have joined some of these webinars, and in today’s blog post we’d like to share with you some of the public and social policy issues that have been highlighted in these online events.

The liveable city

Organised by the Danish Embassy in the UK, this webinar brought together a range of speakers from Denmark and the UK to consider how our cities may change post COVID-19, including questions around green space, high street recovery, active travel and density and types of residential living accommodation in our towns and cities.

Speakers came from two London boroughs, architectural design and urban planning backgrounds and gave examples of experiences in Newham, Ealing and Copenhagen as well as other more general examples from across the UK and Denmark. The seminar’s website also includes links to presentations on previous Liveable City events in Manchester, Edinburgh, Bristol and Glasgow.

What next for public health?

“Healthcare just had its 2008 banking crisis… COVID-19 has generated a real seismic shift within the sector and I don’t think we will ever go back”

This webinar brought together commentators and thought leaders from across the digital health and tech sectors to think about how public health may be transformed by our experiences of the COVID-19 pandemic and the significant shift to digital and online platforms to deliver care.

The speakers discussed data, privacy and trust and the need to recognise different levels of engagement with digital platforms to ensure that specific groups like older people don’t feel unable to access services. They also discussed the importance of not being driven by data, but using data to help us to make better decisions. The webinar was organised by BIMA, a community of businesses, charities and academia across the UK.

Green cities

This project, organised by the Town and Country Planning Association (TCPA), included 3 webinars each looking at different elements of green infrastructure within cities, including designing and planning, assessing the quality of different types of green infrastructure and highlighting the positive impacts of incorporating more good quality green spaces for mental and physical health, as well as for environmental purposes.

Rough sleeping and homelessness during and after the coronavirus

Organised by the Centre for London, this webinar brought together speakers from across the homelessness sector within London, including St Mungos, the Greater London Authority (GLA) and Croydon Council to explore how the COVID-19 pandemic was impacting people who are homeless or sleeping rough in the city.

Each speaker brought insights from their own experiences supporting homeless people in the capital (so far) during the COVID 19-pandemic. They highlighted some of the challenges, as well as some of the more positive steps forward, particularly in relation to co-operation and partnership working across different levels of government and with other sectors such as health.

They also commended everyone involved for the speed at which they acted to support homeless people, particularly those who were vulnerable or at risk. However, concerns were also raised around future planning and the importance of not regressing back into old ways of working once the pandemic response tails off.

Poverty, health and Covid-19: emerging lessons in Scotland

This webinar was hosted by the Poverty Alliance as part of a wider series that they are hosting.  It looked at how to ‘build back better’ following the pandemic, with a particular focus upon addressing the long-standing inequalities that exist throughout society.

The event included presentations from Dr Gerry McCartney, Head of the Public Health Observatory at Public Health Scotland, Dr Anne Mullin, Chair of the Deep End GPs, and Professor Linda Bauld, Professor of Public Health at University of Edinburgh.

A key message throughout was that while the immediate health impacts of the pandemic have been huge, there is an urgent need to acknowledge and address the “long-term challenge” – the impact on health caused by the economic and social inequalities associated with the pandemic.

It is estimated that over 10 years, the impact of inequalities will be six times greater than that of an unmitigated pandemic. Therefore, ‘building back better’ is essential in order to ensure long-term population health.

Returning to work: addressing unemployment after Covid-19

This webinar was also hosted by the Poverty Alliance as part of their wider webinar series on the pandemic.

The focus here was how to address the inevitable rise in unemployment following the pandemic – the anticipated increase in jobless numbers is currently estimated to be over three million.

The event included presentations from Kathleen Henehan, Research and Policy Analyst at Resolution Foundation, Anna Ritchie Allan, Executive Director at Close the Gap, and Tony Wilson, Director of the Institute for Employment Studies.

The webinar highlighted the unprecedented scale of the problem – noting that more than half of the working population are currently not working due to the pandemic, being either unemployed, furloughed or in receipt of self-employment support.

A key theme of the presentation was that certain groups are likely to be disproportionately affected by unemployment as the support provided by the government’s support schemes draw to a close later this year.  This includes women – particularly those from BAME groups, the lower paid and migrants – and young people.  So it’s essential that the support provided by the government in the form of skills, training, job creation schemes etc addresses this, and is both gender-sensitive and intersectional.

Supporting the return to educational settings of autistic children and young people

The aim of this webinar, provided by the National Autism Implementation Team (NAIT), was to offer a useful overview of how to support autistic children and young people, and those with additional support needs, back into educational settings following the pandemic.

Currently around 25% of learners in mainstream schools have additional support needs, and it is generally accepted that good autism practice is beneficial for all children.

The webinar set out eight key messages for supporting a successful return, which included making anticipatory adjustments rather than ‘waiting and seeing’, using visual supports, providing predictability, planning for movement breaks and provision of a ‘safe space’ for each child.  The importance of listening to parents was also emphasised.

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Ellisland Farm, Dumfries. “P1050381.JPG” by ejbluefolds is licensed under CC BY-NC 2.0

Burns at Ellisland

Our Research Officer, Donna Gardiner has also been following some cultural webinars, including one that focused on the links between Scotland’s national poet and the Ellisland Farm site. The webinar was led by Professor Gerard Carruthers, Francis Hutcheson Chair of Scottish Literature at the University of Glasgow and co-director of the Centre for Robert Burns Studies.

Robert Burns lived at Ellisland Farm in Dumfriesshire between May 1788 and November 1791, and is where he produced a significant proportion of his work – 23% of his letters and 28% of his songs and poems, including the famous Tam O’Shanter and Auld Lang Syne.

The presentation looked at how Robert Burns was influenced by the farm itself and its location on the banks of the River Nith.  It also touched on his involvement with local politics and friends in the area, which too influenced his work.

It was suggested that the Ellisland farm site could be considered in many ways to be the birthplace of wider European Romanticism. The webinar also included contributions from Joan McAlpine MSP, who is chair of the newly formed Robert Burns Ellisland Trust. She discussed how to help promote and conserve this historic site, particularly given the impact of the coronavirus on tourism.

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The case for universal basic services

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by Hannah Brunton and Scott Faulds

There are longstanding debates around what should be included in the provision of public services, and this issue was central to the discussion at a recent Glasgow Centre for Population Health (GCPH) Seminar (series 16: lecture 2), at which Dr. Anna Coote presented her proposal for ‘Universal Basic Services’ (UBS). The need for public services like healthcare and education is widely recognised, but services such as adult social care, housing and transport remain largely privatised. As poverty, inequality and environmental issues become increasingly prevalent, could UBS be what is needed to transform public service provision to tackle such problems?

What are universal basic services?

The basic premise of UBS is the idea that public services should be improved and expanded to sufficiently cover all of life’s everyday essentials, for everyone who needs them, irrespective of their ability to pay. One of the main principles identified by Dr. Coote was the idea that public service provision should be guided by the shared basic needs which are common to all in society, such as food, shelter, housing, transport, information, education and healthcare. By combining existing resources and taking collective responsibility for meeting these needs, Dr. Coote proposes that UBS would be a sustainable system that would also allow future generations to manage their own continually changing needs.

A core aspect of the proposal is the idea of the “social wage” whereby all members of society receive a ‘virtual income’ via collective public services, topped up by income support for those who need it, to ensure that everyone’s income is sufficient and that everyone is able to afford the essentials that they are expected to pay for themselves.

How would UBS work in practice?

The proposal involves expanding the variety of public services offered, as well as improving those which exist already, such as education and healthcare. Dr. Coote argues that public services should be broadened to include childcare, adult social care, transport, housing, and information services, universally available to all, and free at the point of use.

However, as Dr. Coote acknowledges, this is easier said than done. The implementation of UBS would mean a major transformation of public services and would require a great deal of investment in social infrastructure, as well as the establishment of clear entitlements to ensure everyone has an equal right to access the services they need.

In practice, Dr. Coote proposes a bespoke approach for each area of need, based on case studies from a range of European countries. For example, the proposal recommends a universal childcare scheme based on Norway’s childcare system, and a free bus system based on transport schemes in France and Estonia.

Benefits of UBS

While Dr. Coote acknowledges the potential difficulties in implementing a system like UBS, her talk outlined the broad range of potential benefits which such a system could bring about, in terms of equality, efficiency, solidarity and sustainability. In terms of social and economic inequality, Dr. Coote argues that UBS could tackle this by reducing income equalities by 20%. The proposal also argues that efficiency would be improved, as investment in public services would deliver more social and economic value than the current market system does. Furthermore, Dr. Coote argues, taking collective responsibility, combining resources, and sharing risks would help to build solidarity and empathy. Finally, with regard to sustainability, UBS could help to tackle the climate crisis by reducing carbon emissions and protecting natural resources, while also improving public health and wellbeing and boosting employment.

Universal basic income

Recently, there has been a spate of trials of what is known as universal basic income (UBI), a form of cash payment paid to every citizen regardless of income or employment status. The concepts of UBS and UBI are in some sense relatively similar: both involve providing some form of statutory support to all citizens. However, Dr Coote, argues that the provision of UBS with a sufficient UBI would be fiscally incompatible. Instead, she suggests implementation of UBS in tandem with a generous, guaranteed income protection scheme. This would include:

  • restoring child benefit to 2010 levels in real terms;
  • swapping the tax-free personal allowance for a cash payment for all but the richest;
  • improving social security payments by 5% for all;
  • removing caps and reduceing rates at which benefits are withdrawn.

The combination of this scheme and UBS have been estimated to cost 5.8% of GDP. By comparison, the provision of a sufficient UBI alone would cost between 20% to 30% of GDP. Dr Coote, invokes the work of Luke Martinelli, who concludes: “an affordable UBI would be inadequate, and an adequate UBI would be unaffordable”. In short, Dr Coote, believes that the provision of a sufficient UBI is unaffordable and that the delivery of UBS, whilst not perfect, avoids the ineffective use of huge amounts of public money which could instead be used to improve and expand upon collective public services.

Additionally, Dr Coote, states that even from an ideological standpoint UBS and UBI are incompatible, arguing that UBI is: “an individualistic, monetary intervention that undermines social solidarity and fails to tackle the underlying causes of poverty, unemployment and inequality”.

For example, proponents of UBS argue that providing people in poverty with a UBI to fend for themselves within an inflated housing market is an inefficient use of public money and contend that it would be more effective to provide quality housing. Research conducted by Oxfam has found that the “virtual income” provided by the provision of universal public services helps to reduce income inequality in OECD countries by roughly 20%. Therefore, it could be argued that by deploying UBS, and substantially enlarging the social wage, people will need less disposable income to meet their needs and flourish.

Final thoughts

At its very core, the concept of UBS can be seen as a desire to create more and better collective services, available as a right, rather than by an individual’s ability to pay. Throughout the seminar, Dr Coote was clear in her belief that UBS is not a silver bullet.  Instead it should be viewed as a principled framework that challenges conventional economic thinking and provides a vision of a better future. In short, UBS can be seen as an attempt to reclaim the collective ideal and as a desire to extend the ‘social wage’ to best meet the collective needs of everyone in society.

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Writing and recovery: creative writing as a response to mental ill health

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“You don’t put yourself into what you write, you find yourself there.”
Alan Bennett

Mental illness, for so long regarded as secondary to physical health, is now being taken more seriously. Media stories about loneliness, anxiety and depression have highlighted increasing concerns about mental ill health, and the issue has also been rising up the political agenda.

In 2017, a survey by the Mental Health Foundation found that only a small minority of people (13%) reported living with high levels of good mental health, and nearly two-thirds of people said that they had experienced a mental health problem.

Prescribed medication is one response to mental health problems, and it’s been reported that the NHS is prescribing record numbers of antidepressants.  But while psychiatric drugs can be of real value to patients, especially those whose condition is very severe, the mental health charity Mind has suggested that alternatives, such as physical exercise, talking therapies and arts therapies, are often more beneficial.

Last month, a conference at the University of Glasgow explored ways in which creative writing is being used to respond to mental ill health, and discussed what makes writing interventions helpful for coping and recovery.

Voices of experience: coping and recovery through writing

“Making and consuming art lifts our spirits and keeps us sane”.
Grayson Perry

Several speakers at the Glasgow conference testified to the effectiveness of writing in dealing with mental ill health and in finding a way to recovery.

In 2012, James Withey experienced a set of circumstances which brought him close to taking his own life. In the darkness of his depression, James felt that he might never recover. But after spending time at Maytree, the UK’s first “sanctuary for the suicidal”, he found that writing about what he was going through offered an antidote to the lies being spun by his depression.

He started a blog, and when he posted a letter to himself, beginning “Dear You.” James found that writing the letter gave him space to express his feelings and to listen to himself.

Before long, readers of James’s blog were responding with their own “Dear You” letters. The word spread that the letters offered a different perspective on recovery, and in some instances, had prevented suicide.

Today, The Recovery Letters project is still going strong, with a website, one published book and another in the pipeline. James is realistic about the project:

“The letters are not a cure for a chronic illness, but they do provide support in helping sufferers of depression accept where they are.”

Policy positions: the view from Wales

“If poetry and the arts do anything, they can fortify your inner life, your inwardness.”
Seamus Heaney

Another speaker at the conference was Frances Williams, a PhD candidate at Manchester Metropolitan University, where she is studying arts and health. In her presentation, Frances explored some of the policy frameworks and public discourse surrounding the field of therapeutic writing in Wales.

She highlighted a recent report, Creative Health, The Arts, Health and Well-being, which  makes a case for the healing power of the arts in many different healthcare and community contexts.  In this report, a creative writing tutor explained some of the ways in which writing can help people experiencing bereavement, including keeping a journal, writing unsent letters, describing personal belongings and resolving unfinished conversations:

“Writing can be a valuable means of self-help, with the page as a listening friend, available any time of the day or night, hearing whatever the writer wants to say. The results of this can be powerful, and include people being able to return to work and adjust more effectively after their loss, acquiring skills for their own self-care which will serve them through the rest of their life.”

Frances also noted that the battle of priorities between impact and value-for-money has driven advocates of arts therapy programmes to defend them in terms of cost effectiveness and social value.

A mapping project by the Arts Council of Wales has taken this to heart, producing in 2018 an audit of the principal arts and health activities currently taking place in Wales.

Writing to the rescue

“By writing, I rescue myself”
William Carlos Williams

The Glasgow University conference underlined the health-giving properties of creative activities and the potential for creative writing to support people suffering with mental ill health. There was no pretence that writing offers a quick-fix solution. As James Withey noted, “…writing is just one element in a toolkit of responses to mental ill health.”

The All-Party Parliamentary Group on Arts, Health and Wellbeing fully supports this concept, and has recommended that policymakers recognise its importance:

“…the arts can make an invaluable contribution to a healthy and health-creating society. They offer a potential resource that should be embraced in health and social care systems which are under great pressure and in need of fresh thinking and cost-effective methods. Policy should work towards creative activity being part of all our lives.”

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Planning healthy cities … integration is key

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Image from Flickr user Sebastian Niedlich, licensed for reuse under a Creative Commons License

Image from Flickr user Sebastian Niedlich, licensed for reuse under a Creative Commons License

By Dorothy Laing

“The environment in which we live, work and spend leisure time – both the physical nature of places and the social environment of communities – has an enormous impact on our health and wellbeing. Health problems such as obesity, chronic heart disease, stress and mental health issues are intricately linked to the environments in which people live and work”. (RTPI, 2014)

Earlier this month the RTPI published Promoting healthy cities: Why planning is critical to a healthy urban future, the third in a series of Planning Horizons papers launched to mark the RTPI’s centenary. The report looks at how planning can help to create healthy cities – one of its main arguments being that health and wellbeing need to be at the core of city design and development.

With a growing number of people living in urban areas, and health problems such obesity and diabetes on the rise, planning for healthy cities is vital. And interest in the links between planning and urban health is nothing new.

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