Tag Archives: Inequalities

‘Breaking the bias’ – gender equality and the gig economy

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Yesterday marked the 111th International Women’s Day, a global day of celebration for the social, economic, cultural and political achievements of women. But it is also an opportunity to reflect on and further the push towards gender equality.

While there has been much to celebrate, it has been suggested that the pandemic threatens to reverse decades of progress made towards gender equality as women have been hit harder both socially and economically than men. However, the shift in working practices during the pandemic may help to transform the future of work to the benefit of women.

There has been continued growth in the digital platform or gig economy workforce, with many women entering this type of work because of the pandemic. The gig economy has been shown to have the potential to improve gender equality in the economy, but it is not without its challenges when it comes to gender parity, as recent research has highlighted.

A platform for gender equality?

The report from the European Institute for Gender Equality (EIGE) highlights that the growth of artificial intelligence (AI) technology and platform or gig work has the potential to create new opportunities for gender equality, but at the same time can reinforce gender stereotypes, sexism and discrimination in the labour market. It found that some of the key attractions of gig work such as its flexibility, are often disadvantageous to women.

The EIGE surveyed almost 5000 workers in the platform economy across 10 countries to understand who they are, why they do platform work, and what challenges they face.  It found that:

  • a higher share of women (45%) than men (40%) among regular platform workers indicated that they worked on digital labour platforms because they were a good way to earn (additional) income;
  • flexibility, expressed as the ability to choose working hours and location, motivated about 43% of women and 35% of men;
  • a higher share of women (36%) than men (28%) said they do platform work because they can combine it with household chores and family commitments;
  • 36% of women started or restarted platform work because of the pandemic, compared to 35% of men.

The flexibility of platform work has consistently been referred to as the main motivating factor for engaging in such work. And this flexibility has been found to be more important for women, particularly in relation to family commitments. In practice, however, the research shows that flexibility is limited, with as many as 36% of women and 40% of men working at night or at the weekend, and many working hours they cannot choose.

On the plus side of the gender equality debate, it seems the gig economy is slightly less gender-segregated than the traditional labour market, with a higher share of men doing jobs usually done by women. For example, traditionally female-dominated sectors such as housekeeping and childcare are more gender-diverse in the gig economy:

  • housework (women: 54%, men: 46%)
  • childcare (women: 61%, men: 39%)
  • data entry (women: 47%, men: 53%)

But the EIGE’s survey also suggests a degree of skills mismatch and overqualification in platform work that affects women in particular. It suggests that highly educated women are more likely to do jobs that do not match their level of education, putting them at greater risk of losing their skills.

Gender bias in AI

The report also shines a light on the issue of gender bias in AI which can be a particular issue in the gig economy where such systems are frequently used.

It argues that gender bias can be embedded in AI by design, reflecting societal norms or the personal biases of those who design the systems. For example, the use of algorithms that are trained with biased data sets perpetuate historically discriminatory hiring practices which can lead to female candidates being discarded.

Platform workers can also be monitored using time-tracking software, which deducts ‘low productivity time’ from pay, increasing ‘digital wage theft’, to which women are more vulnerable.

Considering just 16% of AI professionals in the EU and UK are women – a percentage which decreases with career progression – this is something that needs to be addressed if gender parity in the gig economy, and indeed the entire modern economy, is to be achieved.

Way forward

The EIGE report welcomes new proposed EU legislation to improve the working conditions of platform workers and the EU’s proposed ‘Artificial Intelligence Act’, suggesting this shows promise when it comes to minimising the risk of bias and discrimination in AI. Also highlighted as a positive sign, is the EU’s commitment to train more specialists in AI, especially women and people from diverse backgrounds.

Nevertheless, one of the conclusions of the report is that regulations and policy discussions on platform work are largely gender blind and that action is required on multiple levels to address gender inequalities and discrimination in the gig economy.

To this end, the report recommends that the EU needs to do the following:

  • mainstream gender into the policy framework on AI-related transformation of the labour market;
  • increase the number of women in, and the diversity of, the AI workforce;
  • address the legal uncertainty in the employment status of platform workers to combat disguised employment;
  • address gender inequalities in platform work;
  • ensure that women and men platform workers can access social protection.

There are lessons here for the UK too. Perhaps the fulfilling of these actions will go some way to improving the situation by the time we get to the next International Women’s Day.

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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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Looking back and beyond: The Knowledge Exchange blog in 2021

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If 2020 was the year of the coronavirus, then 2021 was surely the year of the ‘coronacoaster’. From the highs of vaccine rollouts and loosening of social restrictions to the lows of fluctuating case numbers and a worrying new virus variation, we’ve all become unwilling passengers on what feels like an endless un-funfair ride.

But while the pandemic has never been far from our thoughts, it hasn’t taken over complete control of our lives. Research, evidence gathering, conferences and partnerships have continued in fields as diverse as education and housing, culture and the environment.  Which is why, this year’s reflection on The Knowledge Exchange blog in 2021 focuses on some of the issues that we covered which looked beyond the pandemic.

Saving the planet

Until the emergence of Covid-19, many regarded climate change as the greatest threat facing humanity. That threat hasn’t gone away. Last summer, the Intergovernmental Panel on Climate Change (IPCC) released its latest report on the current state of the climate crisis, setting out the already devastating effects of climate change and warning of the deadly impacts, which will intensify as the planet gets hotter.

Throughout this year, our blog has focused on this issue, highlighting the dangers posed by climate change and the efforts to tackle the problem. In April, we looked at the monumental challenge of decarbonising the UK’s ageing housing stock, and highlighted a survey showing that two-thirds of housing associations have started planning to make their homes greener and warmer.

“However, the survey also reported that lack of finance and continuing policy uncertainty remain major obstacles to decarbonising homes. That’s important, particularly given the cost of decarbonisation of social housing – £104bn by 2050.”

We returned to the issue this month, with an overview of plans by government and industry to make the transition from gas boilers to greener ways of heating our homes.

In November, the landmark COP26 climate conference took place in Glasgow, and while the major talking points included protection of the world’s forests and reducing dependency on fossil fuels, our blog focused on how important the circular economy is to tackling global warming:

“…if we were able to double the current 8.6% global circularity figure to achieve 17% circularity, that move alone would achieve the targets on global warming set out by the Paris COP meeting in 2015.”

The cultural imperative

From community murals to television drama, from open-air concerts to singers entertaining neighbours from their balconies, culture and the arts have played a vital role in diverting us from the grim news of the past two years. And although the arts have taken a severe hit during lockdowns, artists across the globe have continued to create and share their work.

In January, we highlighted some of the ways in which creative people have found new ways to express themselves and to support the wellbeing of others:

“Organisations and individuals have been doing a variety of work to reach those most in need such as projects creating new programmes or adapting existing work to reach people who are shielding or vulnerable in their homes, overwhelmingly addressing loneliness and isolation. One participant described their experience: “I found the process of drawing and painting both cathartic and healing at the most difficult time of my life.”

In April, our blog reported on efforts by cultural communities to break down some of the barriers to digital engagement. It’s estimated that seven million people in the UK don’t’ have digital access, while 11.7 million don’t have the digital skills needed to engage online. In an increasingly ‘digital by default’ society, those numbers are troubling.

Our blog post described some of the ways in which arts and cultural organisations are tackling digital exclusion:

“One project managed by Birmingham Museums involved taking digital kit out to care homes for digital arts sessions. This was not only great for wellbeing; it also showed how digital technologies can be adapted to connect with people within communities.”

Levelling up and the foundational economy

The economy is another recurring theme that we’ve highlighted in our blog. The UK is one of the most geographically unequal countries in the developed world. It ranks near the top of the league table on most measures of regional economic inequality. Fixing this is a priority for a government elected in 2019 on a pledge to address inequalities in former industrial regions, and in coastal and isolated rural areas.

In May we reported from a webinar looking at the scope for charities to get involved. On the face of it, the fact that much of the focus is on capital spending could be challenging for charities whose work involves tackling problems such as addiction or homelessness. However, our blog explained that charities shouldn’t write off their chances of obtaining levelling up funding:

“… a lot of the language used in the funding documents is ambiguous – there are repeated  references to ‘community’ and ‘community assets’ without making clear what they mean. This ambiguity could work in charities’ favour. At the same time, many charities work under the banners of skills, employment, heritage and culture. It’s up to charities, therefore, to identify elements in the funding that match what they can offer.”

In February, we shone a light on the foundational economy, which provides some of the essential services of everyday life, such as food, retailing and distribution, education, health and welfare. While these services are vital, many of the workers providing them are among the lowest paid in society.  Our blog looked at the potential value of the foundational economy for the post-pandemic recovery:

“It has been widely agreed that a return to a business-as-usual approach following the pandemic is not the way forward, and that there needs to be a shift in economic policies in order to achieve a more socially and economically just society. Perhaps if such policy change is achieved, a more balanced economy that provides a good quality of life for all can eventually be realised.”

The issues of our times

From town centres to smart cities, from Scotland’s burgeoning space sector to Britain’s hard-pressed food system, throughout the year we’ve been raising awareness of important issues that concern or impact on public policy and practice.

But we haven’t ignored the ongoing public health emergency. In November, we reported from a webinar on some of the lessons from the pandemic and the future role of public health; in July we looked at the important work of health librarians during the pandemic; and in May our blog reported on the role of behavioural insights, data analytics and “nudge” techniques in public health, and in particular during the vaccine roll-outs.

Final thoughts

As we stand on the threshold of 2022, things look uncertain. But, as our blog posts have demonstrated throughout the past year, despite the anxieties and restrictions generated by the pandemic, great work can still be achieved by the public and private sectors, by charities, communities and individuals, for the benefit of society and the wider world.

All of us in The Knowledge Exchange team – Morwen, Donna, Heather, James, Rebecca, Hannah, Euan and Hollie –  would like to wish all our readers a safe and peaceful festive season, and very happy new year.

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Rethinking and rebuilding the voluntary sector post-pandemic

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By Andrew Hogg

From crisis comes opportunity. COVID-19 has had an unprecedented effect on the voluntary sector, but it has also given us an opportunity to rebuild for the better.

With this in mind, the speakers attending the recent ‘Rethink Rebuild’ webinar (organised by NPC) gave their thoughts on how the voluntary sector can move forward to face the challenges and inequalities laid bare by COVID-19 and to create a more equitable society.

COVID-19 has highlighted key systemic inequalities at the heart of our economic system. A recent report from Imperial College London has shown that ethnic minority groups have been disproportionally affected by the pandemic. When age and sociodemographic factors are accounted for, people from these communities are almost twice as likely to die of COVID-19 than their white peers.

Kaneez Shaid, Head of Community Engagement at Rethink Mental Illness, highlighted the direct impact the pandemic has had on people with mental health issues, such as the erosion of support frameworks and statutory services, loss of communal spaces and increased demands for accommodation. NPC have linked COVID-19 with a rise in domestic violence cases, with increased demand for services and donations from voluntary sector organisations, alongside a reduction of charity fundraising efforts:

In many communities it has been the not-for-dividends sector that has provided cohesion, that has provided people with food, with economic viability, access to vaccines, and social infrastructure stopping people falling through the net…the question for me becomes how we make this more visible politically. – Lord Victor Adebowale, current Chair of the NHS Confederation

Seth Reynolds, Principal Consultant for Systems Change at NPC, argued that the pandemic has created a ‘liminal space’ wherein we can pause and reflect on the systemic drivers and fundamental patterns of behaviour that created the inequalities the pandemic has laid bare.

This is a chance to fundamentally and systemically change the way our economy works for the better. There is no going back to normal, so how can the sector provide leadership to face the new challenges going forward?

Collaborative and system leadership

A recurring theme during the webinar was the need for a collaborative leadership approach to accommodate systemic change. Lord Adebowale talked about the need for system leadership, the adoption of which would enable voluntary sector organisations to align their missions and operations towards a common goal. This would set sector-wide objectives and generate a cooperative atmosphere whilst facilitating conditions within which others can make progress toward social change. This means leading beyond the boundaries of one’s own organisational needs to achieve aggregate, cross-sector outcomes.

This would involve understanding the interdependence of the voluntary sector, and decision-making that may go against the immediate concerns of the organisation to achieve collective outcomes. It also entails the acceptance of diversity as not only a good in and of itself, but as Lord Adebowale observed, as an “essential, economical, and operational good”, to include a broad remit of local, grassroots organisations.

A collaborative approach to leadership would also make best use of resources and help align funding to where it is needed. Juliet Mountain, the Director of Shaw Trust, argued that a competitive funding environment means that charities tend towards mission drift and invariably must follow the funding, rather than the needs of those who use their services. She argued that shared intelligence, not just of hard data but of expertise, resources, tools, and decision making, would enable lower capacity groups to easily access and understand generated data. This would enable the triangulation of funding and a coordinated decision-making process – what Lord Adebowale called “process matching intention”.

Power with, not power over

Collaborative and system leadership would also entail a shift towards localism – services either co-produced or fully produced by the communities who receive them – and relationships based on trust, power sharing and diversity. Kaneez Shaid talked of devolving hierarchical relationships between charities and local communities and creating new structures of shared power and co-production, such as integrated care systems and place-based activities embedded into local communities. Leah Davies and Seth Reynolds of NPC similarly argued for local partners and grassroots organisations to be embedded into social recovery plans to co-create structures that are built and maintained by the people using them.

Power sharing can go further than this. Even small, day-to-day changes can help to address power imbalances, such as adapting a more inclusive vocabulary when it comes to working partnerships. Both Kaneez Shaid and Juliet Mountain argued that a shift in language can facilitate a more cooperative mindset and be more inclusive of smaller, grassroots organisations. For instance, using ‘participant’ instead of ‘client’ or ‘colleague’ instead of ‘co-worker’ would create a more inclusive taxonomy and equitable relational partnerships. This in turn would engender collective decision-making and create added value for participants.   

Grant-making

One of the few things to directly result from COVID-19 that has been openly welcomed across the voluntary sector is the increased access to unrestricted funding. In November 2020 over 150 funders made a pledge towards flexible grant-making and trust-based relationships with charities.

Many participants in the webinar who shared their opinions in breakout rooms after the talks also agreed that the temporary suspension of funding restrictions and flexible approaches to grant-making during the pandemic had been hugely beneficial and at times necessary to keep smaller charities open.

Flexible grant making could also involve simplifying and standardising application processes, such as what is asked for from the grantee or the technical vocabulary used in the application. This would mean charities would not have to spend more time than necessary filling out forms and could use templates to increase their application output.

However, as Leah Davies and Seth Reynolds noted, to continue to understand the value of flexible funding and to know where future funding should be allocated, proportionate impact measurement is needed. It is important for funders to be able to keep demand light and proportional whilst having access to a funding feedback loop.

Concluding thoughts

This webinar revealed some key sticking points: cross-sector collaboration, system leadership, and the adoption of new models of power sharing that encourage localism, co-production, shared system analysis, and collective decision-making are needed to dynamically respond to funding needs. Similarly, the collective utilization of resources would allow for greater triangulation of funding and level the playing field for smaller, grassroots groups.

Organisations must come back from the pandemic with a renewed emphasis on community engagement, decentralised and devolved forms of organisation, and embrace the mentality of ‘power with, not power over’. Organisational models and processes, such as affiliate frameworks and decentralised partnerships, should be adopted to encourage power-sharing and to create structures with genuine value to the people using them.

Grant-making has trended towards flexible funding and trust-based arrangements, which is undoubtedly a good thing and grant-makers should continue to provide flexible and unrestricted funds. However, suitable impact measurement is needed to properly determine allocation and value, and that those who need funding the most will get it.

Simply put, we cannot go back to normal. The pandemic has exposed the deep systemic vulnerabilities at the heart of our economic model, and the voluntary sector must adapt to address these vulnerabilities and create a more equitable society.

Further reading: more on the voluntary sector on The Knowledge Exchange blog

Fair and flexible labour market: building back better

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Much has been reported on the recovery from the pandemic and how things can be ‘built back better’ but what about those groups that have been disproportionately affected?

Recent research has highlighted the unequal impacts the pandemic has had on particular groups within the labour market.  From the lowest paid to part-time workers and women, research has considered how things could be moved forward so that those that have borne the brunt of the economic impact are not left behind. In this blog, we take a look at some of these publications, each of which highlights the need to create a fairer and more flexible labour market.

Low paid workers: new settlement needed

The Resolution Foundation’s latest annual Low pay Britain report has warned that the low paid are at greatest risk of becoming unemployed once the furlough scheme ends in September.

Despite the positive backdrop for low paid workers in the run up to the crisis with a fast rising minimum wage following the introduction of the National Living Wage (NLW) in 2016 – which has driven the first sustained fall in low pay for 40 years – the Covid-19 crisis has adversely affected the low paid to a much greater degree than the higher paid. The research showed that workers ranked in the bottom fifth for pay were three times more likely to have lost jobs, hours or have been furloughed than the top paid fifth. Low paid workers are also more likely to work in the sectors most impacted by the pandemic – hospitality, leisure and retail.

As the economy reopens, however, so too do the sectors most restricted over the past year which improves the prospects for low paid workers. Indeed, they are now returning to work fastest. In April alone, almost a million workers came off furlough – more than half of them employees in hospitality, leisure or retail.

But while the report highlights the positive prospects for the low paid, it also addresses several key issues that policy makers will need to consider if the low paid are to benefit from the recovery. Major risks for the low paid are identified:

  • higher unemployment
  • decreasing job security
  • infringements of labour market rights

It argues that low paid workers’ relative unemployment risk after the pandemic is likely to be particularly high given the possibility of structural change concentrated on low paying sectors. And if unemployment rises, it is noted that job quality and infringements of labour market rights are likely to deteriorate.

The Resolution Foundation calls for a new settlement for low paid workers, arguing that “policy makers must look beyond the minimum wage – to job security and labour market regulation – for ways to ensure it’s a recovery that benefits low paid workers”.

Part-time employees: must be included in the recovery

As we move towards the end of restrictions and of the furlough scheme, cracks have also started to emerge for part-time workers, who have been “clinging on in a volatile labour market” according to recent analysis by the Timewise Foundation.

This report notes that part-time employees are one demographic that hasn’t had the same level of scrutiny in the literature as other disproportionality affected groups.

The experience and outlook for part-time employees appears “particularly bleak” according to the report. Despite the furlough scheme being effective in protecting millions from unemployment, it is argued that it is actually masking significant challenges – most notably for part-time workers. The disproportionate impact on part-timers has seen them face higher levels of reduced hours and redundancy. They are also less likely than full-timers to return to normal hours and to hang on to roles during lockdowns.

Evidence shows 44% of part-time employees who were away from work during the first lockdown continued to be away from work between July and September 2020, when restrictions began to temporarily ease. This compares to 33.6% of full-time employees.

The majority (80%) of part-time workers also do not want to work more hours but as Timewise data shows, only 8% of jobs are advertised as part-time – “simply too big a problem to ignore”.

In response to the analysis, a vision for change is set out, focusing on creating a fair and flexible labour market that will:

  • support those in everyday jobs to access flexibility
  • help the millions of people who want or need to work flexibly to find flexible opportunities
  • remove some of the barriers to support those trapped in low-paid work and unable to progress

Women: promoting a gendered recovery

Women have also been disproportionately affected in the labour market, particularly as they are often employed in low-paid and part-time jobs within shutdown sectors such as hospitality and retail, which are notoriously characterised by job insecurity.

This was highlighted in a recent briefing paper by Close the Gap and Engender which looked at the impacts of Covid-19 on women’s wellbeing, mental health, and financial security in Scotland. The paper confirms pre-existing evidence that women have been particularly affected by rising financial precarity and anxiety as a result.

The closure of schools and nurseries and increased childcare disproportionately affected women’s employment and women’s propensity to work part-time places them at greater risk of job disruption. The data shows that young women and disabled women are being particularly impacted by the pandemic.

Key findings include that women are more likely than men to be receiving less support from their employer since the first lockdown, and were significantly more likely than men to report increased financial precarity as a result of the crisis – this was particularly the case for young women and disabled women. Timewise points to the potential for this to add to a growing child poverty crisis.

Similarly to the above reports, which call for the specific affected groups to be included in any future employment strategy, this report concludes by highlighting the importance of a gender-sensitive approach to rebuilding the labour market and economy.

Final thoughts

While furlough has undoubtedly protected many within those groups who have been disproportionately affected by the pandemic, this is only temporary and as all three reports above suggest, these groups are at greatest risk of unemployment and job insecurity when the scheme finally ends.

The research clearly calls for a fairer and more flexible labour market with stronger and better rights for all workers. Failure to address this in the attempt to build back better will only serve to increase the inequalities that already exist in the labour market.

The reports highlighted in this blog post have recently been added to The Knowledge Exchange (TKE) database. Subscribers to TKE information service have direct access to all of the abstracts on our database, with most also providing the full text of journal articles and reports. To find out more about our services, please visit our website: https://www.theknowledgeexchange.co.uk/

Further reading on employment issues from The Knowledge Exchange Blog:

Devolving health and social care in England: an opportunity to transform how we approach health and care?

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In recent years, the Department of Health and Social Care (DHSC) has increasingly encouraged the transfer of powers over health and social care in England away from central government and towards city regions. These bodies, DHSC argues, are uniquely placed to understand the challenges faced by their local populations, the capacities and expertise of their local NHS and to develop plans for the future. This should enable them to approach health at a local level, promoting increased delivery of care in the community, and a greater integration between health and care services.

Putting local places at the centre of “Build back better”

In August 2020 the Health Devolution Commission launched its final report, Building back health and prosperity. Among other themes, like taking a “health in all policies approach”, the report found that devolving accountability and power to a more local level creates the potential to understand communities and places better, and to meet their needs.

The NHS Long Term Plan has also outlined a new direction for the NHS based on the principle of collaboration rather than competition, and the introduction of new structures such as Integrated Care Systems, Integrated Care Providers and Primary Care Networks. These partnerships bring health and social care commissioners together to plan and deliver integrated and person-centred care.

In the context of “building back better”, awareness of how our external experiences and contexts impact our health and wellbeing (for example the impact of poverty, deprivation, housing, and unemployment) is increasingly important.

Beyond the immediate recovery from the pandemic, health devolution could be one way of opening up the possibility of integrating not just disparate services within the NHS – or even NHS and social care services in a locality – but bringing together in a combined strategy and structure all of the services, systems and partners in a community that have an impact upon the health of a local population, and the care services to better meet their health needs.

“It doesn’t have to be a battle”- partnerships and balance are the key to effective devolution

The move away from centralised processes and organisations towards more local ones can sometimes be portrayed as a rejection or an attempt to “break free” from central government. However, practitioners have been increasingly stressing that devolution does not mean complete independence, and that while improved local decision making will improve outcomes for local people, that does not mean that the need for some centralised decision making is completely removed.

On the contrary, some decisions should and will be taken at a national level, but the ability to distribute power, decision making and accountability to a local level will have significant positive impacts for improving “citizen voice”, transparency and co-production in decision making.

This is where the Health Devolution Commission argues that balance, communication, and partnership between the local and national infrastructure needs to be aligned so that devolution can be successful and sustainable. Integrated planning and management of long-term health care strategies is important, as is the ability to bring citizens and local decision makers into discussions about national health policy.

The Voluntary, Community and Social Enterprise (VCSE) sector, including patient voice and carers organisations, also plays an important role in linking together services and communities. As well as partnering to deliver services, these organisations also often offer vital bridges between statutory systems and those communities which can often be excluded from engagement with services or who can find it harder to access them. The commission also emphasised the importance of bringing these bodies into the conversation on devolution going forwards as they will be invaluable partners in the process.

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DevoManc providing the blueprint?

In 2016, as part of a pilot, control of the health and social care budget for Greater Manchester was transferred to a partnership team in the area comprising local authorities, clinical commissioning groups, NHS foundation trusts and NHS England.

The combined authority identified that the health of its population was one of the key obstacles to its economic growth. By relating the concept of regional economic prosperity with health, they began to see health in a completely different way – as part of a wider plan and an investment for growth, not a burden.

“It’s better to have decisions made locally, because local people understand what local problems are and what Greater Manchester needs. We need to work together.”

Lord Peter Smith, Chair of Greater Manchester Health and Care Board

The Greater Manchester Health and Social Care Partnership are working in partnership with other sectors including education and housing to support everything from good eating habits and exercise to education and everyone’s ability to earn a decent living. The partnership is taking action to give children the start they need, support independence in old age, tackle illness earlier on and even prevent it altogether by improving the lifestyles of local people.

Other areas of England are also currently undertaking their own health devolution journeys, including London, West Yorkshire and Harrogate, as well as some other combined authority areas. However, one of the big challenges is that currently, while we can learn from the experiences of those already on their devolution journey, there is no common, consistent or comprehensive understanding of what good heath devolution looks like, full evaluations of the benefits it brings or overarching strategies on how it should be developed.

This is something that will need to be addressed if health devolution is to be successfully rolled out across England.

Final thoughts

Devolution of health to a more local level provides an opportunity to tackle the big public health challenges of our time at source, and to create a better, more joined up community health ecosystem. It also provides the chance to share and collaborate, learning from best practice and delivering improved health and social care services at a regional and national level.

It has been suggested that the coronavirus pandemic, while traumatic in more ways than one for the NHS and its staff, may provide the re-setting point needed to implement some of the changes proposed in relation to greater health devolution. Proponents of this view argue that improved funding to support effective and high quality care, improved integration between health and social care, and greater positioning of health and assessment of the impact of decisions on health across all policy areas, should be among the top priorities as the country looks to recover from the pandemic.

As the Health Devolution Commission underlines:

The pandemic has shown we cannot go back to the way things were. We need a ‘new normal’ and we believe that comprehensive health devolution is the only viable solution to the challenges the country now faces.”

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“The infrastructure of everyday life” – has the time come for the foundational economy?

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The last few years has seen growing interest in what has been termed the ‘foundational economy’ and its potential value for achieving economic security and social sustainability. Accounting for around 44% of UK employment, it has been argued that supporting this section of the economy could ultimately improve productivity. And the current pandemic has placed even more emphasis on the importance of the foundational economy – the part of the economy that cannot be shut down.

What is the foundational economy?

The foundational economy provides universal basic services built from the activities which provide the essential goods and services for everyday life, regardless of the social status of consumers. Primarily delivered locally, these goods and services encompass infrastructures, utilities, food, retailing and distribution, education, health and welfare. Because of this, it is thought to have considerable potential to regenerate the areas where the local economy is relatively weak – perhaps the perfect solution for the levelling up agenda?

The initial manifesto for the foundational economy from researchers at the University of Manchester resulted from dissatisfaction with generic industrial and regional policy focused on promoting competition and markets; with success measured in terms of job creation and GDP growth. According to the manifesto, the foundational economy is “the mundane production of everyday necessities” which is taken for granted by all members of the population. As such, it is often also referred to as the ‘sheltered’ or ‘invisible’ economy.

Scale and value

In providing the infrastructure for everyday life, the foundational economy is also very large. It has been noted that in all European countries, it directly employs around 40% of the workforce. In the UK, around 44% of the workforce is employed in foundational activities. In Germany, it is 41% and Italy it is 37%. The value of foundational output and volume and diversity of foundational employment is therefore much larger than in high-tech and tradeable services, with which policymakers are determinedly focused on.

Other measures of value have also been highlighted, such as household expenditure. The initial manifesto notes the importance of weekly spend on the foundational economy with nearly 30% of all household expenditure going on foundational activities.

Despite providing vital services, and employing a significant portion of the UK population, the foundational economy is marked by low-tech, low-wage, part time and often precarious employment and is potentially at risk from automation, despite the significant ‘human’ element to many of the different job roles which make up this part of the economy. Within society a lot of foundational jobs are still considered by many (often who don’t work in the sector) to be “jobs you move on from” where in reality, for many people, particularly women and migrant workers, this isn’t the case.

But where would we be without these roles providing for all citizens’ basic needs? Job creation and GDP growth may suggest a successful economy but this, it is argued, does not show the wellbeing of all society or sustainability. In the face of current, and indeed future, crises, it seems perceptions may be starting to change as more and more people become concerned with health and wellbeing and the environment. Indeed, it has long been argued that necessity is only recognised in times of crises.

Has Covid-19 shone a vital light on the foundational economy?

While many sectors were shut down due to the coronavirus pandemic, the foundational economy remained open as it was considered systemically important for meeting basic needs. The pandemic has highlighted that this part of the economy is needed at all times, including at times of crisis.

Healthcare staff have become frontline heroes and food delivery drivers are recognised as key workers. But this enhanced status has also highlighted the poor pay and conditions of many key workers delivering these essential goods and services and the inherent inequality that exists in society.

Just like other crises, from natural disasters to large scale economic shocks, these bear most heavily on the poor and vulnerable. The pandemic has shown that these inequalities must be addressed so that basic everyday services are more equally available.

The pandemic has also shown that economies are about more than market economies. It has been argued that there needs to be a move towards meeting a population’s basic needs rather than on individual consumption.

Way forward

Advocates of the foundational economy argue that public policy should focus on securing the supply of basic goods and services for all citizens in a socially responsible way.

The 2020 manifesto for the foundational economy from The Foundational Economy Collective argues for the renewal of the foundational economy with a ten-point programme, including proposals related to:

  • better health and care
  • housing and energy
  • food supply
  • social licensing
  • tax reform
  • disintermediation of investment from pension funds and insurance companies
  • shorter supply chains in foundational commodities
  • citizen engagement
  • better technical and administrative capacity at all levels of government
  • international constructive responsibility

It has been widely agreed that a return to business-as-usual approach following the pandemic is not the way forward and that there needs to be a shift in economic policies in order to achieve a more socially and economically just society. Perhaps if such policy change is achieved, a more balanced economy that provides a good quality of life for all can eventually be realised.

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Healthy ageing: how health inequality can be tackled at the local level

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Image: Peter Kindersley via Centre for Ageing Better

Older people make up a significant portion of our population, and projections show the proportion of people over the age of 60 within the global population is set to rise even further over the coming years. ONS data shows by 2066 there will be a further 8.6 million projected UK residents aged 65 years and over, taking the total number in this group to 20.4 million and making up 26% of the total population.

Supporting people to age well, and age healthily is something which both local and national policymakers will have to take account of in order to not only ensure good quality of life for their ageing populations but also ensure that services are not overwhelmed.

Studies show the higher levels of deprivation people face in their earlier years, the more likely they are to enter older age in poor health and die younger compared with people who experience lower levels of deprivation. This highlights the need to tackle inequality across the life course, with the preventative action having a positive knock on impact on health inequalities in later life.

Some of the main drivers of inequalities include: social exclusion and isolation; access to and awareness of health and other community services; financial difficulties including fuel poverty and housing issues; insecure or low paid employment, with reduced opportunity to save or enrol in a formal pension to prepare for retirement; a lack of transport and distance from services; low levels of physical activity; and mobility or existing poor health, often characterised by long term chronic health issues.

These inequalities often combine and overlap to create even more challenging situations as people move into older life. More recent research has shown that the Covid-19 pandemic has only exacerbated these inequalities further.

Tackling inequalities at the local level

Alongside the national discussions around ageing, local demographic change has received comparatively less attention, despite place-based policies and concepts like “ageing well in place” being used in public health conversations for a number of years.

Research from the Resolution Foundation explores the intersection between demography and place, and its implications for politics and policy while further research is looking increasingly at local level case studies to highlight pockets of best practice which could help to inform the national approach.

A review from Public Health England looked at the specific experiences of older people in coastal and rural areas and the specific challenges they face in comparison to people living urban areas, exploring local level interventions and interventions which adopt a place- based approach, responding to the specific needs of people living in the area.

Other research in this area stresses that councils have a clear leadership role in supporting an ageing society and that they are uniquely placed to create strategies which reflect the needs of their populations. Through local engagement of older people systematically and regularly, and through co-production and co-design in the production of local policies and services, councils are in a position to underpin a more positive outlook on ageing, ensuring that older people are regarded as full citizens, rather than objects of charity or pity.

Approaches to poverty reduction in Greater Manchester

In Greater Manchester, healthy ageing and age inequalities have been made mayoral priorities and the Greater Manchester Combined Authority set up the Greater Manchester Ageing Hub to respond to what policymakers there see as the opportunities and challenges of an ageing population.

In 2018 the city published an “Age Friendly Strategy” to promote increased social inclusion within the city by trying to tackle the barriers to inclusion created by poverty and inequality, including creating age friendly places which allow older people to participate within their local communities, and promoting healthy ageing through strategies like GM Active Ageing, a partnership with Sport England.

Image: Peter Kindersley via Centre for Ageing Better

Creating a consensus on healthy ageing

The Centre for Ageing Better and Public Health England established 5 principles for healthy ageing which they are urging government and other policy actors to adopt to support future healthy ageing the five principles are:

  1. Prevention
  2. Opportunities
  3. Good homes and neighbourhoods
  4. Narrowing inequalities
  5. Tackling ageism

These principles can be used as building blocks to help organisations create strategies and policies which accurately reflect the core needs of people as they age. One thing which continues to be a challenge, however, is integrating intersectionality into both research and strategies or frameworks on ageing.

Not treating “older people” as one homogenous group, but taking account of the individual experiences of specific groups and how this may impact on their experience of inequalities: this is something researchers are making efforts to resolve in their work, and while there are limited studies which look specifically at BAME or LGBT groups, in the future taking account of intersectionality in ageing and inequalities will become more commonplace.

The future of ageing

We are living longer than ever before. Taking steps to reduce inequalities and support healthy ageing will ensure that those extra years are fulfilling, both for the individual and for society.

Helping people to continue to contribute to society, to really live into old age, embrace and enjoy it – and not just exist – in old age should be a priority for everyone, Reducing inequalities to support people to age well will be a major contributor to ensuring this happens.

If you enjoyed this article you might like to read:

A home for life? Developing lifetime neighbourhoods to support ageing well in place

“Same storm, different boats”: addressing covid-19 inequalities and the ‘long term challenge’

Inclusive streets: from low expectations to big dreams

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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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“Same storm, different boats”: addressing covid-19 inequalities and the ‘long term challenge’

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MS Queen Elizabeth in Stornoway

The coronavirus pandemic has impacted upon almost every aspect of life.  However, this impact has not been felt by everyone equally. Some groups of people have been particularly badly affected – both by the virus itself and by the negative social and economic consequences of social distancing measures.  The phrase ‘same storm, different boats’ has been used widely to emphasise this.

The 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 too, such as the growth of precarious employment among sections of the population.

As we move out of lockdown, the long term consequences of the pandemic will continue to be felt unevenly across different sections of society, with those on the lowest incomes being most vulnerable.

As thoughts turn to recovery, there is a growing sense that now is the time to consider how we can create a more equitable society that benefits those most in need.

 

The long-term challenge

During a recent Poverty Alliance webinar, ‘Build Back Better: Poverty, Health and Covid-19: emerging lessons from Scotland’, Dr Gerry McCartney, Head of the Public Health Observatory at Public Health Scotland noted that the coronavirus pandemic was causing three concurrent public health crises:

  • the direct impact of the virus (through ill health and/or death);
  • the indirect impacts on health and social care services (e.g. reduced hospital admissions/referrals, delayed diagnoses); and
  • the long term unintended consequences of physical distancing measures

Dr McCartney’s recent research sets out the different groups at particular risk from covid-19 and outlines a number of ways in which the unintended consequences of physical distancing measures may negatively impact upon health via a complex set of pathways – including reduced physical activity, fear, anxiety, stress, boredom and loneliness, economic stresses related to reduced income and unemployment, the impact of the loss of education, as well as the risk of abuse and exploitation of children not in school, substance abuse, and domestic abuse and violence.

Dr McCartney has also been involved in a project that sought to quantify the direct impact of the pandemic in terms of years of life lost.  The results showed that, over 10 years, the impact of inequality on life expectancy is actually at least six times greater than the direct impact of the pandemic itself.

Dr McCartney referred to this as the “long-term challenge” and argues that in order to address these inequalities, it is crucial that society aims to ‘build back better’ following the pandemic.

Build Back Better

But what does this mean?  Put simply, Build back better argues that pandemic offers an unprecedented opportunity to refocus society on the principles of equity and sustainability.

A recent paper by the Wellbeing Economy Alliance (WEAll) sets out 10 key principles for ‘building back better’, covering a range of environmental, social and governance issues:

It highlights international examples of each of these principles in action, for example, speeding up the adoption of the doughnut economics framework in Amsterdam in response to the pandemic, and through the wellbeing principles implemented by the Wellbeing Economy Governments (WEGo) group, consisting of Iceland, New Zealand and Scotland (and recently joined Wales).

Indeed, in Scotland, the independent Advisory Group on Economic Recovery, established by the Scottish Government, have recently published their findings on how to support Scotland’s economy to recover from the pandemic.  It states that “establishing a robust, wellbeing economy matters more than ever”.

Unequal employment impact

One of the guiding principles set out by the Advisory Group on Economic Recovery is to “tackle inequality by mitigating the risks of unemployment, especially among groups hit hard by the crisis”.

Indeed, unemployment following the pandemic is unlikely to affect everyone equally – women, young people, BAME individuals and the low-paid are predicted to suffer the brunt.

In a subsequent Poverty Alliance webinar, ‘Addressing unemployment after Covid-19’, Tony Wilson from the Institute for Employment Studies (IES) highlights the scale of the problem.  He states that unemployment is rising faster than at any point in our lifetimes (barring a blip in 1947), and is likely to increase by 3 million as a result of the pandemic.

Again, the impact of this will be uneven.  Anna Ritchie Allan, director of Close the Gap, discusses the impact upon women in particular.  As well as being more likely to work in a sector that has been shut down, women are also more likely to have lost their job, had their hours cut, or been furloughed. As women are also usually the primary carers of their children, they have disproportionately affected by the closure of schools and home learning.

A recent report by Close the Gap highlights how the impending post-covid downturn is different than previous recessions, as the restrictions imposed to tackle the virus have impacted most heavily upon sectors that employ large numbers of female (e.g. hospitality, retail, care), as well as services that enable women’s participation in the labour market (e.g. nurseries, schools, and social care). Young and Black and minority ethnic (BME) women have been particularly affected.

For example, Kathleen Henehan, Research and Policy Analyst at the Resolution Foundation, considers how young people’s employment prospects have been affected by the pandemic. She notes that young people leaving education are likely to be worst affected.  However, again, inequalities exist – with those with lower levels of qualifications being particularly affected, and women and BME individuals within those groups affected most of all.

According to Anna Allan, policy to address unemployment as a result of the pandemic needs to be both gender-sensitive and intersectional – taking account of the fact that women are not one homogenous group, and ensuring that any job creation is not just providing more ‘jobs for the boys’.  For example, recent research by the Women’s Budget Group shows that investing in care would create 7 times as many jobs as the same investment in construction: 6.3 as many for women and 10% more for men.

Building forwards

In a third webinar, ‘Disability, rights and covid-19: learning for the future’, Dr Sally Witcher, CEO of Inclusion Scotland, suggests that as well as exposing and deepening existing inequalities, the coronavirus pandemic has created the scope for new inequalities to be created – ‘faultlines’ created by the differing impacts of the virus.

Dr Witcher questions the term ‘build back better’ – 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.

Dr Witcher suggests that for any attempt to ‘build back better’ to be meaningful, it needs to reach out to the people that don’t currently have a voice – the people who have been most heavily affected by the virus.  Not only do these groups need to be involved, but they need to be leading the discussion about what a post-covid future looks like.

A post-covid future

Whilst the coronavirus pandemic has had a massive, devastating impact on people and economies around the world, it has created an opportunity to reflect on what is important to us as individuals and as a society.

There is strong public demand for change. According to a new YouGov poll, only 6% of the public want to return to the same type of economy as before the coronavirus pandemic.

Building back better recognises that addressing the causes of the deep-rooted and long-standing inequalities in our society is critical to a successful post-covid recovery.

There is also a need to protect and enhance public services, address issues of low-pay and insecure work, and prioritise wellbeing and the environment through a ‘green recovery’.

As Tressa Burke, of the Glasgow Disability Alliance, states:

“History will recount how we all responded to the coronavirus outbreak.  We need to ensure that the story told demonstrates our commitment, as a society, to protecting everyone from harm, particularly those most at risk of the worst impacts of covid.”

For further discussion of the wellbeing economy, you may be interested in our blog post ‘How well is your economy? Moving beyond GDP as an indicator of success‘

The Knowledge Exchange provides information services to local authorities, public agencies, research consultancies and commercial organisations across the UK. 

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