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There are two terms of poverty ‘absolute’ and ‘relative’. Absolute refers to the amount of basics that we need to survive and relative is the standards of living in a society at any particular time (Kelly & McKendrick 2007). This essay aims to discuss the impact of poverty on community and social care, the influences it has on health across the lifespan, the relevance to nursing practice, services available to address the problem and local policies on poverty.
Poverty is when a household income (adjusted for the size and make-up of the household) is less than 60% of the UK average income. The circumstances that cause poverty are wide-ranging and include many day-to-day things including health, housing, education, employment and access to services (The Scottish Government 2010).
There has been a steady growth of child poverty in Scotland and in the UK in the last few years. Accordingly households in Scotland where income is lower than most can be considered to be living in poverty (Kelly & McKendrick 2007).
The Government wants to provide children and young people with the best start in life. The Government’s pledge in 1999 to end child poverty by 2020 has already led to 600,000 fewer children in poverty in the UK. Although progress has been made, 2.9 million children still remain in poverty. With the introduction of The Child Poverty Bill in 2009 the Government will be answerable to Parliament on the progress of this Bill (DCSF 2009).
Poverty is not only happening in this country but all over the world. A report out by a leading charity has announced that 4 million children are living in poverty and about 1.7 million children are living in severe poverty in the UK – one of the richest countries in the world (Save the Children 2010).
Child poverty restricts children’s involvement to activities and services. While some children will grow up in low income households and go on to achieve their goals many will not. Poverty places stress on family life and excludes children from everyday activities which other children take for granted (David Piachaud 2005).
The barriers which Lone parents face when they try to move from benefits to work can be that Employers are often reluctant to employ them; which means that lone parents worry about combining work with their childcare responsibilities. Financial stability is crucial, but it is often hard to achieve. Some lone parents working into low-paid jobs find they are simply worse off in work than living on benefits. Citizens Advice argues that adequate support for parents lies in breaking down the barriers to going back to work, the re-organising of the tax and welfare systems, ensuring appropriate childcare; and for employers to provide more flexible jobs (Citizens Advice 2008).
Adair Turner’s Pension Commission report has set out new policies on pensions. The changes to retirement ages which are set to rise to 66 by the year 2030, 67 by 2040 and 68 at 2050. Turner proposes that the Basic State Pension would increase in line with earnings instead of prices from 2010 bringing a rise in income for pensioners. There would also be a reduction in means-tested benefits such as Pension Credit which the Commission believes act as a deterant to saving.
After some pressure by Help the Aged, among others, Adair Turner has decided that entitlement to pensions should be based on residency instead of contributions from the age of 75, while the complex State Second Pension (S2P) would eventually become a flat-rate extra payment. Turner has also set up a National Pension Savings Scheme (NPSS) which would mean workers would pay 4 per cent of their salary into their pension, alongside additional contributions from the Government and employers (Help the Aged 2010).
There are a number of benefits available to help people on low incomes. These are Jobseekers Allowance, Incapacity Benefit, Severe Disablement Allowance, Disability Living Allowance, Pension Credit and Income Support and from April 2004 Child Tax Credit and Child Benefit.
Income Support is a means tested benefit for people whose income falls below a specified level or who have no other source of income. Welfare payments are an important source of household income in Scotland almost one sixth of household income in Scotland comprises welfare payments and state pensions combined. Therefore making household incomes in Scotland more reliant on welfare benefits than any other parts of the UK (Kelly & McKendrick 2007).
The introduction of a National Minimum Wage (NMW) was a major feature of the Labour Party’s manifesto. Following their election the Government set up an independent Low Pay Commission to recommend the level of the NMW and how it should apply to young people and people in training.
The reasons put forward to support an NMW cover three broad areas; social – a minimum wage would target low pay and poverty; equity – a minimum wage reduces exploitation, protects employers, and cuts the cost to taxpayers of topping up low incomes via the social security system; economic – extra demand in the economy would increase employment; a minimum wage could also boost investment and productivity (CIPD 2009).
Child Trust Fund (CTF) is a savings and investment account for children. Children born on or after 1 September 2002 will receive a £250 voucher to start their account. The account belongs to the child and can’t be touched until they turn 18, so that children have some money behind them to start their adult life (Child Trust Fund 2010).
A large income gap between the most weathly and the worst off in society is closely associated with higher death rates worldwide, especially for younger adults, finds a study published on bmj.com today as part of a global theme issue on poverty and human development. Studies show that greater income inequality in a nation is associated with higher mortality rates, but most have focused on wealthier nations. However, it has recently been suggested that the effects of income inequality on health are of importance worldwide, not just in wealthy nations. There is also some evidence that this effect is more pronounced at different ages. They confirm that the impact of income inequality on health is real and that it has a greater influence on mortality in wealthier countries between the ages of 15 and 29, and worldwide between the ages of 25 and 39 (BMJ 2007).
If being poor is bad for you, living in a cold home can be lethal. The annual figures published on ‘excess winter deaths’ are the best we have from official sources – however there are no figures which take in the knock-on costs to the NHS of cold-related illnesses, In the last set of figures, covering the winter months of 2004-2005, the number of winter deaths reached nearly 30,000. There are policies in place to help people who are ‘fuel-poor’, but they do not know that they are fuel poor and can access help. This is where community nurses come in. Health professionals are usually welcome visitors in any house and enjoy a degree of trust from the public. People who need help with their fuel poverty needs probably claim it the least. Many are isolated by poor health or their own poverty. Community nurses do not have the time to become experts but helping their clients to benefit from these programmes would help them to feel better. So encouraging older people who may be cold and poor to explore ‘benefit health checks’ could transform their income, warmth and health (Mervyn Kohler 2006).
Someone living in a deprived area is more than twice as likely to have a long term illness compared with someone in a weathly area. People living with a long term illnesses are likely to be more disadvantaged across a range of social factors such as employment, qualifications, home ownership and income. The impact of deprivation can also be seen in terms of mental health and wellbeing, with a recent Scottish survey reporting higher levels of mental wellbeing being associated with those on higher incomes (Scottish Government 2007).
Studies on the impact of temporary unemployment have demonstrated that being out of work is bad for an individual’s health. Those analyses did not control for the economic cycle, however. In a recent study, Strully24 looked at US interview
data taken from 1999, 2001 and 2003 Panel Study of Income Dynamics. People were asked about certain aspects of their employment, their health and a variety of health conditions. Losing your job was associated with a 54% chance of reporting fair or poor health, and for a person with no pre-existing health conditions, the chances of reporting a new one increased by 83% with job loss. Low unemployment is also associated with the reporting of more poor health conditions (S Bezchruka 2009).
The Black Report, published in 1980 stated that although the establishment of the National Health Service the differences between the health of the rich and poor had widened not narrowed, health had improved over all socio-economic groups but had been greater among the educated and wealthy (Oxford Journal).
The Acheson Report, published in 1998, called for an increase in benefit for women of childbearing age, expectant mothers, young children and pensioners and said that many people on low incomes had insufficient money to buy the food and services necessary for good health. It also called for more funding for education in deprived areas; better nutrition at schools; Children should learn about parenting and relationships, and should receive sex education. (Telegraph 2010).
The above reports by Black and Acheson collected information which showed that ill health and disease are socially patterned with the more wealthy groups of society living longer and enjoying better health than deprived groups. Nevertheless health has slowly improved but there is still a great divide between socioeconomic groups and their health status (Naidoo & Wills 2009).
The Index of Multiple Deprivation 2007. There are seven measurements of deprivation these include income, employment, health and disability, skills and training, education, housing, living environment and crime. There are also six district summary scores for each Local Authority district (there are 354 districts in England) and for each County Council and higher tier (there are 149 of these). A relative ranking of areas, according to their level of deprivation is then provided. There are also supplementary Indices measuring income deprivation amongst children and older people: the Income Deprivation Affecting Children Index (IDACI) and the Income Deprivation Affecting Older People Index (IDAOPI) (Communities.gov 2007).
In conclusion although the Government’s pledge to eradicate child poverty by 2020 is underway there is still a great deal to consider in order to help both young and old people.
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