Ending poverty: the biggest public health challenge of our time

28 July 2022
Ed Davie

By Ed Davie

The interlocking crises of environmental pollution, worsening poverty and ill health can feel dauntingly overwhelming – but our predecessors have shown that change is possible.

Victorian Britain’s polluted, violent, disease-ridden slums must have seemed like an impossible environment to improve, but scientists and social reformers like John Snowe, Florence Nightingale and Charles Booth successfully made the scientific and moral case for better living conditions, human rights, and welfare reform.

After the Second World War another generation created a wave of further reform that transformed the lives of the poorest, and the whole population, with the creation of the NHS, the welfare state and comprehensive education. This was done even after the country had lost nearly half a million lives and been all but bankrupted fighting an existential war.

Open sewers, slums and cholera may be long gone in this country, but our generation faces its own environmental, social and health challenges that we must rise to.

Our review finds clear evidence that poverty and economic inequality, the gap between rich and poor, is toxic to people’s mental health

As a very modest part of that effort, our new Centre for Mental Health policy briefing brings together the evidence on how poverty and economic inequality affect mental health and what can be done to reduce harm. To do that we must understand the problem, identify solutions and work with people to make the changes necessary.

Our review finds clear evidence that poverty and economic inequality, the gap between rich and poor, is toxic to people’s mental health. Children living in the worst deprivation are 12 times more likely to experience multiple adverse childhood events and four times more likely to suffer serious mental illness. Adults living in deprivation have more than double the risk of depression, suicide, and other poor outcomes than the least deprived. It is also clear that a lot of this harm can be prevented – quite small increases in income can reduce threats and improve opportunities for health. Studies have shown that an 8% rise in the minimum wage can reduce suicide rates by up to 6% – that would equate to over 300 saved lives in England every year – and that a 15% rise in a child’s household income can dramatically improve their mental health.

Without change, millions more people will suffer avoidable mental ill health and our already creaking health and social care system will be overwhelmed with demand. As vital as properly resourced mental health services are, we cannot treat our way out of problems created by social and economic conditions that we then send patients back to.

The first step is committing to make ending poverty a national, regional, and local mission

The World Health Organisation describes mental health as ‘a state of balance, both within and with the environment’. We must do better at achieving that balance by reducing the inequality and environmental harms that leave too many people vulnerable to poor mental health.

The first step for real change is committing, as a whole society, to make ending poverty a national, regional, and local mission.

Specific recommendations for national government include increasing social security payments and the minimum wage, building many more energy efficient social rent homes and extending free childcare. Councils should be as generous as they can be with their council tax support schemes and invest in financial advice and smoking cessation services. NHS bodies should become Living Wage accredited, use social value procurement to hire and buy more locally (especially from vulnerable groups) and offer financial advice alongside clinical help.

If our forebears can build entire sanitary, health, education, and welfare systems, then surely we can create solutions to the social, economic, and environmental problems facing our generation? As Maya Angelou said: ‘Now we know better, we must do better’, and do better we must.

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