Don't be poor

Following the Spring Statement in March, the Resolution Foundation published analysis estimating that another 1.3 million people would be pushed into poverty next year. Professor Michael Marmot has warned of an impending “humanitarian calamity” and argued that to deprive citizens of basic material needs robs them of their dignity.

In place of a policy response to the poverty pandemic there is a void. Cue the Health Disparities White Paper (currently being drafted in the new Office for Health Improvement and Disparities). It could be out as soon as May or June, so the influencing window is narrow.

The priority given, by the public and politicians, to tackling the elective backlog in the NHS is understandable. We can see it, right here and right now. However, the Secretary of State for Health and Social Care has also acknowledged the link between poverty and poor health and outlined his ambition to address the ‘social backlog’. Both are essential and both are connected. The Prevention Green Paper, published in 2019, represents the most recently abandoned attempt to consider the barriers that stand in the way of creating healthier people and places.

COVID-19 has shown that the problems of tomorrow soon become the problems of today. Higher levels of poverty and inequality cause fault lines in our economy and society, weakening our collective defences and limiting our future potential. None of our social or economic goals can be achieved whilst poverty blights millions of lives, whether in relation to educational attainment, safe communities or good mental and physical health.

I have borrowed the title of this blog from the Townsend Centre for International Poverty Research. It produced ‘alternative tips’ to the public health advice offered by the Chief Medical Officer. The official guidance is ‘don’t smoke. If you can, stop. If you can’t, cut down.’ The alternative reads ‘don’t be poor. If you are poor, try not to be poor for too long.’

Advice alone does not change behaviour. Every health challenge is created and/or exacerbated by poverty. As individuals we should do what we can to maintain good health and wellbeing. In tandem, politicians and policymakers must grapple with the limits of personal responsibility. Behaviour occurs in a context which, as individuals, we have limited ability to shape. We cannot build active travel infrastructure or affordable homes or take on the powerful commercial interests that profit from harm.

This challenge has played out in recent months as we seek to ‘live with COVID-19’. The balance has not always been struck. Public health principles are challenged more ferociously than during the height of the pandemic; politics, ideology and financial constraints are once again defining factors in policymaking.

It is reasonable to expect citizens to voluntarily take steps to keep ourselves and others safe. It is unreasonable to ignore the real barriers which hold poorer people and communities back. The government’s job is to improve the country’s social and economic circumstances, to enable individuals and communities to flourish.

A word on influencing. The road to change can be littered with obstacles at the best of times, and these are not the best of times. There is a tendency in the world of policy geeks to recoil at ‘magic bullets.’ Social issues are complex, and it stands to reason that a myriad of solutions must be deployed to overcome them. This undoubted truth creates a risk – that on occasion we opt for cautious calls and caveated language when crisp asks, clearly articulated are what the moment demands.

There is always a tension between the world as it is and the world we want to see. Bridging that, by choosing the appropriate means, is key to effective advocacy. For some, this approach feels like opting for pragmaticism over principle. That need not be the case. Making progress is a complicated business requiring compromises in pursuit of an overall objective which may be some years off. Barak Obama provided a masterful articulation of the art of incremental improvements in an address to the Howard University commencement ceremony in 2016. I would recommend reading the whole transcript. He talks about how the the Civil Rights Act and the Voting Rights Act were far from perfect, and unable to make up for centuries of slavery or eliminate racism, but they represented vital steps. He reflects: “I will take better every time, I always tell my staff better is good, because you consolidate your gains and then you move on to the next fight from a stronger position.”

In a febrile political atmosphere, charities may become cautious about advocating strong positions. Campaigning activity, undertaken in the context of delivering charitable objectives, is legitimate and valuable. There are those who seek to undermine the legitimacy of policy influencing and campaigning, sometimes deliberately confusing being political (justifiable) with being party political (unjustifiable). Whether they do this from a position of ignorance or weakness is immaterial, it is wrong. Poverty reduction is a historic cause, central to the mission of many charities, and it should be pursued rigorously and relentlessly.

The tectonic plates of politics are always shifting, perhaps one notable feature of the current uncertainty is talk of morality – whether in relation to breaking COVID-19 laws or asylum policy. I think, and hope, this mood will be with us for a while. Our democracy, with its unwritten constitution, requires individuals, political parties and policies to actively dwell on the moral dimension. David Aaronovitch has written a thoughtful column on this recently, in reference to the breaking of COVID-19 laws in Downing Street.

The alarming upward march of poverty is a test of the moral fabric of our body politic. A toolkit produced by the Joseph Rowntree Foundation, working with the FrameWorks Institute, promotes the need to appeal to common values of compassion and justice, as well as demonstrating that poverty can be solved. It can.

If the Health Disparities White Paper ignores poverty, it will have fallen at the first hurdle. It will look like what it is, walking by on the other side.