Professor Mark Gamsu

Nelly Araujo, Development Manager at RSPH and Professor Mark Gamsu, Professor at Leeds Beckett University, discuss the financial insecurity programme and how it hope to address the often over-looked health issues that financial insecurity causes.

As the country begins to come out of lock down, local Government and the NHS are beginning to consider the wider effects of the pandemic. One of the most profound has been the impact on people who were already experiencing financial insecurity and on those who have become financially insecure because of the impact of unemployment and furlough. In 2018 the Citizen’s Advice report, Walking on Thin Ice: The cost of financial insecurity, highlighted how UK households had been increasingly vulnerable to income changes and unexpected expenses since the 2008 financial crisis. The growth of insecure work, unexpected expenses, major life events and changes at work were identified as significant issues. 

Nelly Araujo

According to a recent Office of National Statistics bulletin, the UK unemployment rate is changing because of the COVID-19 crisis. Furthermore, the claimant count, those claiming benefit for reasons related to unemployment, increased from 1.2 million in March 2020, to 2.8 million in May 2020. This represents an increase of 125.9%.

There is also worrying evidence that there has been an increase in the indebtedness amount of those with the lowest income during lockdown. People’s financial security has always been important, however until recently it has tended to be seen as an issue that is of only of marginal relevance to health providers.

Yet there is a growing body of evidence of the impact that financial insecurity and debt has on health and on people’s ability to make the most effective use of health services. For example, there is evidence of a strong inter-relationship between financial insecurity and acute and chronic health conditions such as poor mental health, cancer and disability. The elderly are also at particular risk of the adverse effects of financial insecurity including ill health and social isolation.

There are also many of examples of integrated approaches to addressing health and financial insecurity such as welfare rights provision in primary care, cancer services and in mental health services. However, most of these have relied on individual champions to establish these and few have been implemented systematically across local health systems and none across England.

One way decision makers in local Government and the NHS can be supported in developing integrated approaches to tackle financial insecurity and improve health is by being able to describe the scale of need in particular populations and then test this against particular interventions such as welfare rights provision.

Prior to the pandemic, the Health Foundation has funded the Royal Society of Public Health to trial a small project to help local authorities and the NHS develop tools to better understand the prevalence of financial insecurity in specific populations, to enable them to feel more confident about commissioning services that respond to these emerging needs .

One of the premises of the project is that services that address financial insecurity such as welfare rights advice, emergency grants, food banks and debt advice can have a greater impact if they are targeted to those populations that have the greatest need and are integrated with health services.

The need for tools that can be used to aid decision making at a local level is urgent. These will help us identify the concrete strategies, which will need to be underpinned by crossectoral and integrated policy plans at a local level, and will help make the case for national action.

This Health Foundation project does provide us with a head start. We are working with three local authorities (Sheffield, Hull and Hertfordshire) to understand the prevalence of financial insecurity and how this may enable the commissioning of better and more integrated services to address the issue. 

In Sheffield, the project brought together a range of local stakeholders to discuss how existing data sets can overlay intelligence and inform integration of services for particular populations. For example, council data suggests that prevalence of mental health issues is positively correlated with indicators of financial insecurity and that addressing the issue involves better integration of housing, benefits, money and debt advice and support services in the wider health system, including public health, health and social care and the NHS.

Whilst stakeholders in Sheffield have argued that, there is sufficient data across the system to start drawing their local financial insecurity and health picture, other decision makers at national and local levels also need to take urgent and proactive action. We stand a much better chance of creating long overdue solutions to such key and urgent health, economic and social problems.

Additonal works cited

Department for Education - School pupils and their characteristics - 2019

T Richardson, P Elliott - "The relationship between personal unsecured debt and mental and phsical health: A systematic review and meta-analysis." 33:1148-1162 (2013).