This document summarizes research on the UK government's welfare reforms replacing Incapacity Benefit with Employment Support Allowance. It finds that those deemed able to work face benefit reductions and mandatory training. However, research shows most long-term unemployed have significant health issues preventing work and higher benefits are linked to better health. A survey found IB recipients have much poorer health than the general population and complex needs, yet policy focuses on employability over health. Improving both health and jobs is key to supporting work, not stigmatizing or reducing benefits.

1. Benefits and Health
Clare Bambra
Professor of Public Health Policy
Socialist Health Association
Labour Party Conference 2011

2. Overview
• Incapacity Benefit replaced with Employment Support Allowance
• Workfare – compulsory training to receive benefits, time limits, lower
benefit rates
• Re-categorisation from deserving to undeserving poor
• ∂
Why? Media and Policy versus research evidence
• Ill health matters
• Conclusion

3. Incapacity Benefit Reform
Employment and Support Allowance
Two-tier system of benefits:
1. Those judged unable to work or with limited work capacity due to the
severity of their physical or mental condition will receive a higher level
of benefit with no conditionality.
2. Those who are deemed ‘sick but able to work’ will only receive an
∂
additional Employment Support premium if they participate in
employability initiatives.
Failure to participate results in the removal of the Employment Support
component and only entitled to basic Employment and Support
Allowance (paid at the same rate as unemployment benefit –
Jobseeker’s Allowance). Since 2010, receipt of Employment and
Support Allowance for the ‘work-related activity’ group is limited to a
maximum of 1 year.

4. Benefit Levels
£115 UK Poverty Line
£91.40 Incapacity Benefit (long-term rate)
£91.40 Employment and Support Allowance (Work-related activity)
£96.85 Employment and Support Allowance (Support Premium)
£65.45 Employment and Support Allowance (Basic Allowance)
£65.45 Job Seekers Allowance ∂
£65.45 Income Support
Welfare Reform bill will reduce benefits for a lot of people – European wide
studies of benefit rates, unemployment and health have shown that
better benefits = less poor health amongst the workless.

5. From deserving to undeserving
• Workfare? Compulsory training to get element of benefit, coercion not
voluntary
• People in receipt of benefits due to ill health or disability have
historically been viewed and treated as more ‘deserving’ or morally
worthy than those in receipt of other types of benefit
∂
• Now they have joined other benefit recipients as undeserving and
subject to coercion.
Why?
Because the legitimacy of the ill health of IB recipients
has been undermined

6. Media representation - Scroungers
The shirking classes: Just 1 in 14 incapacity claimants is unfit
to work (Daily Mail, 27 Jul 2011)
GOVERNMENT MUST END THE INCAPACITY BENEFITS SCANDAL (Daily Express, 22
Apr 2011)
100,000 addicts on state benefits
∂ (The Sun, 9
Nov 2010)
Just one in six incapacity benefit claimants 'is genuine' as
tough new test reveals TWO MILLION could be cheating (Daily
Mail, 20 Oct 2009)
Too fat to work
Almost two thousand people who are too fat to work have been paid a total of £4.4 million in benefit (The Times, 19 Nov 2007)

7. ∂

8. Policy view – employability
• Welfare to Work - Intense focus on IB in recent years (passive to active
to activation) but has been almost exclusively on employability not
health (except CMP and reform of fit note following Carol Black report)
• Supply side interventions: Education, training and work placement
schemes; Vocational advice and support services; Vocational
rehabilitation; In-work Benefits. ∂
• Demand side interventions: Financial incentives for employers;
Employment rights legislation; Accessibility interventions.
• Limited effectiveness in achieving return to work outcomes (Bambra,
2006)

9. Research evidence – structural
unemployment and ill health
• Hidden unemployment
 Beatty and Fothergill thesis (2002) - regional differences in IB rates conceal ‘hidden
unemployment’ in the former industrial areas that some have not recovered from the
fallout of deindustrialisation. Many on IB not find work even without health issues (low
skills etc).
• Health as the key reason for job loss
 Survey of c.3500 IB population found that 70% lost last job due to ill-health, 70% health
∂
limited work ability, and over 90% said ill-health was the main barrier to work (Beatty
and Fothergill, 2010).
• Epidemiological insights
 Marmot et al – Whitehall data those with pre-existing ‘poor health’ twice as likely as
those with ‘very good health’ to take short-term sick leave (1-7 days) and six times as
likely to take long term sick leave (>21 days).
 Higher association between IB claims and morbidity (r=0.98 p<0.01, census LLTI;
r=0.97 p<0.01, census not good health) and mortality (r=0.80 p<0.01, Vital Statistics)
than unemployment (r=0.72 p<0.01, 2001 census) (Bambra & Norman, 2006).

10. Health matters: IB survey
• In 2009, we began a longitudinal survey of the health of long-term IB recipients
in the Job Centre Plus (JCP) South of Tyne region (covering South Tyneside,
Sunderland, and County Durham)
• Participants were recruited at voluntary IB ‘Choices’ events run by the South of
the Tyne JCP
• Between September 2009 and June 2010, JCP invited all eligible long-term IB
recipients (IB receipt of over 3 years) in the region to 28 of these events
•
∂
Of the 8858 individuals invited to the events, 1429 attended (16%) of which 229
participated in the health survey.
• We interviewed 16% of attendees amounting to 2.6% of the total eligible IB
population.

11. Results
• 50% male and 50% female, mean age of 49 (19 to 63)
• Average time on IB was 9 years
IB cohort
∂ Regional National
Tenure – renting 60% 34% 30%
Tenure – social housing 85% 67% 60%
No access to vehicle 42% 34% 25%
Household where no-one
worked 65% 24% 19%

12. Former occupations of participants-
by skill
∂
Majority previously worked in semi skilled (32%) or
unskilled (33%) jobs.

13. Smoking and Drinking
IB cohort National
% Smokers ∂36% 21%
Weekly alcohol consumption
(units)
Men 22 Men 17
Women 14 Women 9

14. Primary health problems
∂
• 50% Musculoskeletal as
primary problem
• Mental health was the primary
health issue for 24%
• 80% had seen a health
professional in the 30 days prior
to interview
•Co-morbidity: almost 60% had
3 health problems or more

15. Validated health measures
90
80
70
60
50
40
∂
30
20
10
0
EQ5D EQ5D-VAS HADS-A HADS-D SF8-MCS SF8-PCS
Our Survey 41 46.45 10.54 8.85 36.9 33.2
UK Population Norm 86 82.48 6.14 3.68 52.1 50.9

16. Conclusions
• Health of IB population much worse than general population
• They have complex health and social needs – much more deprived and
living in poverty
• Moved from deserving to undeserving
• Previous policies have focused on improving the skills and
employability of the IB population, current work programmes have little
∂
by way of attention to health improvement
• Improving health and creating jobs are essential parts of moving people
back to work – not reducing benefits, stigmatising and forced training.