Eliminating Poverty in Britain E-Book

Helen Rowe

• Herausgeber: Flint
• Kategorie: Geisteswissenschaft
• Sprache: Englisch
• Veröffentlichungsjahr: 2023

Seitenzahl: 396

Beschreibung

Can we really end poverty in Britain? Yes, we can. In this groundbreaking book, Helen Rowe brings together the latest research with stories from across Britain to show us that ending poverty in the twenty-first century is possible. She describes the effects of deprivation on our society, institutions, communities, families and individuals – down to their very DNA. By using a combination of compassion, focus and a plan, Rowe describes how we can end poverty in five years, without raising taxes. Her radical ideas are grounded in practical realities, as she reveals how ordinary processes can yield extraordinary results. This book has huge ramifications for Britain and every developed nation globally. It will force governments to face an issue that has been ignored for too long. After Covid-19, Brexit, war, austerity and the global financial crash, Britain deserves a more positive future. How do we create it? Eliminating Poverty in Britain has the answers.

Leseprobe

First published 2023

FLINT is an imprint of The History Press

97 St George’s Place, Cheltenham,

Gloucestershire, GL50 3QB

www.flintbooks.co.uk

© Helen Rowe, 2023

The right of Helen Rowe to be identified as the Author of this work has been asserted in accordance with the Copyright, Designs and Patents Act 1988.

All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without the permission in writing from the Publishers.

British Library Cataloguing in Publication Data.

A catalogue record for this book is available from the British Library.

ISBN 9781803992488

Typesetting and origination by The History Press

Printed and bound in Great Britain by TJ Books Limited, Padstow, Cornwall.

eBook converted by Geethik Technologies

For my beloved daughter and all the little ones.You are too good for this world, so the world is going to have to change.

CONTENTS

Prologue

Introduction

Part One: Our Society

1    Poverty and the Pandemic

2    Poverty and Physical Health

3    Poverty and Mental Health

4    Poverty, Housing and Homelessness

5    Poverty, Crime and Prostitution

6    Poverty and Barriers

7    Poverty, Employment and Caring

8    Poverty and Education

Part Two: Our Money

9    The Green Agenda

10   Finance

11   Procurement

Part Three: Our Future

12   Eliminating Poverty from Britain

13   Poverty and Compassion

14   The Plan

15   Impact of Success

16   Conclusion

Acknowledgements

Appendices

Notes

PROLOGUE

Springtime in London is glorious.

A morning stroll through one of its city farms can be a transporting experience. The further you walk, the more enveloped you become in a landscape of lush new growth glazed in morning dew. A clear blue sky and crisp air shivers your senses awake and your skin gratefully receives the slowly warming sun.

At our local farm, there is a spot by the paddock where, if you look in the right direction, everything you can see is either green leaves or sky. It is easy to imagine yourself in the depths of the British countryside. The horses take no notice of passing humans and the birdsong carries across the fields. They were in full voice on the particular morning I was there.

I leant my elbows against the paddock gate and circled around to take in the view. My eyes lingered on the only part that wasn’t green, a large white sack of fertiliser sat among the wild flowers in the distance. I thought it was a strange place to leave one, but as a city-lover I could hardly pass judgement on the running of a farm, so I turned back to watch the horses.

I began to hanker for coffee and so set off on the short stroll to the farm café. The closer I walked to the sack, the more confused I became. Its colour changed and the texture was softer than expected, until I stopped on the wet grass in a cold silence. It was not a sack at all. It was a duvet that hung across a bench and dangled down to the floor. The only sign of the person beneath was a thick, grey sock poking out of one end.

My stomach hollowed. In amongst this tiny Garden of Eden was the hard reality of poverty and loss. This was not a London issue; it was a countrywide issue caused by decades of spiralling change. A small flock of birds flew over our heads and settled themselves in a nearby tree a reminder that nature and the world beyond would carry on regardless of a person’s circumstances. The beauty of the morning dimmed and the cold air nipped at my fingers. The person underneath must be freezing, I thought. I couldn’t bear the idea that they might not be alive at all. I trudged past quietly, not wanting to wake them.

Wrapped in the warmth of the café, I pondered the future.

It’s a new decade, I thought. What will it contain and for whom?

INTRODUCTION

The idea for this book came to me after a surreal conversation with my colleagues in 2013. We were working at a housing association and in the midst of new austerity measures, which were coming from central government thick and fast. We were grappling with the implications of the bedroom tax, which required residents in social homes that were too large for their needs to pay extra rent, move to a smaller property, or rent out the spare room. The sudden rise in housing costs had caused many people financial harm and we had a duty of care to those involved not to make their situations worse.

The question was this: should we allocate a pregnant woman a two-bedroom property, as we would normally do to ensure her a permanent home with the space for her child, and accept the risk that, if she had a miscarriage, it would not just involve the heartbreak of losing a baby, but she would also have to pay the bedroom tax as well? Or, should we offer her a one-bedroom home, which would mean the inevitable disruption of moving to a larger property with a small child later on and be costly and difficult?

Which would you choose?

The fact is that, if there had been enough social homes built over the decades, this kind of debate would never have been needed. However, when it comes to social mobility, Britain’s past and present do not look different enough. On the face of it, the years 1986 and 2016 seem to have little in common. Advances in technology and medicine have recreated our economy, education and world view. If you had said to an adult in the 1980s that, one day, they would be doing their weekly shop on their mobile phone, you would have received a hearty laugh and roll of the eyes, and yet, here we are. However, take a more detailed look at our social advancement and the gap closes rapidly. A snippet of a childhood memory is as clear to me as a camera reel:

Under a grey London sky, my father held my hand tightly as we walked down the wet, slippery steps of King’s Cross station and into the underpass. The corridors were busy, but for a moment there was a pause in the passing commuters and I looked down an adjoining subway to see a cardboard city continue into the distance. The air was dank and the yellow tiled walls were dirty below the cold strobe lights.

The memory returned to me as I sat on the top deck of a bus driving through Brighton city centre in 2016. Every empty shop doorway (and there were many) had people sleeping rough. The same dank feeling hung in the air as the homeless sat on their sleeping bags in entrances to once-affluent shops. Afterwards, I wandered along the sea front in need of some fresh air, but people were sleeping in the shelters there too. As far as Hove, I found tents pitched on rough land and even outside the swimming pool, on a spot which provided only marginal protection from the wind. It was disorienting. I thought, Aren’t we meant to have sorted these problems out by now? As a mother, I wondered, Is this it? Is this the society I have brought my child into?

Life in the twenty-first century for many millions of people is not what was expected and social stagnation was never part of the vision. Yet, while the technology and new products are as shiny and innovative as had been hoped, no one had mentioned the huge underbelly of people who would still be struggling to get by. It is now clear that waiting for busy politicians to solve enormous issues like poverty is not practical. They are humans like the rest of us and they need new ideas to act upon. I am not prepared to live in perpetual hope of change, and so I write.

This book has taken five years of discussion, interviews, research and thought. Authors who have previously written about ending inequality have generally done so from a global perspective, but I prefer to write about Britain and what I know. In my lifetime here, I have lived alongside some of the wealthiest people in our country and I have worked alongside some of the poorest. I have dined at the most prestigious private clubs in London and spent my evenings filling dishwashers on minimum wage. I have stood at a cash point exhausted from endless hours of work only to see a bank balance that wouldn’t make ends meet. From those I have loved who have known poverty, I have seen how its shadow lingered throughout their lives; it never entirely went away. Through all this, I have learned that extreme wealth brings choice, but not automatic happiness, and that poverty can make people savvy and cynical, but when they are released from its grip, the joy is a shining light in their eyes.

From all these experiences and from listening to those who have gone before, it is clear that the structure of our society is severely wanting. The churn of government policies made on the fly and without full consideration of the consequences has done serious harm. It is not just the lack of political vision that hinders us, but the lack of realistic thinking, and it is not necessary.

I have delved deeply into the subject of poverty in Britain and believe that the way to deal with poverty globally is to create a tailored plan for each country based on the problems and needs of the population, while having regard for their political systems and environmental constraints. The way deprivation affects British society is staggering. Each research paper published on its social or medical effects adds to the growing tide of understanding of just how much poverty affects every person in our country, irrespective of individual income.

This is a book for realists in whichever section of society they may be, whether the upper echelons of political life, people living in hope for a better future, or students starting out on their studies. I am not working to create a utopian society, just one in which our wealth and prosperity reflect our humanity towards one another.

This book is split into three parts: Our Society, Our Money and Our Future. The first part relates to the pressure that poverty puts on our social structures, including the education system, the economy and policing, and how it impacts our biology, from our mental and physical health down to our DNA. The second part focuses on where the money could come from to fund a poverty elimination agenda and how it would need to complement the green agenda, as the two issues are inextricably linked. Here there are a lot of descriptions around how much projects will cost in terms of millions and billions of pounds. For me, these figures can often blur into unimaginable amounts, so here is a way to understand the difference: 1 million seconds equates to eleven and a half days, whereas 1 billion seconds is thirty-one and a half years.

The final section, Our Future, considers the practicalities of removing inequality from Britain and how it could be achieved using three key concepts: compassion, focus and a plan. The plan begins on the first day of a new prime minister’s government and talks through the options and policies that need to be considered. After the plan come the consequences – some will be expected and some less so, including how other countries may respond to a Britain without poverty.

This book draws on medical journals, social research, writing from investigative journalists and authors, and lived experiences to create novel ideas and ways of working. New concepts are rarely perfect, but they don’t need to be. The core ideas are there to be remoulded and worked upon and a full list is provided in the final chapter. What I hope to offer in this book is a foundation on which we can build and go on to consider and question how we create a society of the future that is so exceptional that it is fit for every generation that lives in it.

1

POVERTY AND THE PANDEMIC

Before the coronavirus pandemic, it seemed a far-fetched dream that the whole of government could have a single focus during peacetime, but then Covid-19 came along and changed everything. On 19 April 2020, Britain was into the fourth week of its first lockdown. During the daily press briefing, the then education minister, Gavin Williamson, commented, ‘This is a whole government effort. We are doing everything that is required, everything that is needed.’

His words reverberated; so, it was possible after all. Many journalists and politicians compared the situation to a war. Undoubtedly it was a frightening and uncertain time. It was a life-or-death situation with huge economic and social implications, but it also showed how collegiate working could be done during peacetime and that systems could change rapidly when given the right impetus.

To prevent the spread of the disease and aid the struggling tourism sector, the government gave over 37,000 homeless and rough sleepers temporary accommodation in private hotel rooms, meals and a laundry service under the government’s Everyone In scheme. Lord John Bird, who created the Big Issue magazine for the homeless, highlighted the irony that government attitudes towards the homeless had gone from utter neglect to sudden focus because of the fear of spreading the disease.1

The move became a huge opportunity to get proper support to people with complex needs and had the potential to reduce homelessness significantly in the longer term. Sadly, it was clear that it would not have happened without the virus.

The homeless charity Shelter estimated that, by February 2021, thousands could have returned to the streets and thousands more continued to live in emergency accommodation with no long-term plan for the future.2 Records from the Dying Homeless Project suggest around 1,000 homeless people died during the pandemic, despite government efforts to bring all rough sleepers inside.3 In Scotland, those deaths were mainly caused by drugs and suicide, with none directly related to the virus itself.4 The councils’ response to the virus show how important it is to have specialist support available to deal with street homelessness and have more to offer than simply giving people temporary accommodation for a few months.5 (For further discussion, see Chapter 4.)

By trying to create a nostalgic, wartime spirit during the pandemic, the government sought to suggest that we were all in it together. It was a view that sounded sensible until properly analysed. As the prime minister, Boris Johnson, lay in intensive care with the virus, BBC Newsnight journalist Emily Maitlis put it clearly:

They tell us coronavirus is a great leveller. It’s not. It’s much, much harder if you’re poor. How do we stop it making social inequality even greater? … The language around Covid-19 has sometimes felt trite and misleading. You do not survive the illness through fortitude and strength of character, whatever the prime minister’s colleagues will tell us. And the disease is not a great leveller, the consequences of which everyone, rich or poor, suffers the same. This is a myth which needs debunking.

Those serving on the front line right now, bus drivers and shelf stackers, nurses, care home workers, hospital staff and shopkeepers are disproportionately the lower-paid members of our workforce. They are more likely to catch the disease because they are more exposed. Those who live in tower blocks and small flats will find the lockdown tougher. Those in manual jobs will be unable to work from home. This is a health issue with huge ramifications for social welfare, and it’s a welfare issue with huge ramifications for public health.

Tonight … we ask: what kind of social settlement might need to be put in place to stop the inequality becoming even more stark?6

The American Nobel Prize-winning economist Joseph Stiglitz offered Maitlis some answers. He suggested the disease had highlighted the fragility of the US market economy and the inadequate social support system, which meant that front-line workers could be so poorly paid. He believed there was a need to rethink the US economy once the pandemic was over.7

In Britain, one of the hardest things to hear, along with the death rate, was the food banks’ alarm that they were running out of supplies because the public was stockpiling food.8 None of this suggests that this is a country that has completely solid social foundations. It would be easy to claim that any country under that kind of exceptional pressure would react in the same way, and yet international leaders behaved very differently from each other. The USA’s leadership was slow to react compared with New Zealand’s, which locked down quickly after the first few cases emerged.9 The attitude of a leader is paramount when dealing with a crisis or period of great change. To create a country free from deprivation, our prime minister would need to be empathetic, well informed and practically minded.

Humanity does itself a disservice by forgetting the extraordinary things it is capable of achieving. The density of vying voices, fake news, fake democracies and some charismatic but low-skilled politicians have meant that compassionate policies do not tend to dominate the agenda, unless they make politicians look good. To succeed, a government would need a detailed and holistic plan that can sit above the competing territories of political life. The response to Covid-19 has shown what can be achieved. A focus on eliminating poverty is not impossible.

The implications of the pandemic are slowly becoming clear and will create immense difficulty and hardship over the coming decade. The UK’s national debt, which was already sizeable before coronavirus, will have to be repaid at some point, and that would suggest further years of austerity to come, unless there is somehow a significant boost to the economy. The damage that the cuts inflicted on the lowest-paid people after the 2008 global financial crisis have been obvious for years. However, it is important to remember that austerity was a choice; other options were available, although all had their flaws.

Covid-19 may be an opportunity to press the ‘reset’ button on British society, as we question whether we want to return to an economic model that was so imbalanced. Over the years, it has created and maintained poverty, inflicted harm on the environment and enabled wealth gaps to increase, not just between the richest and poorest, but also between women and men, between communities and between children. Thoughtful innovation and a focus on the needs of the whole population could engender lasting change while reducing pressure on the National Health Service, social services, police and the education system. These organisations consistently place a sticking plaster over the social problems caused by inequality.

With over 227,000 deaths in Britain from the disease, the impact is now clear and continues to be felt. The lack of widespread education in science combined with misinformation on vaccines has increased health inequalities by making many groups hesitant to accept their Covid-19 vaccine. I have met numerous men in our diverse area of London who speak with pride about how they haven’t had a vaccine because they are ‘strong’ and don’t need one. They appear to have ignored or not known the fact that they may be spreading the virus without having any symptoms. Figures from the Health Foundation show that, a year after the pandemic had ended, people living in the most deprived areas, some ethnic minority groups (including 40 per cent of African Caribbean adults) and people without English as their first language are least likely to be fully vaccinated.10

Inequality lies at the heart of so many issues related to the virus that it is now possible to ask the question: if there had been no poverty in Britain when the pandemic began, how much lower would the death toll have been? We now know it would have been significantly lower, as people who lived in the most deprived areas of England and Wales were around twice as likely to die after contracting the virus.11

Yet, in light of this, the elimination of poverty, rather than the alleviation of it, remains on the outskirts of public policy, awaiting its day. When the next pandemic comes, it will be poverty-related issues that will determine how the disease controls our society and economy, so dealing with deprivation now is key to Britain’s future stability.

Protecting the NHS from becoming overwhelmed with patients was at the heart of the government’s strategy against Covid-19, but even without the pandemic, our beloved system has been struggling to deal with the impact of deprivation on the health of the nation, and the costs have been immense.

The NHS spends around £16 billion a year on medicines (excluding pandemic-related costs)12 and the British Medical Association (BMA) has stated that poverty costs the UK health-care system around £29 billion per year. The knock-on effects are serious and include significant changes in life expectancy: for example, in affluent areas of Wales, women can expect to live seven years longer, and men can expect an extra nine years compared to less affluent areas. Children who live in cold homes are more than twice as likely to suffer from a range of respiratory problems as those living in warm homes. And many people cannot afford the cost of their treatment, such as prescription charges, resulting in their condition worsening over time.

It is not surprising, then, that the virus had such a disproportionate effect on the least well-off, as it exacerbated people’s underlying health conditions and increased their chances of death. The BMA highlights that doctors within the NHS can play a role in reducing the impacts of deprivation on their patients by spending more time on prevention, advocating for their patients by writing to local politicians, becoming involved with other organisations, community projects or school boards, or by focusing on health literacy.13

However, this simply highlights the additional workload associated with patients in poverty that doctors have to deal with in addition to their normal clinical duties. If there were no poverty for the NHS to address, staff would have significantly more time to devote to clinical research and further study, or have shorter working hours and be less exhausted.

Research by the Health Foundation and Nuffield Trust in 2020 found that people living in the most deprived areas of England experience a worse quality of NHS care and poorer health outcomes than people living in the least deprived areas. This includes spending longer in Accident and Emergency and having a worse experience of making an appointment with their general practitioner. Yet, many of the causes of these issues are beyond the NHS’s control, such as poor housing.14

For as long as poverty continues to be accepted, the NHS will have to deal with its consequences, while being unable to change the underlying causes. It is an expensive and unhealthy situation for our country. Ending deprivation would be a highly effective way of reducing the costs of the NHS while protecting the public from further pandemics. Covid-19 showed the way that governments can focus on a single issue for years. Dealing with poverty for five years straight would be significantly more productive than ministers continuing to instigate cost-cutting efficiency drives that put further pressure on to an already exhausted medical profession.

2

POVERTY AND PHYSICAL HEALTH

Sleep is a non-negotiable biological necessity … Mother Nature, throughout the course of evolution, has never had to face the challenge of this thing called sleep deprivation, so she’s never developed a safety net and that’s why when you under-sleep, things just sort of implode so quickly, both within the brain and the body.

Professor Matthew Walker, neuroscientist and sleep expert1

Of all the great wonders of nature, the most laborious and perplexing is parenthood. Should you be lucky enough to survive childbirth – as so many in the world tragically don’t – then parenthood brings its own variety of breathtaking highs and mind-bending lows, so great is the entwinement of love. One of the hardest parts is the intensity of sleep loss, which can make your bones ache and your eyes sting, where you feel every breath in your ribcage and sometimes crawling on all fours seems like the only sensible way to get around. You have entered survival mode, and if you are lucky, it will only last a few months; if not, it can last for years.

Anyone who has been through it will understand why sleep deprivation has been used as a form of torture. Those who are full-time parents or trying to work while looking after a little one will be well aware of the impact on performance and emotional stability. For any government that wants a more productive workforce, it is important to understand the deeper impacts of exhaustion. Professor Matthew Walker, Director of Sleep and Neuroimaging at the University of California, explains:

There is simply no aspect of your wellness that can retreat at the sign of sleep deprivation and get away unscathed … sleep loss will leak down into every nook and cranny of your physiology. The decimation of sleep throughout industrialized nations is having a catastrophic impact on our health.2

Walker highlights that every major disease in the developed world has a strong link to sleep deprivation, including Alzheimer’s, cancer, obesity and diabetes. However, he also offers hope, as researchers at the University of California have shown that improving sleep quantity, quality and regularity can heal a variety of serious conditions, including depression, bipolar disorder and anxiety. It can even prevent suicide.3 So, how do we build a society that enables everyone to have a good night’s rest? It is an important question that is rarely asked, and yet it needs to be answered if we are to create a stronger economy and generally lead more contented lives. How can a person raise themselves or their family out of poverty if their body has no respite or time to heal? While some vocal newspapers and politicians condemn those who need government benefits and support, it should be recognised that people can’t work at their best when exhausted and also face greater mental and physical health problems, alongside a rising cost of living. Stress and poverty are directly linked and unsurprisingly affect a person’s ability to sleep, particularly if the obstacles include the lack of a proper bed. Everyone needs a bed and it is not an unreasonable expectation in the twenty-first century.

Getting enough sleep (between seven and eight hours each night) is a basic human need and yet there are many people for whom it is not possible. This includes rough sleepers and those who are sofa surfing or living in cars or noisy temporary accommodation. Children are particularly at risk from sleep loss. Sleep is needed for their growing brains and yet it is difficult to obtain for those who have to share a bed with their siblings, sleep in cold homes, go to bed hungry or who are trying to sleep in cots that are too small because their parents cannot afford a larger one.

The lack of a bed has been a constant issue over the years. In 2021–22, the charity Buttle UK provided over £360,000 in grants to furnish the bedrooms of deprived children. The charity described the impact of their work: ‘Having their own fully furnished bedroom is repeatedly seen as helping to reduce anxiety and stress. Simply having a safe space of their own is so important … particularly for those who are recovering from fleeing domestic abuse.’4

While charities provide excellent and much-needed support, a key concern is the piecemeal provision of the help available, as there is no countrywide system. Access to support depends heavily on where you live and this further exacerbates existing inequalities within the population.

Shift Work

The relationship between poverty and sleep also affects the wider functioning of the economy. For shift workers, including members of the emergency services who work unpredictable hours, a disrupted circadian rhythm (body clock) can have a serious effect on the individual’s ability to function mentally and physically. For front-line workers, these decisions could mean the difference between life and death, or failing in their duties and being charged with misconduct.

Researchers at the Brigham and Women’s Hospital in Massachusetts, USA, examined the effect of shift work on 270,000 people. They found that shift workers were significantly more likely to develop type-2 diabetes regardless of their genetic risk, compared to those who had never worked a night shift. The cause was partly due to weight gain from eating at irregular hours. The pancreas does not work as well at night and so cannot produce enough insulin to break down fats that are consumed when the body should be fasting.5

It is also worth noting that permanent night shift workers exhibit some healthier lifestyle characteristics, including lower levels of alcohol intake and higher levels of physical activity, than other groups … Intervention on body weight and work schedules might be useful in improving metabolic health in all individuals, independent of their genetic(s).6

A recent pilot study on employment patterns found that removing night shifts for people with early morning body clocks, and changing morning shifts for those who prefer evenings, improved the quality of sleep and reduced the chances of contracting chronic illnesses.7 Diabetes costs the NHS around £14 billion each year and can be a debilitating condition. Much of this money is spent on complications caused by the condition, such as amputation, blindness, kidney failure and strokes.8 Governments and businesses have a duty of care to individuals and the health service to reduce the levels of shift work where possible, to ensure that shift timetables are matched to people’s individual sleep cycles, and to ensure that those who do undertake shift work understand how it affects the human body and are compensated accordingly.

A key government priority must be the creation of a society in which sleep is viewed in a positive light. Economic performance cannot continue to revolve around sleep-deprived people at all levels of the wage scale, especially with the rise of home working enabling employees to work longer into the night. It would be interesting to know how many exhausted people were involved in making the high-risk decisions that led to the 2008 global financial crash, or the austerity policies that went on to disproportionately affect the poorest in society.

The relationship between poverty, stress, sleep loss and poor physical health is a nexus that needs to be highlighted and actively dealt with by doing more than simply urging people to get more sleep (as I saw on a billboard once). The NHS will continue to pick up the tab when it comes to the physical effects of poverty, but as funding continues to be tight, some areas of the NHS are becoming less and less ‘free’ for those adults who are not in receipt of benefits. This is unacceptable and NHS dentistry is at the forefront of a health sector that is only accessible to those who can afford to pay.

Dental Health

‘Seventy-five pounds,’ the receptionist said nonchalantly, while punching the numbers into the card reader. It was 2006 and I gulped weakly, feeling sure that there must have been some mistake. I knew private dentists were expensive, but I’d only been in the chair for two minutes – the length of time needed for polite introductions and to ask for a prescription to heal an inflamed wisdom tooth. I wondered if I should have tried harder to organise an NHS dentist, but the trial to find one, travel there, get registered, organise an appointment and wait days or weeks to be seen had felt like an insurmountable challenge. The blinding pain in my mouth had pushed me into saying ‘yes’ to the cost of any local, private dentist with a short waiting time. Perhaps I should have bought some pills online, but there would have been no guarantee of what was inside them, so I walked glumly downstairs to pay more money for my prescription.

When politicians speak with pride of the free health-care system we have in Britain, they never seem to mention dentists. The number of practitioners prepared to do NHS work has been falling steadily over the years until now, in the 2020s, the system is in crisis. It seems farcical to suggest that dental care is free when the provision of it is so low. It is also ironic that many health conditions that the rest of the NHS will deal with for free can be pre-determined through gum disease. Strokes, arthritis, heart disease and diabetes have all been linked to infection in the gums, caused by the build-up of bacteria from plaque. This creates too much inflammation in the body, affecting the bloodstream and slowly damaging blood vessels in the heart and brain over a long period.9 Inhaling bacteria can also infect the lungs and cause pneumonia.10

Ill-health breeds inequality, and the scarcity of NHS dentists can be identified as a governmental system that creates and maintains inequality. It would need to be a key area of change in any poverty elimination programme. Many people don’t have savings, especially since the pandemic, so the costs of an infected tooth could push struggling households into debt. When it comes to dental care, the quiet move towards ‘health if you can afford it’ feels an unpleasant reality from the dark ages before the welfare state.

In his autobiography about growing up during the Great Depression, Harry Leslie Smith described a time when health was based on wealth, and how it echoed into the streets as he played with his childhood friends:

At times, as we traipsed across our patch in the dead of night, our merriment was stopped in its tracks by inhuman noises … they were cries of pain and of torment… The cries that came from open windows sounded like howls from a circle of hell that even my parish priest would have been reluctant to admit existed. They were not the growls of the damned, just the screams from people who were too poor to pay for morphine to ease their pain from cancer and make their passage to the next world gentle rather than grotesque.11

Smith’s experiences led to a life-long love of the welfare state and he acknowledged that, had it not been for the Beveridge Report that promised its creation in 1942, he and many other working-class people would have questioned the benefits of fighting for a country that had so actively maintained their poverty. He was not enamoured with Hitler, but he was aware that his own society had done little to help his family and had directly contributed to the deaths of his sister and father, who were buried in paupers’ graves.

Today, having a healthy body or set of teeth should not depend on how much money a person has or where they live. The system of dentistry in the UK needs to be updated quickly and the government cannot rely on the hope that more people will train as NHS dentists, considering the tuition fees cost a minimum of £35,000. This may be a situation where artificial intelligence (AI) could provide a new, cheaper service for patients.

If an automated scanner could be developed to offer routine check-ups and email the dentist a preliminary report, this could reduce waiting times and free up dentists to focus on more complex work, in the same way that local doctors have passed vaccinations and other medical work on to nurses. The use of AI in dentistry is being studied and early indications suggest it could be helpful.12 A scanner could also be manufactured domestically, creating new jobs, and be offered abroad as part of the international aid package. The Covid-19 Test and Trace system cost £37 billion to set up; an automated dentistry service would surely require a fraction of this and make the system fully accessible again for everyone and especially those on low incomes.

Epigenetics, Inflammation and Poverty

When I studied biology in the early 2000s, university lecturers confidently taught that evolution was caused by random changes in our body’s code: our DNA. (A section of DNA is called a gene and these produce proteins and other chemicals that build our bodies. Genes decide what hair colour we have, how our bodies grow and develop and, sometimes, what we die from.) It was believed that if an unexpected change (mutation) was helpful to an animal or plant – such as improving camouflage – then it would be more likely to survive and pass the new gene on to its children. For harmful changes, the organism was less likely to breed and so the gene died out with it.

However, since then, new epigenetic research has completely transformed this view and has shown how the environment in which we live can directly change the way our genes work. Epigenetics is the system that turns genes on and off. This process works by attaching chemical tags, known as epigenetic markers, to DNA. These tell the cell either to use or ignore a particular gene. The underlying DNA code is not changed, but the manner in which the genes are turned on or off is affected.13 In bees, the queen, workers and drones all have very different bodies and yet they have identical DNA, showing that when genes are expressed (turned on or off) differently, they can create a different animal.14

In humans, an example of epigenetics can be found in post-traumatic stress disorder (PTSD). A traumatic event or series of them can leave an individual in a constant state of stress as the body fails to properly regulate cortisol, the stress hormone. The cortisol gene is wrongly left in the ‘on’ position, causing the body to be in a perpetual state of fight-or-flight. Stress levels in the body are significantly higher than they would normally be, causing a variety of mental and physical health problems for the sufferer, including panic attacks, anxiety and chronic pain. Researchers have found that some of these changes can be passed down from generation to generation, although research is continuing.15

The neuroscience of poverty is a field of research that focuses on the links between brain development and the environment a person is living in. Studies in children point to a disturbing conclusion, that poverty and the conditions that often accompany it – violence, excessive noise, chaos at home, pollution, malnutrition and abuse – affect how the young brain develops. The brain is made up of two substances: grey matter (brain cells) and white matter (nerves these send signals around your body and help you feel sensations and move your muscles).

Researchers have found that deprivation creates less grey matter, which is used for processing information and controlling behaviour, particularly in the hippocampus (memory), the frontal lobe (decision making, problem solving, impulse control, judgement, and social and emotional behaviour) and the temporal lobe (language, sight and sound processing, and self-awareness). Together these brain areas are crucial for learning, following instructions and maintaining attention.16 It is therefore hardly surprising that children growing up in poor backgrounds often struggle in school.

Researchers at University College London have found that inflammation in the brain may be the cause of the reduction in grey matter/brain cells. Normal levels of inflammation help the body to repair tissues after an infection or injury, and in removing and replacing cells that show signs of stress or malfunction.17

Studies have also shown that people on lower incomes have more brain activity caused by stress and this is linked to greater inflammation in the body. Chronic inflammation is thought to play a role in developing many health conditions, such as heart disease, stroke, diabetes and cancer. People with higher levels of stress have increased activity in the amygdala (the brain’s core system for processing fearful and threatening situations) and this has been associated with greater inflammation in bone marrow and arteries. This type of inflammation may account for almost a third of the increased risk of heart disease in people on low incomes.18

American neuroscientist Professor Mary Helen Immordino-Yang has conducted a lot of research into the impact of poverty on the growing body. She has found that growing up in turmoil, even when it is not at home, but on the streets where you live, has an impact on how the brain functions.19 Her work has also highlighted that schools must educate the whole child and not just focus on academia. British schools often try to support vulnerable children, but cuts to special educational needs budgets have made this increasingly difficult. Immordino-Yang’s research suggests that, if Britain did eliminate poverty, it would change the shape and function of children’s brains and even alter when they begin puberty. The brains of children who experience ongoing adversity react by enhancing the sections that promote aggression and anxiety, at the expense of the areas involved in reasoning and memory. Her work has found that, while the brain can change at any time of life, it is particularly sensitive during pregnancy and childhood, in adolescence, on becoming a parent, and in old age.20 In essence, if we want children to have enough self-control to learn and behave well, then our country needs to support their emotional and economic well-being, rather than simply piling on the exam pressure.

In their book, The Neuroscience of Socioeconomic Inequality, Noble and Giebler highlight some essential areas of future scientific research, such as working out the mechanisms that cause changes in the brain, identifying the times in life when the brain is most sensitive to change and providing information on effective cures.21 A focus on eliminating inequality by the British government may not solely involve lifting people out of poverty, but could also provide funding for this type of research. The knowledge gained could be used not just in the education system, but also in the criminal justice system to provide the most appropriate rehabilitation for teenagers and adults.

A child born into poverty will have a significant uphill struggle not just in socioeconomic terms, but also from a genetic and neurological standpoint. These struggles begin in the first year of life and continue through adolescence and into adulthood. By this analysis, dealing with deprivation could create a significant shift in the genetic health of the country, not just now but also in the future. If it is found that DNA markers can be inherited, then dealing with deprivation now could make the coming generations less susceptible to suffering as well.

For the NHS, the impact of poverty on its services are broad. Chronic inflammation is a common factor in diseases such as diabetes, heart disease, depression and anxiety disorders. Antidepressants have been found to deal successfully with inflammation and chronic pain, but they come at a cost.

A proper bed, jobs that enables a good night’s sleep, and truly free NHS dental care are all ways to create a healthier society and stronger economy. However, it is the neurological and epigenetic research that has shown how poverty traps people and that it cannot be simply blamed on a personality defect (as discussed later). Continuing to alleviate deprivation will provide little more than an expensive sticking plaster over problems that cannot be solved by tweaking government policy. Scientists have shown that much more ambitious change is required.

3

POVERTY AND MENTAL HEALTH

Whether an illness affects your heart, your leg or your brain, it’s still an illness, and there should be no distinction, because we know that mental health is just as important to our overall well-being as our physical health.

Michelle Obama, former First Lady of the USA, and author1

My early 30s were rough. The combination of a traumatic childbirth, sleep loss with a baby, and a succession of family deaths led to me being diagnosed with PTSD. To have this condition is to live in a state of permanent hyper-vigilance and stress. Every moment of the day and night is spent in an ultra-sensitive state, where all your senses are looking out for the next danger or threat, even if you are just pottering about at home.

I was prescribed anti-depressants and they were wonderful; it was like taking a holiday from my mind. Within two days of the first pill, the incessant internal dialogue stopped and the pleasure of silence returned, along with the space to breathe once more. The psychiatrist who prescribed the pills referred me to a psychotherapist for eye movement desensitisation and reprocessing (EMDR) therapy, which is a common treatment for PTSD.

‘OK, so what’s EMDR?’ I asked the psychiatrist.

‘Well, I’m not exactly sure, but that’s what you need,’ came the slightly perturbing answer.

Within the mental health field, clinicians are not always aware of how to treat PTSD, but there is information online that can help. It can take weeks, months or years to be cured, depending on circumstances. If life has been particularly difficult, then complex PTSD, which is caused by an ongoing series of traumas, may be diagnosed and then the treatment takes longer.

EMDR is a type of mindfulness technique that is conducted with a therapist and helps to turn traumatic memories into normal ones by stimulating both sides of the brain. A normal memory has emotional distance from a past event, where something awful could have happened, but you can laugh about it afterwards. With traumatic memories, there is no distance. If you see or hear something that reminds you of the trauma, then it triggers the memory and your body reacts as if you are back in the moment. Your heart rate increases, breath shortens, palms sweat. You can be having a quiet picnic in the park and yet, if triggered, you can suddenly feel utterly overwhelmed and in extreme distress. Often you may not know what your triggers are until you are in the midst of an episode. At that point, a hug from a loved one, controlled breathing and a change of scene can all help you to calm down.

The therapy works on one memory at a time and changes details within it, which allows you to create distance and stop the triggers. The stimulation can be created in different ways, by using hand-held buzzers or tapping your body intermittently. (To see how the process works, there is a documentary of Prince Harry having EMDR therapy The Me You Can’t See.)

The relief is palpable when you discover that it has worked for the first time. It is a difficult journey of recovery, but having a positive relationship with your therapist can make it much easier. If you feel that you are in safe hands, then you only have to focus on making the EMDR work. Before each session, I would steel myself to face my fears and that normally involved eating biscuits or handfuls of chocolate to boost my energy levels before going in.

The first question was usually the hardest – ‘How are you?’

Don’t ask me that! I used to think, never quite sure where to start.