Poverty and health

Being poor makes people more likely to have an illness or to die earlier than The prerequisites are for peace, shelter, education, social security, social relations, people who are affluent. Deprivation is food, income, the empowerment of women, therefore a major risk to health. The a stable ecosystem, sustainable resource mechanisms by which poverty use, social justice, respect for human rights threatens health – as well as the and equity. Above all, poverty is the greatest threat to health. relationship between poverty and other risks to health – are the subjects of World Health Organisation much study and debate in this country 1997 and elsewhere. The World Health Organisation considers that poverty is the greatest threat to health.

There has been much effort in recent years by government to establish the now statutory minimum wage. Recent research estimates that a single person in the UK needs to earn at least £14,400 a year before tax (in 2010), to afford a basic but acceptable standard of living. A couple with two children needs £29,200.

Concepts of ‘low income’ The most commonly used threshold of low income is a household income that is 60% or less of the average (median) British household income. In 2007/8, the 60% threshold was worth: • £115 per week for single adult with no dependent children; • £199 per week for a couple with no dependent children; • £195 per week for a single adult with two dependent children under 14; and • £279 per week for a couple with two dependent children under 14.

These sums of money are measured after income tax, council tax and housing costs have been deducted, where housing costs include rents, mortgage interest (but not the repayment of principal), buildings insurance and water charges. They therefore represent what the household has available to spend on everything else it needs, from food and heating to travel and entertainment. In 2007/08, 13½ million people in the UK were living in households below this low-income threshold. This is around a fifth (22%) of the population.

Over the last decade, the poorest tenth of the population have, on average, seen a fall in their real incomes after deducting housing costs. This is in sharp contrast with the rest of the income distribution which, on average, has seen substantial rises in their real incomes.

The UK has a higher proportion of its population in relative low income than most other European Union (EU) countries: of the 27 EU countries, only 4 have a higher proportion than the UK. The proportion of people living in relative low income in the UK is twice that of the Netherlands and one-and-a-half times that of France.

The remainder of this section includes an overview of: • overall deprivation levels (using the Index of Multiple Deprivation), • poverty and its effects on children, • poverty and its effects on working age adults, and • poverty and its effects on older people. 53 Poverty and health

Index of Multiple Deprivation The Index of Multiple Deprivation (IMD) 2007 measures deprivation based on income, employment, health, education, barriers to services, living environment and crime.

IMD 2007 – Borough Rank IMD 2007 Overall Score Borough Quintile (1 is most deprived)

IMD 2007Quintile Overall Score 5 (5) Borough Quintile (1 is most deprived) QuintileQuintile 5 (5) 4 (4) Quintile 4 (4) Middlehaven QuintileQuintile 3 (5) 3 (5) Quintile 2 (4) QuintileQuintile 1 (5) 2 (4) Gresham North and University Quintile 1 (5)

Ayres om e Park Clairville Beckfield Park Local extremes Beechwood End Within Acklam

Ladgate Marton

Brookfield Kader

Hemlington Marton Stainton Coulby West and Newham Thornton

Nunthorpe

The most deprived wards are: The least deprived wards are: • Middlehaven, • , • University and • Marton West and • Gresham. • Brookfield.

IMD 2007 Overall Score IMD 2007 – National Rank Borough Rank (Q1 Most Deprived) Quintile 5 (1) Wards by IMD National Quintile (Number of Wards)Quintile 4 (1) Quintile 5 (Least deprived) (1) National Position Quintile 4 (1) Quintile 3Quintile (4) 3 (4) Middlehaven Quintile 2 (2) Comparing deprivation Quintlie 1 (MosQuintile t deprived) (15 )2 (2)

North Ormesby and Gresham Quintlie 1 (15) in Middlesbrough with Brambles Farm University Clairville Pallister Thorntree Ayres om e Park

Linthorpe Beckfield Park Beechwood End

Acklam

Ladgate Marton

Brookfield Kader

Hemlington Marton Stainton Coulby West and Newham Thornton

Nunthorpe

In the national context, Middlesbrough is the 9th most deprived local authority of 354 in England.

Fifteen of Middlesbrough’s wards are in the most deprived quintile of wards in England. One ward is in the least deprived quintile.

54 Poverty and health

Domains of Deprivation in MiddlesbroughWards

IMD 2007 Ward Borough National Code Ward Name rank Tees rank Rank IMD 2007 Income Domain Employment Domain Health Domain & Education Skills Domain Barriers to & Housing Services Crime Domain Living Environment Red in Total Zone 00ECNT Middlehaven 1 1 6 6171 1707001 32 588 7 00ECPB University 7 11 100 100 127 403 66 249 7388 74 241 7 00ECNK Gresham 9 13 120 120 236 294 164 237 7709 16 84 7 00ECPA Thorntree 2 3 22 22 24 33 29 8 6656 291 4089 6 00ECNQ N Ormesby & Brambles Fm 3 6 54 54 104 91 67 71 7809 178 1186 6 00ECNW Pallister 4 7 60 60 133 114 72 36 7764 33 3079 6 00ECNF Beechwood 5 9 65 65 151 71 56 212 6270 30 4174 6 00ECNY Park End 6 10 75 75 91 144 118 29 6096 114 3680 6 00ECNH Clairville 8 12 116 116 212 116 82 464 7592 6 3478 6 00ECNE Beckfield 10 17 181 181 373 90 113 348 7089 104 4177 6 00ECNL Hemlington 11 21 290 290 289 171 222 586 5425 351 6980 6 00ECND Ayresome 12 23 312 312 426 404 276 335 6611 128 1883 6 00ECNX Park 13 34 770 770 1306 688 431 2274 7844 17 1611 4 00ECNN Ladgate 14 41 1128 1128 1166 840 598 1165 7035 733 5456 2 00ECNJ 16 51 1676 1676 1778 1263 616 2477 4191 1804 7105 1 00ECNP Linthorpe 17 57 2534 2534 3060 2523 1447 4271 7854 318 3311 1 00ECNZ 15 50 1562 1562 1671 1043 1011 2478 4447 1129 6559 0 00ECNR Marton 18 65 4020 4020 6225 3607 2716 4955 3305 1116 6372 0 00ECNC Acklam 19 68 4172 4172 5716 3036 2408 4717 7772 1002 5280 0 00ECNM Kader 20 69 4216 4216 4714 3031 2090 4986 6450 2458 5922 0 00ECNG Brookfield 21 70 4445 4445 6036 2987 2131 3614 6162 3552 6508 0 00ECNS Marton West 22 82 6056 6056 7074 4388 2902 6372 4422 3568 7543 0 00ECNU Nunthorpe 23 86 7095 7095 7651 5158 3617 7424 5862 3588 7645 0 Actual number of wards in red zone 13 12 13 15 12 0 15 3 83 Expected number of wards in red zone 2 2 2 2 2 2 2 2 16 "Excess" number of wards in red zone 11 10 11 13 10 0 13 1 67

Key Among the 10% most deprived wards in England Among the 10% - 50% most deprived wards in England All others

Middlesbrough has more wards in the most deprived 10% than would be expected. Barriers to services and living environment are of less concern than other domains.

55 Poverty and health The impact of financial exclusion A sense of ‘financial exclusion’ is obtained by identifying those people, households and communities which display behavioural, attitudinal and demographic characteristics that collectively indicate a requirement for, and exclusion from, mainstream financial services. Such indicators include income, financial products holdings, affluence, outstanding borrowings and proportion of disposable income spent on household fuel. The demographic profile of each of these characteristics have been combined to create an overall score for each census ward.

The score indicates relative levels of financial exclusion between wards. Each ward is ranked across the 10,000 wards in Great Britain and placed into quintiles based upon likely levels of financial exclusion. The map shows electoral wards in according to their national rank of financial exclusion score. The lower ranked wards, shown in red, indicate relatively higher levels of financial exclusion.

Financial exclusion in Teesside

Financial Exclusion Rank of 10,000 UK Wards Financial Exclusion Rank of8,000 10,000 UK to Wards 10,000 (1) 8,0006,000 to 10,000 to (1) 7,999 (10) 6,000 to 7,999 (10) 4,0004,000 to 5,999 to (14) 5,999 (14) 2,0002,000 to 3,999 to (16) 3,999 (16) 1 to 1,999 (51) 1 to 1,999 (51)

Sarah’s Story – the human cost of credit

Sarah, a single mother of three, has multiple debt The loan company insisted that the agreement must problems. She's been struggling with her finances for be rewritten or the car surrendered, which would over ten years and debt and its related stresses have mean being unable to work. This rewriting of the almost become a way of life for her. Almost all her agreement has happened between two and four debts are to non-mainstream lenders and total times a year for the last five years. Each time the around £10,000. last payment is set at such a high level that Sarah is Sarah is a care assistant and relies on her car to get faced with the choice of giving up the car or re- her to work. Sarah contacted a lending company signing another agreement. through her local newspaper who claimed “instant The loan company use the Bill of Sale Act 1882 as credit – no credit checks” and who were prepared the basis of these agreements. They make their to lend her money if she used her car as security. money from taking as many steps as possible to Sarah was so desperate for cash to pay bills and buy ensure that the loan is rewritten or “churned” as it food that she didn't pay much attention to the interest is known in the business. rate or conditions. Repeat custom is where the real profit is. It is not She received the loan in the form of a cash advance illegal. The impact on Sarah has been vast. Her of £567. On the first of each of the five months marriage has broken down, she doesn't have Sarah had to pay £93.38 with a final payment of enough money to feed her kids properly and they £510.30 on the first of the sixth month. The total to haven’t had a holiday for over ten years. She also be repaid would be £977.20 at an APR of 348.1% suffers from anxiety and depression that is linked to Sarah paid for five months but didn't have the her debts. £510.30 for the sixth month. Source: Rotherham ‘Quids In’

56 Poverty and health

Child Poverty There are around 4 million children living in low income households in the UK. Children are more likely to live in low income households than adults. Half of lone- parents are in the low income bracket, twice the rate for couples with children. The UK has a higher proportion of children living in workless households than many European countries.

Proportion of children living in poverty, 2007 Child poverty In Middlesbrough, the wards with the highest proportion of children living in poverty are: • Thorntree, • Middlehaven, and • & Brambles farm.

Child poverty is defined as children living in families in receipt of out-of-work benefits or tax credits where reported income is less than 60% median income.

Proportion of children living in workless households, August 2006

Workless households In Middlesbrough, the wards with the highest proportion of children living in workless households are: • Thorntree, • Gresham and • Middlehaven.

57 Poverty and health

The impact of poverty on children In Teesside, the proportion of children living in households where no adults are in paid employment varies from 4.8% in Elwick (Hartlepool) to 60.7% in Grangetown (Redcar & Cleveland). The percentage of children gaining 5 or more good GCSE grades ranges from 94% in Northern Parishes (Stockton) to 28% in Middlehaven (Middlesbrough). For all wards in Teesside there is a clear correlation between children living in workless households and educational attainment. Children growing up in disadvantaged homes achieve much less from the education system than children in more affluent homes. They are likely to have more diminished life chances as a result.

Educational attainment (2009) and workless households (2006), Teesside wards

100 90 Each dot represents an 80 electoral ward 70 60 50 40 30 5+ GCSE's A to C (%) A to GCSE's 5+ 20 10 0 0 102030405060708090100 Children in Workless Households (% )

What causes child poverty? The causes of child poverty are diverse. Parents may find difficulties gaining and sustaining work due to constraints such as low skills, a lack of suitable opportunities, poor health and disability or caring responsibilities. Once in work, they may experience low income due to low skills, low hours or low pay and job insecurities. Frequent transitions in and out of work cause instability in income and may be particularly damaging for children’s wellbeing. Causes of poverty exist at a community level too: factors affecting deprived communities, including poor services, high crime rates, and low aspirations increase families’ experiences of deprivation, raise their cost of living and make it more difficult for them to take steps out of poverty. Causes of poverty do not start in adulthood; they often begin at birth and transmit through generations. That is why it is important to improve children’s life chances today, to prevent poverty tomorrow.

Ending Child Poverty: Everybody’s Business, HM Treasury/DWP/DCSF, March 2008

58 Poverty and health

The graph below shows the children in low income families indicator. This counts children in families in receipt of out of work benefits (such as income support or jobseekers allowance) and those in low income work (receiving working tax credit and child tax credit at the same time). It is not the same as child poverty and nationally it counts more children as on low incomes. The indicator is broken down into those who are out of work (in families receiving out of work benefits) and those in low income work (and in receipt of working tax credit); this is expressed as a percentage of children in the area. The stacked bar chart allows comparison between the local authority, region and England. It should not be assumed that smaller percentages in each are good. Progression would be taking up out of work benefits, then moving into employment, and into better paid employment (moving from left to right on the chart). Not all parents get the benefits that they are entitled to – it could be that a high percentage represents a more effective welfare rights service.

Children in Low Income Families Indicator, 2006 Not working (receiving Workless Benefits - JSA, IB, IS or Carer's Allowance) Working (receiving Working Tax Credit and Child Tax Credit)

Middlesbrough UA 31% 29%

North East 23% 26%

Industrial Hinterlands 25% 25%

England 20% 22%

0% 10% 20% 30% 40% 50% 60% 70% Percentage of children

Middlesbrough has shown a reduction in the percentage of children in workless families since 2003 (graph below). Until August 2007, this reduction was in line with regional reductions and better than national reductions. Since 2007 the proportion in Middlesbrough has increased while regional rates have remained similar to the previous year. In 2008 the Middlesbrough level is similar to England.

Change since February 2003 in the percentage of children in workless families

Middlesbrough North East Industrial Hinterlands England

105%

100% 95% 90%

85%

80%

% of the 2003 rate 75%

70%

65%

60% Feb 2003 Aug 2003 Feb 2004 Aug 2004 Feb 2005 Aug 2005 Feb 2006 Aug 2006 Feb 2007 Aug 2007 Feb 2008

59 Poverty and health

Poverty Affecting Working Age People Low income is a major contributor to poverty, and income is greatly influenced by employment status. About 64% of workless couples live in poverty and 56% of workless lone parents. As well as a lack of employment opportunities, other factors such as disability, level of education, language and communication difficulties and caring for others can impose restrictions on an individual’s ability to find employment.

Proportion of working age adults who are not in employment, April 2010

More than half of adults of working age (16-64 for men, 16-60 for women) are not in employment in Middlehaven, University, Thorntree and Gresham but only 1 in 5 in Marton West, a three-fold difference.

Working age adults (%) in receipt of Job Seekers Allowance, April 2010

Unemployment rates are highest in Middlehaven (16%) and lowest in Marton West (1.5%) - a ten-fold difference between these areas. 60 Poverty and health

Trends in Unemployment (Job Seekers Allowance Claimants), 2001 to 2010

10 Hartlepool Middlesbrough Redcar & Cleveland Stockton-on-Tees North East Great Britain 8

6

percent 4

2

0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Unemployment rates in Middlesbrough are consistently higher than both the North East and national rates. Since 2008 unemployment rates have been rising, standing at 8.1% in April 2010, the highest level in a decade.

Incapacity Benefit Claimants, Middlesbrough wards, April 2010

People unable to work due to illness or disability are entitled to incapacity benefit. The highest rate is in Beechwood (19.4%) and the lowest is Nunthorpe, (2.7%), a seven-fold difference.

61 Poverty and health

Trends in Incapacity Benefit Claimants, 2001-2009

10%

8%

6%

4%

2% Hartlepool Middlesbrough Redcar and Cleveland Stockton-on-Tees 0% 2001 2002 2003 2004 2005 2006 2007 2008 2009

Middlesbrough has the second highest level of Incapacity Benefit claimants in the Tees area, and is above both regional and national averages. Rates have been steadily declining since 2005, with a sharper decline apparent in all areas in 2009.

Emergency Hospital Admissions and Worklessness, Tees wards

25

20

15 Each dot represents an electoral ward 10

(% of ward population) 5 All Emergency Admissions Emergency All

0 0 1020304050607080 Worklessness (% of working age population)

For Tees wards, higher rates of worklessness are associated with higher rates of emergency admissions to hospital.

62 Poverty and health

Poverty Affecting Older People Nationally, until the last few years, the proportion of pensioners living in low income households had been falling sharply, from 29% of all pensioners in 1997/98 to 17% in 2005/06. There was, however, no further reduction in 2006/07 or 2007/08. Pensioners now account for just one-sixth of all the people in low income households. And still one-third of all pensioner households entitled to Pension Credit are not claiming it, and around 40% of pensioner households do not claim Council Tax Benefit to which they are entitled.

Income deprivation affecting older people (IDAOPI). Middlesbrough, 2007

Income Deprivation Affecting Older People Index (IDAOPI) by LSOA and quintile Quintile 1 (least deprived) (national rank 23301 - 32300) Quintile 2 (10001 - 23300) Quintile 3 (2901 - 10000) Quintile 4 (1351 - 2900) Quintile 1 (most deprived) (100 - 1350)

63 Poverty and health Pension credit claimants as a percentage of pensioners, 2008

In Middlesbrough pension credit claimants vary from 2.4% to 87.5%. The Lower Super Output Areas (LSOAs) with highest and lowest pension credit claimant rates are:

Highest rates Lowest rates Middlesbrough 001C (Middlehaven) Middlesbrough 016D (Nunthorpe) Middlesbrough 001B (Middlehaven) Middlesbrough 017A (Marton West) Middlesbrough 002C (N Ormesby & BF) Middlesbrough 016E (Nunthorpe) Middlesbrough 003F (Gresham) Middlesbrough 012D (Acklam) Middlesbrough 006C (Clairville) Middlesbrough 018F (Stainton & Thrntn)

Proportion of low income pensioners by household type, UK, 2005/06 to 2007/08

The proportion of pensioners in low income households has fallen from 28% in 1994/95 to 18% in 2007/08. Single female pensioners are most likely to suffer low income and older pensioners are more likely to be in low income households than those aged under 75.

64 Poverty and health Single Pensioners as a proportion of pensioners, 2001

Pension credit claimants as a proportion of pensioners, 2004-2009

60% Hartlepool Middlesbrough Redcar and Cleveland Stockton-on-Tees North East England 50%

40%

30%

20%

10%

0% 2004 2005 2006 2007 2008 2009

The proportion of pensioners claiming pension credit has been falling since 2005. Hartlepool and Middlesbrough tend to have rates above the north east average, while Redcar & Cleveland and Stockton are below the regional average. All districts are higher than the England rate.

65 Poverty and health

Conclusions

Middlesbrough is the most deprived of the Tees PCT / Local Authority areas, it has some major challenges and inequalities. Fifteen of Middlesbrough’s wards are in the most deprived quintile nationally but if deprivation was similar to the national distribution, there would be only five. Financial exclusion, where access to mainstream financial services is restricted, is commonplace in Middlesbrough. Nearly two thirds of Middlesbrough’s wards are in the most excluded national quintile.

Children

In 2007 there were 10,800 children living in poverty in Middlesbrough, many of whom will be living in workless households. Living in a workless household is associated with lower educational outcomes which, in time, will tend to perpetuate the poverty cycle due to diminished life chances. From 2003 to 2007 there was a steady decline in the proportion of children living in workless families, but the subsequent recession has seen an increase in unemployment and many of these improvements may have been undone.

Working-age adults

In April 2010, over half of the working-age adults in Middlehaven were not in employment, but only 16% were in receipt of Job Seekers Allowance, and counted as unemployed. Four other wards: University, Thorntree, Gresham and North Ormesby & Brambles Farm also had above 50% of working-age adults who were not in employment, compared with 19.6% in Marton West. Being out-of-work is a common contributor to low income and poverty. Furthermore, high rates of worklessness are also associated with increase rates of emergency hospital admissions.

Older people

In the decade from 1997 to 2006 there was a marked decline in the percentage of pensioners living in poverty. However, there were still over 8,400 Pension Credit Claimants in 2008 in Middlesbrough. Nationally, low income pensioners are likely to be single female pensioners and pensioner couples aged over 75 years.

66