1. The impact of the economic downturn and policy changes on health inequalities in London UCL Institute of Health Equity www.instituteofhealthequity.org

2. Commissioned by the London Health Inequalities Network. “To assist local authorities in London to identify and mitigate negative impacts of the economic downturn and welfare reforms on health inequalities and the social determinants of health to 2016, particularly employment, income and housing impacts, by providing the following: Literature review on the likely impacts. Some recommendations regarding what local authorities could do to minimise any negative effects. A set of indicators that local authorities should use to monitor the impact of the changes – in development.”

3. London has large inequalities in mortality and health Action to reduce health inequalities needs to focus on the social determinants of health

7. Evidence from previous economic downturns suggests that population health will be affected: More suicides and attempted suicides; possibly more homicides and domestic violence Fewer road traffic fatalities An increase in mental health problems, including depression and possibly lower levels of wellbeing Worse infectious disease outcomes such as TB + HIV Negative longer-term mortality effects Health inequalities are likely to widen

8. The report specifically looks at the impact of the recession on income, employment and housing: The economic downturn is causing a rise in unemployment, a fall in income for many households, which in turn may cause housing problems for those who experience lower incomes. Unemployment, low incomes and poor housing contribute to worse health. These problems are more likely to occur among particular groups within the population and among those already on low incomes.

9. Employment Unemployment is bad for health and can have long-term impacts, particularly for those who experience long-term or early unemployment –London unemployment up from 6.7% (Q2 2008) to 10.1% (Q1 2012) –More deprived areas in London have higher proportions of young people who are NEET Self-rated health can be worse in an economic downturn for those who stay in work –higher levels of job security anxiety, bigger work demands, financial problems resulting from pay constraints, lack of control over work situation –Increased competition for jobs may drive down wages and working conditions –Employers may be less likely to prioritise work-life balance, flexible working and diversity initiatives –Fall in equal pay and sex discrimination claims recently – fear of job loss?

11. Many of those in poverty live in working families. Receiving a ‘living wage’ will support their chances of remaining above the poverty threshold and receiving the ‘minimum income for healthy living’

12. Impact of the welfare reforms £18 billions welfare savings Intended to strengthen incentives to work, but there is a shortage of jobs. Many households face reduced benefits – lower incomes, harder to cover housing costs. Affects low-income households, in particular: workless households; households in more than 16 hours per week of low-paid work; lone parents; households with children; larger families; some ethnic minority households; disabled people reassessed as ineligible for new benefit; private rented tenants. Households unable to afford current accommodation will need to find an alternative solution, eg. Become employed, re-negotiate rent, go into rent arrears (leading to repossession or non-renewal of tenancy), become homeless, become overcrowded, compromise on housing conditions, move to a less expensive area of the capital or out of London. London should expect significant migration within and between boroughs as more areas become unaffordable. Likely widening of socioeconomic health inequalities.

14. Recommendations 1.Assess and respond to area needs –Local measurement and monitoring –Cross-sector working 2.Ensure sufficient incomes –Strengthen financial incentives to work –Sufficient income: Employers should pay a living wage that ensures a minimum income for healthy living –Good quality and affordable childcare 3.Ensure sufficient and affordable housing

15. 4.Ensure an adequate supply of good jobs –Stimulate employment –Encourage ‘good’ work: “Jobs must be sustainable and offer a minimum level of quality, to include not only a decent living wage, but also opportunities for in-work development, the flexibility to enable people to balance work and family life, and protection from adverse working conditions that can damage health” 5.Sufficient provision of services to cope with likely issues NATIONAL MEASURES inc. Health equity impact assessments of all policies and Active Labour Market Programmes

16. Institute website: www.instituteofhealthequity.org Full report: http://www.instituteofhealthequity.org/Co ntent/FileManager/pdf/london-full-rep- medium-res.pdf www.instituteofhealthequity.org http://www.instituteofhealthequity.org/Co ntent/FileManager/pdf/london-full-rep- medium-res.pdf