Nancy Towers is Public Services Lead at Social Enterprise UK
The data, as it has begun to emerge, is shocking. A report from UCL earlier this month shows low income workers disproportionately affected by COVID-19. The British BAME death rate from COVID-19 is more than twice that of whites. Investigations are being launched.
The people facing the greatest deprivation are experiencing a higher risk of exposure to COVID-19 and existing poor health puts them at risk of more severe outcomes if they contract the virus. (The Health Foundation 7th May)
There is no doubt that the economic and social impact of the lockdown, as well as the virus itself, will have a long-term impact on health inequalities. As a society in the UK, we were already at different starting points. The warnings had been sounded earlier this year when Marmot 2020 was published.
“Put simply, if health has stopped improving it is a sign that society has stopped improving.” – Marmot 2020, published February 2020
At the time my excitement for this report felt niche, many outside of the health and care sector may not have heard of the Marmot Review on health inequalities which was published in 2010, or been eagerly awaiting the ten year follow up ‘Marmot 2020’ like I was. It was a depressing but not unexpected read, which should be read as a call to arms – as an end to business as usual.
The original Marmot Review: Fair Society Healthy Lives was commissioned by the then Labour Government and supported by the succeeding Coalition Government, both concerned with rising health inequalities – the unjust and avoidable differences in people’s health across the population and between specific population groups. It demonstrated that health inequalities result from social inequalities, that the lower a person’s ‘social position’ the worst his or her health.
It set out a blueprint to tackling the social determinants of health and thereby health inequalities:
- Give every child the best start in life
- Enable all children, young people and adults to maximise their capabilities and have control of their lives
- Create fair employment and good work for all
- Ensure a healthy standard of living for all
- Create and develop healthy and sustainable places and communities
- Strengthen the role and impact of ill health prevention
10 years later, Marmot 2020 reported that life expectancy which has been increasing steadily over the past century has now stalled. Life expectancy for women in the most deprived areas is decreasing. The amount of time people suffer poor health has increased since 2010.
‘The increase in health inequalities in England points to social and economic conditions, many of which have shown increased inequalities, or deterioration since 2010.’
It’s hard not to link austerity with these poor health outcomes, Council spending in the most deprived areas has been cut the most. A slew of graphs in the report demonstrates the cost 10 years of austerity has brought. Good development for reception aged children entitled to free school meals has stalled for a decade, this has a long-term impact. In order to eat healthily and in line with NHS guidelines the poorest would need to spend three quarters of their disposable income on food.
Social enterprises themselves haven’t been immune to the impact of austerity – previously more likely than small and medium sized businesses and charities to establish in the most deprived areas, we’ve noticed a drop off in social enterprises establishing themselves in these areas in our recent State of Social Enterprise Survey.
There are also at risk as the economy stalls during lockdown. Social enterprises are falling through the gaps of many of the Government’s support schemes to prop up the economy in an attempt to return back to “normal” once the crisis eventually passes.
What can we do?
In a COVID world, the report’s main recommendation to the Prime Minister – to initiate an ambitious and world-leading health inequalities strategy and lead a Cabinet-level cross-departmental committee charged with its development and implementation, seems more important that ever. It highlighted the importance of inclusive growth and social value as part of the strategy. At SEUK we’d agree and we need to push more than ever for recognition of the role that social enterprises can play in addressing the social determinants of poor health. The social enterprise model, purpose led, community and environmentally focused, encourages fair employment (three quarters are a living wage employee), while many are established to directly address the six priorities originally outlined by Marmot. A Scottish research programme investigating the impact of social enterprises concluded that ‘any social enterprise, even without mentioning health in its mission, can be portrayed as acting on social determinants of health’
It’s something we know is true, and our members demonstrate it by their impact: London Early Years Foundation doesn’t just provide childcare they provide support to parents and access to opportunities for the children they care for that means that those from the most deprived backgrounds get the best start in life. Change Please sells coffee and creates training and employment opportunities for those that have experienced homelessness. HCT transport see transport as a way of breaking down barriers for the most vulnerable in society, supporting the most marginalised to access jobs, healthcare and education. Fair for You provides affordable loans for household items as an alternative to high cost weekly payment stores. They all deliver services that we need, while providing a wider benefit to society and the economy -thereby reducing health inequalities.
Re-visiting the reflections of our Chair Lord Victor Adebowale on what an economy populated by social enterprises, rather than shareholder dominated businesses, would look like based on our most recent data; “We would have 4 million more people being paid the real Living Wage. We would have over 1 million more women leading businesses. Our FTSE 100 would have forty women CEOs, not five. We would have 400,000 more businesses led by BAME people. We would have over £118 billion of additional profits reinvested back into improving society and protecting the planet every single year. We would have a lower level of regional inequality, with tens of thousands more businesses spread across the Midlands and the North.” I’d like to add, we’d reduce the health inequality gap between the richest and poorest areas.
We need social enterprise to be the business model of choice to improve society and for the improvements to translate into better health outcomes for those in our most deprived communities. We can build back better.