Dr Tom Ratcliffe, GP

The 2022 Cost of Living Crisis: a matter of life and death

This will be a bleak winter.

Even after the Government’s huge intervention to help pay for increased energy bills, one in four of the population will face fuel poverty. That is a total of 6.7 million households. (1)
And we are starting from a bad place. At the beginning of 2022, 22% of people in the UK were living in poverty. Millions of people, including 500,000 children, had experienced destitution in the preceding 12 months prior to the pandemic. This is the severest form of poverty where people do not have the money to pay for shelter, food, heat and clothing – and it is thought to be getting worse. Rates of poverty affecting children and older people have risen over the last decade.
The Joseph Rowntree Foundation have highlighted changes to the benefits system that have made things worse. Most recently, removal of the £20 Universal Credit uplift. Over the last decade: the two child limit in income related benefits, the benefit cap, frozen local housing benefit rates and a five week wait for universal credit provision. (2)
Looking at the poorest households, 47% of their net income is spent on housing, food, fuel, heating and clothing. And this was before the high levels of inflation we are currently experiencing  (2).
One in three of the poorest one fifth households have less than £250 of cash available to them, meaning they have no capacity to absorb additional costs, emergency / unexpected expenses or, indeed, rising prices. The same households currently have negative disposable income to the tune of £60 per month (3).

It is terrifying to contemplate the possibility of working age benefit cuts, which, at the time of writing, are not being ruled out by policy-makers. Those in power need to ask a simple question: if they do this, how will people who already have less than no money survive?
I work as a GP in an area of West Yorkshire that experiences high levels of poverty and socioeconomic deprivation. Patients coming to the practice for help are more stressed than I have ever seen before. And looking at the above statistics it is not hard to understand why.

The same stories are commonplace:
  • People missing meals on a daily basis to make ends meet or prioritise feeding their children
  • People sitting huddled on the sofa in blankets because they can’t afford to turn on the heating (and it is only September)
  • People missing their medications because they can’t afford prescription fees (I saw a patient last week who narrowly avoided hospital admission for Asthma because he’d run out of inhalers and was waiting until payday before he could cover the cost of his next prescription)
  • Burnt out parents who drop their children off with their grandparents, work a 10-12 hour nightshift, come home, drop the kids at school, and try and grab a few hours of sleep before repeating the same routine day in day out and still barely make ends meet
  • Public sector workers who, on the face of it, you would expect to have decent incomes but who have to rely on foodbanks to get through the week
  • People struggling in dangerous, stressful and/or harmful work environments, with cash strapped business squeezing more and more out of precariously employed workers who have little bargaining power

So, why is this a matter of life and death?

Good housing that is free from cold and damp, secure meaningful employment with adequate household income and access to healthy food are all key social determinants of health. Rising poverty, stress and destitution will all feed through to poorer health and widening health inequalities.
The health gap had already been growing before both the Covid-19 pandemic and the current cost living crisis. Men in the poorest areas of the UK live almost 8 years less than men in the most affluent areas. Women in the poorest areas of the UK live 6 years less than women in the most affluent areas and, for the women in the 10% most deprived neighbourhoods, their life expectancy is actually falling. Comparing rich and poor areas, the difference in healthy life expectancy is as great as 18 years, averaging out at around 12 years across the country. (4)
At times like these we need to be able to fall back on public services, but look at the state of these after 10 years of budget cuts and/or inadequate funding. Where I work, our health centre roof regularly leaks and our local hospitals’ roof is held up by metal supports. Across the NHS, waits for outpatient care are enormous and ambulance delays are commonplace. In the last 12 months, I have had to personally drive three critically ill patients to hospital because we could not get an ambulance to them in time.
Social care is on its knees, schools are struggling to catch up on children’s education post-Covid, the criminal justice system is in disarray and public transport systems are paralysed by strikes and a lack of long term investment. Again, the possibility of further budget cuts at his moment, and a second round of austerity, is unimaginable.
In the short term, over the winter of 2022/23, poverty will have an immediate health impact. More children will end up in hospital with respiratory illness (children living in the poorest areas already have rates of emergency hospital attendances and chronic illness that are 60% higher than children in wealthier areas). Rates of acute cardiovascular and respiratory disease in adults, especially older people, will rise. Mental health problems will get worse, both due to the chronic stress of dealing with poverty, but also as a result of colder homes and hunger.

In the medium to long term, these short term challenges will cast a long shadow. Cold damp homes and poor nutrition mean that children use more of their energy to keep warm and less of their energy to develop health organ systems. For example, lungs develop most in the first 3 years of life and exposure to cold and poor diet during this period increases the long term risk of COPD several fold. There will be more older adults suffering with the long term impacts of strokes and heart attacks that simply would not have happened.
So what can we do?
  • As healthcare professionals, we must speak out about the impacts of social and economic policy and the cost of living crisis on health – if not now, then when?
  • As GPs, we must try and double down on our efforts to address health inequalities – the 20% of the health gap highlighted above that is amenable to healthcare intervention. The Core20 plus five framework is a great place to start (5).
  • As members of the community we must do our bit to link with grassroots organisations and the voluntary and charitable sector to provide additional and targeted support and help people access funding to support our patients and our communities
  • As anchor institutions and, sometimes, major employers, we must ensure that we look after our staff and place our assets, such as buildings, data and universal reach, at the disposal of people who need them or who are trying to make a difference
  • As primary care leaders and organisers, we must consider health inequalities the impact of poverty and destitution at the heart of our decision making, including using Primary Care Network funding to employ people who can help (social prescribers, health coaches and others) and taking services out into the parts of the community that need them most
The coming months and years will not be easy. However, people are waking up to what is happening to the poorest in society, perhaps because we are now all affected in a more direct and obvious way. In healthcare we can be a part in changing things for the better. If enough of us now find the humanity, passion and determination to act, we might do more than survive. We might help sow the seeds of stronger communities and a better society.

  1. Energy Crisis Policy Briefing July 2022: National Energy Action
  2. UK Poverty 2022, The Joseph Rowntree Foundation
  3. Asda Income Tracker June 2022, Centre for Economics and Research
  4. Marmot Review 10 Years On, Health Foundation, 2022
  5. Core 20 Plus 5, NHS England (see https://www.england.nhs.uk/about/equality/equality-hub/national-healthcare-inequalities-improvement-programme/core20plus5/)