The impact of health on economic security

Our new research finds that people with long-term health conditions face the greatest adversity and challenge in achieving economic security.  It is critical that we design systems of support and employment opportunities with those living with long-term conditions at the centre to ensure that this changes.

At the RSA, supported by Impact on Urban Health, we’ve been exploring the relationship between economic security and health. By analysing Understanding Society, a national dataset with over 30,000 respondents and most recently Covid-19 tracking data, we’ve been able to understand better how living with multiple long-term conditions impacts on people’s economic security and confidence in the future.

We know that there is inequality in who experiences long-term conditions, and even more so for multiple long-term conditions. For example, Impact on Urban Health report that one in five people in the most deprived neighbourhoods in Lambeth and Southwark live with multiple long-term conditions, compared to one in ten in the least deprived.

At the RSA we define economic security as the degree of confidence that a person can have in maintaining a decent quality of life now and in the future, given their economic, financial, and social capital. And so it is, by definition, an experience that spans financial, health, and wellbeing experiences and views them as interconnected.

Our research sought to understand, once diagnosed, how living with multiple long-term conditions further impacted people’s economic security.

Specifically, we tested three hypotheses:

1. The experience of economic insecurity is acutely felt by those living with single or multiple long-term conditions.
2. The factors contributing to economic security vary from those living with no long-term conditions.
3. Covid-19 has added to the scale of insecurity for the general population and specifically for those living with long-term conditions.

We learned that people living with multiple long-term conditions experience the lowest levels of subjective economic security, that is their perceptions of their current and future economic circumstances. One in three (33 percent) people living with multiple long-term conditions reported low subjective economic security compared to one in four (23 percent) people living with no long-term conditions.

Subjective economic security was lowest for those who were unable to work due to their health conditions, with 65 percent reporting low economic security. This suggests that for those who are unable to work or unable to find work that meets their needs, there is not enough support to provide them with economic security outside of employment.

We also learned that 53 percent of people living with multiple long-term conditions are in receipt of state support from benefits, with a third (34 percent) in receipt of multiple benefits.

For those who are able to work, those living with multiple long-term conditions are more likely than those with no or one long-term condition to work on zero hours contracts or in part time work, hinting at a need for greater flexibility but that does not undermine security.

This plays out directly on income. The difference in mean gross annual income between those of working age with multiple long-term conditions and those without is £4,340. 

As we look ahead to a recovery from the pandemic, complete with the Chancellor’s Plan for Jobs, and as Integrated Care Systems deliver our health and social care there are opportunities to create an inclusive system that actively supports those living with long-term health conditions rather than placing constrains on their economic security.

Specifically, as a result of our findings we recommend:

1. To provide tailored support on economic security for those managing a long-term condition diagnosis, integrated care systems, in partnership with local authorities and job centres and other stakeholders, should establish local economic security hubs. 
2. To ensure that a need for flexibility at work does not undermine economic security, national government should expand eligibility for, and increase the level of, statutory sick pay. 
3. To support the needs of people with multiple long-term conditions in work and expand the suitability of employment options for those looking for work, local authorities should encourage employers to specifically support those living with long-term conditions with a commitment to health inclusivity. 
4. The Department for Work and Pensions must create a system that better supports people living with long-term conditions by reforming Universal Credit, Housing Benefit and Carer’s Allowance. This should include a reversal of the cut to the £20 Universal Credit uplift. 
5. With a view to exploring a new model of state support based on stabilising incomes and building security in the future, local authorities, with support from national government, should explore a Universal Basic Income (UBI) trial with a specific focus on health and wellbeing outcomes and those living with multiple long-term conditions. 
6. National government must ensure that any recovery plan from Covid-19 includes a specific consideration of those living with multiple long-term conditions, including a risk assessment and an inclusive design for the ‘Plan for Jobs’.

Our briefing paper Economic Security and Long-Term Conditions explores our findings and recommendations in detail, and our supporting data report includes all our data.