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Austerity Is Making Us Sick

Rishi Sunak's rhetoric around 'sick note culture' is a transparent attempt to blame workers for government policies that have pushed millions of us into poverty and ill health.

(Photo by Leon Neal - WPA Pool/Getty Images)

Last week, Prime Minister Rishi Sunak set out plans to tackle what he called the country’s ‘sick note culture’. In a major speech, he declared that welfare had become a ‘lifestyle choice for too many in our country’, arguing that a tougher approach was needed.

It’s a reprise of an all too familiar frame. David Cameron and George Osborne had great success deploying the language of the ‘shirker’ versus the ‘striver’. As rising numbers of sickness undermine economic participation in the UK, the Prime Minister has turned back to the same, divisive argument.

The implication is that sick and disabled people are letting down the economy, and the country. Not only is the idea insulting including the insinuation that people’s mental health conditions do not cause very real distress it is utterly detached from the evidence.

The blunt problem is this: people not in work are not letting down the country. Instead, they have been failed by fifteen years of austerity policies, and their catastrophic impact on the health and wellbeing of the nation. We are not a country of shirkers, but one increasingly ravaged by avoidable illness particularly, in the most deprived parts of the UK. It is only in addressing that injustice that we can improve both life quality and economic prosperity.

Do we really have a sick note culture?

It is true that more people are experiencing more profound barriers to work. The numbers experiencing economic inactivity an economic term for people neither in work, nor looking for it has risen sharply since 2019. As of the latest data, it had breached 3 million for the first time: the highest level since records began. The number of sick days taken has also risen over that period.

Yet, the idea we have a ‘sick note culture’ where a great many of us are only too ready to swap work for sick leave or benefits is false. The number of fit notes issued by GP practices each month since 2019 has remained broadly stable. The idea of a surge is a fiction. 

What has surged is the prevalence of avoidable illness. Cancer, diabetes, depression, asthma, and hypertension rates are all up. Healthy life expectancy is down. Long-covid continues to impact lives.  And when people do fall sick, they find an underfunded NHS in permanent crisis unable to provide reliable access or deliver world-class outcomes. The UK has become the literal sick man of Europe.

When looking at the data on the health of people who are economically inactive, they have the most complicated health needs. IPPR research shows that a quarter have two or more health conditions, while half have three or more, and a quarter have six or more. Any insinuation that this group are not really ‘that sick’ is simply not substantiated: they have very real, complicated and unmet needs.

A coercive approach in that context akin to declaring that ‘the beatings will continue until health improves’.

Injustice is the real cause of our problems

A better diagnosis of the economic challenges being posed by sickness would identify inequality as key. IPPR research has shown that bad health, social and economic outcomes tend to cluster in the same parts of the country.

Compare Hartlepool and West Oxfordshire. Around one in three adults between 16 and 64 years old are economically inactive in Hartlepool, compared to about one in six in Oxfordshire. More than twice as many are in poor health in Hartlepool where the average resident is also more likely to live in poverty or to work in an unsafe workplace.

People living in Hartlepool are not, en masse, choosing benefits as a ‘lifestyle choice’. Rather, they are experiencing concurrent injustices that undermine their health, work, and life chances. It is in addressing this injustice that all who care about health and the impact of sickness on the UK economy must anchor their solutions.

We need a new approach

The blame for rising sickness and the consequences that is having on public finances and the economy lies squarely with the government. The public health community has long argued that rising sickness and a weaker economy is the inevitable end point of austerity’s short-sightedness.

Over the last ten years, the government has worked hard to keep public expenditure down. They challenged the NHS to find tens of billions of pounds of efficiency savings, starving it of resource, capital investment and the right workforce. The local public health grant has been cut substantially over the last ten years. Broader local government funding has been stripped back, with social care provision suffering and some local authorities facing bankruptcy.

It might have saved some money for a few years, but now we’re paying the price: with both our lives and our livelihoods. And in turn, that is undermining both the economy and public services. That is, those short-term austerity savings have an exorbitant cost.

This is the root cause of our current health and economic malaise. In answer, we don’t need more demonisation of the poorest in society, but rather a public health revolution. We need to act on the things that cause bad health: mouldy housing, bad landlords, our broken food system, and toxic air. Alongside that, we need strong, universal healthcare and social care services.

Or put another way, we need whole state support. What we’re getting is whole state punishment, where government double down on the insufficiency, conditionality, and coerciveness of our current approach to welfare. It does not address the root causes of our problems, and it will not work. It’s time to demand a new approach.