Why is it a priority?
Lack of employment opportunities and poverty are two key determinants of health and health inequality. Greenwich has a lower Life Expectancy and Healthy Life Expectancy at birth than either London or England averages. Within the borough the highest rates of ill-health, poor mental well-being and high mortality are in areas with the highest levels of deprivation (except for some cancers that are not related to smoking).
The least deprived men in Greenwich live 4.8 years longer than the most deprived, with a difference of 5.9 years for women. Evidence suggests that these poor health outcomes are related to the fact that Greenwich is a very deprived borough, with both ill-health driving poverty and poverty contributing to ill-health.
This is reflected in the focus placed on tackling poverty and promoting growth by Royal Greenwich. The current impact of welfare reform on some of the most vulnerable residents of the borough has made this relationship even more acute. RBG has one of the highest rates in London of people claiming ESA/Incapacity benefit. Over 50% of ESA claimants in Greenwich have mental health problems or behaviour disorders as their primary condition. Food bank usage in Greenwich has increased greatly between 2012 and 2014. At the same time around 5,000 people are being benefit sanctioned each year, many inappropriately.
The RBG approach to tackling poverty is to help incentivise aspiration and social responsibility by supporting individuals on a path that leads to sustained employment. RBG works in partnership to ensure that interventions are designed to overcome the barriers to employment that many families face are effectively co-ordinated and address the needs of all family members.
What could make a difference at a local level?
- Encouraging and supporting people to take greater responsibility for improving their own circumstances.
- Focus on building resilience – in particular, improving skills and employability.
- Reducing the negative impact of unemployment on the health of those affected and their families.
- Improved responsiveness of health services to changes in people’s social, employment and income status and early recognition of mental health problems, suicidal ideas and heavy drinking.
- Provision of appropriate health service support to enable individuals to best manage their health conditions and feel able to take up employment.
- Supporting people into employment and to sustain employment.
- Preventing homelessness through access to sustained employment.
What are the opportunities for improvement in Greenwich?
- Ensure that front line health professionals are considering employment needs and services helping people to access appropriate support services, including prevention of homelessness.
- Directly adapting and linking existing Public Health and Wellbeing services (e.g. stopping smoking or eating healthily on a low income) of benefit to clients participating in welfare and employment related programmes.
- To develop a borough-wide approach to support GPs to mitigate the impact of poverty on patients, including through social prescribing and provision of welfare advice.
- Joint working to help find ways to ameliorate the health impacts of the welfare reforms especially for those with mental health issues, disproportionately affected by the current changes.
- Facilitate development of a local NHS Health and Social Care Sector training and employment programme.
- Focus on supporting families in poverty especially given the long term effects of child poverty.
- Supporting actions within the Borough to help residents at the point of crisis; including through the Food bank and voluntary sector organisations.