THE health service is arguably our most precious public service, but its function does not exist in isolation. Since its inception there has been a progressive expansion of social “safety nets” built around the health service which complement its function and echo a key founding principle; that we are all equal. One of the most recent developments in Scotland has been the introduction of the Baby Box, designed to provide some parity of opportunity in those first early weeks and months of life.
One of the greatest challenges we face in Scotland is a disproportionate difference in health outcomes between our “haves” and “have-nots”. This is reflected in the staggering differences in life-expectancy across the country. Where I live in East Dunbartonshire, men enjoy the longest average life expectance in the country at 80.5 year; five miles down the road in Glasgow City Centre that figure is 73.4 years. The seven years of difference doesn’t even account for the fact those in poorer areas often have less disease-free healthy-life-years – they may live to 71, but they might have been sick or infirm since their early 60s!
One of the hurdles in meeting the need to change this situation has been the limitations of powers that the Scottish Government has had access to. Fixing the Inverse Care Law – where wealthy groups often gain access to services they don’t necessarily need, whilst poorer populations lack access to them – is a major stumbling block of progressive public health policy. Could universal basic income give us the answer to this?
Universal basic income is a simple, but challenging, principle. At its core, the idea is to provide unconditional income to citizens, above the poverty threshold, to enable people to meet their basic needs; food, shelter clothing etc. This would replace much of the need for a complex means-tested social security system. From a health perspective, it could provide an equal platform that might mitigate some of the big social factors which contribute to ill health; stress, poor nutrition, unsafe living conditions, etc.
Now that Scotland has devolution of some social security powers the time to debate this issue couldn’t be better. Having already made the decision to diverge from the rest of the UK in our income tax policy, many Scots seem more open to the prospect of stigma-free social security at the expense of higher taxation.
There are several ongoing working models looking into the cost of a basic income system, but it is likely to be high. However, big upfront costs shouldn’t be an absolute barrier to considering UBI – citizens who are healthier and with better life opportunities live longer, work longer and would pay back into the system. It would also remove the barrier where benefit claimants are apprehensive about going back to work for fear of having their incomes affected. Additional “healthy life years” gained would also potentially bring savings to our healthcare system. The prospect of having a generation growing up without poverty is an exciting and aspirational goal for those of us who believe in primary prevention of ill-health.
There are many key areas of this idea still to explore, and although those opposed to it would argue the cost and the disincentive to work would make it unfeasible, there are growing concerns that future developments in automation are going to rock the traditional employment market over the next 15-20 years. We will need to think carefully in novel terms about how we address poverty and social security in a future Scotland; universal basic income could be the answer!
Marc Aitken is a junior doctor in Glasgow and a member of NHSforYES.
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