A review of long-term illness, poverty and ethnicity recently published by the Race Equality Foundation identifies the complex, disruptive effects of illness on families and raises a number of concerns.
Long-Term Ill Health, Poverty and Ethnicity looks at the problems faced by families like Shahida and Imran, who live in Whitechapel with their three young children and Imran's father Aziz. Aziz has diabetes and is on a waiting list for a kidney transplant. He has not been able to sustain paid work for two years due to recurrent kidney problems.
Imran has recently had to give up his job as a delivery driver, as his eyesight has deteriorated. As a consequence, he has become depressed and feels unable to look for work. Shahida earns money working from home as a machinist, but it is not nearly enough to manage on. The family have never claimed state benefits and do not know what the future holds for them.
The family is not unusual in having to live with long-term illness and poverty. They are among the disproportionately high number of people from minority ethnic communities whose stressful situation needs attention.
One of the concerns raised in the Race Equality Foundation report is that people with long-term illness and disability are more likely to be unemployed and to be living in poverty. Some black and minority ethnic communities are particularly hard hit because they are more likely to experience long-term illness and disability than other groups.
Bangladeshi and Pakistani families are particularly affected by long-term ill health, with substantially more women and men from these groups reporting ill health above the age of 30 than their white British counterparts.
This combination of circumstances can lead to extreme marginalisation and disadvantage, which can go unrecognised by policy makers who do not realise that the problems are interrelated.
Recent ministerial pronouncements aimed at cutting the number of long-term sick and disabled people receiving benefits and encouraging them into employment make unfair assumptions about such people's capacity to command jobs in the labour market and may further exacerbate inequalities and label communities in a punitive way. Initiatives may fail to reach families like Shahida and Imran's, who are not claiming their benefit entitlements and might therefore be invisible to services.
The levels of male unemployment in these communities are already higher than for other visible minorities. If we add their higher levels of long-term illness into the equation, the situation seems dire. Given the low overall economic participation of Bangladeshi and Pakistani women in the workforce, it is hard to see how welfare to work policies will touch these groups at all.
It is true that both paid and unpaid work can enhance self-esteem and make a valuable contribution to communities as well as to the economy. If paid, it can also raise household income and in some cases lift people out of poverty.
These are compelling reasons for stressing the benefits of work and encouraging co-operation. However, there is evidence that this approach will not work for some communities and groups. The Race Equality Foundation report reviews evidence showing that the combination of obstacles resulting from ill health, low skills and racism can result in particularly low chances of employment for minority ethnic groups. Blanket statements about "getting people into work" can thus make unrealistic demands on these communities.
The report also draws attention to the additional stresses on some minority ethnic people with long-term illnesses relating to their family and household context. Important factors include the availability of support, the co-operation of other family members, complications due to migration and separation, caring responsibilities and conflicting priorities, all of which affect the viability of seeking work.
It is important to recognise that non-participation in paid employment does not mean that a person is unproductive. Voluntary work may be more compatible with poor health, as an end in itself or a stepping stone to later employment.
Lack of benefits
The pressure to get people off benefits is also less relevant when receipt of sickness-related benefits seems to be particularly low for minority ethnic groups. The authors note that it is well established that few claims for benefits are successful without professional assistance. They recommend that specialist support needs to be expanded.
In England, however, the number of GP surgeries offering benefits advice has declined since 2005. There is some evidence that minority ethnic groups are at a disadvantage in accessing specialist support, and there is therefore a need to diversify modes of outreach to ensure benefits support is accessible to more marginalised groups.
Unfortunately, current policy in this area still leans towards blaming the victim instead of looking at the context and circumstances surrounding long-term ill health, poverty and racism and trying to change these.
Long-Term Ill Health, Poverty and Ethnicity by Kaveri Harriss and Sarah Salway is a Race Equality Foundation better health briefing paper. It can be downloaded from www.raceequalityfoundation.org.uk or email firstname.lastname@example.org if you would like a copy sent to you.