ScotPHP: Scotland can use benefit and tax powers to improve people’s health

I missed it when it came out at the beginning of this month, but an interesting report from  the Scottish Public Health Observatory has been trying to identify the possible impact of new benefit policies in Scotland on the health of the population.  The figures are complex, but the basic principle behind them is reasonably straightforward.  Their argument is built on the case that higher income leads to fewer deaths and less health inequality.  Effectively, then, their report is an assessment of the potential distributive impact of different policies in Scotland.  Critically, however, the distributive impact they are considering is not the distribution for individuals or households, but for deprived areas.

Part of their summary is a fairly confusing graph, which seems to suggest that the best method by far would be to increase means-tested benefits by 50%.  The comparison being made, however, is with other policies with very different sizes and shapes – for example, increasing takeup by 1% (a very marginal increase, costing little) or introducing Citizens Basic Income and abolishing all other benefits (a very major change, costing a great deal).  The details about what’s covered and what’s not are sketchy, and the figures are, of course, indicative rather than certain.  The core of the message is this:

increasing means-tested benefits by 50% is modelled to have the biggest effect on reducing premature mortality (5% prevented) and narrowing inequalities in premature mortality (-8%). The results also suggest that the real Living Wage, Local Income Tax and increasing devolved benefits by 50% would be good policies for reducing premature mortality (~2% prevented for each). The two illustrative CBI schemes are also likely to be effective at narrowing health inequalities (-4% for CBI, and -6% for CBI Plus).

In the supplementary papers, Table 2a, it’s possible to find a statement of costs per outcome.  This also needs to be treated with caution, because the costs of CBI cannot be introduced in part; but the best value for money, in the sense of effect for each pound spent,  comes from CBI , improving DLA and PIP, increasing takeup and increasing basic means-tested benefits.  The powers of the Scottish Parliament don’t cover all these options, but they do include powers to improve disability benefits and to increase takeup.  There’s a case to consider, but there has to be a major reservation: at the level of individuals and households, there would be losers among those who are poorest.

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