Some news stories are written in such a way that you know you’re supposed to read them and automatically go “That’s outrageous!” and not think critically about what has been reported and why that state of affairs is as it is. So it is with this news story. The Department for Work and Pensions has released statistics showing that roughly 80,000 people claiming incapacity benefits have difficulties related to alcoholism, substance addictions, and obesity. The Prime Minister announced that there would be “tough action” to get such people into jobs, and that he believed that voters and taxpayers did not want public funds to go to supporting such people, but rather, to supporting “people who are incapacitated through no fault of their own”.
For those unfamiliar with the UK incapacity benefits (IB) system, it’s worth noting briefly that “fault” is not a part of the applications process. Benefits are allocated to those who are unable to work for a serious and documented medical reason which persists of a long period of time. The application requires extensive medical documentation of the impact of the medical condition on the claimant’s daily life and ability to do paid work. So the idea that only those whose medical reasons are “faultless” should be supported is a curious one indeed. I have touched on this idea before, and it seems to me that some of the things that are said to be “lifestyle choices” or “matters of personal responsibility” are in reality matters over which people have very little control through no fault of their own, and even if they did have a choice, it’s unclear to me that there is anything to gain by the proposed Government policy of removing IB entitlement for those people.
(But, as others have written, the narrative of the Good Cripple is that they behave as if they are suffering bravely. They do not do things that can be seen to be their fault. This is part of the Tragedy or Charity Model of disability.)
Obesity
The first thing we should note is that people on incapacity benefits are a very specific demographic group. Because of the restrictions on how incapacity benefits are administered, they are, by definition, people with severe long-term medical conditions, and they tend to be people who rely on benefits/welfare payments as their sole sources of income, which means they live on or below the breadline. We also know, because it is very well documented, that disabled people disproportionately live in poverty.
As I have written before, and as has been extensively documented by others, poverty correlates with lack of access to certain kinds of food. Why? Because beans on toast is cheaper by a very large margin than a large wholesome salad. Or because they cannot afford the cooking facilities, equipment, or fuel with which to cook. Or because they are too ill to cook for themselves and must rely on food someone else cooks or food that is pre-prepared. So one reason people may become obese is because they are priced out of healthier eating, or they are dependent on the cooking choices other people make.
We also know that obesity can be caused by a number of medical conditions; and that many obese people receive poor medical treatment because their doctors incorrectly assume that any health complaint is due to their obesity — this makes it harder for long-term ill people to get the treatment they need to manage their long-term health conditions.
Additionally, many disabled people become isolated in their homes and unable to go out much because of access barriers to people with mobility impairments, fatigue, or other disability-related issues. Without appropriate support (which costs money, and remember we’re talking about people in poverty), people’s ability to go out can become severely limited, and that can quickly impact on people’s ability to get exercise. Another huge barrier to getting exercise can be cost. How many times have I heard a medical professional tell me I should try a gentle yoga or pilates class (because I need low-impact exercise because of my disability), and thought “well, that’ll be the cost of the class, plus a taxi there and back, and who’s going to pay for all that?” So exercising while poor and disabled is not easy.
So there are a number of factors, none of which involve individual “fault”, that can combine to make it likely that many IB claimants will be obese. And perhaps our answer to the report that some long-term-ill people are obese should not be “that’s outrageous!” but “no shit, Sherlock!”
Alcoholism and substance addiction
This case is a little more complicated. Yes, people make a choice when they first decide to drink alcohol or take drugs. But by definition, addiction is a situation in which people are physiologically dependent on alcohol or drugs. That is what it means to be addicted. To suggest that what is required to stop being addicted is an effort of will is to miss the point of what addiction means. Moreover, it is to underestimate how serious addictions can be. For many people, addictions can be so severe that if someone were to simply stop drinking or stop taking the drug suddenly, without medical supervision, they might experience seizures and other dangerous withdrawal symptoms. So in a very serious case of addiction, withdrawal must be undertaken in an inpatient rehabilitation setting. And even if things haven’t quite reach that point, we’re almost certainly talking about professional support of some kind, which means waiting lists.
And here again it is useful to consider how IB is administrated. To suppose that people can claim benefits by saying that they quite like a pint and a spliff on a Saturday night is to dramatically underestimate the difficulty of benefits applications. In order to qualify for IB, one must prove inability to work due to a medical condition, with documentation from your own and independent doctors. That is, the addiction must be extremely severe for a claimant with addiction issues to qualify. So basically, by definition, we’re talking about the people who would major medical support, and possibly have already tried various kinds of medical support.
It’s also worth noting that alcoholism and substance addiction often co-occur with other severe medical conditions, especially mental health conditions. But it is also common for mental health services in the UK to consider alcoholism or drug use a “barrier” to mental health treatment, and therefore either focus exclusively on the drinking/drug taking, or for some practitioners to refuse to see patient until they are sober. So, not exactly conducive to helping people manage the co-occurring conditions. Where the co-occurring condition is a mental health condition, people often face waiting lists of nearly a year just to be told “come back when you are sober”. So, I’m sure a long wait for healthcare that never materialises will cheer a depressed person right up and not make any co-occurring issues any worse, she says, with dripping sarcasm.
Will “tough action” work?
Let’s suppose, as the David Cameron has, that for some claimants, it is a lifestyle choice, to be obese and not be dependent on drugs and alcohol, to the point that they are unable to work. Does it then follow that IB payments should be cut?
I think it highly unlikely that such an approach will be effective in getting people back in stable paid employment. Remember, in order to qualify for IB, they had to have extensive documentation of their inability to work. What the Government is proposing is to move a number of IB claimants onto Jobseekers’ Allowance (JSA) instead. In order to qualify for JSA, one must show evidence of actively seeking work, and be willing to take any job that one is offered. If you fail to fulfill these requirements, your benefit payments are cut off. Many disabled people are disproportionately like to be unable to meet these requirements for perfectly legitimate reasons, like: they are unable to do the job they are offered because of their disability, or they lack the adequate support to do the job they were offered, or they are unable to make the required number of job-seeking moves each week, or are unable to make the required number of job-seeking moves without adequate support.
In other words, this is a hidden way of cutting the benefits people receive, without making it any easier for people to apply for, get, or keep stable paid jobs.
Worse still, it does nothing to address the genuine difficulties that keep people sicker than they might be otherwise, and therefore keep people out of work. It does not make healthy food more affordable or easier to prepare. It does not provide better healthcare. It does not make mental health services better funded, better staffed, better resourced, or better equipped to deal with co-occurring conditions. It does not provide the home care, mobility support, or other support that people might need to meet their basic needs. It does not make exercise more affordable or accessible. It does not provide residential rehab programs, or shorten the waiting lists for those that already exist. It does not provide outpatient rehab programs, or preventative public education and support programs. It does not make any other aspect of social participation and integration any more accessible either. It does not challenge discrimination against disabled people in hiring and workplace practices. And it does not end the high rates of unemployment.
Basically, benefits cuts means that people will go from being able to get by on benefits, to not being able to get by, but also not being able to support themselves. Dire need and deprivation will make people ill, and eventually they will almost certainly end up in hospital, which costs the taxpayer a lot more than IB does. So it’s cruel, it’s pointless, and it’s a false economy. And dressing things up as benefits claimants just being “deliberately” disabled is particularly cruel.
And that really is outrageous.
–IP