Dr Jamelia Harris is currently working on a paper for ReWAGE, the work and employment expert group hosted by Warwick IER and co-chaired by Warwick and Leeds Universities. The paper has been commissioned and funded by Deloitte and will focus on creating a future of healthy jobs.

In this blog for IER she gives a preview of her thinking so far.

According to recent public opinion reported by the Office for National Statistics, the cost of living (reported by 98% of the sample) is currently the top concern in the UK. This importance is unsurprising given recent inflationary pressures, recent declarations of ‘critical incidents’ and high waiting times across the NHS, and the UK being projected to be the only major economy to shrink in 2023.

The impact on living standards of workers has echoed through public discourse, with workers from various sectors striking. An estimated half a million workers participated in coordinated strike action on February 1^st 2023. In the short term, declining real wages affect consumption decisions from necessities (food, heating, housing) to more luxury purchases like going on holiday, but there are longer term impacts too, including the detrimental effect that lower earnings have on health. As part of the ReWAGE programme, researchers at the Warwick Institute for Employment Research have been reviewing existing studies in this area.

The evidence is very strong – lower income is associated with worse physical and mental health outcomes. A 2020 review article assessed 72 papers and found that lower income earners have a higher relative risk for various cardiovascular outcomes such as coronary artery disease, cardiovascular events, strokes and cardiovascular deaths. The risk of lung cancer is also higher for lower income earners. This may be because those with lower earnings are more likely to smoke, start smoking earlier, and are less likely to quit. This group is also more likely to eat processed and, high-salt foods; and less likely to consume fruits and vegetables.

On the one hand, lower earners often have lower levels of education – and education is also a strong predictor of health outcomes. Quasi-experimental studies take account of education when teasing out the relationship between income and health. On the other hand, it can be argued that lower earnings (which are often coupled with precarious work) may limit some healthy choices around diet and exercise; and simultaneously promote unhealthy behaviours to cope with work-related stress.

A 2022 review paper looked at 136 studies and concluded that a gain in income is good for mental health. Almost 90% of the high-quality studies reviewed confirm a positive relationship with income, with either an income increase being associated with improvement in mental health or a fall in income associated with a worsening in mental health. The findings suggest a particularly detrimental effect of income decreases - binary income decrease was associated with a worsening of mental health two and a half times the magnitude for an income increase. Lower monthly earnings are also associated with also affect post-partum depression and work-related burnout, the latter being a particular issue among nurses.

Based on the evidence, policymakers wishing to protect the physical and mental health of the population should try to mitigate societal or economic changes that could further erode income. With the current decline in real incomes and the ongoing strain on the NHS, this becomes an even more pressing policy matter. If left unchecked, the cost-of-living crisis may end up as a health crisis, piling further pressure on an already stretched NHS.