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Podcast series from the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Anna Pearce:
Hello, welcome to this latest episode of 15 Minutes on Health Inequalities. I'm Anna Pearce from the MRC/CSO Social and Public Health Sciences Unit at the University of Glasgow. My co-host today is...
Vittal Katikireddi:
Vittal Katikireddi
Anna Pearce:
And we’re going to be speaking to…
Marcia Gibson:
Marcia Gibson
Anna Pearce:
So we're bringing this podcast to you as part of European Health Week or European Public Health Week, I should say, which this time has the overall tagline: “Health is a political choice”. So, today's discussion is going to be really relevant for that. So I'll kick off. Marcia, you were asked to write an editorial responding to an announcement for an English pilot of a universal basic income. Can you tell us a bit more about what was being proposed?
Marcia Gibson:
The proposal was to give £1600 a month to 30 people across two different sites in England, and the samples were going to be selected by first nominating themselves and then being randomised to intervention or control groups, and it was going to run for two years.
Vittal Katikireddi:
OK, so what's the idea behind the pilot, then? What do you think were the expected benefits beyond just the immediate financial ones?
Marcia Gibson:
Well, the expectation I guess because income is known to be such an important determinant of health. The expectation is that it would lead to all sorts of benefits accruing from improvements in poverty, primarily increased improved health and greater security. And one of the key benefits that basic income advocates believe would come from a truly universal basic income is an increasing equality or a decrease in inequality in society. Obviously, that's the benefits from the perspective of the people who proposed the pilot. That's not necessarily what I would see as being beneficial of either the pilot, or of the basic income.
Vittal Katikireddi:
In the editorial rule that you've written, you set out some reservations about the usefulness of a pilot like this. Can you tell us a bit more about this?
Marcia Gibson:
Well, one of the major issues is just the size of the sample. There's only 15 people in each site who will be receiving any income and it's simply not possible to derive any meaningful estimates of impact from a sample of that size. And certainly not that can be generalised in any way at all, which is acknowledged by the authors that […] that a pilot of that size can't replicate a basic income. But, they do repeatedly discuss testing impacts and demonstrating impacts of basic income in in the report that launched the pilot. The other major issue is that it's not actually funded. The launch of the pilot proposal was really a pitch for funding rather than an announcement that they were going to do a pilot, which was very much the way that was taken up in the media. They did give the impression, I would say, that it was funded and was something that was going to go ahead and that was what then what was very, very widely reported across hundreds of media outlets. The payment levels are unrealistic, giving people £1600 a month. Although I understand that they they've done that in order to remove people from the benefits system, because otherwise they can't deliver an unconditional payment. But in terms of the likelihood of ever being implemented, it was really very, very unlikely and I think a bit unethical, personally, to test the interventions that have little real chance of ever becoming a reality. I do understand and I had a lot of conversations with basic income advocates and researchers last year about the purposes of them doing these types of pilot projects. They are important from their perspective for getting it on the agenda and generating publicity and actually also engaging policymakers, etcetera, etcetera. But that's totally fine, as long as you're upfront about the fact that you can't generate evidence that's generalizable by a lot of that nature.
Anna Pearce:
You previously conducted a scoping review looking at the health benefits of income supplementation policies like UBI. What did you find in that review?
Marcia Gibson:
Well, the key thing is that there never has been an intervention which actually meets all of the criteria for a universal basic income. People bandy the term ‘basic income’ about an awful lot and it's kind of often assumed that that, by definition, means ‘universal’. But then the term gets really obfuscated in use and all kinds of things that aren't basic income get described as basic income. I felt it was really important to be…as you do in any systematic review…to be extremely clear about the definition of the intervention. And we decided that non-conditionality of payments was the most important aspect of our of our putative basic income policy. And one of the most important things that we need to understand is the effects of. So we had that and four other criteria. If, as long as it was unconditional, if it met one of the other criteria, then that would be included. And we therefore describe these as ‘basic-income-like’ interventions, because they're not basic income interventions. They don't meet the definition. And we found 27 studies of 9 interventions at that time. I had the searches updated in May March, sorry 23 and we found a further I guess 16 studies, 16 to 19 studies of all the same interventions, there hadn't been any new interventions. So in terms of the actual results, there were some very strong impacts on health outcomes in some studies. The Alaska Permanent Fund, which has been paying people dividends from their oil resources since 1984. A study of that found that there was a 17.7 gram increase in birth weight for every $1000 of additional income via the APF, which is usually typically $2000- $3000 a year. So that's a really substantial finding and much larger, as I recall, it's much larger than interventions aimed at increasing birth weight typically. Again, in Alaska, there was a really strong effect on infant obesity. 22.4% reduction in middle income groups, not in lowest income groups, but in the middle income groups. Strong effects in the Eastern Cherokee, who have a tribal dividend scheme that has been running since the 90s. Strong effects on things like child mental health, substance abuse, etcetera, etcetera. Arrest, crime, crime indicators went down. Adult mental health and other indicators of family. Family relationships improved, so again, that's the kind of in, in the realm of $2000 a year per household member, including children. But there were also some studies where they didn't find an impact on similar outcomes, which is slightly…Yeah, it's slightly puzzling, although there's potential explanations for some of those differences. There were some negative health impacts on mortality and accidents in Alaska and among the Eastern Cherokee immediately after receipt of payments. But that's actually quite standard. Any large payments have a similar effect and yeah, I’ll maybe talk a bit later about what's kind of interesting - the new studies that have come out from the Eastern Cherokee that are showing generational differences and effects, which may also go some way to explaining the increase in mortality. I think they were broadly smaller than people would typically expect. Although the picture is somewhat confused for the five major studies that were conducted in North America in the 70s, 60s and 70s, because multiple authors reported multiple different versions of the analysis, and each study has a kind of quite a wide range of potential impacts on labour market participation. For mothers of young children and for lone parents, the impacts were larger, with the impacts for men in most of the studies were quite small. And actually that was based on self-report data and when they when they analysed the admin data, they found that there was no impact on employment. And the reason for that being that the NIT was withdrawable if you if you earned money, the payments you got were reduced. So people had an incentive to underreport their earnings. And yeah, so it would appear that for men, labour market participation didn't actually fall by as much as was appeared from the kind of original analysis of the studies and there’s subsequently been a reanalysis of some of those studies that actually show an increase in employment for single parents. Which is not included in the original review. So yeah, I would say overall, the impacts on labour market participation were not as strong as might have been anticipated, but it's very, very important to note that all the positive outcomes are almost always concentrated in people on lower incomes. And where an entire community was included in a study and received payments, impacts on them were small to zero in terms of improved health etcetera, etcetera.
Anna Pearce:
Thanks, that's a really helpful summary across a lot of really relevant outcomes. So just coming back to the labour market effects, so it was anticipated that employment rates would fall as a result of the UBI. But actually, you found that that wasn't necessarily the case. And in some cases it was the reverse.
Marcia Gibson:
Yes. So I think the sort of standard policymakers assumption is that the labour market participation will fall if people get given money unconditionally. But I don't think the data from this, I mean there are reductions, and there are some contradictory findings, particularly for Alaska. But I don't think the findings bear a sore of alarmist take that most policymakers and politicians would have on that.
Vittal Katikireddi:
You've noted a lack of evidence in some kind of areas. In your opinion, do we need more evidence about universal basic income and if so, what form should that evidence take?
Marcia Gibson:
I wouldn't necessarily prioritise seeking evidence on universal basic income. I feel that we do have quite substantial evidence that supplementing the income of people on low incomes does have positive benefits and alongside that, imposing work conditions and sanctioning people to try to get them into the labour market has very, very clear negative impacts. And I would like to see effort being focused on trying to address those issues personally before I would before I would prioritise conducting more trials of universal basic income. As I said, it's important to note that most of these positive impacts are concentrated in people who are on lower incomes. And the other thing that's kind of interesting is that there is some evidence from Alaska that giving payments to people on higher incomes can actually increase inequality. So income inequality has increased in Alaska because wealthy people don't need to spend the money; they invest it in income bearing assets. And another more recent study has shown that they also invest it in the education of their children. Whereas people who are on lower incomes buy a winter coat or food, you know. So I think that the potential for inequalities, they quite dramatically increase as a result of giving money to people on higher incomes is quite high. So yeah, I would very much want to focus on reforming our existing Social Security System so that it is more beneficial to health or it's not actively damaging to health as I believe the current one to be.
Anna Pearce:
We've been chatting a little bit towards the end of that question about income inequalities. In this podcast, we always like to ask people what are the implications of their research for health inequalities. Can you say a bit about that?
Marcia Gibson:
Kind of reiterating what I just said…I think the implications are that, in order to improve health inequalities, we need to invest in, you know, cash payments for people on low incomes essentially and move away from punitive sanctioning and conditionality for people who are on benefits. Or on a mixture of working benefits. So that's kind of that in a nutshell, really.
Vittal Katikireddi:
Marcia, it's been really good to hear about what you've been doing so far. But what's next? What are your plans for further research?
Marcia Gibson:
Well, I'm doing research at the moment on Universal Credit in a really large multi-institution study. So I've been doing qualitative longitudinal interviews with Universal Credit recipients and shortly we'll be interviewing staff. My kind of real main focus for the next year or two or probably up to two years is going to be leveraging the findings from that study as much as possible to influence policy.
Vittal Katikireddi:
Well, I think that's us done for today. So I'd like to thank all of our listeners and Marcia for being here for such an interesting discussion about her work. You can find details of all the publications we've been discussing today in the podcast notes and hope to see you next time.