The health case for Universal Basic Income: transforming policy making and showing political and financial feasibility

We live in an age of crisis. Increasingly, there is understanding that the bases of our crises are material in nature: financial insecurity, poverty and inequality. The cost of living crisis is hitting Britain at the worst possible time since World War II. The global financial crisis (GFC), austerity measures, Brexit and the pandemic have all reduced Britain’s economic, social and health resilience. National institutions and services are under relentless pressure and an increasing number of those in work are now also in poverty – a proportion that is increasing significantly as a result of the cost of energy. Research at Northumbria has demonstrated the link between health and income, and persuaded policymakers and politicians of UBI’s health, social and economic benefits.

While policy has often understandably focused on improving healthy behaviour and increasing the efficiency of services, interest is growing in addressing the social determinants of health. A large body of evidence indicates that a range of conditions are strongly affected by such factors as income, wealth, education, social capital and opportunity. Given the government’s prevention agenda, policymakers are increasingly examining the role of cash interventions to prevent illness. While some GPs have called for cash prescriptions, a range of organisations, health bodies, community groups and politicians have called for trials of Universal Basic Income (UBI): a largely unconditional, regular payment to all adult permanent residents to support people’s basic needs.

A multidisciplinary team led by Professor Matthew Johnson and funded by the Wellcome Trust and NIHR, is examining the health case for UBI at a time in which policy makers are both more aware than ever of the need for public health measures and less able than ever to deploy traditional policy means to deal with the crisis.

The team has explained how UBI could influence health and wellbeing by reducing poverty, increasing predictability of income and reducing inequality. Prof Johnson’s team’s research has used citizen engagement with Royal Society of Arts in vulnerable, left-behind communities, such as Jarrow and Bradford, analysis of large longitudinal datasets, such as the Millennium Cohort Study and Understanding Society, and microsimulation modelling to explore evidence underpinning the theoretical model. Key findings include:

• Income is a primary driver of health outcomes
• Perception of inequality is a key determinant of mental health outcomes
• A UBI of a sufficient size to affect social determinants of health is affordable
• UBI is politically feasible
• Trials of cash transfers can be conducted effectively using a cohesive bank of mixed-methods measures in a generic, adaptive protocol resource

These original, unique justifications have transformed evaluation of UBI’s value to society.

The evidence indicates a clear relationship between financial strain and a range of health, social and economic outcomes. It shows how cash transfers (UBI) can be an effective means of mitigating social determinants and promoting improved outcomes. This is informing the design and evaluation of the Welsh trial of basic income for care leavers. For instance, the research team has influenced policymakers of the importance of evaluating cash transfers against their health value.  

However, there are serious concerns that UBI schemes are not politically feasible, because there is assumption that voters regard it as unpopular, or economically viable due to cost at a time of extreme pressure on post-pandemic public budgets. The team has worked with policymakers to explore these assumptions, concluding that UBI is popular, particularly in ‘red wall’ constituencies in the North of England, and that UBI schemes can be affordable through administrative reform, health savings, growth and land taxes.

This is informing how policymakers adopt and deploy basic income schemes and reform existing welfare programmes. With the emergence of an expanded North East Combined Authority and its role in social policy in mind, this work includes development of a micropilot of a UBI scheme for Jarrow with Big Local Central Jarrow and Compass.