Health inequity is a problem, universal basic income could be a solution

Posted in: Basic income, Culture and policy, Data, politics and policy, Health

Jurgen De Wispelaere is a Policy Fellow with the Institute for Policy Research (IPR), University of Bath. He is a former occupational therapist turned political theorist and policy scholar and an expert in the politics of basic income. This blog was a collective writing effort originally published on 29 January 2024 on the Journal of Medical Ethics website. The full list of authors is listed at the end of the article

In May 2023, academic and policy experts in social protection, economics, public health, history, and ethics gathered at the Brocher Foundation in Geneva to consider the potential for Universal Basic Income (UBI) to contribute to health equity.

Health inequities have long been a recognised global problem. In 2013, a review of countriescovering 74% of the world’s population found substantial variation in health outcomes according to income, education, sex, and migrant status. Achieving health equity is a moral imperative and necessary to fulfil the human right to health. Health inequalities cannot be solved by the health sector alone – achieving health equity requires addressing the social determinants of health that largely involve social domains beyond health, such as social security, education, housing, and issues such as domestic and sexual violence and abuse, race and class prejudice, adverse employment conditions, the physical environment, and climate change.

Poverty and income inequality are fundamental drivers of poor physical and mental health. Poverty is widely recognised as carrying a higher risk of a range of non-communicable diseases. The link between poverty and mental health has been recognised since the 1930s and is well evidenced.

UBI holds promise as a measure to reduce poverty and income inequality. Consisting of permanent, periodic, unconditional cash payments to all individuals, a UBI, especially when coupled with a progressive financing mechanism and the strengthening of universal social protection policies combined with high-quality public services, will raise the incomes of those at the lower end of the income distribution, notably those in precarious employment.

In addition to the role that UBI could play in reducing poverty, some core features of this approach have the potential to reduce health inequalities. The regularity of receiving UBI payments reduces income insecurity, which is a known factor in worse mental health outcomes.

The universality and unconditionality address drawbacks in currently prevalent social protection systems which contribute to poor mental health. Currently, there are large gaps in coverage, adequacy, and comprehensiveness in countries’ social protection provision. For instance, 53.1 per cent or 4.1 billion people worldwide lack any social protection at all. And 33 per cent or some 2.7 billion people worldwide are not effectively covered by any social health protection scheme. These protection gaps exacerbate the deleterious effect of health inequalities.

Poverty stigma and the negative feelings of shame prevalent among those living in poverty are associated with poorer mental health and wellbeing. UBI may reduce poverty stigma by creating non-stigmatising pathways to adequate income that do not depend on a particular social status. Conditionality in the form of benefit sanctions has been found to be associated with increased health problems.

However, while a UBI has the potential to improve health equity, its effects in practice are not yet fully known. In our view, policymakers should consider the benefits of UBI as a means of addressing social determinants of health and reducing health inequalities. We recommend that pilots of UBI include evaluation of its potential to reduce health inequalities and improve health equity. When considering all income support measures, national and international policymakers should assess their likely mental and physical health effects. They should also consider how to reduce or eliminate conditionality for income support.

We are aware of a number of basic income pilots in train or planned, including in Catalonia (Spain), Ireland, the United States, England, and Wales. We encourage research into the health effects of these pilots and look forward to seeing further evidence that contributes to our understanding of how UBI can contribute to health equity. We also encourage research into the specific ways UBI can be designed to maximize its positive impact on health equity. Gleaning lessons from social protection systems that share similar design qualities to UBI — i.e. universal social pensions/universal child benefits— that are easy to access, may also help give insight into the societal-level mental health effects of UBI, where such insights cannot otherwise be derived owing to the absence of a full national UBI anywhere.

Written with Carina Fourie (University of Washington), Troy Henderson (The University of Sydney), Matthew T. Johnson (Northumbria University), Tijs Laenen (Tilburg University (the Netherlands) and the Centre for Sociological Research of KU Leuven), Douglas MacKay (University of North Carolina), Shari McDaid, (Mental Health Foundation (UK), McLellan Works), Neil McHugh, (Glasgow Caledonian University), Kerry Ellen O’Neill (McMaster University), Ian Orton (International Labour Organisation), Matthew Smith (University of Strathclyde), Lou Tessier (International Labour Organisation), Aida Martinez Tinaut (Departament de la Presidència), Vida Panitch (Carleton University), Nicole Valentine (World Health Organisation), Jenna van Draanen (University of Washington), Daniel Weinstock (McGill University, Faculty of Law).

All articles posted on this blog give the views of the author(s), and not the position of the IPR, nor of the University of Bath.

Dr Joe Chrisp is also working on Universal Basic Income for the IPR. His work can be seen here.

Posted in: Basic income, Culture and policy, Data, politics and policy, Health


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