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How to dismantle the welfare state


The British Medical Journal recently published a very important (referenced and evidence based) article
on processes currently underway that could dismantle the post-war consensus to a universal welfare state.

The article is primarily concerned with English policy development and its health and wellbeing impacts – but it has broader implications for economic wellbeing across the UK.

This is how it implies the welfare state will be dismantled:

1. Shift the narrative and policy direction of the state’s role from securing a ‘universal right of insurance for all’ against want, disease, ignorance, squalor, and idleness to ‘providing welfare for the poor’. This has the subtle effect of moving the state’s role away from providing ‘universal security’ to providing just ‘a safety net’ for the vulnerable.

2. Then – separate and promote the idea of ‘deserving poor’ from one of ‘the undeserving poor’

3. Then:

• use the media to keep showing examples of ‘undeserving poor’ and claim that their poverty and social exclusion is solely due to their own laziness (blaming the victim)

• Create a system where the middle class/wealthy see little benefit coming back to them from the payment of their taxes (e.g. by reducing maternity benefits, child care, social care, university education benefits etc)

• Claim that anyone arguing for retention of universal welfare benefits is acting in self- interest or is economically unrealistic or that the middle class are unfairly subsidising the ‘undeserving’.

4. Then bring in policies to dismantle the welfare state that are poorly understood, complex and detailed in their consequences (e.g. welfare reform, NHS reform, education reform), whose implications will also not be immediately obvious – but which will have the long-term consequence of reducing both universal welfare entitlements and the middle class/wealthy citizen support for such social solidarity.

5. It will take some time for the inevitable long term consequences to arrive. These will be – increased health inequalities, reduced social solidarity and social mobility, polarised communities, entrenched poor health and other negative outcomes in deprived and vulnerable communities. But by that time the politically active voting majority will most likely feel that that the increasingly stigmatised 5-20% (‘underclass’) population of the most vulnerable have only themselves to blame for their societal non-participation. This 5-20% are also least likely to vote or have a public voice.

One of the most important ‘capitals’ for economic development is human capital – the asset of a healthy, educated, productive workforce engaged in paid employment throughout their adult lives.

A key prerequisite of a high level of human capital is the presence of a universally accessible social welfare system supported by a broad political consensus. States with high levels of human capital have high rates of economic wellbeing.

If the commitment to the welfare state, as we currently understand it, is destroyed in the ways the BMJ article suggests, then the more challenged northern English boroughs will see huge social and economic impacts. These will be driven by an inevitable cycle of decline resulting in increasing inequality and social polarisation that will significantly impact the immediate health and wellbeing of all citizens over the next ten years and for subsequent generations.

For reasons of social justice and for the sake of continued health and economic wellbeing we need to keep our collective social commitment to the welfare state – and make visible the ways in which the powers and principalities aligned against it are mistaken.

Dominic Harrison
Dominic Harrison is the joint director of public health for Blackburn with Darwen Borough Council, the NHS Care Trust Plus (PCT) and the local clinical commissioning group. He is currently working with the European Office of the World Health Organization on the European Social Determinants and Health Divide Review chaired by Sir Michael Marmot. Follow him on Twitter, @BWDDP
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