Installed in his first job in the poverty-stricken Welsh Valleys, young Dr Manson, the hero of AJ Cronin’s 1937 classic The Citadel is faced with a cluster of cases of typhoid. The water supply is contaminated by leakage from an adjacent sewer, but the authorities remain indifferent to this obvious, persisting threat to human health. Our frustrated hero embarks, with a dissipated-but-ultimately-redeemed older colleague, on a desperate plan to blow up the crumbling sewer and force the construction of a new one. It’s a mining town so explosives are readily come by and under cover of darkness a series of sticks with varying fuses are sent floating off. The results are spectacular, the Councillor’s new villa down the valley is inundated with sewage, and work on new and safer drainage is begun immediately.

The story is brought to mind by the recent report by Philip Alston, the UN Special Rapporteur on extreme poverty and human rights. Its 24 pages outline the extent and mechanisms by which poverty in the UK—“not just a disgrace but a social calamity and an economic disaster all rolled into one”—is created and sustained. Compassion for those who are suffering “has been replaced by a punitive, mean-spirited, and often callous approach.”

One important element has been the introduction of Universal Credit. Alston’s report sets out succinctly how the political choice to implement this “streamlining” of the system while also cutting levels of support has both explicitly intended, and thoughtlessly punitive effects on the most vulnerable. Its architects want “to make clear that being on benefits should involve hardship”—as if that was not apparent to people on low incomes already. This is the thinking of the workhouse, implemented through fixed delays to payments, clawbacks, lack of transparency in the system and a sanctions regime to immiserate people with disorganised lives. A digital by default service for people with the least digital literacy or indeed access to the internet. Employment does not anyway prevent poverty—2.8 million people living in poverty in the UK are in families where all adults work.

Speaking to local authorities and the voluntary sector, Alston is struck by how preparations for the rollout of Universal Credit resemble preparations for a natural disaster or epidemic; “they have expended significant expense and energy to protect people from what is supposed to be a support system.” Meanwhile, in his meetings with the government, “it was clear to me that the impact of Brexit on people in poverty is an afterthought, to be dealt with through manipulations of fiscal policy after the event, if at all.”

Unicef data show that 19% of children under 15 in the UK lived with adults who struggle to buy food. In 2019, in one of the richest countries in the world, we hear news reports of hungry children “eating from school bins.” Shamefully, Parliament’s Environmental Audit Committee, is now calling for the introduction of a Minister for Hunger.

The dynamite is metaphorical, but in the face of such contrived cruelty and indifference, and as life expectancy stalls or indeed falls in some groups, patience seems less and less like a virtue.  

Nick Hopkinson, reader in respiratory medicine, Imperial College London, and medical director of the British Lung Foundation.

Competing interests: None declared.