The story of inequalities in health has been a long one, beginning, in the NHS era, with the Black report and progressing through the Health Divide, the Acheson report, to the Marmot report in 2010. Since the Acheson report, governments have embedded reducing inequality in health policy. The duty to reduce inequality was enshrined in the Health and Social Care Act of 2012. The aspiration has not been turned into concrete policy and service change. In many cases, government austerity policies have worked to increase inequalities. According to the Joseph Rowntree Foundation, in their Destitution in the UK report, local and national government are the biggest creditors on poor people.
Organisations like the Revolving Doors Agency have brought a growing awareness of inequalities in health in the criminal justice system and how NHS and Directors of Public Health should respond. However, there has been little acknowledgment that it is how poorer people are being managed, judged, and sentenced that is unequal. The system suggests, it is a crime to be poor.
Poorer socio-economic groups are over-represented in the criminal justice system. This situation becomes even more obvious when poverty is combined with other factors, such as coming from a minority ethnic background or suffering from mental ill health. There seem to be several reasons behind this disproportionality. There are clear examples of the impact of laws falling disproportionally on the poor.
In England, but not in Wales, Scotland, or Northern Ireland, magistrates have the power to commit someone to prison for up to three months for owing council tax. This is despite the fact that owing tax is a civil debt, it is not a crime.
The Vagrancy Act 1824, passed to deal with soldiers returning destitute from the Napoleonic Wars, made it a criminal act to sleep outdoors. Charities have long campaigned to repeal the Act. Housing Secretary Robert Jenrick has hinted that the 19th-century law which criminalises rough sleeping could finally be scrapped. Responding to a question by Nickie Aiken MP during a debate on the latest rough sleeping figures, Jenrick said he believed the Vagrancy Act should be “consigned to history” and the Government would provide an update soon. We are still waiting for this to happen.
The Vagrancy Act 1824 (section 3) makes begging a criminal offence; it enables the arrest of anybody who is begging. It is a recordable offence and carries a level 3 fine (currently £1,000). Furthermore, local councils can apply to have an Anti-Social Behaviour Injunction imposed on someone whose behaviour is regarded as anti-social. Breaching such an injunction may lead to a hearing in a county court under civil, not criminal, law. The penalty can be imprisonment, suspended or immediate, of up to two years.
School exclusion is a well-travelled road to exploitation by criminal gangs, leading to involvement in the criminal justice system. Recent reports reveal that exclusion rates for Black Caribbean students in English schools are up to six times higher than those of their white peers in some local authorities, highlighting what experts have called an “incredible injustice” for schoolchildren from minority ethnic backgrounds. Traveller children were also excluded at much higher rates. And exclusion rates for mixed-race students were more than four times higher than their white peers in several local authorities.
In England and Wales parents whose children miss school are deemed to have committed the offence of truancy, even if they didn’t know their child had skipped school. Lack of support for children with special educational needs in some schools may lead to children feeling unable to go to school, and refusing to go. Parents with fewer financial resources to find and employ tutors and other support will be disproportionately affected by the law which makes missing school a criminal offence for the parent. In Scotland truancy is a child welfare not a criminal law issue.
Additionally, the poor also get criminalised from law enforcement targeting certain crimes, from having inadequate resources to defend themselves in court and from a lack of support through the different stages of the criminal justice process. Some of these predicaments have long-term effects, causing intergenerational cycles of poverty and criminality.
Much of the unfairness of judging the poor will be obvious to prison health services and mental health colleagues. Large proportions of the prison population are there because of their inability to cope, with low level mental ill health, addictions and poverty. They are in prison largely because of inadequate support and inappropriate care in the community, and through the criminal justice system. Only one in 10 calls to South Wales police are crime related; the rest are complex welfare, vulnerability, and safeguarding matters. The police receive one call every four minutes relating to mental health problems. Resources such as court diversion of vulnerable defendants are still unevenly available and applied.
It is necessary for us to address these grotesque inequalities in health and justice, as we seek to Build Back Fairer after the covid pandemic.
The covid-19 pandemic in the UK has had a dramatic impact on household debt and financial security. The Department for Work and Pensions has seen applications for Universal Credit soar since lockdown was imposed in March 2020. As of the start of May 2020, 1.8 million claims had been received since 16 March—six times the usual claimant rate. Local news reports have also shown that more people than ever are applying for council tax reductions and are struggling to keep up with payments. There appear to have been temporary respites for some of the most vulnerable—through suspension of benefit sanctions, debt-deduction payments and evictions for non-payment of rent. However, many are extending their debt through credit card usage and built up rent debt; many expect to be homeless when evictions are again permitted. As the precariousness of household finances worsens through the economic hit of the coronavirus pandemic, it is essential that we protect those most financially vulnerable. In these circumstances it is more important and more urgent than ever that we end the criminalisation of poverty.
Rona Epstein, Honorary Research Fellow, Coventry Law School, Coventry University
John Middleton, Honorary Professor of Public Health, Wolverhampton University; President, Association of Schools of Public Health in the European Region
Competing interests: none declared