Less money, more problems

In brief

This summary report is about how to alleviate, or reduce the risk of, financial difficulty among people at risk of developing multiple long-term health conditions.

Executive summary

There is extensive evidence of a strong correlation between deprivation, low income, and almost all forms of poor health. People living in deprived local areas are likely to develop multiple long-term conditions 13 years earlier than people living in the most affluent areas. Nearly half of those in problem debt have a mental health condition, according to the National Survey of Health and Wellbeing. The reasons why there is such a strong link between financial difficulty and poor health are complex and multi-faceted:

• Poor health can make it hard for people to work, reducing their income or making them reliant on benefits. Poor health can also increase expenditure, because of the high cost of living with a disability. The combination of low income and high costs means those in poor health are particularly likely to experience financial difficulty.
• Low income can lead to poor health, both directly and indirectly. Those on a low income may struggle to access healthy food, and are most likely to live in unfit accommodation.
• They may struggle to afford to heat their home or meet the costs of managing their condition, from prescription fees to care costs. The stress of managing on a low budget and/or dealing with creditors, may affect the cognitive bandwidth available to manage a complex health condition, and may be a trigger for both mental and physical illness.
• External factors can be a predictor of both poor health and financial difficulty. These external factors include those associated with multiple deprivation, such as low educational attainment, high crime rates, or high expenditure on tobacco, alcohol or drugs.

The scale of these problems can make them feel intractable. However, this research suggests there is real potential for interventions that can end this cycle of poor health and financial difficulty. This research is designed to inform a potential trial or pilot to evaluate whether improving the financial health of individuals or a population can improve their health outcomes, for example by reducing the likelihood of moving from a single to multiple long-term health conditions.

Our goal is to identify the intervention most likely to improve the financial health of this target population. Our hypothesis is that by improving the financial health of those at risk of developing multiple long-term health conditions, we can reduce the proportion who do. In particular we look at the needs of those diagnosed with diabetes, coronary heart disease and depression, as research has shown these are the people most likely to progress to multiple health conditions. We have worked with experts to establish theories of change that explain why financial interventions may work to improve people’s health outcomes.

In collaboration with