Chapter 4: Ensure a healthy standard of living for all

Despite ongoing policy work that aims to tackle discrimination, promote inclusiveness and progress gender equality, women and girls continue to face multiple barriers to reaching their full potential. In particular, there are a wide range of issues linked directly and indirectly to deprivation. This chapter considers the legislation relevant to equality and diversity and examines the impact of poverty on life chances.

Legislation

In 2019, Government published 'Gender equality at every stage: a roadmap for change', but fell short of a Gender Equality Strategy. Alongside this roadmap, the 'Gender Equality Monitor' was published, bringing together a group of metrics from across government to monitor important gender equality issues in the UK.
(Government Equalities Office. (2019). Gender equality at every stage: a roadmap for change)

Government has provided assurances that equality rights and protections will remain even though the UK has left the EU. The 2010 Equality Act is the key legal instrument for equality in the UK, which bans unfair treatment and helps to achieve equal opportunities in the workplace and wider society.
(Government Equalities Office. (2013). Equality Act 2010: guidance.)

As such, the focus is for 'public bodies to address a complex range of inequalities including but not limited to gender'. Included in this change of focus, the Public Sector Equality Duty (PSED) replaced the Gender Equality Duty (GED). The PSED covers gender, race and disability equality duties and extends across nine protected characteristics: age; disability; gender reassignment; pregnancy and maternity; race; religion or belief, sex and sexual orientation.

Gateshead Council published its Equality and Diversity Annual Report, which demonstrates compliance with the PSED, showing its 'due regard' to the need to eliminate discrimination, advance equality of opportunity and foster good relations. The report recognises the value of a society made up of many diverse groups and individuals and considers this diversity to be a strength of the borough, as well as setting out the steps needed to achieve equality in Gateshead.

Living in poverty has serious negative impacts on our health, social, emotional and mental development, behaviour and educational outcomes. Children who are born into poverty are more likely to experience a wide range of health problems, including poor nutrition, chronic disease, toxic stress, developmental delay and mental health problems.
(Office of Disease Prevention and Health Promotion. (2022). Healthy People. Poverty. Literature Summary.)

Women are more likely to live in poverty than men. As discussed throughout this report, gender inequalities mean that women still earn less than their male colleagues, fill more part-time jobs than men, are under-represented in business and face gendered barriers to employment due to caring responsibilities. People who experience poverty in their childhood are more likely to experience poverty in adulthood, which contributes to generational cycles of poverty. Adults living in poverty are at a higher risk of adverse health effects from obesity, smoking, substance use and chronic stress. And older adults with lower incomes experience higher rates of disability and mortality. 

The Department of Work and Pensions (DWP) shows that there are 100,000 more children living in poverty than in 2016/17. Child poverty continues to rise, with almost one in three children in the UK living in poverty.
(Department for Work and Pensions. (2022). Households below average income: for financial years ending 1995 to 2001.)

In Gateshead, 2 in 5 children (42.2%) are living in poverty, which is higher than national figures and has increased substantially over time.
(End Child Poverty Coalition. (2022). Child poverty in your area.)

Whilst 1 in 3 children live in poverty, this increases to 1 in 2 for children living in single-parent households. This can be because of several reasons, such as low maintenance payments for the children, high childcare costs and the absence of a second income. 45% of single parents, 90% of which are women, are living in poverty.
(Women's Budget Group (2019). DWP data reveals: women and children continue to be worst affected by poverty.)

The percentage of all single women living in poverty has stalled for 3 years at 25%, where as a small decrease has been seen for all single men in poverty (from 26% down to 23%).
(Women's Budget Group (2019). DWP data reveals: women and children continue to be worst affected by poverty.)

Whilst much of the attention about the cost of living has been around energy costs, gas and electricity, other costs have been increasing at above the rate of inflation too. For example, in 2020 the cost of childcare increased by 4-6%, which was well above the 1.4% inflation rate.80 Such increases continue to impact poorer households the most with the biggest impact being on women. For pensioners, there are 14.2% who live in poverty and this increases to 20% for those living alone.

There is a greater proportion of pensioners living in poverty in Gateshead (19.4%) which is about 9,600 people (The Income Deprivation Affecting Older People Index from 2019). We know that women live longer than men and are more likely to be single pensioners and therefore are at increased risk of living in poverty.
(LG Inform. (2022). Income deprivation affecting old people index (IDAOPI))

Nearly a quarter (23%) of single female pensioners are poor, the highest figure in 15 years.
(Women's Budget Group (2019). DWP data reveals: women and children continue to be worst affected by poverty.)

In Gateshead, community organisations are working to help local people impacted by poverty. The Gateshead Older People's Assembly (opens new window) was established in 2002 to help people aged 50+ to improve their health and maintain independence through activities that promote socialising, learning and exercising.

As we emerge from the Covid-19 pandemic, the UK is facing a major cost-of-living crisis. This crisis means that the cost of basic goods such as gas, electricity, and food increases faster than average wages, pushing more people into poverty. As such, many more people will struggle to pay for basic items such as heating, eating or travel to work. Women are more vulnerable to the cost-of-living crisis. Women who were already struggling are now under enormous financial pressure as costs continue to rise.
(Finch D (2022). The cost-of-living crisis is a health emergency too)

While the richest households were able to save during the pandemic, the poorest fell further into debt. Also, poorer households experience higher inflation because they spend a larger proportion of their income on gas and electricity, the two services that are increasing the most.
(Thompson K (2022). What is the cost of living crisis?)

The cost of living in the UK has increased by 10.1% in the year to August 2022.This means that if it cost you £1000 a month for rent, transport, food, in August 2021, it would have cost you £1100 to buy the same goods and services in August 2022. If the current average rate of inflation continues into 2023, then it will cost you £1210 to buy the same things.

Gateshead Council recognises and understands the impact of the cost-of-living crisis in the UK and wants to do more to help its residents, delivering on its 'Thrive' ambitions. Working in partnership with voluntary, community and social enterprise organisations, a network of 'Warm Spaces' has been created. Everyone is welcome at any of the 80+ registered venues to stay warm, enjoy each other's company and have a hot drink without being judged or asked why they're there. All visitors are treated equally, with dignity and respect.

The cost of living in the UK has increased by 10.1% in the year to August 2022.

This means that if it cost you £1000 a month for outgoings such as rent, transport, food, in August 2021, it would have cost you £1100 to buy the same goods and services in August 2022. If the current average rate of inflation continues into 2023, then it will cost you £1210 to buy the same things.

Women see this cost-of-living crisis as a 'constant source of worry'. 42% of low paid women had fallen behind on household bills, compared to 35% of low paid men, and 35% of low paid women had skipped meals regularly for financial reasons compared to 29% of low paid men. Women are struggling even more to make ends meet on wages that don't provide enough to live on.
(Living Wage Foundation. (2022). Low paid work and cost-of-living crisis disproportionately affecting women)

The impact of the cost-of-living crisis is gendered:

• Working women have, on average, a lower income than men.
• Women are more likely to have lower paid jobs, more likely to work part time and are sometimes paid less despite being in similar jobs to men.
• Women are already more likely to be experiencing poverty.
• Women have lower levels of savings and wealth than men.
• Women are more likely to be in debt.
• Women's pensions are about half the size of men's.
• Women are more likely to have caring responsibilities. This means that they are less able than men to increase their hours of paid work and income. Childcare costs were increasing above the rate of inflation for several years before this crisis and many mothers are unable to afford such costs.
• Women are the 'shock absorbers of poverty'. They tend to have the main responsibility for the purchase and preparation of food for their children and families, the purchase and use of cleaning products and for the management of budgets of poor households.
• Women often go without food and other necessities themselves to provide for their children. This is likely to have a damaging effect on women's physical health and wellbeing.

The groups of women who are most likely to be disproportionately impacted are:

• Single parents and unpaid carers
• Women with disabilities
• Women already living in poverty
• Women from ethnic minority population groups, including Bangladeshi, Pakistani and black
• Victims/survivors of domestic abuse, including economic abuse.

Women find it hard to leave an abusive relationship if they don't know how they will support themselves and their children, especially as living costs rise. Women with 'no recourse to public funds', who are excluded from claiming social security benefits, are at high risk of poverty if they lose work, or separate from a partner.
(Sangster G, Stephenson MA and Reis S (2022). The gendered impact of the cost-of-living crisis. Women's Budget Group.)

Women also report feelings of shame and guilt as a result of not being able to afford leisure activities or essential items for their children, contributing to the negative mental health impacts of the crisis. 69% of single parents reported that the cost-of-living crisis was having a negative impact on their mental health, although this is likely to be an underestimation.
(Close the Gap. (2022). Gender inequality means that women are being hardest hit by the cost-of-living crisis.)

Food insecurity is when someone struggles to afford or access enough food.
(Food and Agriculture Organisation of the United Nations. (1996). Report of the World Food Summit.)

It is measured in terms of severity: high, marginal, low and very low food security.
(Food and Agriculture Organisation. (2015). Voices of the hungry.)

Those experiencing low and very low food security will have skipped meals, have not eaten when hungry, or have not eaten for one full day.
(Taylor A, Loopstra R. (2016). Too Poor to Eat - Food Insecurity in the UK. The Food Foundation.)

Food insecurity may be long term, temporary or cyclical. It can be influenced by a number of reasons, such as income, employment, ethnicity, and disability. The main reasons why people need to access a food bank include problems with the benefit system, changes to family circumstances, ill-health and lack of support.
(The Trussell Trust (2022). End of year stats)

During the pandemic, the main reasons why people experienced food insecurity were found to be because they didn't have enough money (55%), because of isolation (31%) and lack of access and supply (23%).
(The Food Foundation. (2022). Food foundation release new report showing pandemic effect on food insecurity remains a crisis)

The risk for food insecurity increases when money to buy food is limited or not available. Food price inflation hit 4.3% in February 2022, the highest rate since 2013 and is projected to continue to increase.
(Davey J (2022). UK grocery inflation hits 4.3%, Ukraine conflict adds to pressure - Kantar.)

This means that food insecurity is expected to worsen. 

Since the 2008 recession, food insecurity has become more common in the UK, with numbers at a record high. In 2019/20, 1 in 5 of UK households with incomes of under £200 a week reported food insecurity.
(Department for Work and Pensions. (2021). Family Resources Survey: Financial year 2019 to 2020.)3

Now, more than 1 in 6 people are experiencing food insecurity.
(The Food Foundation. (2022). Food insecurity tracking)

Food insecurity is even higher in single parent households and for households with children getting Free Schools Meals, where two in five have reported food insecurity in the past six months.
(The Food Foundation. (2022). Food foundation release new report showing pandemic effect on food insecurity remains a crisis)

Regional differences in food insecurity mean that numbers are highest in the North East of England, where one in three households are food insecure. Numbers are highest among women and children, with more than one in four who are considered food insecure. This number increases to almost half of households with three or more children.
(The Food Foundation. (2022). Food insecurity tracking)

There is also an increased risk of food insecurity for ethnic minority population groups, who are twice as likely to be food insecure. Adults who identified as being limited a lot by health problems or disabilities were five times greater levels of food insecurity than those without.
(The Food Foundation. (2022). Food foundation release new report showing pandemic effect on food insecurity remains a crisis)

With the cost-of-living crisis expected to last at least two years, it is likely that the number of women, children and families living in food insecurity will get even higher. Lack of food is the presenting problem. However, inadequate income is the root cause of food insecurity. Over half of households on Universal Credit have food insecurity,94 and it is these households that are thought to be more likely to be affected by the rising gas and electricity costs.
(The Food Foundation. (2022). Food foundation release new report showing pandemic effect on food insecurity remains a crisis)

This means that these households will be using their appliances less for cooking, eating cold meals, they are turning the fridge and/or freezer off and washing dishes in cold water. Food insecurity is a public health concern because it can affect the type and amount of food eaten, and thus affect physical and mental health. It can also affect social health as people are unable to take part in 'normal' food experiences, like eating out or inviting friends over, and can begin to feel excluded from daily social life. We know that having a healthy balanced diet is important for good health, therefore people who are most impacted by the cost-of-living are more likely to have a poorer quality of diet. 

The cost-of-living crisis and cuts to crucial support services are mostly impacting single mother households, pushing them into the depths of despair. There are 146 single-mother families per 1,000 families in the North East compared with 24 single-father families per 1,000.
(ONS. (2022). Families and Households in the UK: 2021.)

This equates to 309,000 single mother families and 50,000 single fathers in the North East.65 70% of single mothers are admitting to going hungry to feed their children and skipping baths or showers to keep help save their money for soaring bills. 

These inequalities make women more vulnerable to low income and poverty, a cause of food insecurity. 

This also means that our children and young people are at increased exposure to food insecurity, and the cycle continues. 
(ONS. (2022) Annual Population Survey: April 2021 - March 2022 (Accessed from NOMIS))

Across high-income countries in Europe, the UK has done the most research exploring how food insecurity impacts on women's health and wellbeing. Speaking to women with lived experience of food insecurity shows that they have poorer physical, mental, and social health.
(Bell Z, Scott S, Visram S et al. (2022). Experiences and perceptions of nutritional health and wellbeing amongst food insecure women in Europe: A qualitative meta-ethnography. Social Science and Medicine. 311.)

It is important that we listen to women who have experienced food insecurity to better understand how this impacts on their lives. Here, we have explored the lived reality of food insecurity for women in Gateshead.

*Mary captures the lived reality of most women in a review that included 647 women's accounts of how food insecurity impacts on their health.
(Bell Z, Scott S, Visram S et al. (2022). Experiences and perceptions of nutritional health and wellbeing amongst food insecure women in Europe: A qualitative meta-ethnography. Social Science and Medicine. 311.)

The findings from this review were taken to a group of seven women in Gateshead as part of a workshop. They spoke about how they resonated with all these experiences. While this workshop did not intend to be 
completely representative of all women with experience of food insecurity in Gateshead, it helped to highlight their lived experiences and what occurs here.

Mary is a thirty-year-old woman and mother to three children. Mary's eldest child is in secondary school, her middle child in primary school and her youngest is 18 months old. Before children, Mary worked full-time as a school dinner lady in a primary school, although she is not yet back to work. She lives with her partner, who works full-time. However, they still live life on a low-income and access Universal Credit and Healthy Start Vouchers. 

Mary manages all the food for the family on a tight budget. A budget that keeps changing. Often for the worst. She does her best to access enough healthy food but is not able to all the time. This comes with significant health costs for Mary. 

Despite this, she is constantly juggling her budget and negotiating what to do, deciding whether to heat or eat. This has led to Mary experiencing ruminating thoughts and sleepless nights: "I've had sleepless nights and nights full of tears, where I've just thought I literally don't know how I'm going to get through the next few days. I've got no food, no money...".
(Stack RJ, & Meredith A (2018). The Impact of Financial Hardship on Single Parents: An Exploration of the Journey From Social Distress to Seeking Help. Journal of Family and Economic Issues, 39, p.235)

Mary spoke about how food insecurity has physical health costs too. The poor nutritional quality diet which lacks fruit and vegetables has led to stomach problems. For Mary, food insecurity also impacts her social wellbeing. 

Mary feels unable to participate in social activities that involve food outside of the home. Her budget is so tight that even £3 for a coffee makes a difference, a difference she cannot afford.  Healthy Start Vouchers accessed from pregnancy until her child is four years old have helped Mary provide a nutritional safety net for some fruit and vegetables. However, this is not sufficient to feed the whole family. 

*Mary's story is an extract from 'It ripples through, it's like a dropping stone into a pond...the ripple effect is huge": Food insecurity and health: Insights from women, children, and frontline workers' (Bell, 2022)

The type and amount of food women eat during pregnancy is important for both their own and their baby's health. Certain vitamins and minerals are critical for the baby's development during this time. 

However, food insecurity limits the range of food choices a mother has and her ability to access enough of these nutrients. 

Research from North America shows that food insecurity increases health risks to pregnant women and their baby.
(Ivers LC, Cullen KA (2011). Food insecurity: special considerations for women. The American Journal of Clinical Nutrition. 94;6. 1740-1744.)

For example, food insecure pregnant women are more likely to develop poor mental health and gestational diabetes, whilst their baby has a higher risk of being born too early.
(Dolatian M, Sharifi N, Mahmoodi Z (2018). Relationship of socioeconomic status, psychosocial factors, and food insecurity with pre term labour: A longitudinal study. International journal of reproductive biomedicine, 16, p.563-570)

As chapter 1 explores, pregnancy has life-long consequences for the health of women and their children, contributing to health inequalities from the start of life. In the UK, there are gaps in our knowledge about food insecurity during pregnancy. We lack data showing how many pregnant women are food insecure, what it does to pregnant women's diet and health, what it does to the health of their baby, what pregnant women's experiences are and what support might help them the most. It's important that we work together to understand the impact this is having for our families in Gateshead. 

Since the 2008 global recession, and most recently the coronavirus pandemic, food aid services offering free food parcels have become a well-known feature in our communities. Food banks are grassroots, community organisations aimed at supporting people who cannot afford the essentials in life. Linked to rising rates of food insecurity, food banks also faced increased demand nationally, with 2.1 million food parcels distributed in the 2021/2022 financial year, an increase of nearly a million parcels since 2016/2017 when 1.2 million food parcels were distributed.
(The Trussell Trust (2022). End of year stats.)

Across Gateshead, food aid services offer non-judgmental support to a variety of people accessing them, including women, often moving beyond food to provide support in other ways. Food aid services have positively responded to the issue of food insecurity. The details of emergency food aid networks / providers and wider food support organisations in Gateshead are available at: www.gateshead.gov.uk/costofliving (link no longer available)

Healthy Start vouchers are a cash-benefit accessible to women who are on a low income and are more than 10 weeks pregnant or have a child under four years. These vouchers provide support to buy fruit, vegetables and cow's milk. In summer 2021, the value of Healthy Start vouchers increased and moved from a paper voucher system to a Mastercard that is topped up each week.
(Save the Children. (2022). Gender roles can create lifelong cycle of inequality)

'Tyneside Women's Health (TWH) is a women only mental health service operating across Tyneside. We provide mental health support in women only spaces such as drop-in sessions, creative groups, mental health courses, support groups, and counselling. My role is the Chief Executive Officer, so I oversee all of the services and general running of the organisation.'

When asked about inequalities women who access the service face, Elaine explained: 'The women we support face various issues. We supported an annual caseload of 560 women in 2021/22, and 40% of these women report being a victim of abuse'. 

Of the 177 new women who accessed TWH in 2021/22 the following issues were reported at the point of initial assessment.

49%  reported being a victim of domestic abuse / 34% felt isolated reported debt / 25% financial issues

The following mental health needs were also reported:
87% felt anxious
74% felt depressed
66% felt stressed
74% felt low in confidence
30% reported self-harming as a coping strategy
53% reported having regular suicidal feelings
21% reported making a suicide attempt within the previous 12 months

'All of the women we support have some level of mental health need, and a significant proportion also have a physical health condition or disability. The majority of women are claiming a sickness related benefit. Due to the cost-of-living crisis, women also report difficulties in paying bills, heating their homes, and worry about the future. There are many other barriers for women that prevent them from engaging in interventions such as travel, childcare and other caring responsibilities.' 

We asked Elaine how the work at Tyneside Women's Health strives to tackle these inequalities:
'We offer spaces for women to come and access support from staff and other service users. Some of our services are light touch such as weekly drop-in sessions where women can attend the Centre, have a cuppa and be among others. We also offer creative and therapeutic activities such as a singing group and a reading group to improve general wellbeing.' 

'We provide more targeted mental health programmes to help women create personal safety plans who are feeling suicidal, as well as specific courses focussed on mental health themes such as anxiety management, coping with depression and confidence building. Support groups for older women and younger women are also available where women can access peer support and brief interventions around mental health and an opportunity to share and talk about any issues as they arise.'

'One of our key support groups is for women affected by domestic abuse, the group is open ended and helps women to recover from the trauma they have experienced.'

'Women tell us that coming to Tyneside Women's Health helps them feel less isolated and helps them to improve their mental health: 'It has been a life saver for me, the care support and knowing I could access this at any time although not needed it was there and that was an enormous support. Being alongside other women and being accepted for who I was in my darkest time, celebrating with developing friendships in my journey and feeling I can give care, value and motivation to other women. Finding myself emotionally and mentally more balanced and now in a position to make good decisions for me.'

'The service has enabled me to meet other women within the area. I feel less isolated being in contact with women who have health issues and I am comfortable talking through my own health problems knowing I am not alone. I feel happier knowing there is always a drop-in to attend when I am able.'

'I feel really comfortable in a women only setting and group. I've found I've really been able to fully open up and express myself and grow as a person. I've felt supported, safe and welcomed.'

Finally, when asked what more needs to be done in this area to address these inequalities, Elaine states:
'In general, women feel the brunt of cost of living rises as they are often the home maker and in charge of family budgets. This impacts negatively on women. More generalised support is required. There are long waiting lists for mental health support through the NHS and eligibility criteria for services is unclear. Often charitable organisations continue to support people while they wait for more specialist support with no additional funding. Referrals into voluntary sector services have increased and these continue to be managed without an increase in resource.'

'We are exploring other ways to support women, such as introducing more rolling based programmes that women can join at any point, and developing new service areas such as support groups for women with neuro diverse issues, women experiencing menopause, and women with young children.'

'A key area for development is the ongoing support available for women when children are subject to a child protection plan due to domestic abuse in the family home. Voluntary sector organisations and statutory services need to work better together to improve outcomes for these women and their children and ensure services are supportive rather than punitive for victims, particularly when there is no longer contact with perpetrators.

Chapter 5: Create and develop sustainable places and communities