Universal Basic Income: a missing link in trauma-informed health and social care?

Sarah Blake

doi:10.3399/bjgp21X716381

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What is needed for universal basic income?
Dipesh P Gopal and Rita Issa

Published on: 07 July 2021

Published on: (7 July 2021)
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What is needed for universal basic income?
Dipesh P Gopal, (NIHR) In-Practice Fellow in Primary Care; GP, Queen Mary, University of London
Other Contributors:
Rita Issa, Clinical research fellow in climate change, migration and health (UCL and Lancet Migration); NHS GP, University College London
We read with great interest Blake’s¹compelling case for universal basic income (UBI) to decrease the trauma-inducing nature of the current socio-economic system. As Euan Lawson correctly points out,² the very concept of UBI - regular payments to all citizens regardless of circumstance - is not new. Around the world, numerous local experiments show benefits in health and socio-economic outcomes.³In rural Kenya, a large-scale UBI experiment during the COVID-19 pandemic improved food security, well-being, and rates of illness.⁴ In Canada, a 4-year experiment which ran until 1979 saw an 8.5% decline in hospitalisations and a reduction in GP visits.⁵ Other UBI experiments are equally promising.

However, Blake stops short of acknowledging the conditions required to implement UBI including political will, public demand, and the ability to supply UBI.⁶ The latter, an understandably pragmatic objection, is a key factor mediating public and political will. Proponents suggest UBI could be generated through taxation of income, corporations or wealth, or the abolishment of tax reliefs. UBI could replace alternative welfare systems, and potentially save money overall through improvements in health and wellbeing.⁷

Under a meritocratic socio-economic system, the concept of UBI may have also found more public acceptance through the furlough scheme,...
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We read with great interest Blake’s¹compelling case for universal basic income (UBI) to decrease the trauma-inducing nature of the current socio-economic system. As Euan Lawson correctly points out,² the very concept of UBI - regular payments to all citizens regardless of circumstance - is not new. Around the world, numerous local experiments show benefits in health and socio-economic outcomes.³In rural Kenya, a large-scale UBI experiment during the COVID-19 pandemic improved food security, well-being, and rates of illness.⁴ In Canada, a 4-year experiment which ran until 1979 saw an 8.5% decline in hospitalisations and a reduction in GP visits.⁵ Other UBI experiments are equally promising.

However, Blake stops short of acknowledging the conditions required to implement UBI including political will, public demand, and the ability to supply UBI.⁶ The latter, an understandably pragmatic objection, is a key factor mediating public and political will. Proponents suggest UBI could be generated through taxation of income, corporations or wealth, or the abolishment of tax reliefs. UBI could replace alternative welfare systems, and potentially save money overall through improvements in health and wellbeing.⁷

Under a meritocratic socio-economic system, the concept of UBI may have also found more public acceptance through the furlough scheme, which whilst engendering the spirit of UBI, is not UBI. The scheme affirmed how changes in personal economic circumstances are often beyond an individual’s control and may have pushed UBI into the Overton window - the frame of acceptable political discourse. Meanwhile, criticisms of UBI suggesting it fails to tackle the root causes of poverty and discourages work and societal participation,³ are increasingly unfounded.⁸ As general practice experiences increasing pressures related to service delivery, there is ever-less capacity to impact the upstream determinants of health. With growing evidence supporting the financial and social case for UBI, and rising public acceptability, advocating to our politicians for a fairer socio-economic system with UBI could be one means of fulfilling the doctor’s role as envisioned by Virchow: ‘natural attorneys for the poor’.

References

1. Blake S. Universal Basic Income: a missing link in trauma-informed health and social care? Br J Gen Pract 2021; 71(708): 323.
2. Lawson E. The Health Benefits of Universal Basic Income. Br J Gen Pract 2021; 71(708): 291.
3. Wijngaarde I, Vinanchiarachi J, Readman J. niversal Basic Income (UBI) for Reducing Inequalities and Increasing Socio-Economic Inclusion: A Proposal for a New Sustained Policy Perspective (2020). Crime Prevention and Justice in 2030 107–23.
4. Banerjee A, Faye M, Krueger A, et al. The effects of a universal basic income during the COVID-19 pandemic in Kenya. Innovations for Poverty Action. 2020. www.poverty-action.org/publication/effects-universal-basic-income-during-pandemic (accessed 7 Jul 2021)
5. Forget EL. The Town with No Poverty: The Health Effects of a Canadian Guaranteed Annual Income Field Experiment. Canadian Public Policy 2011; 37(3): 283-305
6. Gentilini U, Grosh M, Rigolini J, et al. Exploring Universal Basic Income : A Guide to Navigating Concepts, Evidence, and Practices. 2020. Washington, DC: World Bank. https://openknowledge.worldbank.org/handle/10986/32677 (accessed 7 Jul 2021).
7. Standing G. Basic income as common dividends: piloting a transformative policy. 2019. Progressive Economic Forum https://progressiveeconomyforum.com/publications/basic-income-as-common-dividends-piloting-a-transformative-policy (Accessed 7 Jul 2021).
8. Kangas O, Floury S, Simanainen M, Ylikännö M (ed.). Evaluation of the Finnish basic income experiment. 2020. The Finnish Government. http://urn.fi/URN:ISBN:978-952-00-9890-2 (Accessed 7 Jul 2021).

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Competing Interests: DPG is an in-practice fellow supported by the Department of Health and Social Care and the National Institute for Health Research. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.