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BMJ No 7105 Volume 315 Medicine and books Saturday 16 August 1997 Britain Divided: the Growth of Social Exclusion in the 1980s and 1990s Ed Alan Walker, Carol Walker Child Poverty Action Group £9.95, pp 308 ISBN 0 946744 91 2 Anyone who felt relieved but not elated at the election result on 3 May need only read this book to understand their emotional shortfall. The defeat of a party that had deliberately engineered mass unemployment as an economic and social lever, targeted the most vulnerable and politically expendable to redistribute money from poor to rich, and routinely denied responsibility for its actions should certainly make our hearts rise. The breadth and depth of poverty the Conservatives have left behind, and the unimpressive responses of the new government to this poverty, offer less basis for optimism. Britain leads Western Europe in its poverty, with twice as many poor households as Belgium, Denmark, Italy, Holland or Sweden. A quarter of men of working age were "non-employed" in 1996, and a quarter of households existed on less than half of the national average income, after housing costs, in the early 1990s. Income support pays £10.55 a week per family and a maximum of £28.85 per child, while the average weekly cost of bringing up a child last year was nearer £52. Child benefit was frozen in the late 1980s, saving the Treasury some £900m a year, a figure strikingly similar to the £900 a week windfall from tax reductions enjoyed by the wealthiest 1% of the population. According to the School Milk Campaign, up to two million British children suffer from poverty related malnutrition, forgoing meals regularly and unable to eat vegetables or fruit in healthy amounts. This poverty is dynamic, but largely untouched by wealth trickling down from above. Employment can abolish it, but many who can find only low paid work will relapse. Young single parents - a group demonised by the cynical rich - and pensioners have least opportunity for escape. The consequences are equally dynamic, with homelessness and begging commonplace, crime increasing, and the expansion of the black economy to include illegal drug consumption on a huge scale. Young people "spare changing" on the street and the poor's all-weather uniform of tee-shirt, jeans, and cheap trainers are the visible signs of institutionalised poverty signalling undercurrents of hopelessness, demoralisation, and ill health. The policies against poverty proposed by politicians are superficial, while the problems are complex, profound, and entrenched. The causes of poverty are overwhelmingly structural, yet solutions are still seen in individual terms, and the sustained commitment needed to reduce poverty and inequality over the long term is missing from the political agenda. The contributors to this book try to remedy that with a compelling defence of the welfare state, a review of possible reforms in the social security system, and a restatement of the benefits of redistribution over privatisation. As the sense of relief fades, so do the election's sound bites. Now we have some serious work ahead. Hopefully the new government will help rather than hinder. Steve Iliffe, reader in primary care University College London Medical School Rating: *** Reviewers have rated books on a 4 star scale (4=excellent) Home | Current issue | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline