Available via license: CC BY 4.0
Content may be subject to copyright.
Comment
www.thelancet.com/public-health Vol 3 July 2018
e307
Neoliberal welfare reform and single parents’ mental health
Over recent decades, national welfare programmes
of Organisation for Economic Co-operation and
Development member countries have become
increasingly focused on achieving high employment
levels among single parents and other social groups
receiving income support.1 Conditionality is a key
ingredient of these so called welfare-to-work policies,
whereby recipients only remain eligible for continued
receipt of payments if they comply with certain
conditions. Internationally applicable evidence of the
effects of these initiatives is, however, lacking, with
a 2017 Cochrane systematic review2 concluding that
tangible effects on the mental or physical health of
single parents were unlikely on the basis of findings
from randomised controlled studies done almost
exclusively in North America. In The Lancet Public Health,
Vittal Katikireddi and colleagues3 report the findings
of their quasi-experimental, nationally representative
longitudinal study of the effects of altered conditions
for receipt of Income Support by single mothers in the
UK. Single parents in the UK are required to actively
seek employment if their youngest child is older than a
certain age threshold: 5 years in 2012 versus 7 years in
2010 and 10 years in 2009. Katikireddi and colleagues
used difference-in-difference models to analyse the
effects of these policy changes on single mothers,
finding a decline in the mental health of affected single
mothers, but no apparent effects on their physical
health. As highlighted by the authors, although the
observed effect size was modest (scores on the Mental
Component Summary of the 12-item Short-Form
Health Survey decreased by 2·13 [95% CI 0·10−4·17]
compared with unaffected single mothers and by
2·21 [0·30−4·13] compared with always affected single
mothers), the public health impact is likely to have been
considerable given that single-parent families constitute
around a quarter of all families with children in the UK.4
Several salient research questions remain unanswered.
First, a broader evidence base is needed that
encompasses all citizens whose health and wellbeing
might be adversely affected by welfare conditionality
measures, including those who are chronically sick or
disabled, those who live in social housing, and those
who are homeless.5 Second, the long-term health effects
must be discerned, including effects on the children of
single parents and their subsequent trajectories through
to maturity. Third, a clearer understanding is needed
of the balance between the positive and negative
effects of welfare conditionality. Fourth, intercountry
comparisons are needed regarding variations in social
policies that might partially account for international
differences in observed outcomes.6 Interlinked national
registry studies have reported that single parents7 and
their children8 in Sweden have poorer mental health and
higher risks of alcohol-related problems and suicidality
than do partnered parents. By contrast with their UK
peers, however, Swedish single mothers are much more
likely to work full-time than are married mothers.7 These
findings undermine the argument that driving more
single parents into employment is certain to produce
universal gains in health and wellbeing.
A 2018 report4 by the UK charity Gingerbread
highlighted that nearly half of all children with a single
parent lived in poverty in 2015–16 and projected a
steep increase in this metric to 61% by 2021–22. The
report also stated that psychological distress is twice
as prevalent among single parents compared with
partnered parents.4 The stated purpose of welfare-
to-work reform is to encourage single parents into
employment, thereby optimising health and wellbeing,
and life chances in the longer term for them and their
children. Employment levels have increased greatly over
the past decades among single parents in the UK such
that 68% are now in work.4 This figure, however, mask
a fundamental flaw in the coherence of the rationale for
welfare-to-work policies, in that single parents might
increasingly be taking up poorly paid and insecure
employment opportunities. The inflexibility of many
low-paid jobs in relation to childcare needs might also
make them unsustainable for many single parents.9
Thus, it is not unsurprising that a third of all children
with a working single parent live in poverty in the UK.4
Childcare costs represent an additional, potentially
severe stressor. In April, 2017, the UK Government
lowered the youngest child’s age stipulation from 5 to
3 years,4 and many single parents affected by this change
will find it challenging and stressful to balance childcare
with employment demands when they are the sole carer
of a pre-school child. As a consequence of these multiple
competing pressures, concerns have been raised that
See Articles page e333
Comment
e308
www.thelancet.com/public-health Vol 3 July 2018
increasingly coercive conditionality strictures might
shift a subset of single parents from receiving Income
Support to receiving health disability payments or to
non-claimant unemployment.10
Robust evaluation of welfare conditionality and
its effect on the mental health of single parents and
other vulnerable social groups is needed. Until a
comprehensive evidence base exists, effective measures
that mitigate the apparent harmful effects of welfare-to-
work programmes must be developed and implemented
to ensure that poor mental health among people who
receive financial assistance from the state does not
deteriorate further. In the longer term, governments will
better serve the people by shaping their social policies
according to sound scientific evidence as opposed to
ideology and dogma.
*Roger T Webb, Vincent Lorant
Centre for Mental Health and Safety, Division of Psychology &
Mental Health, The University of Manchester and Manchester
Academic Health Sciences Centre (MAHSC), Manchester, UK
(RTW); and Institute of Health and Society, Université Catholique
de Louvain, Louvain-la-Neuve, Belgium (VL)
roger.webb@manchester.ac.uk
We declare no competing interests.
Copyright © The Author(s). Published by Elsevier Ltd. This is an open access
article under the CC BY 4.0 license.
1 Whitworth A, Griggs J. Lone parents and welfare-to-work conditionality:
necessary, just, effective? Ethics Soc Welfare 2013; 7: 124–40.
2 Gibson M, Thomson H, Banas K, et al. Welfare-to-work interventions and
their effects on the mental and physical health of lone parents and their
children. Cochrane Database Syst Rev 2017; 8: CD009820.
3 Katikirredi SV, Molaodi OR, Gibson M, Dundas R, Craig P. Effects of
restrictions to Income Support on health of lone mothers in the UK:
a natural experiment study. Lancet Public Health 2018; 3: e333–40.
4 Rabindrakumar S. One in four: a profile of single parents in the UK.
Gingerbread Research Report, 2018 https://www.gingerbread.org.uk/
policy-campaigns/publications-index/one-four-profile-single-parents-uk
(accessed June 15, 2018).
5 Watts B, Fitzpatrick S, Bramley G, Watkins D. Welfare sanctions and
conditionality in the UK. York, England: Joseph Rowntree Foundation, 2014.
6 Whitehead M, Burström B, Diderich F. Social policies and the pathways to
inequalities in health: a comparative analysis of lone mothers in Britain and
Sweden. Soc Sci Med 2000; 50: 255–70.
7 Weitoft GR, Haglund B, Rosén M. Mortality among lone mothers in
Sweden: a population study. Lancet 2000; 355: 1215–19.
8 Weitoft GR, Hjern A, Haglund B, Rosén M. Mortality, severe morbidity, and
injury in children living with single parents in Sweden: a population-based
study. Lancet 2003; 361: 289–95.
9 Millar J, Ridge T. Relationships of care: working lone mothers, their children
and employment sustainability. J Soc Policy 2008; 38: 103–21.
10 Avram S, Brewer M, Salvatori A. Can’t work or won’t work:
quasi-experimental evidence on work search requirements for single
parents. Labour Econ 2018; 51: 63–85.
