Key messages

• Good health underpins our ability to work and lead fulfilling lives. Yet the UK faces a growing working-age health challenge and widening health inequalities.
• between 2011 and 2021, 18% of working-age people living in the most deprived areas moved from good health to poorer health, compared with 13% overall.
• working-age adults living in the most deprived areas faced at least a 43% higher risk of no longer reporting good health than those in the least deprived areas, after accounting for demographic and socioeconomic differences.
• among young adults aged 20-24 years in 2011, women in the most deprived areas had a 72% higher risk of transitioning out of good health by 2021 (70% higher for men).
• unemployment and economic inactivity were strongly associated with deteriorating health: people unemployed but seeking work in 2011 had a 67% (women) and 82% (men) higher likelihood of no longer reporting good health compared with those in employment.
• housing tenure also mattered: people living in private rented housing had a 42% (women) and 34% (men) higher likelihood of no longer reporting good health compared with those living in owned housing; the risk was even higher in social-rented housing.

Policy implications

• policy responses should prioritise preventative approaches that support working-age health, particularly through employment and labour market participation.
• improving housing quality, affordability and security may help reduce the risk of deteriorating health among disadvantaged groups.

Gaps

• broader financial factors such as income dynamics, debt or wealth are not examined directly in the modelling.

Commentary
This analysis provides large-scale evidence linking socioeconomic disadvantage with deterioration in self-reported health among the working-age population. Using linked census data from 2011 and 2021, it demonstrates that people living in the most deprived areas are significantly more likely to move from good health to poorer health over time. The findings highlight how health outcomes are shaped not only by individual characteristics but also by structural socioeconomic conditions such as employment status and housing tenure.

The report identifies employment and housing as two of the most significant factors associated with declining health. Individuals who were unemployed, economically inactive or living in rented housing in 2011 were substantially more likely to report poorer health a decade later. These patterns suggest that economic security and stable housing conditions play a critical role in maintaining good health across the working-age population.

From a care equity perspective, the findings demonstrate how financial and socioeconomic disadvantage contributes to unequal health trajectories across the life course. People in deprived areas face a greater risk of losing good health earlier in life, which may reduce their ability to remain in employment and increase their need for health and social care support. Without policy interventions addressing the wider determinants of health, these structural disadvantages risk reinforcing long-term inequities in health, employment and care outcomes.

Key messages

• around one-third of adults in low-to-middle income families are disabled, a carer, or both
• families that include both a disabled person and a carer face significantly higher rates of material deprivation than families without these circumstances
• income levels are lower in households that include a disabled person or both a disabled person and a carer, even after controlling for demographic characteristics
• disabilities and caring responsibilities can limit participation in paid employment, including reducing working hours or preventing work altogether
• many carers report financial strain linked to the design of Carer’s Allowance, including strict earnings limits and administrative complexity
• public spending on support services for unpaid carers has fallen substantially, with expenditure on carer support in England falling by around one-third since 2014-15

Policy implications

• reforms to the social security system may be required to better support households with disabilities and caring responsibilities
• Carer’s Allowance could be redesigned to remove sharp earnings thresholds and reduce administrative burdens for carers
• employment policies should better support disabled workers and carers who want to remain in or return to work
• restoring funding for support services for unpaid carers may help reduce financial pressures and improve wellbeing
• broader policy responses may need to consider the interaction between disability, unpaid care and labour market participation

Gaps

• the analysis focuses primarily on low-to-middle income households, so findings may not capture experiences across the full income distribution
• further research is needed on long-term financial trajectories for households affected by disability and caring responsibilities
• additional evidence would help clarify how policy reforms affect both carers’ financial wellbeing and care outcomes

Commentary
This report examines how disability and unpaid caring responsibilities shape financial circumstances for families across the UK. It shows that disability and caring are closely linked with lower household income, reduced employment opportunities and greater exposure to material deprivation, particularly among low-to-middle income households.

The findings highlight how caring responsibilities can affect participation in the labour market. Many carers report reducing their hours, changing jobs or leaving employment entirely because of the demands of providing care. At the same time, the structure of Carer’s Allowance – including earnings limits and strict eligibility rules – can create financial instability and discourage some carers from increasing their working hours.

From a social care equity perspective, the report illustrates how financial systems and welfare policies shape the distribution of care responsibilities and resources. When support for unpaid carers is limited, the financial consequences are often concentrated among households already facing economic disadvantage. Reductions in public spending on services that support carers, such as respite provision, can intensify these pressures and shift more responsibility onto families.

Overall, the analysis demonstrates that disability and unpaid care are central drivers of financial inequities within the UK. Addressing these challenges requires policy approaches that recognise the economic value of unpaid care while ensuring that carers and disabled people are not pushed into financial hardship as a result of the support they provide or require.

Key statistics 

• estimates of households experiencing transport poverty range from around 10% to as high as 90%, depending on how transport poverty is defined and measured 

• transport poverty can occur when households cannot afford transport costs, lack access to transport services, or experience excessive travel time to reach essential services 

• people living in low-income households, rural areas or peripheral urban neighbourhoods are more likely to experience transport-related disadvantage 

Key messages 

• transport poverty remains poorly defined and inconsistently measured across research and policy 

• limited attention from transport policy and engineering has contributed to fragmented responses 

• transport disadvantage can restrict access to employment, education, healthcare and social participation 

• both rural and urban populations can experience transport poverty, though the causes may differ 

• current policy approaches often fail to capture the lived experiences of people affected by transport barriers 

Policy implications 

• develop clearer definitions and indicators of transport poverty to support consistent policy responses 

• integrate transport planning with wider social policy areas including health and social care access 

• improve public transport connectivity in areas with limited service provision 

• consider affordability alongside physical accessibility when designing transport systems 

• involve communities affected by transport poverty in policy development and planning 

Gaps 

• there is no widely accepted definition or measurement framework for transport poverty 

• evidence is limited on the scale of transport poverty across different regions and demographic groups 

• more research is needed on how transport barriers affect access to health and social care services 

• limited evaluation exists on the effectiveness of policy interventions designed to reduce transport poverty 

Commentary 

This paper explores the concept of transport poverty and how limited mobility can create wider forms of social disadvantage. Transport poverty occurs when people are unable to reach essential services, employment opportunities or social networks because transport is unavailable, unaffordable or unreliable. 

The authors argue that transport poverty has received relatively little attention from transport policy and engineering compared with other areas of infrastructure planning. As a result, responses to transport disadvantage have often been fragmented and inconsistent. 

Transport barriers can affect many aspects of daily life. People may struggle to reach workplaces, educational opportunities, shops or healthcare services. These challenges can contribute to social isolation and economic disadvantage, particularly for people living on low incomes. 

Transport poverty affects both urban and rural populations. In rural areas, people may face long distances between services and limited public transport. In urban areas, the problem may relate more to the cost of transport or poor connectivity between neighbourhoods and employment centres. 

From a health and social care equity perspective, transport plays an important role in determining whether people can access services. Difficulties travelling to health and social care appointments may delay treatment or prevent people from receiving support. Transport barriers can also affect care workers, who may need to travel long distances to visit people receiving care at home. 

The study highlights the importance of recognising mobility as part of the wider system that supports access to services. Policies that improve public transport availability, affordability and connectivity could help reduce transport-related inequities and improve access to health and social care services. 

Key messages 

• austerity policies introduced after 2010 led to substantial reductions in local government spending across Britain 

• cuts were unevenly distributed, with more deprived areas experiencing greater reductions in funding 

• reductions in central government grants significantly constrained the financial capacity of local authorities 

• austerity has reshaped the relationship between central and local government, reducing local authority autonomy 

• areas with the greatest social and economic need experienced the largest funding reductions. 

Policy implications 

• funding allocation mechanisms may need revision to better reflect local levels of deprivation and service demand 

• greater fiscal autonomy for local authorities could help address regional disparities in service provision 

• national policy decisions on local government funding can have long-term consequences for social care provision 

• monitoring regional impacts of fiscal policy is important to prevent widening geographical disparities. 

Gaps 

• the study focuses primarily on funding distribution and does not examine detailed impacts on specific services such as social care 

• limited exploration of the long-term consequences for service quality and outcomes 

• further research is needed to understand how funding disparities translate into differences in care provision and access. 

Commentary 
This study examines how austerity policies reshaped the financial landscape of local government across Britain. The analysis demonstrates that reductions in central government funding were not evenly distributed, resulting in significantly different financial pressures across local authorities. 

The authors show that areas with higher levels of socioeconomic deprivation experienced larger reductions in government funding compared with more affluent areas. Because these same areas often have higher demand for public services, including social care, the effect of funding reductions can be particularly pronounced. 

The research also highlights changes in the relationship between central and local government. Reduced grant funding has constrained the capacity of local authorities to plan and deliver services independently, increasing reliance on locally generated revenue and limiting the scope for addressing rising service demand. 

From an inequities perspective, the findings show how funding mechanisms can reinforce regional disparities. When areas with the highest levels of deprivation experience the largest funding reductions, the capacity to deliver essential services such as adult social care may be weakened precisely where demand is greatest. This dynamic can widen gaps in access to support across different regions. 

Overall, the study contributes to understanding how national fiscal policy decisions shape the distribution of public services at a local level. Addressing financial inequities in social care will likely require funding approaches that more closely reflect the differing needs and service demands of local communities.