LAUSR

Recently, the Marmot report on health equity raised the alarm on the high and rising level of child poverty in the UK leading to adverse childhood experiences and deteriorating health outcomes. A basic income (BI) given to every person may reverse this trend of increasing poverty and illhealth. In 1797, Thomas Paine proposed a BI in agrarian justice as compensation for landed property, because the land generates income only for the few owners and deprives all other people of their natural common inheritance. Almost 200 years later, Evelyn Forget analysed a first BIlike intervention in the small Canadian town Dauphin, which showed a reduction in mental health problems, accidents and injuries. This article will explain the concepts of health, poverty and BI, how BI can improve health and present evidence for its effects on child poverty and health. The WHO has defined health as a ‘state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity’. Social health means social inclusion and confidence to participate in social activities. It is not explored in most BI studies. A Finnish BI study with longterm unemployed found improved mental health and increased trust in people and societal institutions. The latter two can be interpreted as improved social health. The International Poverty Centre has described three types of poverty: income poverty, want of essential goods and services and multidimensional poverty. BI studies focus on income poverty. Basic Income Earth Network (BIEN) defines BI as a ‘periodic cash payment unconditionally delivered to all on an individual basis, without meanstest or work requirement’. This definition includes five payment characteristics: 1. Periodic, not oneoff grant. 2. Cash, not in kind. 3. Individual, not to households. 4. Universal to all residents without means test. 5. Unconditional without behavioural requirements. Universal or unconditional basic income (UBI) emphasises the last two characteristics. Other important BI features are an adequate amount, financing through different types of taxation and the implementation of a BI scheme through either the state or an independent Common Wealth Fund. BI trials cannot examine the effects of universality, permanence and the financing scheme, while these are part of existing BI dividend schemes such as the Alaska Permanent Fund and Tribal Dividends. Therefore, most studies investigate unconditional cash transfer (UCT) interventions rather than BI. According to most proponents, BI should offer adequate funds to cover basic needs that are not provided by free public services. The Joseph Rowntree Foundation has determined an appropriate financial target for the UK as the minimum income standard (MIS). Opponents of BI argue that such an adequate BI would be too costly to implement. However, cost is not a neutral criterion, because it depends on your perspective of either state budgetary or societal costs. From a societal perspective, a BI for all members of society would be almost cost free or even cost negative when a BI is compared with the actual social protection system with its costly means and behaviour assessments. These assessments would be abolished. Instead means testing would be rigorously and consistently applied in the tax system. The money collected by the state for BI is not spent by the state on products and services as in healthcare. Instead the collected money is redistributed to every member of society. Therefore, the societal costs of BI are almost zero. Most public health interventions such as vaccinations have a specific focus. In the case of BI money fungibility and exchangeability enable the beneficiaries to split and exchange the cash for different goods and services to achieve several objectives related to their health. This supports the emancipation of BI recipients and the adaptation of the intervention to their specific needs. Figure 1 describes the effects of BI on health at the individual and societal level. In the UK context BI recipients are unlikely to spend much of their cash on healthcare, disease prevention and health protection, because these services are provided by the National Health Service (NHS) and Public Health. Despite free services, users still incur some costs such as travel expenses. BI recipients can use most of their cash for health promotion resources such as food, clothing, heating and hygiene items. Above all BI gives people control over their most important personal resource: time. Time autonomy is