Summary of the Project

UK social policy increasingly identifies the importance of tackling poverty and exclusion in the pursuit of reduced health inequalities (DoH 1999; DoH 2003) . However, while a large body of evidence confirms that disadvantaged socioeconomic circumstances are detrimental to health (Benzeval, Judge et al. 1995; Acheson 1998; Graham 2000) , far less is known about the ways in which ill-health undermines socioeconomic status and security.

Recent analyses of p overty dynamics using the BHPS indicate that 8% of cases where an individual moves into poverty are triggered by a rise in the number of household members with limiting illness and 16% by a rise in the number with poor mental health (Jenkins & Rigg, 2001). Child poverty is particularly affected by adult limiting illness (Adelman, Middleton, & Ashworth, 2003), and recovery from ill-health is found to be an important route out of poverty (Jenkins & Rigg, 2001). However, little is known about the pathways that link ill-health to poverty or how they may be broken. The coping strategies used by individuals and households suffering from limiting illness and the ways in which they might be supported are also poorly understood.

Evidence suggests that the impact of limiting illness on individuals and their families can be diverse and far-reaching. While the issue of care-giving is being addressed in ongoing research, less attention has been given to other issues including employment, access to non-labour income, and knock-on effects for other household members such as children's education.

Also, while there is some evidence that the consequences of limiting illness vary between sub-groups, with higher risks of negative outcomes among minority ethnic groups (Arrow 1996; Bound, Waidmann et al. 2003) , again little is understood about why this should be so. Furthermore, since the burden of limiting illness is extremely high among certain minority ethnic groups, particularly Pakistanis and Bangladeshis (Nazroo 1997) , accompanied by correspondingly high rates of economic inactivity, an understanding of the processes linking ill-health to poverty and social exclusion is central to the task of identifying viable routes to socioeconomic security for these groups.

This project integrates the analysis of secondary data from the Family Resources Survey with new qualatative data collection to address three related areas each of which will consider ethnicity and sex as key axes of analysis:

1. To describe the relationships between limiting ill-health and indicators of poverty and social exclusion of individuals and households, including trajectories over time.
2. To document the range of social, economic, and cultural resources that individuals and households employ in coping with / responding to ill-health, including the barriers and opportunities for action.
3. To identify routes via which individuals and households suffering from limiting illness can (i) be lifted out of poverty, and (ii) be buffered against a fall into poverty. In particular, to highlight ways in which existing household coping strategies can be better supported.

This work will provide valuable new insights into the pathways linking limiting illness to poverty. Such findings are of direct policy-relevance to the Department for Work and Pensions' focus on closing the employment gap between minorities and the majority, since high rates of sickness-related economic inactivity contribute importantly to worklessness. The Department for Health's current focus on tackling health inequalities and reducing the burden on the NHS via improved self-management of chronic illness will also be informed by the results. Other key users of this research will be: London Boroughs, Department for Education and Skills, Primary Care Trusts, community-based organisations, and employers' associations.