Past Imperfect

How successful
have charities
been over the
last few decades

April 2016
Joe Saxton and Sarah Eberhardt
joe.saxton@nfpsynergy.net

www.nfpsynergy.net

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Introduction
It is perhaps the single most important question a charity, or any other organisation, can ask itself: are we
doing a good job? It is also one which is very difficult to answer for most not for profit organisations. While
companies can easily measure profit, charities march to a different drum and set of measurement metrics. So
the difficulty in measurement is partly, because working out what timescales to analyse (long-term change
versus short-term impact) can be complicated, and partly because most organisations struggle to find the
resources to conduct this type of analysis.
Even in the wider sector literature there is relatively little analysis of this kind, one of the few is a passing
comment by US commentator Dan Pallotta:

"[The charity sector] doesn't seem to be working. Why have our breast cancer charities not come
close to finding a cure for breast cancer, or our homeless charities not come close to ending
homelessness in any major city? Why has poverty remained stuck at 12% of the U.S. population for
40 years? And the answer is, these social problems are massive in scale, our organizations are tiny
up against them, and we have a belief system that keeps them tiny."1
Whilst we cannot deny that the causes that charities work towards remain problems in need of attention, it is
overly simplistic to claim that the charity sector is not working because of charities failure to solve these
complex issues (though Pallotta makes these points in order to support his wider arguments about how he
believes charities should be working).
In this report we try and look at the issue of the success of charities with some real data and analysis. The
rise of impact evaluation and an increasing focus on accountability and transparency, with charities expected
to demonstrate their impact to their supporters and funders, means this is a good time to try and analyse
when and whether charities are making a positive contribution to their areas of work in a time frame of
decades rather than years.
The areas we look at are: cancer, heart disease, disability, poverty and environment.
We havent picked these areas because we think they are particularly successful, but for two other reasons.
They represent different types of problems that charities tackle and most important they have relatively good
historical trend data for us to analyse. Our apologies for those sectors we have been unable to include, and
our apologies also that we have only begun to scratch the surface of whether charities are successful.
In the second part of the report we try and tease out what this kind of analysis can tell us about the dynamics
of success (or failure) in different areas that charities care about.

Pallotta (2013) The way we think about charity is dead wrong, TED talks transcript, March 2013
http://www.ted.com/talks/dan_pallotta_the_way_we_think_about_charity_is_dead_wrong/transcript?language=en

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How can an individual charity use this report?

While reading this report there are a number things that a charity could bear in mind:

What are the statistics or key figures that demonstrate the progress (or lack of it) relevant to your
charity or organisation. These could be statistics or data at any level: country, county, town or
village. They could be behaviour change, attitudinal change, saved lives, change lives or a range of
other metrics. But knowing what they are is a key place to start.

What do these statistics show about progress in achieving your goals over the timescale of recent
years or decades? If these statistics are difficult to obtain, is now the time to start collecting them?

What does your organisation understand to be the dynamics of successful change in your arena? Is
change created reversible or irreversible? Who are the key partners? What is the role of government?

What is your organisations role in delivering the change (or lack of it) found in these statistics? It is
fanciful for most charities to hope to deliver large-scale change on their own. It isnt fanciful to hope
that every charity might know its role in achieving the ideal big picture that its vision sets out to
achieve?

How does your strategy make sure your charity maximises your role in using your resources to
secure change. How does that strategy complement that of other organisations working in your
sphere?

And how do you make sure all those (staff, volunteers, donors) in your organisation understand how all these
issues fit together and drive a strategy that will make the most of your organisations work and assets? These
are some pretty big issues and we hope reading our report makes you think as much about your organisation
and how it works, as we found we had to think researching and writing this report.

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Health and Disease

Summary
The success of charities working in health in the UK can to some extent be determined using measures such
as mortality rates, over time. The cancer mortality rates for all cancers combined have been decreasing in
the UK since the early 1990s, largely due to better survival rates, resulting from earlier diagnosis and
improved treatments. Similarly, the mortality rate for heart disease has significantly decreased since the
early 1980s, reflecting improvements in both the prevention and treatment of cases.
There is a positive picture suggested by mortality (no of deaths) and morbidity (no who get sick) rates for
heart disease: increasing life expectancy and successful improvements in survival rates have increased the
number of people in the UK living with coronary heart disease and its consequences. However significant
increases in the prevalence of obesity and diabetes also threaten to derail the decreasing trends in
morbidity rates for heart disease. The prevalence of obesity in England has more than doubled in the last 25
years, now affecting over a quarter of adults in England, whilst the number of people diagnosed with diabetes
in England increased by 25% up to 2.5 million between 2006 and 2011.
Diabetes and obesity have considerably greater prevalence rates than cancer, and prevalence rates that are
increasing, unlike for coronary heart disease. However, because they tend to contribute towards other
conditions, rather than directly resulting in mortality themselves, they are perceived differently. Diabetes
increases the risk of cardiac failure, stroke and angina, among others, and of the excess 24,000 deaths with
which diabetes is associated each year, half result from cardiovascular disease. Being overweight or obese
increases the risk of developing coronary heart disease and diabetes, among other things.
Such overlaps make it difficult both to assess the number of deaths directly attributable to obesity and
diabetes now, let alone over time, as well as to determine the role played by charities focused on these areas.
Unsurprisingly diabetes and obesity have not received the same attention from government as cancer and
heart disease, and the extent of charitable work focused on these areas is also considerably lower than for
cancer and heart disease.

In more detail: Cancer mortality rates

Looking at these areas in more detail. Cancer mortality is decreasing in the UK despite small increases in
incidence.2 This can largely be attributed to better survival rates, due to earlier diagnosis and improved
treatments.
Cancer Research UK (CRUK) reports that for all cancers combined, mortality started to fall in the early 1990s.
The European age-standardised mortality rates (AS rates: which take into account that the population
structure is changing) decreased by 27% in males and 20% in females between 1990-1992 and 2010-2012 in
the UK (chart 1). The rate of decrease has slowed down in the last ten years, down to a 13% decrease in
males and 9% in females between 2001-2003 and 2010-2012. This is despite small increases in AS incidence
rates over this period. The rates of people dying from cancer is predicted to fall further (by around 17%)
between 2011 and 2030 in the UK.

http://www.cancerresearchuk.org/cancer-info/cancerstats/mortality/all-cancers-combined/

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Chart 1: All Cancers, European Age-Standardised Mortality Rates, UK, 19712012

As chart 2 below shows, the percentage changes in age-standardised (AS) mortality rates for the top twenty
cancers in males and females between 2001-2003 and 2010-2012 in the UK show varying trends by cancer
type.3 Mortality rates have decreased for twelve of the twenty cancer types in males and eleven in females.
Apart from female lung cancer, all four of the most common causes of cancer deaths in the UK ( breast
cancer, prostate, male lung and bowel) have seen decreases in mortality in the last decade.
The largest falls in mortality have occurred for stomach cancer, reflecting similar decreases in incidence. Some
of the decrease in incidence and mortality in stomach cancer can be attributed to a decline in the prevalence
of Helicobacter pylori (a major cause of stomach cancer), an increase in fresh food in the diet, and possible
changes in coding and diagnostic practices. Other cancers showing large decreases in mortality in the last
decade include cervical cancer (AS mortality rate decreasing by 21% in the last decade, with much of this
decrease being attributed to screening), laryngeal cancer in males (25% decrease), and ovarian cancer (20%
decrease). Even though prostate cancer has shown one of the biggest increases in incidence in the last
decade (AS incidence rates rose by 16% between 2000-2002 and 2009-2011), the AS mortality rate has fallen
by 13% over the last decade.
Prostate-specific antigen (PSA) testing led to the over-diagnosis of some latent, non-lethal tumours, and
accordingly some deaths in the early years of PSA testing around the early 1990s were erroneously attributed
to prostate cancer, so artificially increasing mortality rates. The subsequent decrease in mortality rates may
just represent a return to the background trend that would have been observed if PSA testing had not been
used. It may also represent PSA testing affording earlier diagnosis and therefore more successful treatment,
leading to a genuine decrease in mortality rates.

http://www.cancerresearchuk.org/cancer-info/cancerstats/mortality/cancerdeaths/

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Chart 2: The 20 Most Common Causes of Cancer Death, Percentage Change in

European Age-Standardised Three-Year Average Mortality Rates, Males and
Females, UK, 2001-2003 and 2010-20124

When looking at cancers which have seen a relative increase in mortality, it is important to bear in mind the
incident rate for these cancers. For some cancers, the increases in mortality may also reflect relatively small
increases in incidence but little or no improvement in survival. Liver cancer saw the biggest rise in mortality in
the last decade, increasing by 44% and 50% in males and females respectively. However mortality from liver
cancer is rare in the UK: AS mortality rates are 6 and 3 per 100,000 males and females, respectively. In
females, the second biggest increase is from uterine cancer; this cancer also has a small mortality burden (4
per 100,000 females), but the age-standardised (AS) mortality rate has increased by 15%.

Heart disease mortality and morbidity5

In 1961, the death toll from cardiovascular disease (CVD) in Great Britain was immense. Over 150,000 men
and nearly 170,000 women died from CVD over half of all deaths that year.6 More than half of the deaths
from CVD were from coronary heart disease (CHD). As is still the case today, the majority of the burden of
CVD in 1961 was felt in older age groups, but despite this, CVD was also the biggest killer in every age group
from 35 upwards.
4

Brain, other central nervous system (CNS) and intracranial tumours include malignant, benign and
uncertain or unknown behaviour tumours.
5
Data taken from British Heart Foundation (2011) Trends in coronary heart disease, 1961-2011
https://www.bhf.org.uk/~/media/files/research/heart-statistics/bhf-trends-in-coronary-heart-disease.pdf
6
Overall, mortality rates for CHD, stroke and CVD are much higher for men than women but the number of
deaths is reasonably similar, as women tend to live longer than men.

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The mortality rate of CVD has diminished since the early 1980s. In 1981 there were around 330,000 deaths
from CVD in the UK, down to fewer than 300,000 deaths in 1991 and 180,000 deaths in 2009. Despite this fall
over a relatively short period of time, CVD remains the biggest killer in the UK, responsible for around a third
of all deaths in men and women. However, deaths from CVD in younger age groups have fallen considerably
since 1961 there are now more deaths from cancer than from CVD in every age group younger than 75.
Morbidity rates for coronary heart disease in all age groups have consistently fallen since 1961 (see chart 3
above), so that the risk of death from coronary heart disease for an adult in 2011 is equivalent to the risk of
someone roughly fifteen years younger in 1961. Treatment for heart disease has improved dramatically over
this period, for instance there are now treatments that can dramatically reduce the risk of dying from a heart
attack.

Chart 3: Age-standardised mortality rates for cardiovascular diseases, men,

1961 to 2009, Great Britain

Despite improvements in morbidity rates, and improvements in prevention of new cases of heart disease and
strokes, as well as procedures that have reduced the recovery time for cardiac interventions, there has been a
large increase in the number of people in the UK who are suffering from coronary heart disease and its
consequences. This is due to increases in life expectancy, combined with successful improvements in survival
rates. Over one and a half million people currently living in the UK have had a heart attack, and over two
million people have angina and/or heart failure. The considerable strain this places on the NHS is only likely to
increase as the population continues to age. The BHF argue that pioneering new approaches to treating heart
damage will become increasingly important, with regenerative medicine offering hope of a radical new
treatment in the coming years.7
7

British Heart Foundation (2011) Trends in coronary heart disease, 1961-2011

https://www.bhf.org.uk/~/media/files/research/heart-statistics/bhf-trends-in-coronary-heart-disease.pdf

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As will be discussed in the following two sections, upward trends in the prevalence of diabetes and obesity
also threaten to derail the decreasing trends in heart disease incidence and morbidity rates.

Diabetes
The UK is facing a huge increase in the number of people with Type 2 diabetes. 8 Between 2006 and 2011 the
number of people diagnosed with diabetes in England has increased by 25%, from 1.9 million to 2.5 million
(see chart 4). It is estimated that this figure will rise to 5 million by 2025 (most of which will be Type 2). The
prevalence of diabetes is nearly four times higher than the prevalence of all cancers combined. Moreover,
about 850,000 people with Type 2 diabetes remain undiagnosed. On average, currently only 75% of the
expected cases of diabetes are detected in primary care (ie PCTs/GPs) in England and the gap between actual
and expected rates is closing at a very slow rate.

Chart 4: Prevalence of diabetes compared with other conditions 2006/07 to

2009/10

Each year, diabetes is associated with 75,000 deaths, which is 24,000 more deaths than would be expected in
this group. Half of all deaths from diabetes result from cardiovascular disease, including heart attack and
stroke. There is evidence of significant increases between 2006 and 2010 in unnecessary complications
resulting from diabetes, including retinopathy, stroke, kidney failure, cardiac failure, angina and amputations.
Diabetes is the leading cause of blindness in working age people, and the biggest single cause of amputation,
stroke, blindness, and end stage kidney failure in the UK. By the time they are diagnosed 50% of people with
Type 2 diabetes show signs of complications, many of which are avoidable with good risk assessment and
early diagnosis, patient education, support and good ongoing services. Estimates show that of more than 100
amputations carried out each week from diabetes complications, up to 80% are preventable.
8

Diabetes UK (2012) State of the Nation 2012 England

http://www.diabetes.org.uk/documents/reports/state-of-the-nation-2012.pdf

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Diabetes UK argues that awareness, early identification and prevention of diabetes must be prioritised.
Cancer, stroke and heart disease have been targeted by national programmes to raise awareness and drive
improvement. Diabetes has not.

Obesity
Obesity has been of some concern in the UK for at least 35 years, however in the last 25 years, the
prevalence of obesity in England has more than doubled. Although this recent increase has been seen virtually
worldwide, the rate of increase in England has been particularly high.9
Over a quarter of adults in England are currently obese, but it has been predicted that by 2050, 60% of men,
50% of women and 25% of children could be clinically obese (BMI of 30 and above). 10 Between 1960 and
1974 the mean BMI of men aged below 60 was largely within the normal range of 20 to 25 in England. In
1974 women generally had a lower mean BMI compared to the men, with the exception of the 55 to 60 age
group which was slightly higher for women. From the early 1990s however, mean BMI for all age groups
except 16-24 has been above the normal cut-off of 25. Between 1993 and 2010 the proportion of adults with
a healthy BMI (18.5-24.9) decreased from 41% to 31% among men, and 50% to 40% among women.
Childhood obesity is a particular problem in the UK, and has been increasing since the mid-1980s in both boys
and girls (see chart 5). People who are obese or overweight as children are more likely to be so in
adulthood.11
Being overweight or obese increases the risk of developing CHD, diabetes, impaired glucose tolerance, raised
cholesterol and high blood pressure. Whilst there is agreement in the published research that obese and
underweight individuals have a greater risk of death than individuals of a healthy weight, the precise increase
in mortality reported for a given level of obesity varies. This is likely to result from differences in the
populations sampled, the other variables controlled for in the studies, and the methods employed. Estimating
the number of deaths attributable to obesity is also complicated and there is a lack of conclusive data. 12

Public Health England website, http://www.noo.org.uk/NOO_about_obesity/trends

Public Health England website, http://www.noo.org.uk/NOO_about_obesity/trends
11
British Heart Foundation (2011) Trends in coronary heart disease, 1961-2011
https://www.bhf.org.uk/~/media/files/research/heart-statistics/bhf-trends-in-coronary-heart-disease.pdf
12
Public Health England website, http://www.noo.org.uk/NOO_about_obesity/mortality
10

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Chart 5: Prevalence of obese children by sex, 1974 to 2002/3, England13

The lives of disabled people

Summary
Assessing trends over time in the area of disability is also far from straightforward. The last two decades have
witnessed important legislative changes seeking to tackle discrimination experienced by disabled people. The
disability rights movement was instrumental in helping to get the Disability Discrimination Act passed in 1995,
then superseded by the Equality Act 2010. However, research suggests that negative attitudes and prejudice
towards disabled people continue to persist, and measures such as relative employment rates of disabled and
non-disabled adults show continued discrepancies. Approximately three quarters of the public (whether
disabled or non-disabled) felt that there is at least some level of prejudice towards disabled people, though
disabled people were significantly more likely than non-disabled people to say that disabled people faced a
lot of prejudice.
Studies have shown that a substantial proportion of the population believe that disabled people are less
productive and less capable than non-disabled people, in need of care, and dependent on others. Overall,
disabled people have much lower employment rates and are more likely to be economically inactive than nondisabled people, as well as there being a pay gap between disabled and non-disabled employees.

In more detail: the lives of disabled people

Despite legislative changes there is evidence that negative attitudes towards disabled people continue to
persist.14 Research by Opinium found that the majority of UK adults generally believe that disabled people

13

British Heart Foundation (2011) Trends in coronary heart disease, 1961-2011

https://www.bhf.org.uk/~/media/files/research/heart-statistics/bhf-trends-in-coronary-heart-disease.pdf
14
Scope (2014) Current attitudes towards disabled people
http://www.scope.org.uk/Scope/media/Images/Publication%20Directory/Current-attitudes-towardsdisabled-people.pdf?ext=.pdf

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face prejudice in Britain.15 Well over half (57%) of respondents agreed that there is a little prejudice and
over a quarter (28%) agreed there is a lot. This is in line with previous waves of the British Social Attitudes
survey, which found that approximately three quarters of the public (whether disabled or non-disabled) felt
that there is at least some level of prejudice towards disabled people. Perhaps not surprisingly disabled
people were significantly more likely than non-disabled people to say that disabled people faced a lot of
prejudice (36% compared to 24% in 2009, and 33% compared to 23% in 2005), however, non-disabled
people were more likely to think they faced a little prejudice. This research showed little difference over time.
The Opinium research found that 38% of respondents think of disabled people as less productive than nondisabled people and over three quarters (76%) think of disabled people as needing to be cared for. Similarly
other studies that have shown that a substantial proportion of the population believe that disabled people are
less capable than non-disabled people, in need of care, and dependent on others. 16 Negative attitudes and
discrimination appear to be worse towards people with mental health conditions and learning disabilities,
perhaps due to a generally poor level of understanding about these impairments and how they affect peoples
social participation, or because of negative stereotypes concerning these conditions.
People are also uncomfortable with the idea of disabled people being in positions of authority, though it is
unclear whether this is because they think disabled people cant fulfil these roles. 24% of disabled people
have felt that people expected less of them because of their disability,17 suggesting a lack of understanding
around disabled peoples capabilities.
Overall, disabled people have much lower employment rates and are more likely to be economically inactive
than non-disabled people. They are also less likely to be self-employed. The unemployment rate of both
disabled and non-disabled people rose between 2002 and 2008, while the economic inactivity rate of disabled
people declined and there has been a slight improvement in employment rates.
The decline in labour market prospects of people without qualifications has been particularly adverse for
disabled people compared to non-disabled people. As the chart below shows, more than three quarters of
disabled men with no qualifications were employed in 1974-76, compared with under two fifths in 2001-2003.
Even among disabled men with the highest qualifications, only 75% were in work in 2001-03 compared to
93% in 1974-76.

15

Opinium (2013) research: 2,081 online interviews with nationally representative sample of UK adults
aged 18+, conducted between 11 19 September 2013. Referred to in Scope (2014).
16
NatCen (2007) Attitudes towards and perceptions of disabled people findings from a module included
in the 2005 British Social Attitudes survey.http://disabilitystudies.leeds.ac.uk/files/library/robinsonNatCenDisabilityModuleAug2007.pdf
Department for Work and Pensions (2002) Disabled for life?: Attitudes towards, and experiences of,
disability in Britain.
17
Opinium (2013) research: online survey of 1,014 UK adults aged 18+ whose day-to-day activities are
affected by long standing physical or mental impairments, conditions, illnesses or disabilities, conducted
between 7 17 June 2013. http://news.opinium.co.uk/survey-results/paralympiclegacy referred to in Scope
(2014).

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Chart 6: Proportion of men with limiting long-standing illness who are in work,
by highest educational qualification18

Meanwhile, the majority of men with no limiting long-standing illness of any qualification level were employed,
and there is considerably less variation over time. Those with the highest qualifications are only slightly more
likely than those with lower qualifications to be in work. Even among those with no qualifications, 85% were
in work during 2001-03, compared to 95% in 1974-76.

Poverty in the UK and overseas

Summary
Poverty is often defined in terms of whether households or individuals have enough resources or abilities
today to meet their needs, or to participate fully in society. According to recent research into poverty in the
UK by the Joseph Rowntree Foundation (JRF), child poverty has fallen overall in the last five years. However it
remains the highest of any age group as it has since the early 1990s. Pensioner poverty is currently at a
record low level; from having a greater risk of poverty than the rest of the population in the 1980s,
pensioners now have the lowest poverty of any age group. Meanwhile, poverty among working-age adults has
risen, and is currently the highest on record. The JRF has argued that the coalition has ignored the high level
of poverty among young adults, and highlights the significant increase in the number of working-age adults
without dependent children in poverty.
This research measures poverty relative to the average (median) household income, 19 setting the threshold as
60% of median income. Given the fall from 9% to 4% in median household income between 2012/13 and
18

National Equality Panel, 2010

Poverty is often defined in terms of whether households or individuals have enough resources or abilities
today to meet their needs or to participate fully in society. Poverty may be measured in absolute or relative
terms. Absolute poverty refers to a set standard which is consistent over time and between countries, such
as the percentage of the population eating fewer calories than is required to sustain the human body.
Relative poverty views poverty as dependent on social context, for instance a level of income set at a fixed
19

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2007/08, this means that the poverty threshold has also fallen. Therefore the improvements in the poverty
rate among pensioners and children, particularly in the last five years, are not necessarily achievements to be
celebrated. Moreover, the trend for the poverty rate among working-age adults is particularly worrying.
Statistics suggest that income inequality has also been increasing at both ends of the spectrum, with the
poorest falling further behind the average and the richest moving further ahead.
Enabling comparisons of poverty rates between countries and regions, the poverty headcount ratio shows the
proportion of a country or regions population living below the internationally set poverty line of $1.25 a day.
Whilst the number of people in Sub-Saharan Africa living on less than $1.25 a day substantially increased
between 1981 and 2011, the poverty headcount ratio has been falling since the early 1990s. However this
needs to be seen in the light of the dramatic population growth rate in Africa, which saw an annual rate of
2.6% growth between 1950 and 2010. The UNs latest Millennium Development Goals report found that the
overwhelming majority of people living on less than $1.25 a day belong to two regions: Southern Asia and
sub-Saharan Africa. In 2010, one third of the worlds 1.2 billion extreme poor lived in India alone. Indias
poverty rate has decreased since 1994, albeit a limited decline: down from 49.4% in 1994 to 42% in 2005
and 32.7% in 2010.20 In contrast to India, Chinas poverty rate was down from 60% in 1990 to an impressive
16% in 2005 and just 12% in 2010. However, despite this reduction, China ranked second after India, being
home to about 13% of the global extreme poor.21 In addition, the Gini Index suggests that inequality has
been increasing overall across this period in both China and India.

In more detail: Poverty and inequality in the UK

The most recent research into poverty published by the Joseph Rowntree Foundation shows the variation in
both the proportion of the population in poverty, and the nature of the trend line for each group over time. 22
This research measures poverty relative to the average (median) household income, setting the threshold as
60% of median income.

proportion of the median household income. Inequality is about the distribution of income, consumption or
other attributes across the population.
20
UN (2014) The Millennium Development Goals Report 2014
http://www.un.org/millenniumgoals/2014%20MDG%20report/MDG%202014%20English%20web.pdf
21
UN (2014) The Millennium Development Goals Report 2014
http://www.un.org/millenniumgoals/2014%20MDG%20report/MDG%202014%20English%20web.pdf
22
Joseph Rowntree Foundation (2014) Monitoring poverty and social exclusion 2014
http://www.jrf.org.uk/publications/monitoring-poverty-and-social-exclusion-2014

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Chart 7: Proportion in poverty by age group, 1982 to 2012/13

Child poverty has fallen overall in recent years (see chart 7), however it remains the highest of any age group
as it has since the early 1990s. Child poverty is still highest in cities, but urban areas now appear to be better
at providing a decent level of education than rural areas. Pensioner poverty is currently at a record low level;
from having a greater risk of poverty than the rest of the population in the 1980s, pensioners now have the
lowest poverty of any age group.
Meanwhile, poverty among working-age adults has risen, and is currently the highest on record. Although
unemployment fell by 300,000 in the last year and the number unemployed for over a year fell for the first
time in a decade, wages have also fallen across the distribution for full and part time workers and low and
high earners. There has been movement between worklessness and low pay two thirds of those in work
now but unemployed a year ago are in low-paid work. The values of benefits have also fallen. Meanwhile, the
income required to reach the minimum standard of living has risen more than prices in general as essentials
have risen in price more than non-essentials, so influencing the lived experience of poverty.
The single biggest change of recent years found by the research was a fall from 9% to 4% in median
household income between 2007/08 and 2012/13.23 The incomes of the bottom tenth have fallen further and
for longer and are now 8% below their level a decade ago.
Since the poverty threshold is indexed to the median household income in this research, as income falls, so
does the poverty threshold (now 9% lower than in 2007/08). So while there are 13 million people in poverty
in the UK, it would be 3 million higher if we used the poverty threshold from 2007/08. While any decrease in
poverty is to be welcomed, if it is only the result of how poverty is measured, rather an increase in how much
income people actually have, then any celebrations should be distinctly muted.
Having looked at relative poverty, it is worth considering how these trends compare with absolute poverty as
measured by setting the low income line of 60% of median income in 2010/11, and then adjusting it annually
with inflation. Absolute poverty fell in the late 1990s and early 2000s; however since median income also rose
during this time, poverty relative to median income changed less than absolute poverty. Similarly, the rise in

23

Joseph Rowntree Foundation (2014) Monitoring poverty and social exclusion 2014
http://www.jrf.org.uk/publications/monitoring-poverty-and-social-exclusion-2014

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absolute poverty over the past couple of years (particularly after housing costs) is not seen in the relative
measure which, after a small increase between 2004/5 and 2007/8, has been decreasing (albeit only very
slightly) because median income has also been falling. 24
Changes to the way the welfare system operates have worsened the experience of poverty for many of those
affected whether through rising sanctions, longer waits for assessment or poor job outcomes through
welfare-to-work programmes. Legal support for social welfare cases has been almost completely withdrawn.
As well as cutting support to people with debt and housing problems, this leaves people powerless to
challenge incorrect decisions related to their benefits. The JRF has argued that the coalition has ignored the
high level of poverty among young adults, almost a third of whom are in poverty. Although the number of
pensioners in poverty has fallen, the number of working-age adults without dependent children in poverty has
also significantly increased25
Income inequality is commonly measured by the Gini coefficient, which summarises the degree of inequality
in the income distribution in one number. The Gini coefficient takes a value of between 0 and 1, where the
higher the value, the higher the inequality. For example, South Africa has the highest Gini coefficient in Africa
at around 0.63, while Slovenia has a low coefficient at around 0.23.26 The data for this measure suggests that
income inequality in the UK increased rapidly in the 1980s, fluctuated during the 1990s and 2000s and rose
slowly to reach a peak in 2007-08. Inequalities have been increasing at both ends of the spectrum, with the
poorest falling further behind the average and the richest moving further ahead.

Poverty and inequality overseas

To enable comparison between regions and countries (given differences in poverty lines set nationally and
differences in purchasing power, or cost of living, across countries) the World Bank provides data on poverty
trends using international poverty lines in an attempt to hold the real value of the poverty lines consistent
across countries.27 Thus it considers the number of people living on less than $1.25 a day in purchasing
power parity (PPP $) at 2005 international prices. The poverty headcount ratio shows the proportion of a
country or regions population living on less than $1.25 a day (see chart 8 below)

24

Joseph Rowntree Foundation (2014) Relative and absolute poverty over time:
http://data.jrf.org.uk/data/relative-absolute-time/
25
Guardian (2011) http://www.theguardian.com/news/datablog/2011/dec/02/poverty-working-fmailieswith-children-uk
26
The Real Wealth of Nations: Pathways to Human Development, 2010" (PDF). United Nations
Development Program. 2011. pp. 7274. ISBN 9780230284456.
27
World Bank Poverty and Equity data website: http://povertydata.worldbank.org/poverty/home/

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Chart 8: People living on less than $1.25 a day: Sub-Saharan Africa

However, since the early 1990s, the poverty headcount ratio (shown by the red line) has been falling across
the region. Unlike the total number of poor, this ratio takes into account the total population figures and so
reflects the dramatic population growth rate in Africa. The number of sub-Saharan Africans grew from 186m
in 1950 to 859m in 2010, a 2.6% average annual rate. On current trends, by 2050, Africas under-18
population will increase by two thirds, reaching almost 1 billion, and close to half of the world population of
children will be African by the end of the 21st century. 28
The latest Millennium Development Goals report by the UN found that the overwhelming majority of people
living on less than $1.25 a day belong to two regions: Southern Asia and sub-Saharan Africa. In 2010, one
third of the worlds 1.2 billion extreme poor lived in India alone. India reduced its poverty rate from 49.4% in
1994 to 42% in 2005 and 32.7% in 2010.29
In contrast to India, China brought its poverty headcount ratio down from 60% in 1990 to an impressive 16%
in 2005 and just 12% in 2010. However, despite this reduction, China ranked second after India, being home
to about 13% of the global extreme poor in terms of population.

28

Unicef (2014) Generation 2030: Africa

http://www.unicef.org/publications/files/Generation_2030_Africa.pdf
29
UN (2014) The Millennium Development Goals Report 2014
http://www.un.org/millenniumgoals/2014%20MDG%20report/MDG%202014%20English%20web.
pdf

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Environmental destruction
Summary
The discussion so far has focused on causes limited to a specific region, however environmental charities tend
to have a far wider remit. Biodiversity is declining rapidly due to land use change, climate change, invasive
species, overexploitation and pollution, and shows no indication of slowing.
Virtually all of the earths ecosystems have now been dramatically transformed through human actions,
particularly in the recent past. Areas of particularly rapid change over the past two decades include
deforestation and expansion of croplands in the Amazon basin and Southeast Asia, and land degradation in
drylands in Asia. Between 20% and 50% of 9 out of 14 global biomes have been transformed to croplands;
habitat conversion to agriculture typically leads to reductions in local native biodiversity.
Over the past few hundred years, it is estimated that humans have increased the species extinction rate by as
much as three orders of magnitude. The most definite information, based on recorded extinctions of known
species over the past 100 years, indicates extinction rates are around 100 times greater than rates
characteristic of species in the fossil record.

In more detail: Environmental destruction

The GreenFacts initiative, which seeks to make the factual content of complex scientific consensus reports on
health and the environment accessible to non-specialists, argues that across the range of biodiversity
measures, current rates of loss exceed those of the historical past by several orders of magnitude and show
no indication of slowing. Biodiversity is declining rapidly due to land use change, climate change, invasive
species, overexploitation and pollution.30

Changes to ecosystems
Virtually all of the earths ecosystems have now been dramatically transformed through human actions (see
chart 9). More land was converted to cropland in the 30 years after 1950 than in the 150 years between 1700
and 1850. Between 1960 and 2000, reservoir storage capacity quadrupled and, as a result, the amount of
water stored behind large dams is estimated to be three to six times the amount held by rivers. Some 35% of
mangroves have been lost in the last two decades in countries where adequate data are available
(encompassing about half of the total mangrove area). Roughly 20% of the worlds coral reefs have been
destroyed and an additional 20% have been degraded.
Areas of particularly rapid change in terrestrial ecosystems over the past two decades include:

30

the Amazon basin and Southeast Asia (deforestation and expansion of croplands);
Asia (land degradation in drylands); and
Bangladesh, Indus Valley, parts of Middle East and Central Asia, and the Great Lakes
region of Eastern Africa.

GreenFacts Digest: Current Trends in Biodiversity http://www.greenfacts.org/en/biodiversity/l-3/3extinction-endangered-species.htm

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Chart 9: Percentage change 1950-90 in land area of biogeographic realms

remaining in natural condition or under cultivation and pasture

In all realms (except Oceania and Antarctica), at least a quarter of the area had been converted to other land
uses by 1950, and in the Indo-Malayan realm almost half of the natural habitat cover had been converted. In
the 40 years from 1950 to 1990, habitat conversion has continued in nearly all realms. Between 20% and
50% of 9 out of 14 global biomes have been transformed to croplands. Tropical dry forests were the most
affected by cultivation between 1950 and 1990, although temperate grasslands, temperate broadleaf forests,
and Mediterranean forests each experienced 55% or more conversion prior to 1950. Biomes least affected by
cultivation include boreal forests and tundra. While cultivated lands provide many provisioning services (such
as grains, fruits, and meat), habitat conversion to agriculture typically leads to reductions in local native
biodiversity.

Loss of species
Over the past few hundred years, humans have increased the species extinction rate by as much as three
orders of magnitude. This estimate is only of medium certainty because the extent of extinctions of
undescribed taxa is unknown. However, the most definite information, based on recorded extinctions of
known species over the past 100 years, indicates extinction rates are around 100 times greater than rates
characteristic of species in the fossil record.
An aggregate indicator of trends in species populationsthe Living Planet Indexuses published data on
trends in natural populations of a variety of wild species to identify overall trends in species abundance (see
chart 10). It currently incorporates data on the abundance of 555 terrestrial species, 323 freshwater species,
and 267 marine species around the world. Although more balanced sampling would enhance its reliability, the
trends are all declining, with the highest rate in freshwater habitats. While the index fell by some 40%

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between 1970 and 2000, the terrestrial index fell by about 30%, the freshwater index by about 50%, and the
marine index by around 30% over the same period.

Chart 10: The Living Planet Index, 1970-2000

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Part 2: What are the conclusions of this kind of

analysis?

The aim of this section is not to analyse the success or failure of different charity sectors in tackling their
respective causes. It is to try and pull out the cross-cutting threads which help all charities learn from the
trends of these specific issues and causes that we have analysed. Here are our twelve conclusions and
themes that we have identified.

1. These are big complex problems

Our first, and perhaps self-evident observation, is that the problems charities try and tackle (in their visions
and missions) are big and complex. In most cases these problems are multi-stranded in their origins and in
their solutions. We say this because the idea that a few simple services will be the only solution needed is
quite simply false in most cases. In order to achieve lasting change charities may need to run services,
change public attitudes, change government policies or laws, change the way that companies or public
services behave, and much more. Given the scale of these problems, charities should not be surprised that
eradicating, or even diminishing them is a huge task.

2. Attribution is very difficult

Closely linked to the fact that these problems are complex, is the reality that attributing the credit for who
solved the problems is very difficult. This is not just between individual charities, but between charities and
government or other players. The reason that attribution matters is that a charity wants to know it is making
a difference in its investment in an area of work. The danger is that too much concern about attribution could
lead to a charity or charities doing less work in an area, because they cant be definitive about their
contribution.

3. Some problems arent solved by charities at all (and some are)

Different problems are solved to a greater or lesser degree by charities and NGOs depending on geography,
politics, societal norms and culture. Finding treatments for cancer is globally tackled by charities (as well as
companies and governments), while who tackles poverty varies between countries. In China the state is the
main, indeed probably the only agent for reducing poverty. In many countries, such as South Sudan, the role
of government is much much smaller, and that of aid charities and agencies much greater. Any analysis of the
role of charities will be both geography and cause specific.

4. Collaborations and partnerships are critical

Given the complex nature of the problems it is inevitable, indeed probably critical that those organisations
who want to tackle these problems collaborate in some way, shape or form. This is not simply because big
problems require more than the resources of any single organisation to tackle them. It is also because
collaboration makes sure that resources are not duplicated, that all the different facets of an issue are
addressed, and that those with specialisms use them to best effect. No charity is an island.

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5. The problems being tackled arent static

Perhaps the most sobering of all the issues in section 1 of the paper is how the problems that were being
tackled in the 60s and 70s are often not the problems of today. This has multiple implications. One is that the
charities attempting to tackle todays problems may not have the scope and scale necessary if they are
resourced up for yesterdays problems: obesity is a case in point. Another implication is that because it takes
years or even decades to build up the range of activities needed to tackle a problem, there may be a time lag
before charities and other players can get the services up to speed. Huge progress has been made in tackling
cardiovascular and coronary heart disease (see chart 3) but we have barely begun to even know how to
tackle the problem of obesity or microbial resistance to anti-biotics.
The same is true in environmental issues in the sixties the problem of DDT was overcome, and most people
have now forgotten about acid rain in the eighties, because ecosystem destruction and climate change now
appear to be the biggest threats to the environment.

6. Changing government behaviour is critical

There is one thread that runs through each of the areas that we looked at in section 1. Governments and
other institutions are an absolutely vital player in solving the problems: whether its in taxing and banning
cigarettes in public places, or addressing NHS provision for diabetes and obesity, or creating policies that
reduce or create poverty, or legislating on the emission of greenhouse gases. There are almost no problems
that charities tackle in which government doesnt have a major or minor role in solving.
So those who say that charities should stick to their knitting and stop campaigning: campaigning is part of the
knitting. The Salvation Army was founded in part to change attitudes to poverty and alcohol. The Slave Trade
was abolished by using the judicial system and legislation. Support for, and opposition to the poor laws is
almost as old as the laws themselves. Whatever way you look at it back over the centuries, government is a
critical potential player in solving societys problems, and as such is a critical partner for any charities who also
want address those problems.

7. No change can be a major achievement

In terms of what charities are trying to achieve, deciding what success looks like can also be an issue in itself.
This can be because it isnt simply a matter of working out how to measure success in impact or evaluation
terms. At the most fundamental level, it can be because an achievement might just be to stop a change
happening (as with climate change), to reverse a change (as with a government policy) or to promote a
change (for example increasing vaccination rates). Even slowing down the rate of change (as with species
extinction) could be seen as a success. In terms of assessing whether the sector has been successful, each
issue and each cause needs to be assessed separately.

8. Some problems, such as infectious diseases, are irreversibly changed for

the better
Even within the limited number of areas we have examined, there are clear differences in how reversible any
progress or success is. The progress in the areas of health and disease, particularly where the solutions are
medical (as opposed to lifestyle) are usually all but irreversible. The best example of this is the area of

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vaccinations and infectious disease. The eradication of smallpox and near eradication of polio are all but
irreversible.

9. While others, such as poverty and the environment are always reversible
Progress in overcoming poverty or reducing environmental destruction, will always be highly reversible. A
crude generalisation would say that these differences in reversibility are largely down to whether the solutions
or problems are centred on human behaviour. The more that progress depends on human behaviour the
more reversible any progress is likely to be, or the more likely it is that progress will be patchy or incomplete.

10. Timescales matter

The timescales over which any evaluation is made are very important. Too short a time span and the impact
of individual governments or policies become too important. Too long a time span and almost everything is
better than 100 years ago (except perhaps, in the environment) so assessing progress becomes meaningless.
It is probably worth charities assessing whether progress has been made over different time-spans: 1 year, 5
years, 10 years, 25 years and more. While our analysis is inevitably at a top level, a specific sector could
make a much more granular analysis.

11. The world is not homogeneous

One of the challenges of measuring success is that almost any change will take place at different rates in
different places and manifest differently in different populations. As we have seen, poverty has reduced much
more quickly in China than India. Similarly the rates of environmental destruction vary between countries and
between regions within countries. In the same way cancer survival rates and levels of obesity can change
between parts of the UK and even between counties and hospitals. So, anybody interested in success needs
look at the range of data, rather than just a single data point.

12. There are multiple strategies that charities can use to change the world
Any organisation who is interested in the success of its work over the course of time needs to have a clear
sense of how its mission will deliver that change. Some call this a theory of change. There are a number of
strategies for delivering change by charities: delivering services directly, changing government laws or
policies, changing corporate behaviour, changing public attitudes, or acting as an innovator for new, more
effective services delivered by others. The most competitive sectors for change, such as international
development, have a range of players engineering change through a variety of mechanisms.

How can an individual charity use this kind of analysis?

To repeat what we set out at the beginning, there are a number of implications for any charity that come out
of any analysis of this kind:

What are the statistics or key figures that demonstrate the progress (or lack of it) relevant to your
charity or organisation. These could be statistics or data at any level: country, county, town or
village.

What do these statistics show about progress in achieving your timescale over recent years or
decades? If these statistics are difficult to obtain, is now the time to start collecting them?

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How does your organisation understand the dynamics of successful change in your arena? Is change
reversible or irreversible? Who are the key partners? What is the role of government?

What is your organisations role in delivering the change (or lack of it) found in these statistics? It is
fanciful that most charities will deliver change on their own. It isnt fanciful to hope that every charity
might know its role in achieving the ideal big picture that its vision sets out to achieve?

How does your strategy make sure your charity maximises your role in using your resources to
secure change. How does that strategy complement that of other organisations working in your
sphere?

And how do you make sure all those (staff, volunteers, donors) in your organisation understand how all these
issues fit together and drive a strategy that will make the most of your organisations work and assets?

Conclusion
This report has been profoundly illuminating for us. It has left us pleasantly surprised (at improvements in
cardio-vascular disease and improving rates of cancer survival for example) and predictably depressed (at
increases in obesity and environmental destruction).
However perhaps the most important revelations that we have had as a result of researching and writing this
report are two-fold: First that the way that charities deliver their mission is little researched or understood.
There is almost no literature which looks at what strategies charities can have for mission delivery, particularly
across different sectors. In other words charities across sectors learn little from each other in the most
effective way to deliver their mission.
Our second revelation is that there are common threads in mission-delivery activities (services, campaigning,
research, etc.) and that the right kind of activities can make investments in change much more effective. So a
strategy for mission-delivery which focused on making irreversible change makes much more sense than
those which are only temporary. Similarly activities which are contagious, can be spread person to person, are
much more effective than those which require direct contact with every beneficiary. Understanding the nature
of the problem being solved is equally important: so a problem which is constantly replenishing, such as
poverty, is much harder to tackle than something which just requires a change in a law or a policy.
For all these reasons we are now writing a report which looks at the most effective strategies and activities
for mission delivery, which we hope will be published in the first half of 2016.

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About nfpSynergy
nfpSynergy is a research consultancy that aims to provide the ideas, the insights and the
information to help non-profits thrive.
We have over a decade of experience working exclusively with charities, helping them develop evidencebased strategies and get the best for their beneficiaries. The organisations we work with represent all sizes
and areas of the sector and we have worked with four in five of the top 50 fundraising charities in the UK.
We run cost effective, syndicated tracking surveys of stakeholder attitudes towards charities and non-profit
organisations. The audiences we reach include the general public, young people, journalists, politicians and
health professionals. We also work with charities on bespoke projects, providing quantitative, qualitative
and desk research services.
In addition, we work to benefit the wider sector by creating and distributing regular free reports,
presentations and research on the issues that charities face.

If you have any comments, queries, complaints or compliments on this report please contact Joe Saxton on
joe.saxton@nfpsynergy.net

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