Poverty and child health in the U.k.: using show for action

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  1. Sophie Wickhamone,
  2. Elspeth Anwarone,
  3. Ben Barrone,
  4. Catherine Police force2,
  5. David Taylor-Robinsoni,2
  1. ane Section of Public Health and Policy, University of Liverpool, Liverpool, United kingdom of great britain and northern ireland
  2. 2 Constitute of Child Wellness, University Higher London, London, Britain
  1. Correspondence to Dr David Taylor-Robinson, Section of Public Wellness and Policy, Whelan Building, Academy of Liverpool, Liverpool L69 3GB, UK; David.Taylor-Robinson{at}liverpool.ac.uk

Abstruse

At that place are currently high levels of kid poverty in the UK, and for the beginning time in almost two decades kid poverty has started to ascension in accented terms. Child poverty is associated with a broad range of health-damaging impacts, negative educational outcomes and adverse long-term social and psychological outcomes. The poor health associated with child poverty limits children'southward potential and development, leading to poor wellness and life chances in adulthood. This article outlines some central definitions with regard to child poverty, reviews the links betwixt kid poverty and a range of health, developmental, behavioural and social outcomes for children, describes gaps in the prove base and provides an overview of electric current policies relevant to child poverty in the UK. Finally, the article outlines how child health professionals can have activeness by (1) supporting policies to reduce child poverty, (2) providing services that reduce the health consequences of child poverty and (iii) measuring and understanding the trouble and assessing the affect of action.

  • Children's Rights
  • Kid poverty
  • Wellness inequalities
  • Child health professionals

This is an Open Admission article distributed in accordance with the terms of the Creative Commons Attribution (CC Past 4.0) license, which permits others to distribute, remix, adapt and build upon this piece of work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/past/4.0/

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  • Children's Rights
  • Kid poverty
  • Health inequalities
  • Child health professionals

Introduction

The latest figures suggest that in 2013–2014 at that place were 3.7 million children living in poverty in the UK—3 in every 10 children.1 Furthermore, levels of child poverty are ascension. For the first time in almost two decades, child poverty in the UK increased in absolute terms in 2011–2012.2

Higher levels of child poverty are associated with worse child health outcomes. Children growing up in poverty in the Uk feel a broad range of agin kid wellness and developmental outcomes, and are more probable to develop chronic conditions in childhood compared with more flush children.3 It has been estimated that eliminating child poverty in the Great britain would salvage the lives of 1400 children under 15 years of historic period annually.4 Furthermore, the consequences of child poverty price the United kingdom of great britain and northern ireland economic system £29 billion a twelvemonth in 2013, upward from £25 billion in 2008.5

The loftier level of poverty found in the Britain is associated with many negative kid health outcomes.6 For case, childhood bloodshed (aged 0–14) in the United kingdom is significantly college than similar countries in Europe.7 In children under five, the UK mortality rate is the highest in Western Europe, double that of Sweden.8 Effigy 1 farther shows that countries with a college proportion of children living in relative poverty (below 60% median income) accept college infant bloodshed rates.

Figure 1

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Figure one

Child poverty and infant mortality in the Organisation for Economic Co-functioning and Development (OECD) countries. Kid poverty information are taken from EUROMOD figures, and infant bloodshed is taken from UNICEF (2014). EUROMOD, a European benefit-tax model and social integration.

To assist child health professionals to appoint in the debate nigh child poverty, here nosotros outline some cardinal definitions, review the links between child poverty and a range of health, developmental, behavioural and social outcomes for children,9 and provide an overview of current policies relevant to kid poverty in the UK. Finally, we appraise what further actions need to be taken and describe the important role that kid health professionals can play.

What is kid poverty?

The theoretical underpinnings of 'poverty', how it is defined and measured are important equally these concepts influence the strategies and policies called to address poverty. In 1979, Peter Townsend defined poverty as:Individuals, families and groups in the population tin be said to be in poverty when they lack resources to obtain the type of diet, participate in the activities and have the living atmospheric condition and civilities which are customary, or at least widely encouraged and canonical, in the societies in which they belong. (ref. x, p. 31)

This formulation of poverty every bit being relative (rather than absolute) to a particular context recognises that standards of living change over time. The well-nigh widely used measure of relative poverty inside the European Matrimony is the proportion of individuals with household incomes less than a particular proportion of the electric current median of that population. For the purposes of international comparisons, UNICEF use a cut-off of 50%, whereas in the United kingdom of great britain and northern ireland relative poverty is generally calculated as <sixty% of the median.xi ,12 Past contrast, absolute poverty is measured confronting a static threshold that just rises with aggrandizement, even if gild is becoming more or less prosperous. This measure indicates individuals living in poverty getting better or worse off in absolute terms.12 In practical terms, living on an income of <lx% of the median means that many families struggle to run into basic needs like food, heating, transport, article of clothing and the extra costs of schooling like equipment and school trips.thirteen

Being in receipt of income-related welfare benefits has also been used as a measure of poverty. In the UK, this can include being the recipient of income back up, job seekers allowance, housing benefits, council taxation benefits or working revenue enhancement credit and child tax credit. Free schoolhouse meal eligibility is a statutory benefit available to school-aged children from families who receive other qualifying benefits and is widely used as a measure of childhood disadvantage related to poverty, peculiarly in educational analyses.14 This is often used as an expanse based measure, like the income impecuniousness affecting children index, which is the percentage of children aged 0–fifteen living in income-deprived households on the ground of receipt of diverse welfare benefits.15 Objective and subjective measures of material impecuniousness relating to lack of resources available to individuals that society deem important have besides been used as child poverty measures. Subjective measures may include factors such as the extent to which children have altogether celebrations, appropriate clothes for all weather, holidays and parents with access to a car. In general, researchers take found like patterns of clan of poverty with child health outcomes whichever mensurate of poverty is used.xvi

Children tin move in and out of poverty over the course of their lives. In the Millennium Cohort Study, a representative sample of children from the UK born in 2001, most half (47%) of children experienced relative poverty one or more than times between the age of 9 months and 11 years, and nine% of children experienced persistent poverty (in all five waves of the study; Due south Wickham, E Anwar, B Barr, et al. Unpublished data: experiences of poverty in the UK Millennium Cohort Study).

Wellness and social consequences of child poverty

Children living in poverty in the United kingdom of great britain and northern ireland are more probable to:9

  • die in the first year of life

  • be born small

  • exist canteen fed

  • breathe secondhand smoke

  • become overweight

  • suffer from asthma

  • have molar disuse

  • perform poorly at school

  • dice in an accident

Even for children with genetic atmospheric condition similar cystic fibrosis with no socio-economic bias in incidence, poorer children feel poorer outcomes, including worse growth, poorer lung part, higher take a chance of Pseudomonas infection, worse employment opportunities and ultimately poorer survival.17 ,18 Figure 2 shows the association between levels of kid poverty and a range of child health outcomes in local regime in England.19

Figure 2

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Effigy 2

Kid poverty and pct of children seriously injured or killed in a road accident; obese at reception age; admitted to hospital with a mental health condition and infant bloodshed in Local Regime in the United kingdom. The size of the dot is proportional to population of each local authority. Information are from Public Health England (2015).

In that location has been some debate nigh the extent to which the relationship between poverty and health outcomes for children is causal or owing to other factors. Yet, a recent systematic review of the literature concluded that a family unit'due south income makes a significant difference to children'southward outcomes: poorer children take worse cognitive, social-behavioural and health outcomes in part because they alive in households with depression incomes. This human relationship was found to exist contained of other factors that accept been establish to be correlated with child poverty (eg, household and parental characteristics).20 The review suggested that out of the 34 studies only 5 found no upshot of kid poverty on the various outcomes; this was mainly due to their methodological limitations.20 The authors highlight that longer durations of kid poverty have a more severe effect on children'southward outcomes than brusque-term experiences of poverty.

Alongside these health-damaging impacts, living in poverty is associated with negative educational outcomes and agin long-term social outcomes. Kid poverty impacts on children's school readiness: past age five, children from the poorest 5th of homes in the UK are already on boilerplate over a year backside their expected years of evolution.21 Past historic period eleven, only iii-quarters of the poorest children reach the government's Key Phase 2 levels compared with 97% of children from the richest families.22 Only 21% of children from the poorest quintile, measured by parental socio-economic position, attain five skilful General Certificate of Secondary Education (grades A*– C) compared with 75% for their rich counterparts.22 Contempo evidence suggests that child poverty is associated with structural differences in several areas of encephalon development, and this may account for the differences in bookish achivements.23 Two recent studies from the United states of america show how child poverty influences the development of specific areas of the brain that are critical for the development of language, executive functions and memory.23 ,24 This so impacts education prospects, job opportunities and hereafter lifestyle choices.25

We know from longitudinal studies that children growing up in disadvantaged circumstances have a higher run a risk of death in adulthood beyond almost all weather that accept been studied, including mortality from stomach cancer, lung cancer, haemorrhagic stroke, coronary eye disease and respiratory-related deaths, accidents and alcohol-related causes of expiry.26 ,27 These studies demonstrate that exposure to kid poverty is a critical result not only for child health, but also for developed health. Though the focus of this newspaper is on poverty, in that location is a social gradient in many of the health outcomes listed to a higher place, with greater social disadvantage leading to greater wellness impacts. This is powerful prove that social and economic weather condition do not just impact poor children but exert their influence beyond the entire social spectrum.ix ,28 This has profound policy implications every bit the effect of policies on child poverty are then multiplied across children's life courses. As children'southward lives unfold, the poor health associated with poverty limits their potential and evolution across a whole range of areas, leading to poor health and life chances in adulthood, which then has knock-on effects on future generations.29

Research gaps

That poverty is bad for child wellness is non in doubtfulness. What is unclear is how and when social disadvantage leads to ill health, that is, how it 'gets nether the skin'. Poverty has been highlighted as the virtually of import social determinant of child health in high-income countries.6 ,30 But poverty is probable to be the cause of wide-ranging effects on health exerted through a myriad of biological, behavioural, environmental and psychosocial mechanisms that are all the same not well understood.8 Poor health outcomes might be the effect of cumulative exposure to disadvantage,31 or exposure during sensitive or critical periods, or both of these.28 For example, Seguin and colleagues take identified the importance of chronic cumulative poverty for outcomes such equally asthma32 and obesity.33 Furthermore, poor health, particularly during critical periods of childhood and boyhood, may limit future development with subsequent furnishings on social position and health later in life.25 A better understanding is needed of the specific pathways through which exposure to adverse childhood socio-economic circumstances, and peculiarly poverty, affect specific health and social outcomes in item weather condition and contexts.six ,20 ,34 Elucidating the mediating components of pathways will help identify times and circumstances that are acquiescent to intervention.

Cantankerous-national comparisons may yield useful information in order to explain both the differences in child poverty rates in rich countries seen in figure ane and how whatsoever policy differences impact on child wellness and well-being.11 Strategies to reduce kid poverty and the consequences of child poverty generally involve three key components—early babyhood education and intendance, income redistribution through the do good and tax systems, and policies to increase the employment chances and wages of families living in poverty.35 While there is prove that all three components are likely to be effective at reducing child poverty, less is known about whether some approaches are more likely to lead to greater health benefits than others. Further investigation is needed into the interaction between different policy approaches and the determinants of child health in society to prioritise policies that are likely to take the greatest impact not just on child poverty but also on child wellness.

What is the UK currently doing about child poverty?

Within the Uk, several targets have been previously gear up to eradicate child poverty (see box 1 for details). Figure three shows the trends in child poverty over recent years. The UK was the beginning European land to systematically implement and evaluate policies aimed specifically at reducing kid poverty.36 In particular, the Labour government set targets to reduce and eventually 'eradicate' child poverty, inside 10–20 years. Though significant progress was fabricated, the 2010 targets to halve kid poverty were missed.

Box i

Uk policy on kid poverty

1999: Catastrophe Child Poverty past 2020: In 1999, the and then Prime Minister Tony Blair made a commitment to halve child poverty by 2010 and eliminate child poverty by 2020. After many years of being a neglected effect, child poverty was on the political agenda.

Key actions to reduce child poverty included getting parents into work and a more progressive tax and benefits organisation (peculiarly to those targeted at children such as child benefit and child tax credit).

2010: The Child Poverty Deed was passed with cross-political party support. The Act enshrined the child poverty hope in police and required the government to produce a national Child Poverty Strategy. The coalition government, elected in May 2010, pledged to maintain the goal of ending child poverty in the UK by 2020.

Although relative poverty brutal substantially in the decade after the 1999 Tony Blair pledge to cease child poverty, from 3.4 million children then to ii.half-dozen million children, the 2010 child poverty targets were missed. Critics argued that not enough parents moved into work, and work did not pay as well as it should. The proportion of poor children who came from working households increased.

2011: A new arroyo to child poverty: tackling the causes of disadvantage and transforming families' lives 2011–2014 was published to fulfil the obligations under the Child Poverty Act 2010 to set out plans for tackling child poverty. It provided a framework for ending child poverty by 2020.

2014: The child poverty strategy, 2014 to 2017 was published with two main aims to engineer a shift abroad from supporting families through income transfers towards tackling the root causes of poverty by enabling more than parents to enter work and earn more. Second, to pause the intergenerational cycle of poverty through raising the attainment of poor children so that they will be ameliorate off every bit adults.

The strategy was criticised by the Social Mobility and Child Poverty Commission for falling far short of what is needed and a missed opportunity to become back on track towards coming together its legal obligation to end child poverty by 2020. Later on a decade of falling levels, independent projections from both the Institute for Fiscal Studies (IFS) and the New Policy Establish (NPI) suggested that child poverty volition increment by 2020.

2015: The Welfare Reform and Work Nib removes the government'southward duty to end child poverty past 2020 and changes the target for kid poverty in the Great britain, moving away from a measure based on income to focusing on the 'root causes' of poverty such as unemployment and family breakdown.

There is concern that many of the proposed changes in the Bill volition either push more than children into poverty or limit the government'due south ability to properly monitor levels of child poverty across the U.k.. In particular, the income cap and changes to tax credits have also been strongly criticised for negatively affecting families with young children.

New definition of child poverty has also been criticised for having a moral and judgemental dimension. As there has also been an increase in the proportion of children in poverty living in a working family, critics fence that reporting on a measure focused on children in workless households volition non get to the heart of understanding child poverty in the U.k..

The current UK government has at present abolished the Child Poverty Human activity and with it the target to eliminate child poverty by 2020. Aslope removing these targets, there has been a shift in how the Great britain government plans to mensurate child poverty from a focus on income-based indicators to factors related to 'family breakup, debt and addiction'37 outcomes that conflate the consequences of kid poverty, with the cause—a lack of material resource.38

Recent analyses of electric current policies implemented in the U.k. in response to the economic crisis show that children are among the groups being striking hardest.39 Nosotros know that family incomes have fallen considerably during the recent economic downturn and take connected to decline as other economic indicators improve.40 Children's services are beingness disproportionately hit past current thrift measures, with early years budgets facing significant cuts.41

In the Summertime Budget 2015, the chancellor announced more cuts to the welfare system to have the UK from a 'low wage, high taxation, high welfare economy' to a 'higher wage, lower taxation, lower welfare state'.41 A report from the Joseph Rowntree Foundation assay shows that information technology is poor children who are going to exist hit hardest by these changes,42 with lone parents and families with children who depend on welfare back up seeing their incomes significantly reduced. Although the controversial proposal to cut kid tax credits was recently scrapped in the Chancellor'southward Autumn budget, these cuts will withal be introduced later with the replacement of tax credits with a new arrangement—Universal Credit.43 The regime has argued that these cuts to in-work welfare benefits will exist offset past the introduction of a college minimum wage—referred to as a National Living Wage (NLW). The latest analyses, however, suggest that lonely parents will still lose out, and for couples with children, both will take to work full time on the NLW to get close to a decent standard of living.43

What needs to be done?

What kid wellness professionals can practice (both as individuals and as providers of health services)

All children have a right to the best possible health, as enshrined in the United nations Convention on the Rights of the Child. The UK government, therefore, has a legal and moral responsibility to ensure that all children develop to their total potential. Based on recommendations made by the WHO Committee on the Social Determinants of Health, there are a number of ways that, as individuals or collectively, kid health professionals should have activeness on the social determinants of wellness and reduce child poverty.44 ,45

Support policies to reduce child poverty

Child health professionals and their professional associations can abet for policy action on the social determinants that support parents' capacity and ability to care for children.46 Nosotros demand child wellness professionals to advocate for more equitable welfare reforms, with the test that they must protect children equally the nearly vulnerable members of our social club.2 This will include labour market, revenue enhancement and transfer polices that aim to elevator all families with children out of poverty.

We propose advocacy for policies that:28

  • provide sufficient income support for an adequate quality of life for all families with children;

  • provide affordable housing;

  • provide affordable, high-quality early years childcare;

  • provide affordable public transport;

  • provide better social security support for families caring for children with chronic illness;

  • prioritise agile labour market programmes to achieve timely interventions to reduce long-term unemployment;

  • tackle in-piece of work poverty, through the introduction of a true living wage;

  • back up parents into employment in order to maximise household incomes.

Provide services that reduce the wellness consequences of child poverty

In order to reduce the consequences of poverty, a commitment to universal services and a focus on proportionate universalism (services provided to everyone, but with a calibration and intensity that is proportionate to the level of need) that supports all children, particularly in the early on years, is a disquisitional and toll-effective investment, and these services should be protected.47 The Healthy Child Program, for example, is based on a model of 'proportionate universalism'.48

Some of the key actions recommended in the Marmot review28 and Field49 include:

  • protecting investment in early years services;

  • shifting expenditure towards the early years wherever possible;

  • providing high-quality and consistent support and services for parents during pregnancy;

  • provision of high-quality universal services in childhood;

  • routine support to families through parenting programmes, children's centres and cardinal workers, delivered to meet social needs;

  • providing support so that all children can access a salubrious diet in the early years;

  • providing high-quality habitation visiting services;

  • focusing on narrowing the educational attainment gap at all stages.

Information technology is vital to take a whole family approach to the care of children, with appropriate involvement of the full range of social services support available to families living in disadvantaged circumstances that may assist to mitigate some of the effects of poverty. Kid health professionals demand to speak upward for their patients within management settings. At a customs level, they demand to advocate for a greater connectivity between general practitioner practices, hospitals, schools, community centres, benefit services and sure start centres to support parents to access all the benefits and services they are entitled to and piece of work to reduce any stigma associated with using these services.42

Measure and empathize the problem and assess the impact of action

Child health professionals take a primal role in conducting high-quality inquiry investigating the links between child poverty and health and investigating the impact of changes to service provision on health inequalities. This is a critical moment for children and families in the UK, facing changes to preventative services in the customs at the aforementioned time as levels of child poverty increase. Important changes include the transfer of public health commissioning duties to local authorities (eg, the Health Visitor Implementation Programme) and the impact of cutting backs to the role of children's centres in delivering the early years agenda.50 There is a articulate need for a better understanding of the impacts of changes to services on the most disadvantaged, improved data and monitoring at an individual and population level.2

Conclusions

A wealth of show demonstrates the toxic bear on of child poverty: in concrete changes in brain structure and poor health and life chances. Child poverty is rising, and the U.k. government has abolished plans to attempt to eradicate it. Kid health professionals need to act every bit advocates for more equitable welfare reform in order to protect the most vulnerable in society. Children are oftentimes non in a position to speak out for themselves and for this reason are offered special protection under the United Nations Convention on the Rights of the Child.51 The arguments here are not just about the evidence. Reducing poverty and its impacts on children is morally and legally the right thing to do.

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    Athenaeum of Disease in Babyhood 2016; 101 i-i Published Online Outset: 19 Jul 2016. doi: 10.1136/archdischild-2016-311570