Review Poverty and child health in the UK: using evidence ...

1 Review Arch Dis child : first published as on 8 February 2016. Downloaded from on January 20, 2022 by guest. Protected by copyright. Poverty and child health in the UK: using evidence for action Sophie Wickham,1 Elspeth Anwar,1 Ben Barr,1 Catherine Law,2. David Taylor-Robinson1,2. 1. Department of Public health ABSTRACT and a range of health , developmental, behavioural and Policy, University of There are currently high levels of child Poverty in the UK, and social outcomes for children,9 and provide an Liverpool, Liverpool, UK. 2. Institute of child health , and for the rst time in almost two decades child overview of current policies relevant to child Poverty University College London, Poverty has started to rise in absolute terms. child in the UK. Finally, we assess what further actions London, UK Poverty is associated with a wide range of health - need to be taken and describe the important role that damaging impacts, negative educational outcomes and child health professionals can play.

2 Correspondence to adverse long-term social and psychological outcomes. Dr David Taylor-Robinson, Department of Public health The poor health associated with child Poverty limits WHAT IS child Poverty ? and Policy, Whelan Building, children's potential and development, leading to poor The theoretical underpinnings of Poverty ', how it University of Liverpool, health and life chances in adulthood . This article Liverpool L69 3GB, UK; is de ned and measured are important as these con- outlines some key de nitions with regard to child @ cepts in uence the strategies and policies chosen to Poverty , reviews the links between child Poverty and a address Poverty . In 1979, Peter Townsend de ned range of health , developmental, behavioural and social Poverty as: Received 22 December 2015 outcomes for children, describes gaps in the evidence Revised 6 January 2016 base and provides an overview of current policies Individuals, families and groups in the population Accepted 7 January 2016.

3 Published Online First relevant to child Poverty in the UK. Finally, the article can be said to be in Poverty when they lack outlines how child health professionals can take action resources to obtain the type of diet, participate in 8 February 2016. by (1) supporting policies to reduce child Poverty , (2) the activities and have the living conditions and providing services that reduce the health consequences amenities which are customary, or at least widely encouraged and approved, in the societies in which of child Poverty and (3) measuring and understanding they belong. (ref. 10, p. 31). the problem and assessing the impact of action. This conception of Poverty as being relative (rather than absolute) to a particular context recog- INTRODUCTION nises that standards of living change over time. The The latest gures suggest that in 2013 2014 there most widely used measure of relative Poverty within were million children living in Poverty in the the European Union is the proportion of individuals UK 3 in every 10 Furthermore, levels with household incomes less than a particular pro- of child Poverty are rising.

4 For the rst time in portion of the current median of that population. almost two decades, child Poverty in the UK For the purposes of international comparisons, increased in absolute terms in 2011 UNICEF use a cut-off of 50%, whereas in the UK. Higher levels of child Poverty are associated with relative Poverty is generally calculated as <60% of worse child health outcomes. Children growing up the 12 By contrast, absolute Poverty is in Poverty in the UK experience a wide range of measured against a static threshold that only rises adverse child health and developmental outcomes, with in ation, even if society is becoming more or and are more likely to develop chronic conditions less prosperous. This measure indicates individuals in childhood compared with more af uent chil- living in Poverty getting better or worse off in abso- It has been estimated that eliminating child lute In practical terms, living on an income Poverty in the UK would save the lives of 1400 of <60% of the median means that many families children under 15 years of age struggle to meet basic needs like food, heating, Furthermore, the consequences of child Poverty transport, clothing and the extra costs of schooling cost the UK economy 29 billion a year in 2013, like equipment and school up from 25 billion in Being in receipt of income-related welfare bene- The high level of Poverty found in the UK is ts has also been used as a measure of Poverty .

5 In associated with many negative child health out- the UK, this can include being the recipient of For example, childhood mortality (aged 0 income support, job seekers allowance, housing 14) in the UK is signi cantly higher than similar bene ts, council tax bene ts or working tax credit countries in In children under ve, the and child tax credit. Free school meal eligibility is a UK mortality rate is the highest in Western Europe, statutory bene t available to school-aged children double that of Figure 1 further shows from families who receive other qualifying bene ts that countries with a higher proportion of children and is widely used as a measure of childhood disad- living in relative Poverty (below 60% median vantage related to Poverty , especially in educational To cite: Wickham S, income) have higher infant mortality rates. This is often used as an area based Anwar E, Barr B, et al.

6 Arch To assist child health professionals to engage in the measure, like the income deprivation affecting chil- Dis child 2016;101: debate about child Poverty , here we outline some key dren index, which is the percentage of children 759 766. de nitions, Review the links between child Poverty aged 0 15 living in income-deprived households Wickham S, et al. Arch Dis child 2016;101:759 766. 759. Review Arch Dis child : first published as on 8 February 2016. Downloaded from on January 20, 2022 by guest. Protected by copyright. Figure 1 child Poverty and infant mortality in the Organisation for Economic Co-operation and Development (OECD) countries. child Poverty data are taken from EUROMOD gures, and infant mortality is taken from UNICEF (2014). EUROMOD, a European bene t-tax model and social integration. on the basis of receipt of various welfare bene Objective between the age of 9 months and 11 years, and 9% of children and subjective measures of material deprivation relating to lack experienced persistent Poverty (in all ve waves of the study; S.)

7 Of resources available to individuals that society deem important Wickham, E Anwar, B Barr, et al. Unpublished data: experiences have also been used as child Poverty measures. Subjective mea- of Poverty in the UK Millennium Cohort Study). sures may include factors such as the extent to which children have birthday celebrations, appropriate clothes for all weather, health AND SOCIAL CONSEQUENCES OF child Poverty . holidays and parents with access to a car. In general, researchers Children living in Poverty in the UK are more likely to:9. have found similar patterns of association of Poverty with child die in the rst year of life health outcomes whichever measure of Poverty is be born small Children can move in and out of Poverty over the course of be bottle fed their lives. In the Millennium Cohort Study, a representative breathe secondhand smoke sample of children from the UK born in 2001, about half (47%) become overweight of children experienced relative Poverty one or more times suffer from asthma 760 Wickham S, et al.

8 Arch Dis child 2016;101:759 766. Review Arch Dis child : first published as on 8 February 2016. Downloaded from on January 20, 2022 by guest. Protected by copyright. Figure 2 child Poverty and percentage of children seriously injured or killed in a road accident; obese at reception age; admitted to hospital with a mental health condition and infant mortality in Local Authorities in the UK. The size of the dot is proportional to population of each local authority. Data are from Public health England (2015). have tooth decay employment opportunities and ultimately poorer 18. perform poorly at school Figure 2 shows the association between levels of child Poverty die in an accident and a range of child health outcomes in local authorities in Even for children with genetic conditions like cystic brosis with no socio-economic bias in incidence, poorer children There has been some debate about the extent to which the experience poorer outcomes, including worse growth, poorer relationship between Poverty and health outcomes for children lung function, higher risk of Pseudomonas infection, worse is causal or attributable to other factors.

9 However, a recent Wickham S, et al. Arch Dis child 2016;101:759 766. 761. Review Arch Dis child : first published as on 8 February 2016. Downloaded from on January 20, 2022 by guest. Protected by copyright. systematic Review of the literature concluded that a family's or both of For example, Seguin and colleagues have income makes a signi cant difference to children's outcomes: identi ed the importance of chronic cumulative Poverty for out- poorer children have worse cognitive, social-behavioural and comes such as asthma32 and Furthermore, poor health outcomes in part because they live in households with health , particularly during critical periods of childhood and low incomes. This relationship was found to be independent of adolescence, may limit future development with subsequent other factors that have been found to be correlated with child effects on social position and health later in A better Poverty (eg, household and parental characteristics).

10 20 The understanding is needed of the speci c pathways through which Review suggested that out of the 34 studies only 5 found no exposure to adverse childhood socio-economic circumstances, effect of child Poverty on the various outcomes; this was mainly and particularly Poverty , affect speci c health and social out- due to their methodological The authors highlight comes in particular conditions and 20 34 Elucidating that longer durations of child Poverty have a more severe effect the mediating components of pathways will help identify times on children's outcomes than short-term experiences of Poverty . and circumstances that are amenable to intervention. Alongside these health -damaging impacts, living in Poverty is Cross-national comparisons may yield useful information in associated with negative educational outcomes and adverse long- order to explain both the differences in child Poverty rates in term social outcomes.