Child poverty and child healthJonathan Bradshaw

Have we become acclimatised to greater inequality?

National Science Learning CentreUniversity of York

11 January 2016

Family income makes a significant difference to children’s outcomes: poorer children have worse cognitive, social-behavioural and health outcomes

This relationship was independent of other factors that have been found to be correlated with child poverty (e.g. household and parental characteristics).

Cooper K, Stewart K. Does money affect children’s outcomes? Joseph Rowntree Foundation 2013. https://www.jrf.org.uk/report/does-money-affect-children%E2%80%99s-outcomes

UK spatial International comparative Time series Incidence Longitudinal

Types of evidence

UK spatial International comparative Time series Incidence Longitudinal

Types of evidence

Poverty and health: NE local authority ranksBradshaw J, Noble M, Bloor K, Huby M, McLennan D, Rhodes D, Sinclair I, Wilkinson K. (2009) A Child Well-Being Index at Small Area Level in England, J. Child Indicators Research 2, 2, 201-219

UK spatial International comparative Time series Incidence Longitudinal

Types of evidence

Health .630**

Education .540**

Subjective .664**

Behaviour .588**

Housing .664**

Overall well-being .823**

Overall excluding material .719**

Correlation coefficients of material well-being and all the other domains OECD (UNICEF Innocenti RC11)

Child poverty rate by infant mortality rate

Figure

Source: The Lancet 2014; 384:1923 (DOI:10.1016/S0140-6736(14)62271-6)

Under five morality versus child poverty

Child poverty rate by under 19 deaths

Child poverty rate by low birth-weight rate

WELL-BEING BY CHILD POVERTY RATE: EU only

Child well-being and inequality: EU only

Child subjective health by family affluence (HBSC)

Comparative performance on child outcomes  Comparative

performanceSource

     Material well-being    Relative poverty BHC Middling SILC (2013)‘Absolute’ child poverty BHC

Middling SILC (2013)

Child poverty gaps Good SILC (2013)Material deprivation Middling SILC (2013)Persistent poverty BHC Good SILC (2013)Inequality Bad UNICEF (2010)Health    Still births Middling Cousens et al 2011Infant mortality Middling World Development Indicators 2015Child deaths Middling WHO mortality data base (UNICEF 2013)Low birth weight Middling World Development Indicators 2015Breastfeeding Good OECD Family data base (2005)Immunisation rates Middling OECD Family data base (2010)Self-assessed health Bad HBSC (Currie 2012)Obesity Good HBSC (Currie 2012)Sex Bad HBSC (Currie 2012)Diet Middling HBSC (Currie 2012)Alcohol Bad HBSC (Currie 2012)Smoking Good HBSC (Currie 2012)Drugs Bad HBSC (Currie 2012)Exercise Good HBSC (Currie 2012)Inequality Middling UNICEF (2010)

Comparative performance on child outcomes  Comparative

performanceSource

     Subjective well-being and mental health

   

Life satisfaction Bad HBSC (Currie 2012)Mental health Middling HBSC (Currie 2012)Suicide Good OECD Family DatabaseTalking to mothers Middling HBSC (Currie 2012)Talking to fathers Middling HBSC (Currie 2012)School friends kind and helpful

Middling HBSC (Currie 2012)

Liking school Middling HBSC (Currie 2012)Subjective health Bad HBSC (Currie 2012)Education    Literacy achievement Middling PISA (2012)Maths achievement Middling PISA (2012)Science achievement Middling PISA (2012)Inequalities in achievement

Middling UNICEF (2010)

Staying on rates Bad OECD Family data base(2015)NEET Middling OECD Family data base (2015)Housing    Housing satisfaction Good SILC (2013)Living space Good SILC (2013)Inequality in living space Bad UNICEF (2010)Environment Good SILC (2013)Child maltreatment    Fighting Good HBSC (Currie 2012)Been bullied Good HBSC (Currie 2012)Bullying others Middling HBSC (Currie 2012)Children in care -  Crime -  Childcare    Spending Middling OECD Family data base (2015)Enrolment 0-3 Bad EU SILCEnrolment 3-5 Bad EU SILCCosts to parents Bad OECD Family data base (2015)Staff/child ratios Bad OECD Family data base (2015)Time and space Middling Children’s Worlds Survey

OECD (2015) How’s Life for Children

UK spatial International comparative Time series Incidence Longitudinal

Types of evidence

Child poverty:1979-1995/660 per cent equivalent household income

05

10152025303540

1979

1980

1981

1982

1983

1984

1985

1986

1987

1988

/9

1989

/9019

90/1

1991

/219

92/3

1993

/419

94/5

1995

/6

% p

over

ty ra

te

Before HousingCostsAfter HousingCosts

• Relative low income = Equivalised net household income less than 60% median 2020 target: <10% of children

• Combined low income and material deprivation = Material deprivation >20% and equivalised net household income less than 70% median 2020 target: <5% of children

• ‘Absolute’ low income= Equivalised net household income falling below 60% of the ‘adjusted base amount’ 2020 target: <5% of children

• Persistent poverty= Equivalised net household income less than 60% of median for 3 years prior to current year 2020 target <7% of children.

Child poverty targets for 2020

• Plan to cut £80 billion deficit by 2013• 20% from increases in taxes• 80% from cuts in services and huge reduction in

public employment• Whole package highly regressive• And cuts directed at children (not pensioners)• Child poverty already increasing • Unemployment was 2.5 million – youth at record high1

million plus• Real earnings falling for six years

Then recession and coalition government

• Child benefits frozen for three years then 1%• To be taken back from higher rate tax payers – through

the tax system• EMA abolished• Health in Pregnancy Grant and child trust funds

abolished • Cuts in childcare tax credits 80% to 70% subsidy and

Surestart maternity grant restricted to one child• Cuts in Child tax credits – 2011 reneges on promise for

above inflation uprating• Uprate benefits by CPI rather than RPI. Now 1% for

three years• Increase VAT from 17.5% to 20%• Benefit cap and bedroom tax

Coalition cuts in family benefits

Impact of direct tax & benefit reforms introduced or planned income decile group and household type) (whole population income decile group, (Equality and Human rights Commission 2014)

Combined impact of tax, welfare and other public spending changes as a proportion of total household living standards (net income plus the value of public services in the base year) by family type

Cuts in spending per capita by child poverty rate. Local authorities in England

Child poverty act targets

Labour periodtrend 1997-2010

After 2009 to latest

Source

Material well-being      Relative poverty BHC HBAI‘Absolute’ child poverty BHC

X HBAI

Material deprivation ▪ HBAIPersistent poverty BHC ▪ HBAIHealth      Still births ≈ ONSInfant mortality ONSChild deaths ONSLow birth weight ≈ ≈ ONSBreastfeeding ONSImmunisation rates X DoHGeneral health HSELongstanding illness ≈ HSELimiting longstanding illness

HSE

Diabetes X X HSEAsthma ≈ ▪ HSEDental health ▪ HSCICInjuries and accidents DoTObesity X ≈ HSCICDiet (fruit and veg) X HSCICAlcohol HSCISSmoking HSCICPhysical activity ▪ X HSCICDrugs CSEW

Trends in child well-being: = getting better, X=getting worse, ≈no clear trend, ▪=missing data

Labour periodtrend 1997-2010

After 2009 to latest

Source

Subjective well-being and mental health

     

Happiness overall X BHPSMental health ≈ ONSSuicide X ONSHappiness with friends X BHPS/USHappiness with family ≈ ≈ BHPS/USHappiness with school work BHPS/USHappiness with appearance ≈ X BHPS/USHappiness with life X BHPS/USHappiness with school ▪ BHPS/USEducation      Key stage 2 attainment DFE5 GCEs A-C DFELevel 2 qualifications DFEStaying on rates DFEExclusions ≈ DFENEET ≈ DFEHousing      Homelessness X DCLGTemporary accommodation X DCLGHouse conditions EHS/EHCSChild maltreatment      Fatal abuse ≈ Home Office

Physical abuse X NSPCCNeglect ≈ X NSPCCChildren in care      Length of spells in care ▪ DfEPlacement stability ≈ DfEEducation attainment DfEChildcare      Formal participation ≈ DFECrime and drugs      Proven offences YJBArrests YJBWorry about crime ▪ MORI

Trends in child well-being: = getting better, X=getting worse, ≈no clear trend, ▪=missing data

Child homelessness up

Youth suicides have stopped falling

Taylor-Robinson et al BMJ 2013;347:f7157

Infant mortality by socio-economic classification

UK spatial International comparative Time series Incidence Longitudinal

Types of evidence

Pillas D, Marmot M, Naicker K, et al. Social inequalities in early childhood health and development: A European-wide systematic review. Pediatric Research 2014;76:418–24. doi:10.1038/pr.2014.122

Eliminating child poverty in the UK would save the lives of 1,400 children under 15 years of age annually

Children in poverty in the UK

Die in the first year of life; Be born small; Be bottle fed; Breathe second-hand smoke; Become overweight; Suffer from asthma; Have tooth decay; Perform poorly at school; Die in an accident.

UK spatial International comparative Time series Incidence Longitudinal

Types of evidence

Poor children have a higher risk of death in adulthood across almost all conditions that have been studied, including mortality from stomach cancer, lung cancer, haemorrhagic stroke, coronary heart disease, respiratory-related deaths, accidents, and alcohol-related causes of death Galobardes B, Lynch JW, Smith GD. Childhood socioeconomic circumstances and cause-specific mortality in adulthood: systematic review and interpretation. Epidemiologic Reviews 2004;26:7–21. doi:10.1093/epirev/mxh008 Galobardes B, Lynch JW, Smith GD. Is the association between childhood socioeconomic circumstances and cause-specific mortality established? Update of a systematic review. Journal of Epidemiology & Community Health 2008;62:387–90. doi:10.1136/jech.2007.065508

Longitudinal

Ambition to deal with deficit by 2020 Mainly by huge cuts in working age benefits Welfare Reform and Work Bill Huge cuts in tax credits delayed by Autumn

Statement but introduced in Universal credit as it rolls out

Child poverty targets abolished IFS child poverty up 200-600,000 by 2020

Now austerity under the Tories

We do not need to be doing thisCoalition aspirations for public expenditure as % GDP (IMF WEO database October 2015)

• There is national and comparative evidence that child poverty and child health and well-being was improving until 2010.

• Austerity measures have hit families with children hardest• Child poverty will increase – all gains swept away 2020

targets missed.• Child health and well-being bound to suffer.• However evidence is not really there yet.• Work needed!

All Party Parliamentary Group on Health in All Policies Inquiry launch: Child Poverty and Health – the Impact of the Welfare Reform and Work Bill 2015-2016

Sophie Wickham, Elspeth Anwar, Ben Barr , Catherine Law, David Taylor-Robinson, Child poverty: Using evidence for action, Arch.Child. Diseases

Conclusion

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