Feature

Poor children, poorly adults

Ending child poverty is the way to begin to narrow health inequality, argues Claire Kober

Children’s health in the UK has improved enormously in the past century but social class, household income and health remain strongly linked. Social inequality breeds health inequality and children born into poverty are more likely to die in the first year of life; die from an accident in childhood; be born too small; be born too early; have a shorter life expectancy than children born to wealthier parents; and suffer both physical and mental illnesses.¹

Health inequalities are the UK’s most visible public health challenge. The Department of Health’s consultation on health inequalities revealed that a boy in Barnet will live more than seven years longer than a boy in Manchester, and a girl in Kensington, Chelsea and Westminster can expect to live six years longer than a girl in Manchester.²

Within months of coming to power in 1997, the Labour government asked Sir Donald Acheson, a former chief medical officer, to conduct an independent inquiry into health inequalities.³ It found that inequalities in health status ranged across social class, gender and ethnicity. Mortality and life expectancy follow a social gradient and Acheson found that many social class differences had widened over the previous 20 years.

The report identified 10 priority areas for policy development, where scientific and expert evidence indicated the potential for cost-effective and affordable interventions to reduce inequalities. It also made three major policy recommendations:

• all policies likely to have a direct or indirect effect on health should be evaluated in terms of their impact on health inequalities, and should be formulated in such a way that by favouring the less well off they will, wherever possible, reduce such inequalities;

• high priority should be given to policies aimed at improving health and reducing health inequalities in women of childbearing age, expectant mothers and young children;

• steps should be taken to reduce income inequalities and improve the living standards of households in receipt of social security benefits.

As Acheson’s recommendations demonstrate, the most effective interventions to reduce inequalities in child health are not health interventions, but fiscal and public policy initiatives. Inequalities in health are the result of so many complex interactions that the solution must involve more than one agency.

In an important study, researchers examined the effects on life chances of eradicating child poverty by giving children in social classes IV and V the same good chances of health that children in ‘higher’ classes currently enjoy.⁴ To do this, the poorest 20 per cent of children were reassigned to higher social classes on a prorata basis and thus given a lower risk of death.

The researchers found that about 1,400 lives a year among those aged under 15 would be saved if child poverty were eradicated (using the government’s relative definition of child poverty). This represents 92 per cent of all ‘excess’ child deaths in areas of higher than average mortality.

They concluded that redistribution of wealth would have the greatest absolute effect (in terms of numbers of lives saved) and that eradication of child poverty has the greatest relative effect (in terms of the proportion of lives saved).

Children are not usually poor independently of their families or carers – so alleviating child poverty requires the alleviation of family poverty. It also requires raising the living standards of those who do not yet have children but who are poor – otherwise children will continue to be born into poverty.

In terms of reducing the direct effects of child poverty on health, the picture is complex. The current government has launched a number of policies that should impact positively on children’s health. The Sure Start and New Deal for Communities programmes – including, importantly, the promotion of breastfeeding – have been innovative and generally well received but they will still only reach a third of children in poverty by 2004.

Nevertheless, early years interventions on their own are not enough. Children need consistent help throughout their childhood.Schools offer an ideal opportunity for health-improving interventions and programmes such as Five- A-Day and the National Healthy Schools Standard have undoubtedly made an impact. There is still scope for improvement in the provision of both food and physical activity within schools.

The transition into adulthood is also challenging, with experimentation with sex and drugs (including alcohol and tobacco) potentially adversely affecting both current and future health. The environment too has an impact. The provision of good quality housing has a profound effect on determining health status. Other interventions such as traffic calming measures, reduced speed limits and the provision of safe play areas would have a substantial impact on reducing child health inequalities.

There is overwhelming evidence that childhood poverty has a dramatic and long-term impact on individuals, communities and the society we live in. Investing in poor children improves not only their life chances but also the experiences of the community around them. Inevitably, decisions on public spending are subject to competing demands, but giving every child the best start in life makes sense and is surely the right choice.