Most people don’t know this striking fact, but the UK has a serious child poverty problem. More than 1 in 4 children in the UK live in poverty. That’s nearly 4 million. And if projections are correct, we can expect that number to rise to 5 million by 2020.
Earlier this month I discussed this problem on Sky News. The Royal College of Paediatrics and Child Health has been working with the Child Poverty Action Group to survey front line child health workers across the country, and their report, “Poverty and child health: views from the frontline” reveals some startling conclusions about the impact of poverty on child health. The report is based on a survey of more than 250 paediatricians whose comments provide insight into the grave reality of life for the millions of children living in poverty in the UK. What’s clear is that poverty hurts children – and more and more doctors are seeing this in their practice. More than two-thirds of paediatricians surveyed said poverty and low income contribute ‘very much’ to the ill health of children they work with, with more than 50% of respondents saying that financial stress and worry added to family vulnerability. But what this survey adds is a glimpse into exactly how poverty is hurting our children. Housing problems or homelessness and food insecurity were said to be significant contributors to the ill health of children seen by almost two thirds of respondents. Crucially, 40% of doctors had difficulty discharging a child in the last 6 months because of concerns around housing or food insecurity.
As a paediatrician, I see the connection between poverty and poor health in children every day. I will never forget the four-year old boy who turned up in the Emergency Department some weeks ago. He had rickets and skin problems because his mother couldn’t afford healthy food like fruit and vegetables. He had a chronic cough and recurrent chest infections because his mother couldn’t afford to move out of their cold, damp home. And his language skills trailed those of other children of his age because his single mother was so busy working to juggle two poorly paid jobs and so stressed by financial troubles that she didn’t have the time to teach him properly.
It is cases like this that lift the lid on the UK’s poverty problem. Whether it’s housing, income levels or food security, poverty hurts children. The latest research shows that in 2015 infant mortality rose for the first time in a decade. Worse still, while mortality has been rising for the poorest children since 2010, it has continued to fall for more advantaged groups. In other words, inequalities are widening – and this is not a situation we should be facing in the world’s fifth largest economy in 2017.
The importance of socioeconomic status and the social gradient to health are well established. A series of major analyses commissioned by successive Labour governments, from Sir Douglas Black’s 1980 report on Inequalities in Health to Sir Michael Marmot’s 2008 review, Fair Society, Healthy Lives: a Strategic Review of Health Inequalities in England post-2010 all reiterate that progressive health policy can only be delivered through progressive economic and social policy. These reports point to the things that we as a society can do to improve public health. The fact that we live with problems like air pollution, food insecurity and health inequalities is testament to the political choices that have been made about the economic organisation of our society. Despite the overwhelming evidence they provide, none of these reports has ever been seriously acted on, and since 2010 the policies of successive governments, particularly those linked to austerity and the withdrawal of social security, have aggravated the problems these reports aimed to alleviate. This failure has left us with a higher proportion of children in poverty than any other western European nation and persistent stark inequalities in health and well-being.
Without sufficient money and support services many families simply cannot provide the safe homes or healthy food that is required for children to grow and flourish, not to mention afford the travel required for hospital appointments if a child were to become sick. For me poverty delivers a double blow to children: first it removes access to the basic ingredients for a healthy life, and then on top of that the stress, anxiety and insecurity it causes triggers mental health issues to boot. As London GP Jonathon Tomlinson has recently shown trauma in childhood has effects in adulthood: tripling the risk of heart disease and chronic respiratory disease, and quadrupling the risk of type 2 diabetes. For children in poor families living in an unequal society like the UK – one that allows poverty rates to rise – this is a lose-lose situation.
“Poverty and child health: views from the frontline” sends a very strong message to whoever comes into power on June 8th: child health matters. The high levels of poverty in the UK today are putting the health of over a quarter of an entire generation at risk. Low family incomes, inadequate housing and cuts to support services are jeopardising the health of shockingly large numbers of children. The result is that paediatricians like me are trying to do the best we can for our patients despite the shocking effects of economic and public health policies.
This report is a clarion call for the next Government to tackle poverty urgently. Child health is about much more than health services and throwing money at the NHS. Health care should not be treated as fire-fighting – the cornerstones of preventative medicine are public health & social care, so this has to be about the social and economic policies that shape the society we live in. An easy place to start would be to re-instate the UK’s poverty-reduction targets, but that won’t be enough. The next Government must also reverse the cuts to public health services and to universal credit, which will only leave families worse off.
The UK’s children are already lagging behind the rest in Europe. If health inequalities are not tackled soon we not only risk storing up health problems for future generations, but being left behind entirely. If this happens it will be the children of poor families who suffer most.