The impact of poverty on child health

Josephine Tucker, Head of Policy and Research at Child Poverty Action Group, writes about the impact of poverty on children's health and what we as health professionals can do.

Update - September 2022 - The College has launched a child health inequalities toolkit to help paediatricians support vulnerable families and advocate for better health policies, including a position statement with recommendations to all four UK nations.

New government statistics show that child poverty has increased for the third year running, to 4.1 million or nine in every classroom of thirty. Projections from the Institute of Fiscal Studies suggest that it will top five million by 2021. That’s five million children living on a family income of less than 60% of the national average (measured after housing costs), and unable to keep up with the living standards others enjoy.

The causes are flatlining wages, combined with huge cuts to financial support for low-income households, the majority of which have hit families with children. These include reductions in child tax credit, a freeze on child benefit while inflation rises, and the ‘two-child limit’ in tax credits and universal credit. Single parents and larger families are particularly hard-hit.

The evidence linking poverty with ill-health is unequivocal. Birthweights in the most deprived areas are on average 200g lower than in the richest, and children in disadvantaged families are more likely to die suddenly in infancy, to suffer acute infections, and to experience mental ill-health.

Last year CPAG and the RCPCH surveyed paediatricians about the impacts of poverty. More than two-thirds said that poverty and low income contribute ‘very much’ to ill-health among their patients, and almost half believe this has worsened in recent years. Their heartbreaking comments highlight how inadequate housing, homelessness, food insecurity, and the stress and stigma of poverty are affecting children’s physical and mental health in a myriad of ways. We hope that this will stand as a call to action for anyone who cares about the health of a whole generation to do something about poverty.

[I see patients with] poor nutritional state from poverty or low income, with growth below [what is] expected.

By causing worry, stress and anxiety in families, children have a little part of their childhood taken away.

One of the most striking findings to me was how the stress created by poverty and the constant worry about making ends meet makes it much harder for families to cope when children are unwell. This chimes with CPAG’s experiences – we have met parents who are worried sick about their children’s needs but are overwhelmed by the immediate stress of trying to keep a roof over their heads. Some fear – often for good reason – that they might lose their job if they take a day off work, or have their benefits sanctioned if they cancel an appointment at the jobcentre.

Constant concern about finances and housing conditions affects families of children with long term conditions; they face difficulty in dealing with treatment as they are preoccupied with other issues.

We are also seeing the effects of the dramatic decline in funding for local services such as Sure Start centres. Doctors answering the survey also highlighted that it has become harder and harder to access other therapies like speech and language therapy or mental health care, leading to the development of serious problems which could previously have been addressed at an earlier stage.

Another shocking area of the findings was about the impact on children of living in homes which are unsafe, overcrowded or simply inadequate. This is damaging for all children, and particularly for those with particular health or emotional needs.

[I see] children being unwell with back-to-back respiratory illnesses, living in overcrowded shared accommodation.

Overcrowding makes looking after difficult children with learning difficulties or autism next to impossible.

Poor housing and lack of safe outdoor space also in part explains the worrying evidence that children in poverty are at significantly increased risk of injury and death from accidents, including in road accidents, fires, accidental drownings and accidental poisonings.

It is poverty itself which causes worse outcomes among children. A systematic review by researchers at the LSE found a causal relationship between family income and child outcomes, independent of other factors like parents’ education. This is partly due to simply having more money to spend on children, and partly because of parental stress and anxiety. Other studies have shown that when low-income families have more money, they spend it on things which are good for children - like clothes, fruits and vegetables - and less on alcohol and tobacco, and mothers’ mental health improves.

The impacts of poverty on physical and mental health are lifelong, being seen in higher rates of arthritis, high blood pressure, respiratory illness and depression, among others, in later life. Already, women in the most deprived parts of the country can expect 35 fewer years of good health than in the wealthiest. A political commitment to reducing child poverty, backed by concrete action, is urgently needed if we are to safeguard the health of the next generation. 

In the meantime, local action can make a big difference. If you work with families, don’t be afraid to ask whether they have any difficulty making ends meet, and be ready to give details of local welfare rights advice services, children’s centres, parents groups and other forms of support. If you are seeing effects of poverty or changes to benefits on children, please consider submitting evidence to CPAG through our early warning system, and asking your council and MP to take action.

If you’d like to hear more about CPAG’s campaigns, please visit their website.