Health inequalities tool 1 - Improve your understanding of child poverty and health inequalities

This tool will help paediatricians understand how child poverty is defined in the UK context, including evidence of how poverty drives health inequalities and affects child health outcomes.
Icons of heads with thinking cogs and speech bubble; background with repeated icon of family

What do we mean by ‘child poverty’?

When a person does not have the resources to live according to an acceptable standard, they are living in poverty. One in four (27%) children live in poverty in the UK, defined as living in a household with an income less than 60% of the median household income, known as the poverty line1 . Families below this poverty line have insufficient income to raise children at an acceptable standard of living.  

Around one in three children live in poverty in the UK, and this proportion is increasing.

 The main drivers of child poverty in the UK are:  

  • Insufficient income and high living costs associated with raising children and young people2 . However, 75% of children and young people in poverty have at least one parent doing at least one job - they are living in “in-work” poverty3
  • Having someone with long-term condition in the household increases the risk of children and young people living in poverty due to barriers to employment4
  • Lone parent families, the majority of which are headed by women, are at higher risk of falling into poverty4
  • Poverty is higher among children and young people from certain ethnic minority groups compared to children in White British families4
  • The causes of poverty and how it affects child health and well-being will differ by geographical location. There are regional variations and disparities between rural and urban areas, with coastal and other towns affected by reduction of long-established industries having high rates of poverty. However, the challenges, opportunities and strategies required to address problems in these areas will vary. 

Figure 1 – Structural financial drivers of family poverty

Diagram shows structural financial drivers of poverty, and how connected: low financial resilience, debt, insufficient financial income, high financial outgoings, acute shocks to the system - all leading to less opportunities for children

Download this diagram (PNG) 

What do children and young people think?

Children and young people from RCPCH &Us4  say that poverty includes: 

  • Not having enough money 
  • Not being able to eat healthily 
  • Not having tablets, computers, consoles or phones 
  • Not having the right school uniform 
  • Not having a comfortable bed to sleep in 
  • Not being able to do activities like swimming or football, or going to the cinema or on holiday 
  • Worrying about different things and having more arguments or feeling stressed 
  • Having to think about how much essential things cost like petrol, electricity, food, clothes, toys 
  • Not being able to go to school or doctors appointments 
  • Not having spaces outside to go to 
  • Being discriminated and bullied
  • Not living in a safe space or safe environment physically or emotionally

Evidence of how poverty drives child health inequalities in the UK

Health inequalities are the avoidable, unfair and systematic differences in health outcomes between different groups of babies, children and young people. Children and young people living in poverty are more likely to have poorer health outcomes including low birth weight, poor physical health, and mental health problems. 

Mortality in childhood:

  • Infants in the 10% most deprived areas are twice as likely to die in infancy as those in the 10% least deprived5 .
  • There was a clear association between the risk of death and the level of income for children who died in England between April 2019 and March 2020. This association appeared to exist for all categories of death except malignancy6 .  
  • Over a fifth of the 3,200 child deaths in the period examined might have been avoided if children living in the most deprived areas had the same mortality risk as those living in the least deprived6 . This translates to over 700 fewer children dying per year in the UK. 

Acute and long-term illness:

  • Children and young people living in poverty are significantly more likely to require hospital admission7 , and were 72% more likely than other children to be diagnosed with a long-term illness8
  • Rates of obesity in children living in the most income deprived areas are rising, while the rates are decreasing in the least income deprived areas9 .  

How does poverty affect child health outcomes?

We highlight four key mechanistic considerations: 

  1. Families don’t make “bad” or “good” choices; decisions are constrained by systems, personal capacities and culture, and the choices made are often the best available in these circumstances.
  2. The odds stack up against children: Adverse experiences, which are usually multiple, have a cumulative negative effect on later physical and mental health and are three times more common in the context of poverty than in affluence.
  3. The Inverse Care Law: Put simply, children in poorer families have less access to healthcare, and a worse experience of care when they get there.
  4. Poverty gets under your skin: The pathobiological effects of socioeconomic deprivation are illustrated below. For more information see college website

Figure 2 – The pathobiology of poverty in childhood

Figure 2 – The pathobiology of poverty in childhood

Download this diagram (PNG)

You can read more detail in our position statement, Child health inequalities driven by child poverty in the UK.

    What do children and young people think?

    Children and young people have told us how poverty affects them, including the following10  : 

    • Not enough money for healthy nourishing food, leading to a poor diet and unhealthy eating. It would be easier to get disease and get sick because of poor diet and poor hygiene. It would also be hard to sleep, which would also affect your mental health. 
    • Not able to afford to go to social events or sports clubs, go on holiday, or go on school trips. You might be left out. 
    • Can’t afford good housing, could be homeless. You would be lacking basic things like electricity, or hot, clean water – leading to poor hygiene (dirty clothes, hair etc). 
    • You may end up being bullied, or possibly becoming a bully. People might make fun of you, and you might be bullied because you can’t afford clothes or have a dirty uniform. 
    • Poverty would result in poor mental health and could lead to depression or anxiety. You could feel angry and frustrated and might lash out at people. 
    • You would become vulnerable and might be exposed to ‘dodgy’ people and drugs. You could be forced to make bad choices and get up to trouble. 

    More from the health inequalities toolkit