Child poverty and child health - PowerPoint Presentation

Child poverty and child healthJonathan Bradshaw Have we become acclimatised to greater inequality? National Science Learning Centre University 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 spatialInternational comparativeTime seriesIncidenceLongitudinal Types of evidence

UK spatialInternational comparativeTime series Incidence LongitudinalTypes of evidence

Poverty and health: NE local authority ranks Bradshaw 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 spatialInternational comparativeTime series Incidence LongitudinalTypes 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 performance Source       Material well-being     Relative poverty BHC Middling SILC (2013) ‘Absolute’ child poverty BHC MiddlingSILC (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 2011 Infant mortality Middling World Development Indicators 2015 Child deaths Middling WHO mortality data base (UNICEF 2013) Low birth weight Middling World Development Indicators 2015 Breastfeeding 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 performance Source       Subjective well-being and mental health     Life satisfaction Bad HBSC (Currie 2012) Mental health MiddlingHBSC (Currie 2012)Suicide Good OECD Family Database Talking 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 SILC Enrolment 3-5 Bad EU SILC Costs 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 spatialInternational comparativeTime series Incidence LongitudinalTypes of evidence

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

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 employmentWhole package highly regressiveAnd 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 abolishedHealth 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 period trend 1997-2010 After 2009 to latest Source Material well-being       Relative poverty BHC   HBAI ‘Absolute’ child poverty BHC XHBAIMaterial deprivation ▪  HBAI Persistent poverty BHC  ▪ HBAI Health       Still births ≈  ONS Infant mortality   ONS Child deaths   ONS Low birth weight ≈ ≈ ONS Breastfeeding   ONS Immunisation rates X  DoH General health   HSE Longstanding illness  ≈ HSE Limiting longstanding illness   HSEDiabetesXXHSEAsthma≈▪HSEDental health▪HSCICInjuries and accidents DoTObesityX≈HSCICDiet (fruit and veg)XHSCICAlcoholHSCISSmokingHSCICPhysical activity▪XHSCICDrugsCSEW Trends in child well-being:  = getting better, X=getting worse, ≈no clear trend, ▪=missing data

Labour period trend 1997-2010 After 2009 to latest Source Subjective well-being and mental health       Happiness overall  X BHPS Mental health ≈ONSSuicide  X ONS Happiness with friends  X BHPS/US Happiness with family ≈ ≈ BHPS/US Happiness with school work   BHPS/US Happiness with appearance ≈ X BHPS/US Happiness with life  X BHPS/US Happiness with school ▪  BHPS/US Education       Key stage 2 attainment   DFE 5 GCEs A-C   DFE Level 2 qualifications   DFE Staying on rates   DFEExclusions≈DFENEET≈DFEHousing   HomelessnessXDCLGTemporary accommodationXDCLGHouse conditionsEHS/EHCSChild maltreatment   Fatal abuse≈Home OfficePhysical abuseXNSPCCNeglect≈XNSPCC Children 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 spatialInternational comparative Time series IncidenceLongitudinalTypes 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.2014.122Eliminating child poverty in the UK would save the lives of 1,400 children under 15 years of age annually

Children in poverty in the UKDie 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 spatialInternational comparative Time series IncidenceLongitudinalTypes 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 2020Mainly by huge cuts in working age benefitsWelfare Reform and Work BillHuge 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 2020Now 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. DiseasesConclusion

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