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Child poverty and child healthJonathan Bradshaw
Have we become acclimatised to greater inequality?
National Science Learning CentreUniversity 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 spatial International comparative Time series Incidence Longitudinal
Types of evidence
UK spatial International comparative Time series Incidence Longitudinal
Types of evidence
Poverty and health: NE local authority ranksBradshaw 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 spatial International comparative Time series Incidence Longitudinal
Types 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
performanceSource
Material well-being Relative poverty BHC Middling SILC (2013)‘Absolute’ child poverty BHC
Middling SILC (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 2011Infant mortality Middling World Development Indicators 2015Child deaths Middling WHO mortality data base (UNICEF 2013)Low birth weight Middling World Development Indicators 2015Breastfeeding 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
performanceSource
Subjective well-being and mental health
Life satisfaction Bad HBSC (Currie 2012)Mental health Middling HBSC (Currie 2012)Suicide Good OECD Family DatabaseTalking 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 SILCEnrolment 3-5 Bad EU SILCCosts 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 spatial International comparative Time series Incidence Longitudinal
Types of evidence
Child poverty:1979-1995/660 per cent equivalent household income
05
10152025303540
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
/9
1989
/9019
90/1
1991
/219
92/3
1993
/419
94/5
1995
/6
% p
over
ty ra
te
Before HousingCostsAfter HousingCosts
• 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 employment• Whole package highly regressive• And 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 abolished• Health 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 periodtrend 1997-2010
After 2009 to latest
Source
Material well-being Relative poverty BHC HBAI‘Absolute’ child poverty BHC
X HBAI
Material deprivation ▪ HBAIPersistent poverty BHC ▪ HBAIHealth Still births ≈ ONSInfant mortality ONSChild deaths ONSLow birth weight ≈ ≈ ONSBreastfeeding ONSImmunisation rates X DoHGeneral health HSELongstanding illness ≈ HSELimiting longstanding illness
HSE
Diabetes X X HSEAsthma ≈ ▪ HSEDental health ▪ HSCICInjuries and accidents DoTObesity X ≈ HSCICDiet (fruit and veg) X HSCICAlcohol HSCISSmoking HSCICPhysical activity ▪ X HSCICDrugs CSEW
Trends in child well-being: = getting better, X=getting worse, ≈no clear trend, ▪=missing data
Labour periodtrend 1997-2010
After 2009 to latest
Source
Subjective well-being and mental health
Happiness overall X BHPSMental health ≈ ONSSuicide X ONSHappiness with friends X BHPS/USHappiness with family ≈ ≈ BHPS/USHappiness with school work BHPS/USHappiness with appearance ≈ X BHPS/USHappiness with life X BHPS/USHappiness with school ▪ BHPS/USEducation Key stage 2 attainment DFE5 GCEs A-C DFELevel 2 qualifications DFEStaying on rates DFEExclusions ≈ DFENEET ≈ DFEHousing Homelessness X DCLGTemporary accommodation X DCLGHouse conditions EHS/EHCSChild maltreatment Fatal abuse ≈ Home Office
Physical abuse X NSPCCNeglect ≈ X NSPCCChildren 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 spatial International comparative Time series Incidence Longitudinal
Types 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.2014.122
Eliminating child poverty in the UK would save the lives of 1,400 children under 15 years of age annually
Children in poverty in the UK
Die 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 spatial International comparative Time series Incidence Longitudinal
Types 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 2020 Mainly by huge cuts in working age benefits Welfare Reform and Work Bill Huge 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 2020
Now 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. Diseases
Conclusion
@profjbradshaw