Why do we need to care about poverty? Ian Leech presents a strong case that it affects us all, not just those experiencing it. He also references projects which offer hope of breaking the cycle of worthlessness, ill health and deprivation experienced by the families and individuals affected
Today, in the UK, 3.7 million children (more than one in five) are living in absolute poverty (where income is adjusted for inflation) (DWP, 2014). Under current government policies an expected 600,000 more children will be dragged into the bracket by 2015/16 (Browne et al, 2013).
By 2020, 4.7 million children are projected to be living in poverty. The decade between 2010–2020 will be the first to see a rise in absolute poverty since records began in the early 1960s (Social Mobility and Child Poverty Commission, 2014).
The grim statistiscs don’t just end there: around one in five, or 8.7 million (DWP, 2014) working age adults are living in what the government classes as relative poverty, when families have a net income that is below 60% of median net disposable income. Presently that works out at around £250 a week. Just under two million pensioners are living similarly.
Worryingly, DWP figures show that work does not provide a guaranteed route out of poverty in the UK. Two-thirds (66%) of children growing up in poverty live in a family where at least one member works. Children’s charity Barnardo’s says poorest families can have as little as £12 per day per person to buy everything they need such as food, heating, toys, clothes, electricity and transport.
This summer the UK Faculty of Public Health (FPH) said that poverty is forcing people to have dangerously poor diets; children and young people’s consumption of healthy foods decreases and unhealthy foods increases from social class I to social class V (Dowler et al, 2001). It is also leading to the return of rickets and gout – diseases of the Victorian age that affect bones and joints.
Faculty president Prof John Ashton said that increasing numbers of people on low wages are not earning enough money to meet their most basic nutritional needs for maintaining a healthy diet.
‘We should not accept this in the UK, the world’s sixth largest economy and the third largest in Europe,’ he said. ‘An affordable nutritious diet is a prerequisite for health. We view the rise of food poverty as indicating the reversal of what was a long process of improvement in food availability and affordability since World War Two.
Carmel McConnell, founder of the Magic Breakfast Charity (which provides a free breakfast to 8,500 British schoolchildren in need each morning), echoes his concern describing how teachers in the schools she works in expect to see a dramatic decline in the health of their pupils as they return after the holidays: ‘Teachers tell us they know even with free school meals it will take two to three weeks to get their kids back up to the weight they were at the end of the last school term because their families cannot afford the food during the holidays.’
Councils struggling to cope
It is hardly surprising then that local councils are finding it difficult to cope. The 2010 Child Poverty Act places a duty on local authorities to prepare a ‘local child poverty needs assessment’ setting out the essential needs of children living in poverty in the area, and to prepare a child poverty strategy to set out measures that the local authority propose to take to reduce child poverty in boroughs.
Alison Wall, who works as a public health strategist for Camden Council, explains how it works: ‘Each local authority puts together a poverty strategy. They will look at the services and how they can ease child poverty, what facilities they provide, like family centres. ‘Some just look at children and others do it from the perspective of how the poverty of parents impacts on children, because the two are obviously linked.’
In Bradford, where a total of 61% of children in the district live in low income households, the city’s Child Poverty Commission set out, among other recommendations, that no child should live in substandard housing and that the council should provide a comprehensive range of summer activities for children and young people, especially for those from poorer families.
It also aimed for the ‘cliff edge’ at age 19, when youth unemployment suddenly rises, to be addressed to ‘break the cycle of worklessness.’
Poverty’s effect on the health of individuals as well as society is huge and well documented. Women from poor families are more likely to be short, be in poorer health and have significant psychological problems when they come to pregnancy – all of which are important determinants of pregnancy outcome (Hennessy & Alberman, 1998).
During pregnancy poorer women are more likely to gain less weight and to smoke (Hennessy & Alberman, 1998). There is a finely graded decrease in birthweight from the highest to the lowest social groups. Poor infants are more likely to be born small and/or early (Smith et al, 2007). And, as birthweight and gestational age are the main determinant of perinatal survival, there is a consistent social gradient in perinatal mortality (Meis et al, 1997).
There is also a strong social gradient in sudden unexpected death in infancy that has become more marked since the ‘Back to Sleep’ campaign, which advised parents to place babies on their back or side to sleep to avoid overheating, and to avoid smoky environments (Drever & Whitehead,1997).
There is a very large research base to show that children from families living in poverty and deprivation do less well from early in life, that they fall behind their peers at school, and that they have more mental health problems (Reiss, 2013) and employment problems in adult life.
Social disadvantage affects mental health
An increase in childhood behavioural and emotional problems also increases in those who are socially disadvantaged (Meltzer et al, 2000). The relationship appears to be less strong in early childhood, but gathers strength in middle childhood (Bradley & Corwyn, 2002). Positive social, emotional and behavioural (SEB) skills in childhood have been ultimately linked to higher educational attainment and stronger job prospects in adulthood, whereas adults who faced financial hardship during childhood are more likely to have high blood pressure, heart disease, respiratory illnesses and symptoms of mental ill-health.
Another study by the University of Exeter Medical School in 2013 discovered that a greater percentage of children with Attention deficit Hyperactive Disorder (ADHD) came from families below the poverty line than the UK population as a whole, with average family incomes for households whose study child was affected by ADHD at £324 per week, compared with £391 for those whose child was not. The study found the odds of parents in social housing having a child with ADHD were roughly three times greater than for those who owned their own homes.
A Joseph Rowntree Foundation review found that all identified minority ethnic groups had higher rates of poverty than the average for the population. Rates of poverty were highest for Bangladeshis, Pakistanis and Black Africans, reaching nearly two thirds for Bangladeshis. Around 70% of Bangladeshi children were found to be poor. Pakistanis were found to be nearly as poor as Bangladeshis on many counts.
And rates of poverty were also higher for those living in Indian, Chinese and other minority ethnic group households.
Do our children deserve this?
Poor children do not only have a higher prevalence of chronic conditions but the impact of chronic illnesses on their lives appears to be greater. Asthma severity is greater among children from lower socio-economic status homes and even conditions such as insulin dependent diabetes mellitus that do not show a social gradient are associated with more hospital admissions among poor children (Starfield & Budetti, 1985).
Heavier drinking is more common among disadvantaged young people and more hazardous drug use is linked to poverty and unemployment (Sweeting & West, 2001), while teenage parenthood is strongly socially patterned (Lawlor et al, 2001).
Death rates from injury and poisoning have fallen in all social groups except the poorest and these children are 13 times more likely to die from injury than the most privileged children (Edwards et al, 2006). Suicide among boys and self-harming behaviour in younger children are both serious causes of concern), with recent research pointing to a worrying upward trend (PHE, 2014b).
The importance of early intervention
But it isn’t only health that is effected. Children from poorer backgrounds lag at all stages of education. The Child Poverty Action Group says that by the age of three, poorer children are estimated to be, on average, nine months behind children from more wealthy backgrounds.
According to Department for Education statistics, by the end of primary school, pupils receiving free school meals are estimated to be almost three terms behind their more affluent peers.
The government is more keen than ever for health professionals to concentrate efforts and resources on early interventions to help break the cycles of deprivation and poverty.
Troubled familes receive a boost
Nationally, the government’s Troubled Families Programme has been working with local authorities and their partners to help 120,000 troubled families in England turn their lives around by 2015.
The programme, headed up by Louise Casey CB, aims to find school places for children that have been excluded, reduce youth crime and put adults on a path back to work; all by dealing with each family’s problems as a ‘holistic’ whole rather than responding to each problem separately. Single key workers are usually allocated to a family. This approach is resource intensive, but gets results.
The success of this programme is apparent in that the remit has recently been widened. While retaining its focus on reducing truancy, crime and anti-social behaviour, the expanded programme will apply this approach to a larger group of families with a wider set of problems including vulnerable young children ‘in need’ under five, domestic violence, parents experiencing debt and health problems as well as children at risk of being taken into care (DCLG, 2014).
The programme will also continue to prioritise getting adults into work, with the Department for Work and Pensions providing 300 specialist troubled families employment advisers who will also work with young people at risk of becoming unemployed.
Casey explained, ‘Families with an average of nine different serious problems need help that gets in through the front door of their home and to the heart of what is really going on in their lives. The Troubled Families programme has been able to do that by taking a “tough love” approach and dealing with the whole family and all of its problems. This has been the start of a revolution in the way that we work with our most challenging families and which we need to accelerate in the years ahead.’
Public Health England also want to show support to parents by encouraging a culture of ‘less harsh parenting’. In their paper Local action on health inequalities (Public Health England, 2014b) they reference schemes such as the Incredible Years Programme and the NSPCC’s Improving Parenting, Improving Practice service. Both are examples of programmes that work with parents to help them develop positive relationships with their children through play sessions. The NSPCC sessions are filmed so parents, along with an NSPCC children’s worker, can watch themselves and learn more about how positive responses to their children can build strong relationships and increase their confidence in their parenting skills. The ultimate aim of these programmes is to create a warm and stable home environment, which in turn can help parents’ self esteem and encourage those who might be unemployed or low paid to want to go back to work.
Aside from national groups supporting families, help has emerged in a number of regions with local agency input. The Welsh government recently made an additional £67 million funding available for its Flying Start programme, which is helping up to 36,000 children under four and their families in some of the country’s most deprived areas. The core elements of the programme include free part-time childcare for two to three year-olds, an enhanced health visiting service, access to parenting programmes and early language development.
Surveys have shown that Flying Start has resulted in greater engagement with family services than would have been the case without the programme. Those living in Flying Start areas had on average 5.7 more visits from the health visiting team than families in non-Flying Start areas.
In Manchester, the affordable warmth access referral programme offers advice to people living in fuel poverty. Its support services include benefit and debt advice, support with home repairs and improvements and energy efficiency advice.
With a dramatic increase in referrals from across the social and care sectors research by the UK Public Health Association showed the programme resulted in an estimated 2.55 life years gained from living longer and an estimated gain in quality adjusted life years (QALYs) (per person helped) of between 1.67 and 31.16.
Collectively, programmes like these prove that schemes tackling poverty can work; the help just needs to be targeted in the right way