The UK has one of the most unequal distributions of wealth of all western countries and a new report today by the Social Metrics Commission (SMC) revealed that 4.5 million people are more than 50% below the poverty line, and seven million people are living in persistent poverty.

This is sobering reading given that children and families living and growing up in poverty and low-income households are at risk of many negative health and social consequences during childhood and into adulthood. 

There is a raft of evidence linking poverty with ill-health. 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.

Figures show that there are 4.6 million children living in poverty with half living in persistent poverty, meaning they are in poverty now and have also been in poverty for at least two of the previous three years. Most also live in a family where someone is disabled.

Compared to the UK average of 22%, poverty rates are higher in Wales (24%) and London (28%) and lower in the South East (18%) and Scotland and Northern Ireland (both 20%).

Poverty and poorer health outcomes

According to NHS Scotland, there are several ways in which living in poverty can lead to poorer health outcomes in children, as well as into adulthood. Being exposed to some or all of the key factors below, as well as the accumulation of exposure over time, can adversely impact on child development and health outcomes.

  • Limited money for everyday resources - including good quality housing
  • Stress of living in poverty
  • Unhealthy lifestyles
  • Poorer education and employment opportunities.

Kerry McKenzie, NHS Health Scotland’s Organisational Lead for Child Poverty, said: “The healthy development of our children leads to higher educational attainment, positive social development and better health.  It’s not right that this is severely compromised by living and growing up in poverty."

She said that child poverty should not be accepted as inevitable and that the evidence is clear that tackling poverty is possible and requires action on the drivers of poverty by increasing income and reducing costs for families with children.

She added: “More than two out of three children living in poverty in Scotland are in working households. In-work poverty can be tackled by increasing wage levels, creating sustainable employment opportunities and providing suitable, affordable childcare. Providing financial support through fair social security can also influence health positively."

Better public health interventions to address unequal distributions of wealth 

Last year the Child Poverty Action Group (CPAG) and the Royal College of Paediatrics and Child Health 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.

Inadequate housing, homelessness, food insecurity, and the stress and stigma of poverty affect children’s physical and mental health in a myriad of ways. 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. 

Josephine Tucker, Head of Policy and Research at Child Poverty Action Group, said that one of the most striking findings to her 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.

She added: "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."

Childhood mortality rates and poverty

The Lancet also published a report last year that stated that better public health interventions to improve a new mother’s health before and during pregnancy could improve childhood mortality rates. 

It looked into the reasons why England and Sweden have different childhood mortality rates after researchers found that deaths in children under-5 years old occur one and half times more often in England than in Sweden. The difference is largely due to children in England typically weighing less at birth, being born earlier, and having more birth anomalies (such as congenital heart defects) than in Sweden.

However, the researchers said, as the UK and Sweden having similar levels of economic development and universal healthcare, Sweden’s lower mortality rates should be achievable within the UK. 

Good maternal health (including maintaining a healthy weight, avoiding chronic illnesses such as diabetes, high blood pressure, psychological stress and infections) and health behaviours (such as a healthy diet, and avoiding smoking, drugs and alcohol during pregnancy) are associated with healthy fetal development during pregnancy. However, many adverse maternal characteristics are more common in England than in Sweden.

Spending cuts to Sure Start should be reversed

Recently, a Institute for Fiscal Studies report found that Sure Start, a programme targeted at parents and children under the age of four living in the most disadvantaged areas, had major health benefits for children.

Sure Start significantly reduced hospitalisations among children by the time they finished primary school and that these effects built over time. It found no significant effect at age 5, but by age 11 greater Sure Start coverage prevented around 5,500 hospitalisations per year (18% of the pre-Sure-Start baseline). It also found that at younger ages, a reduction in infection-related hospitalisations played a big role in driving these effects. At older ages, the biggest impacts were felt in admissions for injuries.

At its peak in 2009–10, Sure Start accounted for £1.8 billion of public spending (in 2018–19 prices), about a third of overall spending on programmes for the under-5s. But in the decade since, the context has been one of funding cuts, consolidation and centre closures, with funding falling by two-thirds to £600 million in 2017–18.

The way ahead?

Philippa Stroud, Chair of the SMC and CEO of the Legatum Institute, said: “It is concerning that overall poverty has remained at almost the same level since the early 2000s, under Governments of all colours. But it is also clear that beneath the surface there are significant differences in the experience of poverty among different groups of people. Decisions made by policymakers can have a significant impact on who is in poverty and how deep and persistent that poverty is. These new findings highlight the urgent need for a more united and concerted approach.

“The Commission brings together perspectives from the right and left, and all of us are committed to establishing a consensus on poverty measurement. I call on people and organisations from across the political spectrum to support this new approach so that we can all put our energy into creating the policies and solutions that build pathways out of poverty.”