Repetition does not transform a lie into a truth

Yesterday the Centre for Social Justice (CSJ), a ‘leading think-tank’ (their description, not mine) published a report called ‘Rethinking Child Poverty’ and issued an accompanying press release calling on the government to ‘scrap flawed child poverty targets’.

Child Poverty Action Group and Channel 4’s Fact Check have already examined some of the assumptions and statistical work in the release and found it wanting, perhaps an example of the ‘educational failure’ that the CSJ mention as a cause of poverty. The CPAG report suggested that one of CSJ’s claims was ‘nonsense’ and could ‘only stem from a failure to understand the difference between the median income (the middle income) and the mean income (the average income)’ while the Factcheck blog suggests the report is ‘misleading’. Both of these responses are worth reading and I will not duplicate what they have covered.

Miles Corak, in a blog post, predicted what the criticisms of a UNICEF report released on the same day would be and his comments are also relevant to the CSJ report. He wrote that the response from critics would include:

Relative poverty rates are not poverty at all, they are measures of inequality, the critique continues, and as such can never be eliminated.

The CSJ wrote:

The first methodological flaw of the Government’s central measure of poverty is that it is defined in relative terms. The result of this is that the poor will always exist statistically, as it is inevitable that some in society will have less than others

Entirely predictable then. What is also unsurprising is the way that poverty is framed and this post concentrates on the language used in the press-release (and which is echoed throughout the report) which, once again, sets out to link poverty with individual or family ‘problems’ and behaviours. Here’s a few examples:

Poverty is about more than money – it is about the family breakdown, addiction, debt-traps, and failing schools that blight the lives of our children

the accent would be on measuring the underlying causes of blighted young lives, such as family breakdown, welfare dependency and educational failure, rather than the symptoms of low relative income

The ‘relative’ yardstick takes no account of the true, underlying causes of a deprived upbringing, for instance whether a child has the love and care of two parents, whether he or she has the role model of adults who go out to work for a living, or whether drug or alcohol addiction scars family life

Yet we know from our own extensive research as well as the research of others that the key drivers of poverty are family breakdown, educational failure, economic dependency and worklessness, addiction and serious personal debt

Other factors that should be taken into account include the ability to save, the quality of a child’s parenting, family stability because children from broken homes are twice as likely to suffer behavioural problems than those from intact families, levels of worklessness in households because children tend to repeat the work habits of their parents, access to good schools, truancy rates, drug and alcohol addiction and levels of household debt

The press-release consistently ignores the potential for any kind of link between income and family circumstance, ignores the centrality of money in our society, portrays that society as largely benign and passive and lays the blame for child poverty at the door of the parents. No mention is made of political or societal responses to these examples of ‘social breakdown which fuel’ poverty. But if family breakdown is a driver of child poverty, why are poverty rates for lone parents different in different countries? Are differing levels of unemployment symptomatic of different cultures and attitudes to work, both regionally and internationally (and what about in-work poverty). Poverty is the result of political and economic decisions and there isn’t a great deal of ‘evidence’ worthy of the name that suggests otherwise. Anecdotes are not quite the same thing.

The ‘extensive’ evidence that they mention largely consists of their own work and government commissioned research. No academic publications feature in the report at all, which should be, but isn’t, surprising. The CSJ speak highly of their Alliance, a group of over 300 ‘grassroots poverty-fighting charities’ who tell them what life is like for people in poverty. Why not speak to the people themselves rather than relying on intermediaries? Academic research (including work that we’ve covered here by Kathy Hamilton and Chris Warburton-Brown) that has actually gone out and spoken to people on low-incomes has found that money, and more specifically a lack of it, plays a central role in people’s lives.

Regular readers will know that this is an issue that we cover quite frequently here and I’m beginning to get a bit sick of reading (and writing) about this stuff, but it is, as a colleague said to me, a ‘zombie arguement’: no matter how much you think you’ve killed it off, it keeps coming back to life and, unfortunately, it appears to be particularly resilient at the present time. But, as Franklin D. Roosevelt argued,a lie does not become a truth no matter how often it is repeated.

What is particularly worrying, in my mind, is the opportunity that this intervention, and others like it, presents to the government to discuss poverty in a different way and which legitimises the ‘new approach’. There have already been reports of a desire within the government to scrap the income related targets and the CPAG response notes that:

it is difficult not to regard many of the arguments advanced in the CSJ report as little more than a smokescreen to allow the government to claim to do ‘something’ about poverty without spending any money. If poverty is about income, self-evidently we need to bolster family incomes. But those who attack poverty measures (however poorly) provide cover for the coalition to keep cutting the incomes of poor families, while claiming to champion their cause

while over on the Conservative Home website, Jill Kirby from the Centre for Policy Studies (believers in freedom and responsibility) was writing:

Given the CSJ’s reputation for researching and analysing the causes of poverty and deprivation, its intervention in the debate should provide the coalition with a welcome opportunity to replace Labour’s narrow and self-defeating policy with a more authentic and constructive approach. It could also present the Prime Minister with a chance to reaffirm his commitment to tackling social problems by supporting and strengthening families.

Many of you will be aware that Iain Duncan Smith founded the Centre for Social Justice and that Christian Guy, the MD of CSJ, is his former speech writer. It is unlikely that this report came as a shock to the government. Interesting times lie ahead….

Regards,

Steve

Miles Corak has very kindly given us permission to re-blog his post on the UNICEF report launched today – it’s well worth reading. It’s very interesting as a number of the responses he predicts from critics can be found in the Centre for Social Justice report also launched today, but we’ll discuss that in more detail on another post later on this week. Again, just to be clear – this is Miles’ post and not mine

Many thanks Miles,

Regards,

Steve

Economics for public policy

David Morely, UNICEF Canada’s Executive Director, has just issued a bold challenge. “It is clearly time for Canada to prioritize children when planning budgets and spending our nation’s resources, even in tough economic times,” says a press release announcing the publication of a report on child poverty.

In fact, the UNICEF Innocenti Report Card released today is the 10th in a regular series on child poverty in rich countries, each report hitting the headlines every second year or so.

Sadly, when it comes to discussions of child poverty kick-started by these reports there are two things that are not new: the conclusions; and the reaction of pundits and many policy makers. I say “sadly” because the two are not linked, and public policy discussion is not the better.

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The Trouble with ‘Troubled Families’ (Part 3)

“Turning round the lives of these families is a core element of our strategy”

On page 39 of the government’s child poverty strategy, the above line can be found in relation to the ‘120,000 families in England with multiple problems.

This is consistent with the ‘new’ approach to tackling poverty in identifying familial issues and ‘problems’ as the ’causes and drivers’ of disadvantage and focussing on the most vulnerable and the most disadvantaged. This post explores why it is problematic that the troubled families agenda has become a ‘core element’ – both implicitly and explicitly – of the ‘new approach’ to tackling child poverty.

In our first post on this subject, we identified that these 120,000 families were identified back in 2004. (See Ruth Levitas’ working paper on ‘troubled’ families for a fuller critique of the problems with the identification of 120,000 such families). In 2004, there were 2,800,000 children living in households with less than 60% of the median income. That means that, unless the 120,000 families identified in the same year all have lots of children (and there’s no evidence that they have) they probably account for a relatively small percentage of families with children living in poverty. If the composition of each family mirrored the household composition of children living in households in poverty then this would still only account for around 11% of children living in poverty (a very approximate figure). This is, of course, far lower than the 55% of children in poverty living in households where someone is working, for example. It is also worth noting that whilst the government assumes that the number of ‘troubled families’ has remained static since 2004, research on poverty dynamics carried out by JRF in 2007 highlighted that ‘Point-in-time studies underestimate the scale of poverty in the UK’ and so the percentage of families in poverty or at risk of poverty who have multiple problems is probably much lower than 11%.

Also, in many cases with these families, and because of the criteria, work may not be the best or most appropriate solution for them. The lives of families where there are  maternal mental health problems and/or ‘a long-standing limiting illness, disability or infirmity’ may not be ‘turned around’ by the introduction of (probably low paid) work into their lives.

This situation wouldn’t be as ‘troubling’ if the definition and portrayal of ‘troubled families’ had remained close the original criteria of having 5 of 7 specific disadvantages. These are:

• No parent in the family is in work;
• Family lives in overcrowded housing;
• No parent has any qualifications;
• Mother has mental health problems;
• At least one parent has a long-standing limiting illness, disability or infirmity;
• Family has low income (below 60 per cent of median income);
• Family cannot afford a number of food and clothing items.

Concerns arise through the conflation of these ‘problems’ with problem behaviours as we have discussed before.  The government consistently identifies ‘the family’ as the appropriate place for ‘intervention’. Section headings on ‘Reducing the impact of family breakdowns’, ‘Improving parent’s learning and skills’ and ‘We are supporting strong parenting’ all identify family troubles as issues that require intervention if poverty is to be addressed. In this narrative, the sources of poverty are problems within a household and the ‘most disadvantaged’ are those families with the most problems.

In the child poverty strategy, the criteria above is included as a footnote. The second paragraph in the section ‘Supporting families with multiple problems’ notes that ‘The Prime Minister has appointed Emma Harrison, an entrepreneur who specialises in getting jobseekers into work, to lead part of the work to support families with multiple problems’. This work was called ‘Working Families Everywhere’ and was focused on the 100,000 ‘never worked’ families, as Harrison called them. So the 120,000 families are, in the child poverty strategy,  instantly associated with families that have never worked. They have also been linked, by David Cameron, with the riots last summer and the government’s quest for social justice. ‘Problem behaviours’ among people on low incomes have also been identified by Iain Duncan Smith on a number of occasions to justify the new approach to tackling child poverty:

Take a family headed by a drug addict or someone with a gambling addiction – increase the parent’s income and the chances are they will spend the money on furthering their habit, not on their children.

(2011 Families and young people in troubled neighbourhoods speech at the LSE)

Ask yourself this: what happens to the children of a drug addict if you increase their welfare payments? Is their family really pulled out of poverty? When you measure the effect on real life outcomes, the extra money may actually have made things worse. You have failed to tackle the root cause of the problem – the damaging addiction. As the extra money is spent on drugs, so the dependent family continues to live in poverty, for unless something changes in the adult’s life, nothing changes for the child.

(2011 Keith Joseph Lecture)

The constant linking of poverty and ‘problem’ behaviours is not accidental. If turning around the lives of 120,000 troubled families is a core element of tackling child poverty, one can only assume that the other families living in poverty also behave in similarly problematic ways, but perhaps not to the same extent. Of course, there is nothing ‘new’ about this ‘behaviourism’ approach as John Veit-Wilson noted in 2000:

Poverty is expressed in the form of unacceptable behaviours deviating from the ‘respectable’ behavioural norms of dominant society or as dysfunctional to standards of conformity, for instance as the deprived or depraved lifestyle of a subculture or ‘underclass’. The inadequacy of people’s power over resources is seen as irrelevant to the question of how they behave.

Best wishes,

Steve

***The Troubled Families agenda was covered by Radio 4’s ‘More or Less’ programme a couple of weeks ago where Professor Ruth Levitas highlighted some of the issues with the approach and, in lieu of a spokesman, a statement from the government was also interviewed. It is well worth a listen if you have 10 minutes or so and can be found here***

The trouble with troubled families (Part 1) can be found here

The trouble with troubled families (Part 2) can be found here

Guest Post: Aspiration. Where is it?

Guest Post by Rebecca Fisher

Working for an international volunteer organisation, it’s easy for me to take for granted the benefits that travel, cultural exploration and volunteering can have on an individual and the way a person views the world and their place within it.

The importance of aspirations has been discussed heavily in education policy and practice in the past few years, with some arguing that it is a lack of aspiration within low-income families which causes a lack of aspiration in their children, resulting in low levels of social mobility in deprived areas in the U.K., something being discussed by Nick Clegg today, on the first anniversary of the launch of the Social Mobility strategy

With the help of some funding, Madventurer was able to take a group of volunteers from a school within a disadvantaged area in the North East of England, to work on a community development project in Ghana in 2011. The school has transformed itself over the past few years and affirms that one of its aims is not to raise its students aspirations , but to allow its students to “pursue their own ambitions.” However, due to questions raised by the press and certain politicians, one might be inclined to ask what these ambitions are, or if they even exist, although recent research by the Joseph Rowntree Foundation questions some of these assumptions.

Due to the funding received, the cost for the students’ trip was minimal, which meant that the trip was open for all to apply to, regardless of financial background. Recruitment for this trip was based upon interviews which students had to prepare and present to a panel of impartial judges, and 13 students were selected based upon their ideas and passion for working within the community in Ghana and not on their ability to pay for the trip.

In October 2011, the Madventurer crew travelled to Ghana with the school group, and during a 2 week trip the students worked very hard, completing the construction of a 4 classroom block for a community school and working with the local students in the afternoon in a cultural and educative exchange. I have worked with young volunteers on different projects in the past, but it was not until this school trip that I witnessed such a striking change and development in the volunteers. I think this was due to the fact that the students had never experienced, or even considered, embarking upon a trip like this before and the effect it had on them was significant. When discussing with the teachers what they viewed as the biggest developments for the students they all agreed it was not that they became ambitious or aspirational, but that they realised what their ambitions and aspirations could be and how they could reach them.

Dependent on funding, Madventurer strives to take as many youth and school group volunteers from local areas throughout the UK on overseas development projects as possible, due to the positive development seen in the volunteers’ and the results witnessed after their return. On our youth and school volunteer group trips in the past, we have seen volunteers realise their career paths: one volunteer going on to study Architecture after completing an African Art Project at school following their trip; three young volunteers pursuing careers as youth workers; and one of our volunteers from last year now wants to pursue a career in international development and will be completing her work experience in Madventurer’s UK office this summer

I returned to the school last week to carry out a presentation for the students who will be volunteering with us this October. My presentation included pictures and video footage from the project last year and all of the students were moved and excited about these past achievements and the possibilities that this year’s project holds. For me, this reaction and the successes of past projects with young volunteers, shows how it is not a lack of ambition or aspiration within children from low-income backgrounds which is inhibiting social mobility, but that they have perhaps not been given the opportunity to discover what their aspirations could be and how they can reach them.

Rebecca Fisher

Head of Global Volunteering

Madventurer

Madventurer provides sustainable and ethical projects worldwide, pursuing development, global education, cultural exploration and life changing experiences. Madventurer is a not-for-profit organisation which helps raise funds for the MAD (Make A Difference) Foundation – Registered UK Charity No 1111805.

www.madventurer.com

Inclusion or stigma?

Last Friday, Dr. Kathy Hamilton from the University of Strathclyde gave a seminar in Durham on ‘Inclusion or Stigma? Low Income families and coping through brands‘. The paper that the seminar was based on can be found here and the presentation that Kathy delivered can be found here or by clicking on the image below

The seminar was very well received and three things in particular struck me about Kathy’s presentation.

1. Household budgeting

Kathy noted that many of the households considered spending money on ‘brands’ (visible consumption) to be ‘non-discretionary’ and spending on goods and services consumed within the household (invisible consumption) was considered to be disretionary. This was a strategy to ‘protect’ the children in the household from bullying or stigma (or from obtaining the goods using illicit methods) and reminded me of Chris Warburton- Brown’s work on maternal deprivation. (If you haven’t read his blog, please do so here and his presentation at another of our seminars can be found here)

2. Exclusion

The presentation contained a couple examples of ‘strong’ versions of social exclusion. John Veit-Wilson (1998, p45) identified that ‘weak’ versions of the social exclusion discourse focus on changing individuals characteristics whereas stronger versions ‘also emphasise the role of those who are doing the excluding’. This was particularly the case with the lone parents who felt empowered and independent by caring for their children without the support of the father whilst the wider societal discourse of ‘single mothers’ saw them as reliant on welfare; and with the consumption practices that help inclusion at a micro (neighbourhood) level provoking the threat of stigma at a macro (wider societal) level. Here’s a good ‘applied’ example from the Sunderland Echo which reports that ‘Sunderland bar bans ‘chavs’ in bid to end trouble’. The manager of the bar states that there will be ‘no labels which are classed as undesirable‘ (my emphases)

3. Social Marketing

The pervasiveness of the market and the potential (or otherwise) of ‘social marketing’ generated a lot of discussion during the panel session. The idea that an activity (marketing) that is involved in generating the stigma and exclusion that we were discussing could also form part of a strategy to address the exclusion reminded me of a paper (on social capital) by Smith and Kulynych. They argue that:

there are many problems with using a vocabulary … drawn from the predominant economic model to overcome the deficits of this model (p160)

and that

the use of the language of the stock market to discuss … the amelioration of social problems reflect the seeming hegemony of capitalism (p166)

This ‘language of the stock market’ includes not only social marketing and social capital but also, for example, ‘ethical consumption‘, ‘social return on investment‘, ‘ethical finance‘ and ‘sustainable development‘. Smith and Kulynych propose that these terms:

serve to make the social, economic and political relations that characterize capitalism appear a largely natural and inevitable aspect of human activity, as well as to help legitimate these relations.

In other words, the market is often presented as the answer, no matter what the question. This approach, it could be argued, can also be seen in the ‘new approach’ to tackling child poverty in the UK.

But these are just some of my thoughts. As ever, we’re always keen to hear yours……

Steve

*Many thanks to Kathy Hamilton for leading the seminar, Nick Ellis for chairing it and to Alison Garnham, Jeremy Cripps and Victoria Wells for taking part in the panel discussion.

A couple of days before the event, Helen Goodman, the Shadow Media Minister, who was hoping to attend the seminar, called for curbs on advertising directed at children

Freedom’s just another word……

I have recently had cause to re-acquaint myself with the Government’s Child Poverty Strategy and was struck by often the word ‘freedom’ is used. It appears 9 times in total, all in relation to reforms which will ‘strip away’ or ‘lift the burden of’ bureaucracy. The full list of appearances is below:

…radical reform of the skills system based on the Coalition principles of fairness, responsibility and freedom.

They (Work Programme providers) will have the freedom to design and implement innovative services which focus on individuals’ needs.

…giving local authorities the freedom to make better use of social housing through control of their own income, expenditure and planning process.

 The White Paper sets out how the Academy programme raises standards, particularly in disadvantaged areas, by giving power and freedom back to head teachers and teachers.

 We want teachers to have greater freedom to use their professionalism and expertise in order to help all children progress

 the transparency agenda will reinforce these new freedoms, allowing communities to influence and challenge their local services

The new Work Programme will give providers the freedom to tailor help to individuals and in return will pay according to results

The Government is currently reviewing these and other statutory duties to make sure they strike the right balance between giving local authorities the freedom and discretion they need to get things done, whilst protecting the most vulnerable people

Our reforms will strip away bureaucracy and give local partners the freedom to focus on the needs of communities whilst being held accountable for achieving positive outcomes for families

In contrast, other words and phrases that one might expect to feature regularly in a child poverty strategy do not appear nearly as often:

 the word ‘rights‘ only appears in the main text of the document four times, and only once in relation to children’s rights.

‘in-work poverty’ only appears twice in the main text, despite over half of the children in poverty living in a household where an adult works.

‘adequate’ and ‘minimum’ do not appear at all in the main body of the text

‘standard of living’ appears twice – in the context of severe poverty: ‘Evidence suggests that there are those with seemingly very low incomes who still have a reasonable standard of living’

So freedom from state bureaucracy obviously plays an important role in the ‘new approach’ to tackling child poverty and the ‘old approach’ is characterised as being over-generous with benefits, leading to ‘entrenched benefit dependency’.  However, this focus on freedom for service providers reminded me of a chapter I read in the David Harvey book ‘A brief history of neo-liberalism’ a little while ago. He argues, with the help of Karl Polanyi, that:

Planning and control are being attacked as a denial of freedom. Free enterprise and private ownership are declared to be essentials of freedom. No society built on other foundations is said to deserve to be called free. The freedom that regulation creates is denounced as unfreedom; the justice, liberty and welfare it offers are decried as a camouflage of slavery

He goes on to say that:

the idea of freedom … degenerates into a mere advocacy of free enterprise, which means ‘the fullness of freedom for those whose income, leisure and security need no enhancing and a mere pittance of liberty for the people, who may in vain attempt to make use of their democratic rights to gain shelter from the power of the owners of property’

At a time when non-participation in the labour market brings increased attention from the state through a variety of ‘capability assessments’, ‘work experience’ style programmes and the potential extension of conditionality to those in work, it is, perhaps, a surprising contrast to look at the extent of the freedom from state intervention being proposed for service providers.

Any thoughts?

Steve

***Update*** Adrian Sinfield contacted me today (18/05/2012) to provide me with a quote from an older Conservative MP, Harold Macmillan, who declared in 1938, in The Middle Way, that:

‘Freedom and poverty cannot live together. It is only in so far as poverty is abolished that freedom is increased’ (1938, pp 371-2).

Quite a contrast from the ‘new’ approach.

Many thanks Adrian,

Steve

The Right to be Heard (and to blog and tweet….)

I’ve been lucky enough to attend two fascinating seminars in the last week that have explored rights based approaches to tackling poverty. Aoife Nolan discussed ‘Child Poverty & the Law’ in Newcastle last week and Ruth Lister presented on ‘Power not pity’ in Durham earlier on today. I intend to post some (most likely jumbled) thoughts on those discussions at a later date but one of the things that was mentioned at the event today was the potential for social media to help give people with direct experience of poverty a voice and so I thought I would share a couple of examples that I’m aware of and ask readers to share others via the comments facility. So here goes…..

(Clicking on each of the pictures should take you to the original source)

The Wrong Trainers

A series of short animated films narrated by children and produced by the BBC

 

Spent

An excellent short interactive game produced in the USA but which travels well and which forces players to make decisions that people on low incomes have to make every day…..

Benefits. A lifestyle choice

A short 4 minute film, fittingly made on a low budget, by the Poverty Alliance as part of their EPiC (Evidence Participation Change) project which seeks to give people with experience of poverty a voice in decision making processes.

All of the above examples, you will have noticed, have involved organisations using social media tools to promote the views or experiences of individuals or groups with experience of poverty so these experiences are still, well, mediated to some extent.

The best examples I have come across in terms of individuals (as opposed to organisations) using social media have been those involved with the Spartacus Report calling for responsible reform, and associated with campaigning around the Welfare Reform Bill. Blogs such as ‘Benefit Scrounging Scum’, ‘Diary of a Benefit Scrounger’ and ‘The Broken of Britain’ all document daily life dealing with disabilities by the people who directly experience disability.  I’m not aware of any similar blogs which exist that deal more explicitly with life on a low income. I’m sure there must be some…..

The situation for child poverty is, of course, complicated further when children might be involved, although this example from Newcastle City Council’s Children’s Rights Team, made with the help of 300 young people, called ‘Our Lives. What we do. And where we live’ shows it can be done.

We also re-blogged a post earlier this week about a photographer who has used Google maps in the US  to highlight images of poverty and there is nothing to stop individuals doing this. Children North East are also currently exploring ways to develop their work with children and young people using social media and we will keep you updated with this as and when it comes to fruition.

Finally, before I leave you, here’s a particularly uplifting social media event advocating Power to the People in Tynemouth. Not particularly poverty related and not necessarily involving people on a low income, but a good example (I hope) of the potential of social media to bring people together, do things they might not usually do, generate discussion, convey messages and promote events and stories that mainstream media may not be particularly interested in…..

So, please share your knowledge with us and, indeed thoughts about the potential of social media to help facilitate people with poverty having a greater say in discussions about poverty. Without your input, it’s not really ‘social’ is it?

Best wishes,

Steve

A New American Picture: Doug Rickard

I came across this post a couple of days ago and thought it was worth ‘re-blogging’ it here. Regular readers will be aware of the participatory photography project that Children North East, a regional children’s charity, have done with children and young people using disposable cameras to capture their daily lives and experiences of poverty and this project/piece of work is quite similar, albeit in America.

It looks like it could be a good way to develop a similar project with a potentially wider audience and engage people with experience of poverty in discussing what their daliy life is like and how poverty impacts on them.

Jessie Sutherland

Doug Rickard captures U.S. Poverty from the comfort of his own home – with the use of Google Maps. I am interested in what these images mean to the role of the documentary photographer. How has technology changed the way people interact with each other and experience the world? This work brings up a lot of interesting questions for students to ponder. See more here.

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Ensuring a Healthy standard of living for all

The only one of the six recommendations that the Marmot Review on Health Inequalities that hasn’t been taken up by the Coalition Government is ‘Ensuring a Healthy standard of living for all’.

Last week we responded to a Department of Health consultation on health outcomes for children and young people. The consultation focused on a number of health related outcomes but our response focused solely on public health issues and the role that poverty and inequality play in children’s health and health inequalities. This post is based on our response, which framed ‘the health service’ in the context of a broader welfare state. Our response drew on existing evidence and was largely based on 2 summary papers published by the End Child Poverty campaign. These reports, along with other background reading I undertook, proved to be painful reminders of the effects of poverty. ‘Poverty’ may be a social construction (or a political one as someone suggested to me last week, asking why I ‘envied’ the rich) but the effects of poverty and inequality are well documented social facts that cannot be denied. The government’s child poverty strategy refers to the ‘so-called’ social gradient, although health does feature quite prominently in the document, mainly in relation to funding and structural reforms which will ‘incentivise’ improved health outcomes for poorer communities.

Sections in bold are questions asked by the consultation documents. 

In your view, where is the health service falling short for children and young people, what is our weakest link and what can we do to improve things to make sure it makes a real difference to the lives of children and young people?

The NHS / ‘health service’ is not the only tool at the government’s or society’s disposal to improve health, especially where public health is concerned. It is with public health outcomes for children and young people, especially those living in poverty or low-incomes that this response is concerned with.

We believe that the health service is falling short for children and young people by not adopting the 6^th and final recommendation of the Marmot Review: Ensuring a Healthy standard of living for all[1]. The priority objectives within this Policy Objective (D) propose:

1.  a minimum income for healthy living for people of all ages,
2. a reduction of the social gradient of living through progressive taxation and fiscal policies
3. reducing the cliff edge faced by people moving between benefits and work.

There is a large amount of evidence (which will be known to the health service and does not need recounting here) which demonstrates that making progress on these 3 fronts would have a significant positive impact on the health and well-being of children and young people from poorer families.

The ‘weakest link’, we would argue, is the number of children living in or at risk of poverty in the UK. In a paper for the End Child Poverty campaign[2] Donald Hirsch and Professor Nick Spencer have written that: ‘Poverty is the greatest preventable threat to health, and tackling it is fundamental to addressing health Inequalities and boosting life chances’

and that the

evidence has profound implications for public policy. It suggests that effective action to tackle child poverty would make an important long-term contribution to many health-related policy objectives, including reducing obesity, reducing heart disease, increasing breast feeding and improving mental health.

Not only does child poverty affect health during childhood, but it also affects adult health as well. In a separate paper[3] drawing on over 70 different studies, Professor Spencer argues that:

it is now clear that poverty and low socio-economic status in early life adversely affect health in ways that transmit across time and contribute to poor adult health. In other words, poor social circumstances in childhood are associated with poor health both in childhood itself and in adult life

In the UK, we are aware of the Inverse Care Law, where the people that need health services the most are the least likely to access them and often receive the worst treatment. Professor Danny Dorling, in a recent book called ‘So you think you know about Britain’ highlighted that:

‘our doctors tend to live and work in the areas where the fewest people are ill (which is in no small part caused by drawing almost all young medics from such a narrow set of privileged backgrounds and then paying them so highly for their services)’.[4]

Dorling also notes a ‘positive care law’ in relation to

‘the correlation between the locations of the population with health needs and those providing many hours of unpaid care a week.’[5]

A ‘revaluing of care’ is needed so that care provided by parents and carers for children and young people is recognised. The financial cost of having children should be recognised through the benefits system but unfortunately a number of child and maternity related benefits have either been stopped or frozen, reducing their real value. In a paper called ‘The Cuts: what they mean for families at risk of poverty’ CPAG highlight that a baby born in a low income family in April 2011 is ‘around £1,500 worse off compared to a sibling born in April 2010’.[6]

With so many different parts of the health system in place, what do they need to focus on and improve to make sure they each work together to deliver the best possible health service for children and young people ?

 The work of ‘You’re Welcome’ is important in ensuring that health services take the needs and views of children and young people into account when designing and delivering services.

At a time of unprecedented change and fragmentation of services within the NHS, it is difficult to know how the health system will emerge but we would argue that addressing the social determinants of health and the income inequalities that exist within our society are as important as changing the structure of the NHS. Dorling notes that, despite recent re-structuring and increased spending in the NHS:

In poorer neighbourhoods in poorer parts of the country mortality rates have hardly fallen in the most recent decade and the numbers of people reporting they are suffering from a debilitating illness have risen quickly. In contrast, in the most affluent areas of the country, life expectancy has in some years been rising by more than a year per year, a rate that is impossible to achieve for long without securing immortality, and rates of reported illness and disability in such places have been falling rapidly.[7]

We know that socio-economic status has a profound impact on children’s health – and that of their parents and it is these underlying causes of poor health that need to be addressed as urgently , if not more so, than changes to the structures of clinical health services.

Is there anything else you’d like to tell us?

The profound impact that poverty and low income has on health is already well known and relatively uncontested. As such, there is not much more that we can tell you.

It is, however, unfortunate that despite this knowledge, independent estimates predict that the government’s policies will see an increase in child poverty in the coming years[8]. This news comes at a time when low income families are facing large reductions in their standards of living. As such, it is unclear how the health of these children will improve when their economic and material circumstances are deteriorating.

We have known since Victorian times that poverty affects health and so eradicating poverty must be central to any attempts to improve the health outcomes of children and young people. Dorling illustrates this graphically when he writes[9]:

‘Unfortunately, we will always suffer from child mortality, but there is no good reason, other than because of our greed and ignorance, for those mortality rates to be higher for children from poor families.’

You still have time to respond to the consultation as the deadline was extended until 31 May 2012. The link to the consultation is below:

http://healthandcare.dh.gov.uk/children-say/

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[1] Fair Society, Healthy Lives, The Marmot Review, 2010

[2] Unhealthy Lives, End Child Poverty. Available here: www.endchildpoverty.org.uk/…/Intergenerational_Links_between_c..

[3] Childhood Poverty and Adult Health, End Child Poverty. Available here: www.endchildpoverty.org.uk/…/Childhood_Poverty_and_Adult_Hea… Similar

[4] So You Think You Know About Britain, Dorling 2011, p145

[5] Ibid, p146

[6] The Cuts: what they mean for families at risk of poverty, CPAG, 2012. Available here:  www.cpag.org.uk/CPAG_The_Cuts_what_they_%20mean_feb%202…

[7] So You Think You Know About Britain, Dorling 2011, p144

[8] Child and Working Age Poverty from 2010 – 2020, Institute for Fiscal Studies 2011. Available here: http://www.ifs.org.uk/publications/5710

[9] So You Think You Know About Britain, Dorling 2011, p140