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 6th and final recommendation of the Marmot Review: Ensuring a Healthy standard of living for all. The priority objectives within this Policy Objective (D) propose:
- a minimum income for healthy living for people of all ages,
- a reduction of the social gradient of living through progressive taxation and fiscal policies
- 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 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 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)’.
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.’
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’.
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.
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. 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:
‘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.’
 Fair Society, Healthy Lives, The Marmot Review, 2010
 Unhealthy Lives, End Child Poverty. Available here: www.endchildpoverty.org.uk/…/Intergenerational_Links_between_c..
 Childhood Poverty and Adult Health, End Child Poverty. Available here: www.endchildpoverty.org.uk/…/Childhood_Poverty_and_Adult_Hea… Similar
 So You Think You Know About Britain, Dorling 2011, p145
 Ibid, p146
 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…
 So You Think You Know About Britain, Dorling 2011, p144
 So You Think You Know About Britain, Dorling 2011, p140