New Working Paper – Child Poverty & Public Health

“The foundations for virtually every aspect of human development – physical, intellectual and emotional – are laid in early childhood”

Professor Michael Marmot

“Poverty is the greatest preventable threat to health, and tackling it is fundamental to addressing health inequalities and boosting life chances”

Professors Donald Hirsch & Nick Spencer

 In July 2013, a joint letter was sent by to the Lead Members for Children’s Services and Chairs of Health and Wellbeing Boards, calling for local authorities to do everything they can to improve children’s health. The letter included a request to sign up to a ‘Better health outcomes for children and young people’ pledge.

We have today published a new Working Paper – DUBS_ILG_NECPC Working Paper 3 – from the North East Child Poverty Commission, based at the Institute for Local Governance, in Durham University Business School. The paper highlights the links between child poverty and health, provides background information on the situation in the North East and identifies ways in which local authorities can help to tackle poverty and mitigate its effects. There is much that local authorities can do to improve children’s health. Policies relating to education, employment, housing and welfare support can – and should – all have a positive impact on children’s health. However, in a report exploring the ‘prevalence, characteristics and distribution’ of child poverty in the North East, Professor Jonathan Bradshaw noted that “Most local authorities in the NE have worse child health than you would expect given their child poverty” (p2, 2009) and “on health, it is striking how many areas in the NE are doing much worse than would be expected given their material well-being rankings” (p29). The paper draws on research that argues that attempts to tackle health inequalities and improve the health of disadvantaged communities ‘needs to move beyond ‘bad behaviours” (Katikreddi et al 2013)

As well as the information and resources provided in the Working Paper and the Appendix to the joint letter, further resources and information relating to public health can be found on the FUSE website  (FUSE is the Centre for Translational Research in Public Health in the North East) and the Wolfson Research Institute for Health & Wellbeing, based at Durham University. The Wolfson Research Institute has a specific Research Theme of Tomorrow’s Healthy Adults which ‘focuses on children and young adults, specifically targeting issues that will determine their long-term health and wellbeing’.

If you have any questions about the Working Paper, please do not hesitate to contact me.

Best wishes,

Steve

An idea whose time has come….

We, in the North East, are often accused of ‘lagging behind’ other regions in various ways, although I’m not entirely sure how many sleepless nights this causes in the region. One area where it would have been nice to have been leaders rather than followers, however, is in recognising the importance of paying employees a Living Wage. In case you’ve missed it, this week is Living Wage Week in the UK and the new rate of £7.45 per hour was announced by Julia Unwin, the Chief Exec of JRF, on Monday.

The Living Wage Foundation also released a list of accredited Living Wage employers which, unfortunately, did not contain any local or regionally based organisations. However, it is not all bad news (in fact there’s some very good news and reasons to be optimistic about the future pay for the lowest paid employees in the region. Here, then, are some reasons to be cheerful:

• Scotswood Natural Community Garden in the West End of Newcastle are an accredited Living Wage employer (we believe they are the first and only organisation based in the region – although they don’t appear on the list) and, as a small charity reliant on grant funding for most of their income, they deserve praise for taking the step towards being a Living Wage employer. They have chosen to become a Living Wage employer, I understand, because it fits with their aim of promoting sustainable living.
• Newcastle City Council have become the first public sector organisation in the region to commit to being a Living Wage employer, although they have decided not to pursue accreditation at this stage. They are also encouraging other employers in the city to also become Living age employers and one large property development company responsible for the regeneration of a large area of the city centre is exploring the financial implications of paying the Living Wage to staff in a new hotel that is planned.
• Durham University Labour Club have started campaigning on the issue of a Living Wage to get Durham University to become a Living Wage employer. They have written an excellent blog on the subject which highlights that one of a PVC for Durham wrote in a JRF report exploring how universities could help disadvantaged communities that they can ‘also set an example to other employers by promoting good practice, such as ensuring that all employees are paid at least the Living Wage’. They have also set up a petition which will be delivered to the University and I would encourage people to sign it.
• The Northern TUC (who have been quite busy recently with work around regional pay in the public sector) are continuing to work with a number of public sector organisations in the region to encourage them to become Living Wage employers. They are holding what is likely to be an excellent and packed event in Middlesbrough tomorrow (Friday 9th November) to discuss the reality of austerity and what poverty pay means for millions of workers across the UK.
• This post is part of a Blog Action Day, organised in conjunction with VONNE, the umbrella body for the voluntary sector in the North East. Jo Curry, their Chief Exec, recently spoke in favour of the Living Wage at an event where the role of the institutional behaviour of organisations in producing and reproducing poverty was discussed. Carrie Brookes has written an excellent blog summarising some of the issues facing voluntary sector staff here and the issue was also discussed at the Newcastle CVS AGM earlier this week. Jeremy Cripps, the Chief Exec of Children North East is also due to publish a blog about the subject here. In other words, the voluntary sector in the region are now talking about the Living Wage and what it means for them….

So, it is rare that David Cameron and I are in agreement, but on this we are. He said that the Living Wage was ‘an idea whose time has come’ and it appears that us folk in the North East are beginning to think he may just be right.

Unfortunately, the Prime Minister has not felt it unnecessary to act in support of his statement since becoming Prime Minister. We, however, will extend an offer to any representatives from employers in the North East reading this blog. We, the North East Child Poverty Commission, will work with you to provide you with as much information and support as we can possibly can to demonstrate that paying a Living Wage can be a very good, sound business decision. I’m sure the Northern TUC and the Living Wage Foundation will make similar offers, if appropriate.

Kind regards,

Steve

An excellent summary of Living Wage week coverage can be found here and also using the hashtag #Livingwage on Twitter

Surviving or Thriving case study: Scotswood Natural Community Garden

Guest post by Amanda Hannen (VONNE)

Q & A

Scotswood Natural Community Garden

August 2012

The Scotswood Natural Community Garden aims to promote learning about nature, the environment and sustainable living in Scotswood, Newcastle upon Tyne. The Garden itself is a beautiful and wild site of more than 2 acres where a range of activities for children and adults are run. The Garden’s activities include educational workshops for schools, Forest Schools, volunteering opportunities for adults, a weekly youth club and regular community open days.

VONNE talked to Chris Francis at Scotswood Natural Community Garden about the impact of the spending cuts and the recession on their youth work programme:

Can you describe the impact of the spending cuts and the recession on your organisation?

At the moment there’s been very little impact because our youth programme is funded by Children in Need and we are just in our first year of a three year tranche of funding from them, so in terms of the general work we do there has been no reduction there. We have also applied for some small amounts of funding to top up the Children in Need fund to cover some of the activities that the organisation does with children and we’ve been successful with £1,000 here, a £1,000 there – that sort of level of income. If you’ve got three years of funding then in that time you’re quite comfortable and happy to continue, it’s when we reapply that we’ll be in a more competitive market and the situation could become more critical. I guess in two years time we’ll be thinking about resubmitting when the money runs out the end of October 2012. The concern is when we go back to Children in Need in two and a half years time, we’re aware that there is going to be more demand on those funds.

In terms of the [impact on] people we work with, this part of Newcastle is fairly deprived so the fact that there are fewer jobs around, increased pressure on families and less people working for local authorities with their cutbacks, there is less support available to families out of work.

Can you tell us about changes you have seen around you which might have an impact on your organisation or your sector in the future?

We know that in the west of Newcastle there’s been a change in the city councils tender process for delivery of youth work in the area, resulting in the latest contract going to a large organisation who didn’t really have much of a presence in the West End of Newcastle. One or two smaller organisations that are based here have missed out on that funding and it’s certainly caused a bit of uncertainty and anxiety amongst those groups that had the [city councils] funding. There’s meant to be dialogue between those groups to see how all that moves forward. We didn’t have money from that source so we haven’t been directly affected.

It’s a tricky one because I’ve been here for about 11 months now and the whole tendering process is something I’ve not been involved in before this job. I’d been on a few training courses and the advice we were given then was basically follow the money. If you apply and don’t get it, and a larger or national organisation does go and talk to them to offer your help in delivering it and subcontract.

The other change I’m conscious of is the number of local authorities that are moving their services out into new charitable organisations – I’m aware that North Tyneside has done that with their leisure services – their country parks. They’ve created a new charity, which will be able to apply for sources of funding that in the past the local authority couldn’t possibly have applied for. This will obviously put them in competition with people like us for those sources of funding. So, I can see that being a problem, I can’t define the problem but it will mean there’s more demand on funding pots as they [Local Authorities] create more charities to do this work and they all apply to the same pot. That will have an impact.

What do you think your organisation might do in the lead up to the funding coming to an end?

We’ll certainly talk to Children in Need who have funded us so far, going back to them for further funding. They are impressed with what we do and I think what we do here is fairly impressive, the kids do benefit enormously. So going back to them would be the first point of call. If that wasn’t successful or we had indications that that wouldn’t be successful we would look at other grant making bodies really. We have looked at tendering but the issue is that if you do start chasing tenders you lose sight of what you’re actually good at and end up doing things that don’t quite fit so that would be a concern really. But they do sound really attractive – you put in a tender, you get paid to cover the overheads of the organisation and away you go.

We did look at a tender for alternative education provision for 14-16 year olds in Newcastle but again it’s a very complicated process to go through and we weren’t quite ready at that stage, but that would have involved working with children who either had been excluded or at risk of exclusion from mainstream education. Many of the kids we work with now are in that bracket but we weren’t quite sure how we’d deliver that, we’d need to invent some new system and it all takes time and effort really. We only had about two weeks to complete the tender so we decided to leave it. We certainly would look at tenders but I think there are dangers for organisations who deliver quite a direct service really.

How would you describe the long term future of your organisation?

I think the future is looking fairly good…I think. We’ve just got some money from the Big Lottery Local Food Programme for two years of working with local schools to develop their food grown in the schools. There’s lots of interest in the work we do because we’re linking people with nature, the value that brings in all sorts of ways. There aren’t that many organisations in this particular neck of the woods that can do that so easily and I think we do get to the heart of some of those issues.

But we are aware that Children in Need might come back in two and a half years and say ‘no, actually you’ve had your six years now, go somewhere else for your money’ and that then puts the whole youth programme at risk and for the kids involved it’s important stuff.

Lastly, what would your key messages be to central government, commissioners and funders?

They must be aware of the fact that if they reduce the amount of money being made available to local charitable organisations then they are going to increase the competition between those groups. That can be a good thing, it could make us work more creatively and in partnership to try and deliver the same for less, so I can see in some respects that will be a positive driving force for change. But clearly when it goes too far you see things being cut that are essential to the local community. Government knows the value of the voluntary sector, they know what it brings to society, and they already know that, they’ve got the figures. If all these people providing services on a voluntary basis stop doing it, it’s a massive cost to society if that wasn’t being done. I do think it is a danger when you make every decision based on the cost of it rather than the value of it. I suppose we have seen it before from government of similar colours, where you save the money centrally and pass the problem on to people further down the line, with no real thought for the impact on the communities who rely on them and who benefit enormously from the local charities who do tremendous work.

Government has all the evidence on how important it is to engage people with the natural world. We tick so many boxes from the point of view of the mental health of people who get involved, local food production is a massive part of what we do and certainly organisations now are looking at that aspect of the local area for all sorts of reasons, including sustainability of a local food supply. The Big Lottery has put a lot of money into local food projects and we just got money from them for this.

Government know the value of what we do and there is a deluge from the top at the moment to the bottom but if there’s no money there it’s not going to happen. When we talk about individuals, all of the kids benefit enormously from the experience they have and the relationships they develop with the staff and other members of the group are just so important to them. If we weren’t doing that, that would be another group of kids not getting that level of support from anywhere really. The impact of the young people involved in the project, meeting positive role models – if those things suddenly stop, the reality is they’re back on the streets doing things that kids of those age who don’t have role models get involved in. How do you pick up the cost of that?

Amanda Hannen

VONNE

Chris Francis

Scotswood Natural Community Garden

chris@sncg.org.uk

This interview forms part of work carried out by North East Child Poverty Commission, with support from VONNE, to identify the impact of the spending cuts and recession on VCS services to children and young people in the region. It forms part of the sector-wide campaign, ‘Surviving not Thriving’, led by VONNE.

CPAG Guest Post: Going hungry despite Free School Meals

Guest post by Rys Farthing

New figures published by the Child Poverty Action Group and the British Youth Council reveal that many poor children are going hungry at school, including those entitled to free school meals.

 Some 3.6 million children live below the poverty line, and while not all of these will be in school, only 1.27 million children are registered for Free School Meals. This means that many young people living below the poverty line are not entitled to FSM. And for these young people, the price of school meals – at around £9.40/week – is prohibitively expensive.

 The research aimed to examine the adequacy of the current Free School Meal scheme. Currently, only young people whose parents are on out-of-work benefits are entitled to receive free school meals (FSM). If FSM are meant to benefit ‘poor kids’, out-of-work entitlement  is poor targeting indeed; 62% of children growing up below the poverty line come from households that have at least one adult in employment. Estimates suggest that around a third of schoolchildren living below the poverty line are not entitled to receive free meals, their parents are not on out-of-work benefits, rather they might be in part time or low paid work.

2013 presents an opportune moment to address this inadequacy. The introduction of Universal Credit will mean that all ‘out-of-work’ and ‘in-work’ benefits are combined. The current rules around entitlement have to be redesigned. This presents both opportunities but also real risks. Firstly and importantly, if entitlement remains inadequate children from low income families will miss out on hot, healthy lunches, with all of the knock on effects for their health and education. Children from lower income households often go hungry and have poorer health outcomes and educational attainment than their better off peers. FSM can help realise their right to food, and help close health and education gaps. Secondly, if we don’t get entitlement right, FSM could work against the stated intention of ‘making work pay’ that is driving the Universal Credit.  Setting an income threshold for entitlement introduces a big ‘cliff edge’ into family finances and could make families financially worse off for taking a job. Thresholds can mean that getting a small pay rise or taking on an extra shift could cost families dearly; if they move just above a threshold, they will lose £376 worth of FSM per child.

However, the report highlights a second type of inadequacy that affects the children who are entitled to FSM. In most secondary schools (and some primary schools) children receiving FSM get an “allowance” to buy their lunch at the canteen.

 However one in seven of the young people surveyed in this research said that their allowance did not allow them to buy a full meal.

 Young people from eight schools around England gave their lunch menus as evidence; a full meal could be purchased from their allowance from only 2 of the menus. For example, in one school the allowance given to FSM students was £2.00, but painfully the “meal deal” was £2.05. Most places gave an allowance that was enough to get a slice of pizza and a drink, or a main meal but nothing to drink. This inadequacy means that schools are breaching the regulatory guidelines that have so improved school food since the days of the Turkey Twizzler … but perversely, this breach only affects children who live well below the poverty line.

 Many students suggested that this lack of money, and the small size of their school meal left them hungry. One of our youngest respondents, who is under 11, said that “I don’t get a lot to eat, (I’m) always hungry after having dinner… As we don’t get much food that’s why mummy still cooks us a meal at home but soon as we get home we eat lots while dinner is cooking”. Another said “there’s not enough money allocated to us and I go home hungry most days.”

Inadequate amounts left a number of poor children in the difficult position of having to take back food, or pay for what they overspent on attempting to buy a healthy meal. One student detailed their concerns (about getting detention for buying fruit):

“I think that the system honestly is a bit crap because you don’t know how much you have spent and if you overspend you’re given detention and you have to pay back what we spent!”

The best way to make sure that poorer children enjoy a meal is to entitle all families who receive Universal Credit to FSM. While this would almost double current entitlement, such an investment is the only way to make sure the FSM scheme works.  The Department for Education will be launching a consultation into entitlement in the coming weeks, and when it does, we should be wary of options that replicate current inadequate entitlement. We also need to make sure that for their part, schools are pricing meals and providing allowances that make sure a Free School Meal is what is says on the tin.

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