Helen Roberts: How poverty destroys our children's health

From a talk given at Gresham College in the City of London by the Professor of Child Health at City University

Some ways of dealing with problems work better than others. Every child has the right to expect that professionals intervening in their lives will act on the basis of the best available knowledge. But the majority of interventions in children's lives are not robustly evaluated before they are introduced. In that sense, much of the work done with children is an uncontrolled experiment.

While the post-war period has seen a sharp decline in deaths in childhood in the UK, continuing problems face children and young people, and inequalities in childhood remain stark. The most effective time to intervene to reduce inequalities in health is in early life. Child public health is potentially the most important – and most effective – activity in health and social care, encompassing as it does interventions in health, education, housing and public policy.

There is compelling evidence linking health and wealth. To make a difference to inequalities in health, we need to tackle not just health problems but the determinants of those problems. While mortality has markedly decreased over the last century, reported ill health among children is rising, with particular increases in respiratory diseases and emotional problems. A fifth of children and adolescents experience psychological problems, while a child in the lowest social class is twice as likely to die before the age of 15 as a child in the highest social class.

Disability compounds these problems. Families with disabled children have only 78 per cent of the resources of all families with children, but it costs three times more to bring up a child with a disability than a child without disabilities

The gap between the most and the least disadvantaged children in terms of the main cause of child deaths – accidents – has widened in the last decade. There is a steeper social class gradient for child accidents than for any other cause of death, and a child from the lowest social class is five times more likely to die in a house fire than a child from a well-off home.

Children and young people in care get a particularly poor deal. They are less likely to be protected from infectious disease through immunisation than other children, and young women in and leaving care have babies much earlier than other women.

Children born into poverty are more likely than their better-off neighbours to die in the first year of life; be born small, be born early, or both; be bottle fed; die from an accident in childhood; smoke and have a parent who smokes; have poor nutrition; become a lone parent; have or father children younger; die younger.

Projects dealing with the effects of poverty, even when evidence-based, are a sticking plaster on a gaping wound. New initiatives can be used to avoid confronting the reality that child poverty can be reduced by political and economic action. Inequalities in health can only be fundamentally tackled by policies that reduce poverty and income inequality. This means poor people getting more money. A secure family income is one of the most important elements in enabling children to be healthy, to gain a good education, to live in a safe environment and to make choices about their future. The investment required to eliminate child poverty is relatively small, amounting to 0.48 per cent of GNP in the UK.

The health service on its own cannot tackle inequalities in child health. Some of the inequalities are widening, and some measures taken to improve health may actually widen inequalities. There is, however, good evidence that the best overall support for a disadvantaged start is a good education.

A minimum income standard is needed to maintain good health and the wellbeing of children, while for sustainable impact of initiatives of known effectiveness, long-term mainstream funding is needed. Improving the prospects of children and young people is an investment rather than an expense.