Effects on children’s health of being poor and ways in which health inequalities can be addressed
Drawing on research and theory critically discuss the effects on young children's health and wellbeing of being poor in a rich country such as the UK. How can such health inequalities be addressed?
The health and wellbeing of children within the UK has become a controversial topic amongst policy makers, due to the major health inequalities surrounding children in the UK. A report submitted by the Department of Health (1980) concludes that on the whole, health within the UK has improved since the introduction of the welfare state; however there is still widespread health inequality which has resulted in a vast number of children living in poverty.
Poverty is defined as a circumstance characterised by severe deprivation of basic human needs, including food, safe drinking water, sanitation facilities, health, shelter and access to education and information. (United Nations, 1995) Poverty has further been defined in literature in terms of relative and absolute poverty. Relative poverty is where individuals are living in a rich country such as the UK, where there are higher minimum standards which no individual should fall below. These standards should continue to rise as the country expands economically. On a higher scale, the concept of absolute poverty includes anyone deemed to be living below the minimum standards of the above essentials. It is important that individuals do not fall below this standard as it can have devastating consequences. Although poverty has numerous definitions, it must be remembered that child poverty is the poor circumstances experienced throughout the duration of childhood by children and young people. It differs from adult poverty due to the diverse causes and effects. The impact it has on children during childhood can be everlasting. (CHIP, 2004;UNDP, 2004).
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Social exclusion is where families have limited access to good health, adequate diet, the ability to participate in the community (Smith 1990). In this sense, poverty and social exclusion are directly related, since families living in poverty often do not have access to the above necessities. The health statuses of various groups of people are dependent upon numerous factors, one which is social status. A person's social status is almost directly related to the person's health and social group that they belong to, thus has a potential effect on the health and life chances that one may encounter. Categorically, socio-economic groups in the community vary from the high class to the working class, with geographical location being a primary factor. For example in Britain, those that live in affluent areas are more likely to live a healthier and more productive life than those who live in a deprived location on a low income. The social status element has broadened the gap between communities, allowing poverty to continue to dominate the lives of children. Children are vulnerable to deprivation; even when it is only for a short period in their lives. It can still have long term implications on their growth.
I aim to critically discuss these effects and look at ways in which health inequalities can be addressed.
Childhood is a very vulnerable stage for children, as they are dependent on their parents or guardians to fulfil their needs. Children require basic resources and services to develop mentally, physically and emotionally. To develop into a healthy adult, necessary requirements include educational facilities, vaccinations, healthcare, security, nutrition, clean water, and a supportive environment. Due to their sensitivity during this "critical stage of life, children are particularly vulnerable to exploitation and abuse" (CHIP, 2004: pg. 2).
Furthermore, children living in poverty face numerous deprivations of their rights: survival, health and nutrition, education, participation, and protection from harm, exploitation and discrimination. "Over 1 billion children are severely deprived of at least one of the essential goods and services they require to survive, grow and develop" (UNICEF,2005b: pg. 15)
Children growing up in poverty are more likely to experience emotional and behavioural problems both of which have a negative effect on their wellbeing. Additionally most problems encountered throughout childhood continue into the adolescents and adulthood years. Antisocial behaviour can be due to cultural and social factors which can have an immense influence on the individual. Living in inadequate and overcrowded housing conditions on estates which are associated with crime increases these risks.
Bronfenbrenner's ecological theory suggests that human behavioural development is shaped by one's environment. The theory acknowledges that a child affects as well is affected by the settings in which they spend time in. The time spent by children in negative surroundings will have a detrimental effect on their personal behaviour. He states that as the child develops, the interaction and relationships formed with others around them become more complex, and that this would continue to arise whilst the child's physical and cognitive formation was to grow and mature. A study conducted by Clark in 1996 found that children suffer socially from frequently being re-housed in to more affordable housing. These children felt that they lacked stable friendships and had difficulty forming friendships due to the frequent school changes, schools hence became a place of social deprivation rather than a place where friends could be gained. Moreover, Oppenheim (1996) and Dunn (2000) both argue that children feel excluded because they cannot afford to socialise with their peers leaving them segregated from those around them.
Furthermore Smith (1995) indicates that failure to fit in with their peers' results in profound effects on children's behaviour. Blackburn (1991) goes on to argue that poverty affects psychological and behavioural processes which diminish life choices. This can lead to increased feelings of powerlessness and low self esteem as a result. In some cases this can cause the individual to form coping strategies which include alcohol or illegal drugs.
Gilman et al (2003) highlights that childhood adversity extensively increases the risk of depression, as well as long term negative effects on children's health and wellbeing. The health and well-being of children is interrelated to the quality of housing, the appropriateness of the location and affordability. Housing is a key component of both the physical and social environments in which children are exposed to, and plays a direct and indirect role in the achievement of positive development. A study undertaken by the Board of Science 2003 found that stable, safe and secure housing is a fundamental aspect in the healthy development of a child (Board of Science and Education, 2003). Faulty structure and inadequate facilities, for example heating, can cause accidental injuries (English House Condition Survey (EHCS), 1996). Factors affecting the health of children include the cost, quality, occupancy and the stability of the housing, along with the neighbourhood environment in which the child resides. Moreover, affordable accommodation for poverty-stricken families is frequently restricted to housing with substandard physical properties (Dunn, 2000), and is often in surroundings with socio-environmental problems which provide further disadvantages to physical and psychological well-being. Potvin et al (2002) argues that the housing tends to be in specific locations, resulting in segregation of low-income communities, when combined with poor access to employment opportunity, this can lead to socially deprived neighbourhoods. Klitzman et al (2005) confirms that these neighbourhoods are inclined to be unsafe, with limited access to essential facilities and services. This inevitably leaves fewer opportunities for social integration, and also poses health risks to the community, particularly for the vulnerable groups, residing within these environments.
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Curtis 2004 argues that inadequate housing may further influence individuals' health and mental well-being through increasing their level of stress. This can put a tremendous strain on a child, as the child distinguishes the atmosphere within the home as being depressing. He goes on to acknowledge that crowded living conditions can result in easier transmission of infectious diseases i.e. tuberculosis and increases the likelihood of acquiring respiratory illnesses such as asthma and bronchitis particularly if family members are smokers. Excessive noise levels also result in sleep deprivation, which can affect the growth and psychological wellbeing of a child, as they may experience tiredness and low energy levels whilst at school, which would lead to poor concentration. Similarly this can also have adverse affects on adults and children alike and lead to negative psychological effects, including aggression, depression, irritability, and frustration with others in the family. This is reported to contribute to family issues and potential violence. (Curtis, 2004)..
The English House Condition Survey confirmed that 1,522,000 UK residences did not meet the mandatory standards set (EHCS, 1996). For many deprived communities, the only housing available is unsatisfactory. The World Health Organisation (WHO) advocates that, during the cold weather, the average room temperature should remain at a constant 18-20C (WHO, 2005). However, in the EHCS survey it was estimated that 40% of the UK population resides in temperatures below these guidelines. 19% of housing in the UK is cold, and damp compared to the 9% recorded in Germany (EHCS, 1996). Despite specific measures adopted by local governments, housing policies continued to remain inadequate in many regions. For example, insulation of properties is a major government initiative at present. This is recognised as a cost effective intervention that could increase room temperatures whilst decreasing fuel costs for poverty-stricken families. However, The Warm Front scheme, which provides funding for insulation, is not available to pregnant women and young children, unless they are in receipt of specific social security benefits. Despite repeated evidence of the effects of poor housing, and associated lack of heating, public health interventions remain insufficient.
Economical accommodation for poorer families can be excessively expensive, and the payment of rent or mortgage costs can result in minimal disposable income for fuel, food and other basic necessities (EHCS, 1996). Obesity is a known health issue associated with poverty; a consequence of low incomes and inexpensive inferior foods, which result in high fat and high salt diets. Consequently, it has been determined that people with serious health issues are more likely to occupy the least health-promoting segment of the housing market, which in turn, aggravates health problems.
Children born into poor circumstances also tend to have fewer educational opportunities than children are born into families where parents have been educated, or there is more disposable income available in the household. Hetherington et al (1991) argues that poor parents find it increasingly difficult to provide intellectual, stimulating tools or resources, such as toys, books, and technologically advanced equipment to their children. The complexity of their circumstances also prevents them from increasing the child's opportunity of receiving a pre-school education, giving them the opportunity of a positive foundation which is essential during the 'critical period' of learning and development. Failure to attend pre-school can result in low academic attainment at a later stage. (www.surestart.gov.uk) Furthermore, since many social peer relationships form during the early years, children who do not have these experiences tend to lack confidence and self-esteem (Hetherington et al (1991), When placed within the classroom environment at an older age, these children are more likely to choose to remain segregated rather than participate within class discussion as they feel stigmatised due to the life they lead and have poor confidence when interacting with their peers. They feel that children that live in affluent areas have greater confidence and should be the speakers.
In the mid 1990s, there was an extremely high rate of relative child poverty in Europe, and the UK at present still has a high rate of poverty and the worst birth weight in deprived areas in comparison to any other Western European country (Sandwell-Smith, 2003). Therefore in 1999, Prime Minister Tony Blair made a pledge to eradicate child poverty by 2020, halving it by 2010, and making a difference by 25% in 2005. In order to do this, several changes were put into place such as the implementation of a taxation system, changes in benefit eligibility and the way it is paid, the introduction of the tax credits and the investment in children's services. Around the same time, the Millennium Cohort Study (2000) established that babies being tracked were already showing larger differences in their health status at the age of three, according to their family conditions. Among children in families with income below £10,000 a year, 4.2% suffered chronic illnesses at this age, compared to just 1.7% among wealthy families on over £52,000. This significant difference highlights the importance of living above the poverty line. Such evidence has paved the way for numerous Government initiatives that attempt to close the gap on health inequalities in the UK.
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According to the UK's statement to the United Nations General Assembly Special Session on Children in 2002, the UK is restructuring the machinery of government to put the welfare of children and young people at the heart of policies and services, to ensure that children's and young peoples voices shape the priorities and practices of the government, and to bring together the government, the voluntary sector, businesses, local communities and families with a vision for young people. (United Nations 2002)
Ten years on research shows that the government still holds a strong will to tackle child poverty and has always had it on the agenda, and is continuing to be a key aspect in the battle against child poverty. In a response to the recent release of poverty figures, the government insisted that the £1 billion already committed in this years budget with help to lift a further 250,000 children out of poverty, however they believe an additional £3 billion will be needed to invest in tax credits and benefits in order to meet the 2010 target set by former prime minister Tony Blair. (End Child Poverty HBAI Report 2008).However in a policy briefing on education and child poverty released in March 2008, The Child Poverty Action Group (CPAG) condemned the government for not addressing this issue properly and claimed that the educational gap between disadvantaged children and their peers would continue to increase and that part costs incurred should be claimed through local charging polices ( End Child Poverty 2008).
Although some of the government's policies and strategies have not achieved their full potential there is still room for improvement with the ideas already formed. This can only take place if there is a major transformation in the way policy makers address the issue and implement strategies. For example the existing tax credits system consists of a working element for parents who are on a low income and a child based element on the number of children under the age of eighteen in full time education. This currently needs to be reviewed and updated; the combined value of child tax credit and child benefit needs to be increased in line with inflation and earnings. The reformation on the administration of tax credits and benefits is also essential as in previous years there has been discrepancies on the amounts paid and the overpayment of these allowances.(www.hmrc.gov.uk)
In conjunction with the above, the benefit entitlement system needs to be reassessed for all UK residents irrespective of immigration status as at present those that are not UK nationals are not entitled to specific benefits.
Another significant aspect is that the government has made various attempts to work towards creating more jobs, and getting people off benefits into work however; it needs to be that the jobs created are enhanced and beneficial, financially for those that are qualified and have the relevant experience.(www.jobcentre.plus.gov.uk)
There is conclusive evidence that living standards and housing conditions are interrelated and poor socio-economic situations during childhood negatively influence the health status once a child reaches adulthood. The exposure of the young to these situations contributes to long-term ill health. This is worsened due to diminished immune systems and the greater exposure to negative environments which they have little or no control over. (Klitzman, et. al., 2005). Insufficient facilities and the overcrowding of properties are very much a major concern with infectious disease, while damp and mould can cause various respiratory problems (Bornehag, et. al., 2005). Nevertheless, the debate around housing and health and wellbeing is inclined to be concerned with the discourse of poverty. (Dunn, 2000). However, looking at research there seems to be much less consideration of the indirect effects of poor housing upon health, such as social exclusion (Curtis, 2004) and depression, and psycho-social effects are repeatedly overlooked. Moreover in recent years, socio-economic determinants of health have returned to policy debates, and housing conditions are, once again, recognized as a critical influence upon public health (Board of Science and Education, 2003). Recent studies have shifted focus in the direction of a broader-ranging perspective with regard to poverty, and health and quality of life, which presents the possibilities of enhanced understandings of the determinants of health status.
The General Assembly of the United Nations 1948 states that everyone has the right to a standard of living sufficient for the health and wellbeing of himself and his family. This Includes food, clothing, housing and medical care.
As with many health determinants, the quality of housing is directly related to income. Trying to reduce these adverse effects of poor accommodation remains a major challenge. Health inequalities are not reducing in the UK, and the worst health is experienced by those who are most socially and economically deprived (Stanwell-Smith, 2003). As in the nineteenth century, there is a profound need for a rigorous public health reform. Essential to this must be enhanced living standards and prevention of ill health, so as not to become trapped in the inevitable cycle of poverty many children still find themselves in today.
Although the government has evidently reaffirmed its commitment to meeting its child poverty targets, and has developed both the organisational competence and the political drive to do so, there still seems to be a vast majority of children living in poverty and it is highly unlikely that the 2010 target is to be met, based on current spending levels. However it is not too late to improve the strategies enforced to provide a healthier future for the children who will be the new generation of the workforce for years to come.
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English House Condition Survey (1996). Office of the Deputy Prime Minister. Available at http://www.odpm.gov.uk/stellent/groups/odpm_housing/documents/page/odpm_house_603825.hcsp
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