Introduction Poverty and Maternal Health Poverty, Birthweight and Perinatal Health Poverty and Mortality in Infancy and Childhood Poverty, Disability and Physical Health Poverty and the Mental Health of Children and Young People Poverty and Health-Related Behaviour in Childhood and Adolescence Poverty, Educational Attainment and Children’s Health Conclusion References 2 3 4 6 8 10 12 14 15 16
By Professor Nick Spencer published by End Child Poverty with the support of GMB
Poverty and social inequalities in childhood have profound effects on the health of children, and their impact on health continues to reverberate throughout the life course into late adulthood. Globally and historically, poverty has been the major determinant of child and adult health1 and, even in rich nations such as the UK, it remains a major cause of ill health with huge public health consequences.2 The rapidly growing and developing fetus3 and child 4 seem to be particularly vulnerable to the adverse effects of poverty providing a further powerful argument for policy initiatives designed to protect children from its worst effects.5
Here, I summarise the physical, emotional and psychological health consequences of poverty for children. Maternal and child health are intimately linked and, consistent with the intergenerational approach advocated by the Acheson Report,6 I start with a brief review of the effects of poverty and low socio-economic status on maternal health – particularly as it affects readiness for pregnancy and fetal well-being. Birthweight has major consequences for survival in early infancy, health throughout childhood and into adult life and the impact of poverty on this is considered next. Death,disability and illness in infancy and childhood, closely linked to birthweight and poverty, are discussed before examining the consequences of poverty for the emotional and psychological health and wellbeing of children. Poverty and material deprivation in rich nations appear to have a negative effect on parenting, leading among other things to child abuse and neglect. The links between child poverty, parenting and child protection are reviewed. Finally, the links between poverty, educational attainment and children’s health are discussed. In addition to the direct consequences of poverty on children’s health, two related themes run through this paper. Children from minority ethnic groups living in rich nations suffer double jeopardy7 in that they are more likely to live in poverty8 and are likely to suffer discrimination as a result of racism.9 Throughout this paper, attention is given to these dual effects and how they impact on child health. Although living in poverty has the greatest effect on the health of children and adults, those with incomes above the poverty level have health outcomes that are worse than the highest income groups. Many child and adult health status measures, such as death rates and rates of acute and chronic illness, get steadily worse as you pass from the highest to the lowest socio-economic status groups.10 These so-called ‘social gradients’ have important implications for health and social policy interventions aimed at promoting child and adult health. For this reason, the existence and role of social gradients in child health will be emphasised throughout the paper.
Poverty and Maternal Health
The health of the mother has a profound effect on the health of her children. This effect is most noticeable during pregnancy but persists throughout the child’s life. I concentrate here on the impact of poverty and low income on the relationship between maternal health in pregnancy and during the early years of her child’s life and child health.
Poverty in childhood exerts its effect throughout the life course and can be transmitted across generations. Intergenerational transmission