Hannah Zhu, Emma Sunderland, Akudo Okereafor, Guddi Singh

Introduction: Child Poverty is a HUGE PROBLEM

Poverty is not just a moral issue but it is a massive health issue. Poverty in the UK has increased over the past 10 years and the Covid-19 pandemic has made things SO much worse. Many families were just about “surviving” on their household budgets but Covid-19 has pushed many to breaking point. Many families’ stress and challenges have resulted in domestic violence and relationship breakdowns, further impacting their children. 

Poverty damages health throughout life 

Poverty makes EVERYTHING WORSE. Mums in poverty are more likely to die in childbirth and tragically their babies face a higher risk of death too. Chronic diseases like asthma, obesity and mental illness as well as accidents and trauma are more likely in poorer children and that means more visits to A&E. The challenges these families battle include isolation, unemployment, debt, temporary housing and displacement, crime and violence. These all impact on their health enormously throughout life. The children we meet living in poverty today can expect to spend a third of their lives in poor health and to die up to 10 years earlier (Michael Marmot, 2020). As child health professionals, we are in a unique position to reach to masses of families daily, many of whom may not be aware of services. We must reach out and empower them!

Definitions and Stats: Child Poverty is a PANDEMIC

There are many ways to define child poverty, but from a doctor’s perspective:

“Child poverty is when families don’t have enough money for their children to have a healthy diet, join in activities or have the living conditions you’d expect in the UK (adapted from Townsend, 1979).”

“Surely this is just a problem for a small number of the families that I see?”  

“NO!”

1 in every 4 children on your ward, in your clinic, in your child’s class at school are living in poverty. That’s 4 million children in the UK, half of whom have gone to school hungry because their parents couldn’t afford to feed them. Destitution levels (which means not having the BARE essentials of food, heating and a roof over your head) are expected to double as a result of COVID19 pandemic.  

In the last five years, food bank use in our network has increased by 74%

Possible effects of child poverty that we should learn to spot in our patients: Physical & mental health:  – Low birth weight – Higher rates of infant mortality – Obesity – Unplanned hospital admissions – Poorer outcomes for long term conditions (such as asthma and diabetes) – Accidental and non-accidental injuries – Anxiety, depression and suicide  Educational outcomes: – Poorer academic achievement  – Higher rates of special educational needs  Behavioural and social outcomes: – Poorer neurocognitive and social development.  – Experience of stigma and bullying from peers  – Social isolation and deprivation  Family Dynamics: – Disrupted family functioning – communication breakdown, impulsive behaviour and family stress – Higher risk of relationship breakdowns Later outcomes into adulthood – More likely to take up smoking, use alcohol or drugs – Increased lifetime risk of cardiovascular disease and certain cancers – Lower lifetime earnings – Higher rates of being – Not in Education or Employment Training (NEET) – Reduced life expectancy  THESE EFFECTS PERPETUATE BEYOND THE INDIVIDUAL AND ARE INCREASED FOR FUTURE GENERATIONS.

Case Study 1: Naomi

Situation: Naomi 8m, mother worried she is unwell as vomited twice this morning. Naomi has global developmental delay and is being investigated for epilepsy.

Background: Both parents were furloughed due to Covid-19. They’ve never had financial difficulties before so they’re increasingly stressed about budgets. Since Naomi is in hospital so often, they’re struggling to find alternative employment. Not aware of disability living allowance (DLA) or carers’ allowance. She is their only child and parents each care for her in 12-hour shifts. Her mother admits she is not sleeping and is very tearful. She admits forgetting to start her feeds on two occasions and feels exhausted. She suffered with depression 5 years beforehand having struggled to conceive for many years. She is not eating, has very few friends and no support.

Assessment: Parental exhaustion impacting feeds. Trip to ED at 11pm was a cry for help.

Recommendations: Advise to see GP urgently to assess for depression. Ask about key worker for disabilities. Discuss referral to Social Services to get help applying for DLA, carers’ allowance, respite care etc. Signpost to local employment advice. Recommend forums to support families with complex needs.

Thinking outside the box, what wider things can I do to fight poverty? 

Addressing the root causes of child poverty isn’t easy but there are LOTS of ways you can use your experiences in healthcare to fight poverty. 

Here are just a few suggestions:  

1. Stay informed and share learning:

• The RCPCH has information about child poverty news, impact and aims for reducing child poverty nationally: https://www.rcpch.ac.uk/key-topics/child-poverty
  • Attend events such as the RSM Child Health Festival to bridge gaps in knowledge: https://www.rsm.ac.uk/events/paediatrics-and-child-health/2019-20/pdn16/

2. Local support:

There are many opportunities to get involved in your local area. This could be supporting charities like food banks (https://www.trusselltrust.org/), homelessness charities (https://www.homeless.org.uk/) and Christians Against Poverty ( https://capuk.org/). Many of these local charities offer debt counselling, job clubs, life skills help with living on a low income, money management courses and fresh start clubs that help with overcoming addiction. Think about how you might work in partnership with local organisations to develop the response to child poverty within your hospital. 

3. Campaigning:

There are also opportunities to campaign for wider government level changes, by writing to your local MP or partnering with organisations such as:

• Medact: https://www.medact.org/
  • Child Poverty Action Group : https://cpag.org.uk/

Summary 

Child poverty damages all aspects of child health and wellbeing. We all need to be able to spot

families living in poverty and to understand how it might have contributed to their clinical presentation

and impact their quality of life. 

Key learning points: