Child poverty, health and wellbeing

Kerry McKenziekerry.mckenzie@nhs.net

Outline

• What are health inequalities ?

• What does child poverty look like in Scotland ?

• What are the causes of child poverty ?

• What does this mean for children’s health and wellbeing?

• Challenging stigma and negative representation of poverty; myth busting

• Practical action: role of schools in mitigating the effects of child poverty

NHS Health Scotland

Our vision is a Scotland in which all of our people and communities have a fairer share of the opportunities, resources and confidence to live longer, healthier lives.

Our mission is to reduce health inequalities and improve health.

Health inequalities are the unfair and avoidable differences in people’s health across social groups and between different population groups.

These data have been updated using the ScotPHO profiles published in June 2015 comparing the life expectancies in Broomhill (close to Jordanhill station) and Parkhead & Barrowfield (close to Bridgeton station) intermediate zones.

Theory of causation of health inequalities

“Having insufficient money to lead a healthy

life is a highly significant cause of health

inequalities.”

Professor Sir Michael Marmot

Marmot Review, England 2010.

http://www.instituteofhealthequity.org/projects/fair-society-healthy-lives-the-

marmot-review

Relationship between child poverty, health & inequalities

• Children’s early life experiences and the social circumstances in which they live strongly influence their outcomes in later life.

• Inequalities begin before birth, can adversely impact health throughout adult life, and can persist across generations.

• There is a link between socio-economic disadvantage during the early years and health inequalities.

• The opportunity to reduce the impact of these inequalities is likely to decline as children age.

• Income matters for child health

Source: Scottish Government (2017) Poverty and Income Inequality in Scotland: 2015/16

Trends over time

Source: Institute for Fiscal Studies; Scottish Government (based on DWP HBAI data).

% of children and working age adults in poverty AHC,living in a household with at least one adult in employment

The geography of child poverty

Source: Giles and Richardson (2017), based on HMRC data.

Child poverty risk and area deprivation

Source: Giles and Richardson (2017), based on HMRC data.

Who is at risk of poverty?

Source: HBAI dataset, DWP 2015/16

Who is at risk of poverty?

Source: Family Resources Survey

0

5

10

15

20

25

30

35

40

2010/11 2011/12 2012/13 2013/14 2014/15 2015/16

Pe

rce

nta

ge

Axis Title

Percentage of children in relative poverty, after housing costs, by age of youngest child in household: United Kingdom, 2010/11 to 2015/16

Source: Family Resources Survey

0 - 4

5 - 10

11 - 15

16 - 19

Causes of poverty• Employment status

• In-work poverty

• Costs of living: housing, childcare, fuel

• Social security benefits, including tax credits

• Educational attainment

• Underpinned by structural factors e.g. local and national housing and labour markets

In-work poverty

• Low wages• Insufficient hours• Job insecurity• Lack of progression

→ Many households experience fluctuations and variations of unemployment, employment, poverty and eligibility for social security payments and tax credits.

The social security system

Source: DWP HBAI, various years.

0

10

20

30

40

50

60

70

80

90

100

2010/11 2011/12 2012/13 2013/14 2014/15 2015/16

Percentage of children in relative poverty after housing costs, by benefits claimed by household: UK, 2010/11 to 2015/16

Jobseeker's Allowance

Employment and Support Allowance

Child Tax Credit

Working Tax Credit

Income Support

Not in receipt of any state support

"For the first time in post-war history, the increases to the cost of essentials are not being matched by increases in support given to families from the state. ……the struggle that low-income families face to make ends meet will become steadily harder, especially because it is being combined with numerous other cuts ……..…..these cuts are particularly painful for non-working families, who already have little over half what they need to cover family costs. For them, the “safety net” of means-tested support no longer merits this name, since it does not offer the safety of an income capable of covering essentials.”

‘Welfare reform’ and its impact

• Term refers to the wide range of reforms to the benefits and tax credits system introduced in the Welfare Reform Act 2012 and the Welfare Reform and Work Act (2016)

• Monitoring the impact of welfare reform, inc. on children and families

‘Welfare reform’ 2010 -(not exhaustive):

• Universal Credit

• ‘Bedroom tax’

• cap on benefits – reduced to £20,000 a year for couple/lone parent

• changes to child benefit

• changes to tax credits

• increased severity of sanctions

• freeze on most working-age benefits

Financial losses to claimants?

Estimates per annum based on post-2015 reforms by 2020/21:

• £1bn financial loss in Scotland pa

• Families with dependent children hit hardest

• Largest losses fall in poorest areas

• More deprived the local authority, the greater the financial hit

• In addition to the financial losses from pre-2015 reforms

Source: Beattie, C & Fothergill, S (2016) The Impact on Scotland of the New Welfare

Reforms. Available from http://www.parliament.scot/S5_Social_Security/General%20Documents/Sheffield-Hallam_FINAL_version_07.10.16.pdf

Impact?….on women

And the impact being overwhelmingly felt by women …………Since 2010, £26 billion worth of cuts have been made to benefits, tax credits, pay and pensions. 85% of this has been taken from women’s incomes.Source: Engender (2015) http://www.engender.org.uk/content/publications/Engender-Submission-to-the-Welfare-Reform-Committee-Inquiry-into-Women-and-Welfare.pdf

…..on lone parents and their children

Negative impact of changes on income level is more severe amongst this group ….expected to lose £2380 per annum by 2021The Austerity Generation, November 2017, p19. http://cpag.org.uk/content/austerity-generation-impactdecade-cuts-family-incomes-and-child-poverty

Impact on children and families?• Many families are experiencing financial difficulties

-entitled to less

- administrative problems are leading to income crisis or insecurity.

• Impact on other services such as health and housing through rent arrears/defaulting…eviction

• Emergency food aid (food banks)

• Health impact – stress, anxiety, food or gas/electric payments, malnourishment/weight loss

• Destitution, severe financial hardship

• Getting into debt, using doorstep lenders

‘One woman was 10 minutes late for an appointment due to

an unforeseen event with one of her children (a four-year-

old needing the toilet on the way to an appointment), and

she was sanctioned. The impact of this sanctioning for her

well-being and the well-being of her family was devastating.

She was without money for four weeks and, as a result,

she was unable to purchase fuel cards for her gas and

electricity meters or feed her children’

Child Poverty Action Group Scotland

Sanctions

http://www.cpag.org.uk/scotland/early-warning-system

Professor Green: Living in Poverty (BBC3 documentary)

https://www.youtube.com/watch?v=cgHhsthOwKA

• Parents try to protect their children from the consequences of living life on a low income.

• Children, especially older children, do notice and this can result in their making sacrifices of their own.

• Children’s sacrifices include not letting parents know about opportunities that may cost money and pretending that they do not want to participate in school and leisure activities in the first place.

Impact?

• Impact on physical and mental health and wellbeing of pupils

• pale skin, thin, stress & anxiety, no hot water or heating, no money for snacks/don’t bring a snack, inappropriate clothing for winter, homelessness, hungry, uniforms are worn out

• Attendance affected

• Social exclusion from extra-curricular activities

• Impact on concentration and ability to learn

EIS members survey 2016/17

Themes

• Food insecurity

• Financial stress and

worry

• Homelessness /

poor housing

• Poverty

exacerbating poor

health

‘Poverty makes

children sick’

‘Those children from the most deprived

backgrounds are experiencing much

worse health compared with the most

affluent…..

……more likely to have negative health

outcomes, to be born with low birth

weight or fail to thrive and be exposed

to risks that perpetuate ill health such

as poor diet, lack of physical activity,

parental drug or alcohol misuse and being in care………More must be done to reduce the number of children living in poverty in Scotland and to minimise the impact of deprivation on health outcomes.’

The State of Child Health 2017

Recommendations for Scotland

Royal College of Paediatric and

Child Health

http://www.rcpch.ac.uk/system/files/

protected/page/SOCH-

recommendations-Scotland.pdf

Money affects children's outcomes• Cooper & Stewart (2017) - systematic review examined the

evidence on whether household financial resources have a causal effect on children's health, cognitive and behavioural outcomes

YES

• Poorer children have worse cognitive, social-behavioural and health outcomes in part because they are poorer, and not just because poverty is correlated with other household and parental characteristics.

• The evidence relating to cognitive development and school achievement is the clearest, followed by that on social and behavioural development.

Cooper, Kerris and Stewart, Kitty. “Does Money Affect Children’s Outcomes? An update.” Centre for Analysis of Social LSE, July 2017http://sticerd.lse.ac.uk/case/_new/research/money_matters/report.asp

Child mental wellbeing & income

Source: Scottish Health Survey

Cumulative impact

In general, children from poorer families have poorer educational outcomes compared to those from more affluent families

The Children and Young People’s profile

@scotphohttp://www.scotpho.org.uk/comparative-health/profiles/online-profiles-tool

The Children and Young People’s profile

• 52 indicators– Child health, maternal health, education, employment, poverty, safety,

health behaviours– Organised by SHANNARI domains

• Geographies– Data presented by health board, local authority and intermediate zone

(where possible)– Compared to the national average (default) or other area

• Presentations– Spine chart– Rank chart– Time trend

Educational attainment and inequality• Differences in educational attainment are both a driver

and a consequence of poverty• Individuals with higher qualification levels and skills are

much more likely to be in employment, and have better employment prospects and higher earnings.

• This reduces the risk of poverty for more highly qualified individuals and their children

• Evidence that increases in parental income levels directly leads to increases in educational attainment of children living in poverty, and contributes to a substantial narrowing of the attainment gap

• Income matters to educational outcomes

Educational inequality

• In general, children from poorer families have poorer educational outcomes compared to those from more affluent families

• Pre-school children from low income families were about 13 months behind in vocabulary skills and 10 months behind in problem solving skills compared to their affluent peers

• Early cognitive development is linked with educational attainment, which, in turn, influences longer-term employment prospects

Reducing the attainment gap – the role of health and wellbeing interventions in

schools - NHS Health Scotland

• identify and review health and wellbeing interventions in a school setting that could contribute to reducing inequalities in educational outcomes

• Insufficient evidence to draw firm conclusions, but…..the quality of implementation of social and emotional learning programmes was important for positive outcomes.http://www.healthscotland.scot/publications/health-and-wellbeing-interventions-in-a-school-

setting

What is the main cause of child poverty in Scotland today?

• Their parents suffer from alcoholism, drug abuse or other addictions (29%)

• Because of inequalities in society (16%)

• Their parents do not want to work (13%)

• Their parents have been out of work for a long time (10%)

• Their parents' work doesn't pay enough (8%)

Scottish public opinion

Source: Scottish Government (2015) Public Attitudes to Poverty, Inequality and Welfare in Scotland and Britain, p. 15

Dr Morag Treanor, University of Stirling

• The ‘Poverty of Aspiration’ is a myth• School is important to, and for, children from low

income households• Parents from low income households value

school and want to help• All parents want the best for their child• Parents from low income households less likely to

know what that looks like or how to achieve it• Parents from low income households less likely to

know how to help their child

https://www.era.lib.ed.ac.uk/bitstream/handle/1842/25787/CRFR%20briefing%2091%20-%20Treanor.pdf?sequence=1&isAllowed=y

‘Can we put the ‘poverty of aspiration’ myth to bed now?’

Great British Benefits Handout (Channel 5)

Benefits Street (Channel 4)

Benefits Britain: Life on the Dole (Channel 5)

My Big Benefits Family (Channel 5)

Financial management

Source: Finney & Hayes (2015), based on Wealth and Assets Survey 2010-12.

Underclaiming of benefits

• Underclaiming of benefits is a big problem• Only 56% of families with children entitled

to Job Seekers Allowance received it in 2014/15

https://www.youtube.com/watch?v=3O9OtswwnEU

Child Poverty (Scotland) Act 2017

Child Poverty (Scotland) Act 2017

• Income based targets• SG Delivery Plan• Measurement Framework • Local child poverty action plan

report• Independent Poverty and

Inequality Commission

http://www.legislation.gov.uk/asp/2017/6/contents/enacted

What can be done at a school/service level?

1. Leadership 2. The role of schools in mitigation- understanding and awareness of child poverty; challenge stigma- poverty-proofing/ cost of the school day- income maximisation/ free school meals3. Understand poverty in your school community4. Work with other partners to target resources

Child poverty, health and wellbeing eLearning module

To raise awareness of child poverty issues in Scotland and its impact poverty has on children and young people’s health and wellbeing.

Learning outcomes• Describe what child poverty is and what causes it

• Outline how child poverty is defined and measured in Scotland

• Explain how poverty impacts children and young people’s health and wellbeing

• Reflect on your role in reducing the impact of child poverty

Features

• Films and infographics

• Reflection points

• News forum

• Additional learning section

• Short quiz

Register for free for an account with the NHS Health Scotland Virtual Learning Environment

https://elearning.healthscotland.com/course/index.php?categoryid=132

CPAG Scotland Cost of the School Day

Cost Barriers to Learning & Participation

City of Edinburgh Council

COST BARRIERS TO LEARNING AND PARTICIPATION

School trips“My mum felt guilty that I couldn't go… Why do we have costly trips then? It puts people under pressure and it makes people embarrassed and disappointed if they can't go.” (P7)

“We have to pay for theatre tickets - seeing live performance is part of SQA courses.” (S5)

Fun events“You see one or two [at charity coffee mornings], you know, if they don't have it… ‘Got fifty pence?’. ‘No, no, it's okay. I don't want cakes.’ And that breaks my heart. Because that's maybe their defence.” (Staff)

“We get kids that don't come in on the non-dress code days. Why? Because they don't have anything new… The kids would never admit that. They don't say, ‘It's because I've nothing new.’ It's just, ‘Oh, I wasn't well that day, Miss.’” (Staff)

School clubs“We used to get told we had to bring… old trainers to wear on the pitch. But everyone didn't have trainers.” (P7)

POVERTY SHAME AND STIGMA

Learning “Children have the embarrassment of us saying 'do you have your money? You can't cook today‘” (HE teacher)

Uniform“Shoes and bags, that’s one of the biggest things. There’s some people you get that are nasty and pure heavy cheeky.” (S4)

“Some people get paid monthly and cannae even get new shoes until next month, but they expect it the next day.” (S4)

School trips“I think my grandad put some in, and my mum put some in, and the school put the rest in. And they were alright about that but then I still felt like some of my teachers were looking down on me for that.” (S5)

Friendships

“A lot of people, I think, that have maybe got a lower

income, round about the school, seem to be isolated

and they've no got a lot of friends.” (S4)

Eating at school“If your pals are going out at lunch you'll be a loner. It puts you out the group because they're going out and then you're sitting there on your own with a free meal.” (S3)

Financial inclusion

• Staff asking about money worries and offering a referral to a money/welfare advice worker….in school

• Provide information on, and support to apply for, free school meals and the school clothing grant

Example: Glasgow City Council identified families on housing benefit & council tax reduction and sent them a voucher to be cashed at a Paypoint venue……uptake rate 97%

Thank you

Contact: kerry.mckenzie@nhs.net

Kerry McKenzieOrganisational Lead – Child Poverty

NHS Health Scotlandwww.healthscotland.scot