‘No room for protection’: how the cost of living crisis affects children’s health
By Rebecca Bellars, Head of Media and Public Affairs at RCPCH.
The cost of living crisis weighs on all our minds at present. For those who are already living on the breadline, it weighs even more heavily on their shoulders. With no bills left to cut back on nor shops to switch to for better prices, households are left with no wriggle room for protection.
It is shocking to think that across the UK approximately 30% of all children are living in poverty — four million in total. It is already far too high, yet projections indicate this number will reach five million by 2030. Worryingly, these estimates were made before the rate of inflation reached a towering 8%; the UK faces a perfect storm of soaring energy bills, rising taxes, increasing prices and wage stagnation for the past two decades. According to the Resolution Foundation, the poorest 10% of households spend twice the share of their family budget on food and energy bills compared to the wealthiest 10% of households. Without robust child-centred policy and welfare intervention imminently, how many more children will be living in poverty in generations to come?
What does child poverty look like?
How poverty impacts children throughout their lives is put forward in study after study, from mental health problems, low birth weight, dental decay, and long term health conditions such as obesity and asthma. Not only that, but these issues are also generational, and growing up in poverty often means your children will too.
Children from lower socioeconomic groups are more likely to be at risk of tooth decay, the most common reason for hospital admission among children…
Dr Mairi Stark, RCPCH Officer for Scotland, has worked for the last 25 years as a paediatrician in Scotland. As the clinical lead for acute paediatrics at the RHSC in Edinburgh, she is seeing more and more children coming into dental units with blackened teeth. Highlighting the impact of poverty on children’s oral health, she said that pandemic diets have been “high calorie, fat-dense food that are not actually healthy”. While these choices of food are low cost, Mairi notes that “higher sugar content means an increasing amount of dental decay”.
RCPCH’s State of Child Health report shows that children from lower socioeconomic groups are more likely to be at risk of tooth decay, the most common reason for hospital admission among children aged five to nine in the past three years. It can be prevented with control of sugar consumption, but cheaper food is more often higher in sugar making it difficult for families on limited budgets. Interventions like fluoride in water supplies can also strengthen tooth enamel and prevent decay. However, in Scotland, no public drinking water supply is currently fluoridated.
Mairi says that during the pandemic, children’s oral health was detrimentally impacted by the suspension of the Childsmile programme in Scotland, which provided toothbrush monitoring and fluoride varnishing as part of their aim to improve standards for those living in more deprived areas and therefore reduce health inequalities. The in-person services that they provide have only recently relaunched.
The generational cycle
Dr Steve Turner, RCPCH Registrar, is a consultant paediatrician in general and respiratory paediatrics at Royal Aberdeen Children’s Hospital and says he can see the impact poverty has on child health when he speaks to his patients’ parents and carers: “In clinic we see the intergenerational effects of illness and poverty. You might be seeing a child with asthma whose mum also has asthma. The family is struggling financially and living in a council house with lots of damp and mould. The mould makes everyone cough and wheeze. The stress makes mum smoke more which makes everyone cough and wheeze even more. If we could support this family, their collective well being (mind and body) would be so much healthier.”
“Poverty and health are linked,” says Steve, “Breaking that cycle would be the holy grail.”
Steve recently researched how household income is linked to fetal size in the womb during pregnancy and low birth weight. By undertaking ultrasounds during the second and third trimester and taking a birth weight measurement of over 20,000 individuals, Steve found that not only does low birth weight correlate to lower income households, but the impact is already seen in the second trimester. “Poverty and health are linked,” says Steve, “Breaking that cycle would be the holy grail.”
Whole system change
The crux of the problem for paediatricians and their NHS colleagues is that what they try to fix in clinics and on wards extends well beyond the health system. “Health — mental and physical — falls in our lap to tackle,” says Steve, “But the pathway for children to get to that point is about the welfare state.”
“Paediatricians can make a difference. They can work with RCPCH where the advocacy programme makes a difference.”
Recent data published by End Child Poverty Coalition shows a reduction in child poverty overall in the UK in 2020 and 2021. This temporary improvement is likely to be related to the additional support of a £20 uplift to Universal Credit provided to low-income families during the COVID-19 pandemic. Though this was a temporary intervention, it shows how extra financial support can be effective for families. Reducing health inequalities in children has to start with child poverty, and that takes a whole-system approach — welfare, education, transport, food — with children at the centre.
What next?
As the cost of living crisis continues, many households are likely to face next winter in an even more difficult position than today. Energy price caps are likely to rise for a third time in October 2022 putting another squeeze on already strained household budgets and forcing families to make choices between food to eat and heating their homes. But Steve says that paediatricians shouldn’t feel disheartened, and that there is always something that health professionals can do: “Paediatricians can make a difference. They can work with RCPCH where the advocacy programme makes a difference.”
