Intended for healthcare professionals

Editorials

Eradicating child poverty

BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7204.203 (Published 24 July 1999) Cite this as: BMJ 1999;319:203

A serious aim of the British government that doctors must support

  1. Richard Smith, editor
  1. BMJ

    Britain has more children living in poverty than any other country in the European Union. But, to its credit, the government is determined to eradicate child poverty, described by Gordon Brown, the Chancellor of the Exchequer, as “a scar on the soul of Britain.” The prime minister has set an ambitious target, even more ambitious perhaps than trying to achieve peace in Northern Ireland: “Our historic aim,” he says, “will be for ours to be the first generation to end child poverty.”

    Last week the Chancellor and Alistair Darling, secretary of state for social security, called a meeting in Downing Street to discuss eradicating child poverty. “Many important meetings have been held in this room,” the Chancellor began, “but none more important than this.” Cynics might say that this was the Labour government trying to reassert some old Labour values after doing poorly in the European elections, but an academic at the meeting pointed out that in 25 years' studying child poverty this was the first time he had been invited to discuss the subject with the Chancellor. The recent BMA report on growing up in Britain reminded readers that “The Chancellor has a much greater impact on health than the secretary of state for health, a thought that may well not cross the minds of either.”1 It seems to have crossed the mind of this chancellor.

    The task is huge. One in three children in Britain lives in poverty (defined as an income less than half the mean equivalised income after housing costs). That means more than four million children, up from about 1.3 million in 1979. Two of every five children are born in poverty and one in six families is pushed into poverty by the birth of a child. The incomes of the families with the poorest children have fallen in absolute terms in recent years. Unemployment is the main cause of child poverty. One in five children lives in a family without work, and nine out of 10 children in workless households are poor. Children are also more likely to be poor if they live in large families, have lone parents, or are from ethnic minorities (particularly Pakistani and Bangladeshi families).

    Poverty, as every doctor knows, is a major determinant of health, much more so than access to health services.16 A boy born to professional or managerial parents has a life expectancy five years higher than one born to parents in partly skilled or unskilled occupations.2 Morbidity is also higher in poor children, as is the incidence of educational failure, teenage pregnancy, crime, and the likelihood of living in poverty as an adult.1 2

    Breaking this cycle of poverty and hardship is difficult, and poverty has been a feature of Britain and most other societies since long before the BMJ appeared in 1840. The eradication of child poverty may thus seem like an empty political promise, but the government has a four pronged strategy for achieving its objective. It admits it will take at least 20 years.

    The first prong is to promote work. Employment is the main route out of poverty, and the number of people in employment has increased by 400 000 since 1997 to give the highest number in employment in British history. Nevertheless, 1.8 million people are still out of work in the United Kingdom, and many children live in families that have been without work for years. Those at the meeting presented evidence of the appearance of a group that have suffered long term social exclusion—an underclass. Getting children in these families out of poverty will be the most difficult part of eradicating poverty. There seems to be evidence too that in a workless family either both parents get a job or neither do—and many families need two jobs to pull themselves out of poverty. It may thus be possible for the number of jobs to increase without the number of families in poverty falling. And there are questions about the quality of work where two incomes are needed to support a family and the effect on children of both their parents having to work.

    Directing more money to the children in greatest need is the second prong of the strategy. The government aims to spend £6bn more on children by the end of this parliament through a combination of increased benefits and tax credits. These have been aimed at the poorest children, and the 1998 and 1999 budgets should between them lift 800 000 children and 550 000 adults out of poverty. Nevertheless, it will become steadily harder to reduce the number in poverty not only because the very poorest will be last but also because poverty is defined relative to the income of the population, making it a moving target. Questions were also raised at the seminar about whether it was more important to increase income or counter social exclusion: a means tested benefit may create a sense of exclusion; and income may rise but “hardship” increase as well (for example, through increasing debts). And the problem persists that up to half of very poor people do not take up benefits to which they are entitled.

    The third prong of the strategy is to improve services, particularly education, for all children but especially poor children. Some teachers are sceptical about this commitment, but the government is spending £540m on Sure Start, a programme of preschool support and education based on a famous United States study, Head Start, that showed long term benefits.1 Most poor families cope under great strain, and parental interest in learning is an important determinant of what happens to poor children. But the seminar heard how low expectations from teachers and others can be damaging. Mr Darling called for an assault on the “poverty of expectation.” The government must also see through its action plan for reducing health inequalities.4

    The final prong of the strategy is to mobilise voluntary help and community action. Poverty cannot be overcome with a purely top down strategy, and the Chancellor is keen to build better relations with the voluntary sector. Many of those at the seminar were from the voluntary sector. Doctors, who are spread throughout Britain and who know the consequences of poverty, have a great contribution to make here. We have argued before in the BMJ that doctors should take on poverty in the way they have taken on tobacco and nuclear weapons.5 There is now an Intercollegiate Forum on Poverty and Health, and the forum and the government should surely be working together.6 The colleges need to increase their commitment, not least by giving more resources

    Can Britain really abolish child poverty? The poor, says the Bible, are always with us. But it would be hard to think of a better aim to unite people in Britain, and certainly doctors will want to play their part, both individually and through their organisations. Perhaps the same commitment and strategic thinking can then be gathered to counter poverty among children right across the world.

    References

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