All Party Parliamentary Group Health in All Policies
Child Poverty and Health – the Impact of the Welfare Reform and
Work Bill 2015-2016
Introduction
We welcome the opportunity to respond to this inquiry. We have responded to those
questions most relevant to our areas of experience and which impact on population health
and reduce health inequalities in Scotland. We have used Scottish data to illustrate our
arguments where appropriate but these are likely to be just as relevant to England.
Why we are responding
We are responding to this consultation because:




Child poverty is common, preventable and has profound links to the quality and
length of life.
Income is a key determinant of health and health inequalities.
Most social security issues and labour market legislation remain reserved to the UK
Government.
Priorities at a UK level have an indirect impact on Scottish Government priorities, by
setting funding levels and influencing the ‘grammar’ for policy responses to social
problems.
It is important to note that there are two issues at stake here: the diversion of public policy
and resources away from the scale and nature of child poverty (with serious implications for
the poorest 20-40% of children in the UK), and the downplaying of income as a key
determinant of child health and health inequalities, with implications for the majority of
children in UK society (outside the wealthiest households).
In your view, what is the relationship between child poverty and child health,
including inequalities?
Child poverty has the capacity to influence child health and health inequalities in three ways:



The direct association between childhood poverty and childhood health outcomes
The indirect association between parental poverty and child health outcomes
(mediated through parental mental health and capacity to parent effectively)
The long-term consequences of child poverty for disadvantage in adulthood,
including many key determinants of health
Direct association between childhood poverty and childhood health outcomes
Poverty is bad for children’s social, emotional and mental health, their cognitive development
and (to a lesser extent) their physical health1. Children’s life circumstances impact on their
physical, psychological and wider development from before birth. Adverse and complex
Cooper K, Stewart K. Does Money affect Children’s outcomes? A Systematic Review. York: Joseph
Rowntree Foundation; 2013.
1
social factors experienced during pregnancy have the earliest impact on the health of the
infant and their mother. There is a link between socio-economic disadvantage and health
inequalities during the early years; in particular there is an increased risk of unintentional
injuries, social emotional and cognitive difficulties2. In short, money matters.
Health outcomes and determinants for children and young people in Scotland are strongly
patterned by income. The Strengths and Difficulties Questionnaire (SDQ) is a measure of
child mental health. In 2014, Scottish children aged 4-12 in the two lowest income quintile
households were six times as likely to have an abnormal SDQ score, compared to those in
the highest income quintile (13% vs. 2%)3. While just 2% of children in Scotland in the
highest income quintile households had bad/very bad health, this increased to 6% in the
second lowest income quintile and 8% in the lowest income quintile4.
Indirect association between parental poverty and child health outcomes
The association between parental mental health and child health outcomes (especially
behavioural difficulties) is well established5 6. Paternal mental health, like that of children, is
heavily patterned by income. The 2008 Millennium Cohort Study found that 9.2% of mothers
and 8.2% of fathers living in poverty in the UK reported having emotional problems that
limiting work or study “quite a lot” compared to 3% of mothers and 2% of fathers not living in
poverty7.
Long-term consequences of child poverty for disadvantage in adulthood, including many key
determinants of health
As noted above, there is a clear association between childhood poverty and worse health
outcomes in childhood and adolescence. The opportunity to reduce these inequalities is
likely to decline as children age8. Poor mental health in childhood has a large negative
impact “on the ability of affected children to work and earn as adults and on intergenerational
and within-generation social mobility.”9 Adolescents with behavioural problems are more
likely to leave school with no qualifications, be in a low social class in adulthood and (for
those with severe behavioural problems) report financial difficulties in adulthood10. This has
consequences for adult health inequalities.
2
MacDonald W, Beck S, Scott E. Briefing on child poverty. Evidence for Action, NHS Health Scotland;
2013.
3 Scottish Health Survey 2014.
4 Scottish Health Survey 2014.
5 Hobcraft JN, Kiernan KE. Predictive factors from age 3 and infancy for poor child
outcomes at age 5 relating to children’s development, behaviour and health: evidence from
the Millennium Cohort Study. York: University of York; 2010.
6 Marryat L, Martin C. Growing Up in Scotland: Maternal mental health and its impact on
child behaviour and development. Edinburgh: Scottish Government; 2010.
7 Gregg P, Propper C, Washbrook E. Understanding the Relationship between Parental Income and
Multiple Child Outcomes: a decomposition analysis. Centre for Market and Public Organisation,
Working Paper No. 08/193; 2008.
8 MacDonald W, Beck S, Scott E. Briefing on child poverty. Evidence for Action, NHS Health Scotland;
2013.
9 Goodman A, Joyce R, Smith JP. The Long shadow cast by childhood physical and mental problems
on adult life. PNAS 2011; published ahead of print March 28, 2011, doi:10.1073/pnas.1016970108
10 Colman I, Murray J, Abbott RA, Maughan B, Kuh D, Croudace TJ, and Jones PB. Outcomes of
conduct problems in adolescence: 40 year follow-up of national cohort. BMJ 2009;338:a2981.
If carried through, what will be the impact of the welfare reforms on:
Levels of child poverty in England (and inequalities)
Welfare reform and any further changes to social security are likely to have an impact on
child poverty and inequalities throughout the UK, not just England.
Children’s health and wellbeing (including mental health and wellbeing)
We are concerned that removing the four child poverty targets set out in the Child Poverty
Act 2010 and the UK Government’s duty to meet the targets will encourage policy-makers
and the public to ignore the scale and nature of child poverty in the UK and distort policy
responses to it. This is likely to reinforce existing inequalities in child health.
We welcome a focus on full employment but we are concerned that the lack of definition may
allow high levels of in-work poverty (of the 3.7m children in relative poverty in the UK in
2013/14, 63% of them lived in households where at least one adult was in paid
employment11), spatial and occupational inequalities in demand for labour12 and the
importance of good work for workers’ health and their families13 to be ignored.
Worklessness (and indeed the other measures outlined in the Bill) are not proxy or better
measures of income poverty – they are related issues, but without attending to income as
well the prospects for child health are not good. North American experience is that welfare
reform policies focused on increasing parental employment rates without concern for
earnings or household incomes either had no effect or adverse effects on children’s health.
The few programmes that had a positive impact on childhood health all had an earnings
supplement component.14
Impact on vulnerable groups
We are also concerned other measures in the bill, particularly increased risk of sanctions for
responsible carers associated with Universal Credit, will have detrimental consequences for
vulnerable groups. Lone parents and their children and families with at least one disabled
member are especially at risk. Between 2004/05 and 2014/15, the number of lone parents
claiming Income Support/JSA who were sanctioned doubled (from 31,000 to 60,000) in
Britain, despite the numbers claiming benefits falling substantially15. One Parent Families
Scotland have argued that both the threat and use of sanctions is already having a
11
HBAI 2013/14, Table 4.5db: Percentage of children in low-income groups by various family and
household characteristics, United Kingdom.
12 Taulbut M, Robinson M. The Chance to Work in Britain: Matching Unemployed People to
Vacancies in Good Times and Bad. Regional Studies Volume 49, Issue 12, 2015.
13 NHS Health Scotland. Inequality briefing: Good work for all.
http://www.healthscotland.com/documents/26039.aspx
14 Waldfogel J. Welfare Reforms and Child Well-Being in the US and UK. London: Centre for Analysis
of Social Exclusion; 2007.
15 In 2004/05, 31,000 were sanctioned from a caseload of 823,000; In 2014/15, 60,000 were
sanctioned on a caseload of 585,000. All figures are for Great Britain (Source: DWP).
damaging effect on parents and children’s health and wellbeing16. The Bill proposes to
increase this conditionality, with likely negative consequences for the mental health of lone
parents not currently in employment17 (and for their children’s current health and future life
chances, as outlined above). A sensible response would be to extend the provision of 30
hours of free childcare to include school holidays, which would increase the likelihood that
lone parents are able to gain and sustain employment, and to restore flexibilities for lone
parents into the benefits system (as regulations rather than guidance), as recommended by
Gingerbread18. One Parent Families Scotland have also argued that to make sustainable
employment a reality for lone parents “instead of focusing on punitive measures…more
attention should be placed on tackling the real barriers which parents face”, such as
childcare, skills, good quality employability services and flexible employment opportunities.19
Scottish Directors of Public Health & NHS Health Scotland, January 2016.
16
One Parent Families Scotland. OPFS Briefing: Welfare Reform and Work Bill Report Stage.
http://www.opfs.org.uk/wp-content/uploads/policy20151026a_opfs-briefing-welfare-reform-work-billreport-stage.pdf
17 Harkness S, Skipp A. Lone mothers, work and depression. London: Nuffield Foundation; 2013.
18 http://www.parliament.uk/documents/lords-committees/Secondary-Legislation-ScrutinyCommittee/Gingerbread-submission-universal-credit-final.pdf
19 One Parent Families Scotland. OPFS Briefing: Welfare Reform and Work Bill Report Stage.
http://www.opfs.org.uk/wp-content/uploads/policy20151026a_opfs-briefing-welfare-reform-work-billreport-stage.pdf