Reducing child poverty and improving health through multi-sectoral policy making, by Linden Farrer

11 May 2015

The environment a child experiences has a profound influence on later life chances and outcomes, and difficult experiences during early childhood can have serious negative effects on the development of cognitive, communication, social and emotional skills[1]. A wide range of difficult experiences are associated with adverse child health and development outcomes, including neighbourhood deprivation, lack of housing tenure, material deprivation, and lower parental income and wealth[2]. These collectively point to the multi-dimensional nature of child poverty. Early childhood is therefore a critical period during the life course, during which policies and interventions across a range of areas can have a lasting influence, by helping to improve well-being and reduce future costs associated with ill-health and unemployment.

It is with these principles in mind that Inês Zuber MEP has drafted the own-initiative report on “Reducing inequalities with a special focus on child poverty[3]. In it she responds to the fact that child poverty is growing in Europe, that the effects of child poverty can last a lifetime and that they seem to reproduce across generations, and makes a strong case that austerity policies have directly increased child poverty in the European Union.

So what should be done about it? Zuber recommends: 1) Increasing support for children through universal benefits, 2) Guaranteeing universally free health services for children and parents, 3) Improving labour laws so that they provide more security and tackle precarious and illegal forms of employment, and 4) Eliminating the possibility of housing eviction for families that cannot afford their rent.

Many of these policy solutions tie in with the recommendations of the recently concluded FP7-funded DRIVERS project. While DRIVERS did not focus specifically on child poverty or on the consequences of ‘austerity’, it did suggest ways to improve health through policy and practice in three important areas (or periods) of the life course: early childhood, employment & working conditions, and income & social protection – areas that had been identified as particularly important in determining health in previous research[4]. DRIVERS proposed specific solutions to improving health and reducing health inequalities, which may be worth reflecting on in the light of this own-initiative report.

Because adversities and poverty follow a social gradient (rather than simply being a case of ‘facing vs. not facing adversity’), DRIVERS concluded that universal services need to be provided that are responsive to need[5]. Furthermore, a comprehensive range of services are needed: parenting and family support, high-quality early childhood education and care, and good healthcare in the pre- and postnatal periods. Effective interventions that improve child health seem to be those that augment parental capacities, improve housing conditions, provide day care, speech and psychological therapies for children, and improve parents’ skills and knowledge[6].

In terms of work & employment, DRIVERS reiterated that lower occupational groups are at higher risk of work-related ill health than higher occupational groups. This means that parents experiencing poverty are more likely to have jobs that are stressful and pay less than those who live in relative affluence. Forget the preconception that the bank manager suffers the most stress: it is lower occupational groups who suffer the highest levels of physical and psychosocial stress in their working lives. The solutions to improving quality of work, particularly for lower occupational groups which need it the most, are similarly multi-faceted: prioritising labour market and occupational health and safety regulations, making available appropriate occupational health and safety services, fair wages, monitoring adversities at work, encouraging workers, employers, trade unions and other stakeholders to work together to improve working conditions, and implementing active labour market programmes to integrate vulnerable groups (back) into the labour market[7], [8].

Social protection cuts across the life course, providing services and a financial safety net when it is needed most – often during periods of life transition, such as after the birth of a child or when someone becomes unemployed. Social protection therefore needs to protect against different kinds of risks and particular attention should be paid to those at risk of being marginalised. Unsurprisingly, higher levels of social spending are generally linked to better health and smaller inequalities, but DRIVERS went further and showed that coverage is crucial: 90% (or more) of the workforce needs to be covered by unemployment insurance for the health benefits to become apparent; at the moment, many countries fail to ensure this level of coverage. Finally, enabling people to access and obtain the social protection they are entitled to, providing integrated support to families with complex needs, and making sure that front line staff have the means necessary to treat their clients appropriately could meet the needs of people experiencing poverty better and improve the uptake of social protection and the experience of those accessing it[9].

Zuber’s report is scheduled to be voted on by members of the Employment and Social Affairs Committee on 15 July 2015. Hopefully her colleagues will agree that the existence and increase of child poverty in the European Union is indeed shameful, and that policy makers need to respond to it with multi-dimensional and cross-sectoral policies, covering social protection, health services, employment laws and housing policies. As she notes, “the negative policy measures taken today will have irreversible negative impacts on the lives of these people and on society”, and the need for action is therefore acute. Even though the report is non-binding, a strong stance could influence the European Parliament’s response to other dossiers – and press home to member states and the European Commission that much more needs to be done to at European, national and local levels to ensure that increasing numbers of children enjoy a decent and poverty-free start to life.

 

[1] DRIVERS (2015). Universal, quality early childhood programmes that are responsive to need promote better and more equal outcomes in childhood and later life. Available here

[2] Pillas D, Marmot M, Naicker K, Goldblatt P, Morrison J & Pikhart H (2014). Social inequalities in early childhood health and development: a European-wide systematic review. In: Pediatric Research, 76(5), 418-424. DOI: 10.1038/pr.2014.122.

[3] Available here

[4] See for example: 1) WHO. Review of social determinants and the health divide in the WHO European Region: Final report. 2014. 2) Marmot M, Allen J, Goldblatt P, Boyce T, McNeish D, Grady M, Geddes I. Fair Society, Healthy Lives. The Marmot Review. Strategic Review of Health Inequalities in England post-2010. London: 2010.

[5] Goldblatt P, Siegrist J, Lundberg O, Marinetti C, Farrer L & Costongs C (2015). Improving health equity through action across the life course: Summary of evidence and recommendations from the DRIVERS project. Report produced as part of the ‘DRIVERS for Health Equity’ project, Brussels: EuroHealthNet.

[6] Morrison J, Goldblatt P, Pikhart H, Ruiz M. Early child development: Report on case studies. Report produced as part of the ‘DRIVERS for Health Equity’ project. Research Department of Epidemiology and Public Health, University College London. London: 2015. Available here

[7] DRIVERS (2015). Improvements in quality of work, particularly for people in lower occupational groups, would contribute to a significantly healthier and more productive Europe. Available here

[8] Siegrist J, Montano D & Hoven H (2014). DRIVERS final scientific report: Working conditions and health inequalities, evidence and policy implications. Report produced as part of the ‘DRIVERS for Health Equity’ project, . Düsseldorf: Centre for Health and Society, Faculty of Medicine, Heinrich Heine-Universität.

[9] DRIVERS (2015). Well-designed social protection systems can improve the lives of people and reduce health inequalities. Available here.