This guest blog is written by Laura Martin, Senior Health Improvement Officer – Early Years (Child Poverty) at NHS Health Scotland.
NHS Scotland understands and cares about child poverty and has made tackling health inequalities a priority. Poverty remains one of the most serious problems facing children today. Its effects last a lifetime, negatively impacting on health, education, social and physical development and seriously harming future life chances and opportunities. Under the United Nations Convention on the Rights of the Child all children and young people under the age of 18 have the right to enjoy the highest attainable standard of health and the right to a standard of living that is sufficient to meet their physical, emotional and social developmental needs. Under the Children and Young People (Scotland) Act 2014, we have a duty to report the steps we have taken to secure, better or further effect these rights for children. NHS Scotland is committed to giving all of its children the best possible start in life and the opportunities to fulfil their potential.
How does poverty impact on the health outcomes of Scotland’s children and families?
There are a number of ways in which exposure to family socio-economic status may impact on health during childhood and into adulthood. For example: the impact of family place in hierarchy and power within society; family ability to pay for goods and services; differential environmental exposures; or through impact on the skills and resources, including emotional and nurturing resources, that parents have available for effective and positive parenting. In most cases, it is the accumulation of individual risks and protective factors and the developing child’s response to these which will impact on adult health.
The Scottish cohort study Growing Up in Scotland (GUS) 2010 report on health inequalities in the early years (before the age of 4) found that:
- Levels of long-term health conditions and poor general health were relatively low at this stage, but showed a social gradient, increasing as deprivation increased.
- Problems with behaviour, psychosocial health and language were unequally distributed. Children in the most disadvantaged groups were at greatest risk, with these difficulties demonstrating a strong association with deprivation.
- Rates of unintentional injury were only increased in the most deprived families.
- Children from poorer circumstances experience increased exposure to risk factors including prolonged exposure to maternal smoking, long-term maternal general and mental health problems, poorer diet and lower physical activity levels.
- Disadvantaged households face a double burden in their experience of health inequalities, as both the children and adults within them are at greater risk of negative outcomes
The longer that children spend in poverty, the greater the likelihood that they will experience such problems as obesity, unintentional injuries, social, emotional and behavioural difficulties when compared to children who live temporarily in poor circumstances or have never lived in such circumstances.
Financial Inclusion – working in partnership to mitigate the impact of child poverty
Financial inclusion is a broad term which includes routine enquiry and referral to money advice services; debt management; access to grants; budgeting skills; onward referral to employability pathways; mitigation of fuel and food poverty. There are a range of statutory and non-statutory approaches to financial inclusion in Scotland, including services developed in the NHS.
A recent study presents evidence of the positive impact of financial inclusion services on health including reducing stress and anxiety, better sleeping patterns, reversal of weight loss, changes in medication, reduced contact with primary care team, reduction or cessation of smoking, improved diet and physical activity, reducing the risk factors and increasing protective factors experienced by children within families living in poverty.
Example of a local financial inclusion project in partnership between the NHS and Citizens Advice Bureau
Healthier Wealthier Children is a Children and Families Financial Inclusion initiative. It is mainstreamed in NHS Greater Glasgow & Clyde partnerships between Local Authorities and Money Advice Services after seedcorn funding in 2010-12 from the Scottish Government. It fits with a broader approach, for example, in NHSGGC, financial gain for NHS money advice referrals since 2010 is over 20,000 referrals with £24 million financial gain.
The key principles of Healthier Wealthier Children are:
- NHS staff are trained in routine enquiry money worries and make referrals to money advice services
- Financial inclusion is mainstreamed into patient and staff education programmes
- Money Advice staff receive specialist training on child poverty issues and have flexible approaches (e.g. telephone, evening appointments)
- A full assessment is carried out covering unclaimed welfare benefits, debt, grants available and employability options
- NHS provides funding to money advice services, with a role in facilitating partnerships, organising training and ensuring monitoring
The financial gain to date is £8.5 million gain, around 8,700 referrals with an average of around £3000 gain per family per annum. Outcomes reported include: reduced stress for families; prevention of financial crisis and major stress as clients are seen ‘earlier’ by money advice services; improved budgeting; increased uptake of unclaimed welfare benefits (e.g. Healthy Start; Tax Credits; Disability Living Allowance for children); Scottish Welfare Fund grants for white goods (e.g. cookers, fridges); referral to employability pathways; evidence addressing fuel and food poverty and patient feedback that this intervention can make a huge difference to health and social functioning.
Key messages for advice service professionals in working with families
Accessing services can be challenging for parents either through physically getting to an office, or waiting for a drop in appointment with children. Advice services could try to meet families where they are already accessing services, provide home visit appointments where required or provide appointments to avoid waiting times.
- Be aware of the stigma of poverty, and that low-income families are less likely to take up services that are seen as just for the poor, for example ‘benefits support’. General money advice services may be less stigmatising.
- Think about your contact with parents and families and what resources you expect them to have and afford.
- Don’t assume everyone knows what services are free, and is already receiving everything they are entitled to – many families miss out on things like Healthy Start vouchers, free medicines for children and the free childcare place.
- Make links with local NHS services to ensure that you are working together in the best interests of your clients and their children.
- Be aware of local services on offer which may of use to your clients, for example cooking classes, free swimming lessons, smoking cessation support etc.
NHS Health Scotland are keen to work in partnership with financial inclusion services to develop a national approach for the delivery of financial inclusion services to pregnant women and families with young children. If you are interested in learning more about this work or would like to let us know about a project you are working on please contact: Laura Martin NHS Health Scotland firstname.lastname@example.org.
A longer version of this article and more information can be found on www.maternal-and-early-years.org.uk/topic/background/child-poverty.