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Poverty
  1. TONY WATERSTON, Consultant paediatrician

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    Poverty and Child Health. Edited by Nick Spencer. (Pp 249; £18.50 paperback.) Radcliffe Medical Press, 1996. ISBN 1-857775-068-3 .

    Are there really still poor people in Britain? Will the poor always be with us? Can the health service do anything about it anyway? Never a disbeliever in poverty, I have become a sceptic of late on the possibilities of doctors making a difference. But no longer, after reading Poverty and Child Health. It challenged me, gave me fresh ammunition, and provided some very good pointers for action. And, indeed, action is needed, by our college and by every paediatrician in the country, if we are to reverse the horrendous slide into inequality evident in the UK in the mid-90s.

    Poverty and Child Health is an academic book but not a book just for academics. It is highly readable, and the clarity of the print and the prose is remarkable, as are the end of chapter summaries effective. Spencer does not generally overstate the case, though I did detect one example of hyperbole: the association of iron deficiency anaemia with socioeconomic status is by no means as strong as he suggests.

    Spencer takes a genuinely international perspective, and this is valuable particularly as some of the best examples of poverty reduction are from outside Europe. Sri Lanka and Kerala do outstandingly well through their emphasis on education for all and equitable income distribution, while Brazil is spectacularly bad as the rich get richer, and the poor poorer. But surely our poor aren’t that poor? Spencer devotes 17 pages to defining and measuring poverty, and these are a must.

    The Jarman index gets a thumbs down, Townsend a modest cheer. While the European Union defines poverty as income less than 50% national average, the author stresses the value of measures of income inequality. I now know to use the Gini coefficient to compare income inequality between countries.

    The middle of the book covers familiar territory on the evidence for links between poverty and child health and the causal debate, filled with clear figures and tables. The section on ethnicity and race—not at all the same, as some might think—is another gem. Spencer comes down firmly in the ‘structural’ camp as opposed to behaviour as the main cause of poverty, and who could disagree with his logic? Few outside the bounded horizon of the present government. The exposition on nutrition and child health is another excellent section (what are the cheapest sources of calories in UK? Meat pies, sausages, chips, and Mars bars).

    Only 11 pages are devoted to health service approaches, which is partly because of the relative ineffectiveness of health service action, and partly because effective solutions are scanty. The principles are well drawn: equity, empowerment, data monitoring, advocacy, and accessibility are central. The example of Australia is highlighted: there, specific targets are set for disadvantaged groups. Sandwell is one of the few health authorities in UK to have used a similar approach. Health education advice is sadly ineffective in bridging the gap between rich and poor.

    Spencer ends with pointers for future research. What better agenda for the research unit of our new college?

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