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Poverty and child health. N Spencer. (Pp352, 2nd ed.) Radcliffe Medical Press. ISBN 1-85775-477-8 .
I noted contrasting newspaper headlines in the week I read this book (February 2001): “5m Britons living on the breadline” (referring to the Breadline Europe survey in September 1999), and “Parents are to blame for child poverty”, a Peterborough City Council Leader commenting on the finding of the Poverty in Peterborough 2000 report. These summarise the breadth of attitudes represented in the country, and doubtless too in paediatricians, over the causes of child poverty. How much is it really parents' fault that children go to school dirty, with holes in their shoes, and without any breakfast, or indeed do not go to school at all? The blame culture is common, particularly among the conservative media, and those who live in poverty are well aware of this. Low income parents know that they carry the responsibility for parenting their children adequately. The evidence is that mothers will give up treats, trips, and an adequate diet for themselves in order to feed and clothe their children.
The Breadline Europe survey mentioned above measured poverty on the yardstick of the public's assessment of the absolute essentials of life: households lacking at least six of these were categorised as being “a lot” below the level of income needed to avoid absolute poverty. Nine per cent of the population came into this category. And the current European Union figures put the UK at the bottom of the league with a massive one in three children living in poverty. As UNICEF put it, “the UK emerges as a serious contender for the title of worst place in Europe to be a child”.
So, what is new in Spencer's second edition? In reviewing the first edition in this journal in May 1997 I wrote of the limited space given to health services approaches to tackle health inequalities. There is considerably more on this area in the new edition. Figures on poverty are updated, and there is a new section on measuring child health, though this is rather inadequate on the “assets” (health) as opposed to the “deficits” (disease). Perhaps the main change since the first edition is that there is a Labour government which has made a commitment to ending child poverty by 2020, ten years too long, in the view of the Child Poverty Action Group. In the meantime, how can we as paediatricians reduce the effects of poverty on childrens' health?
In Spencer's eyes, the most important means are political, through backing policies of redistribution: this would require a higher level of taxation for the well off. Spencer shows that Britain is bottom of the list for income redistribution in Europe. Sweden is at the top, with those on welfare achieving 83% of national average economic well being compared to 48% in UK.
Secondly, paediatricians should be aware of and support specific social policies aimed at families such as maternity allowance, additional benefits for lone parents, and child benefit.
Thirdly, there are specific health sector interventions of known effectiveness that paediatricians and their Royal College might take forward in collaboration with others. The basic principles of these are equity, empowerment and participation, intersectoral working, information and data monitoring, accessibility, flexibility, and advocacy. Examples of evaluated programmes are the accident reduction programme in Harlem, New York, which uses innovative community development methods, and the community mothers scheme in Dublin, which trains local volunteers in a home visiting programme.
The involvement of paediatricians in such schemes is limited at present, but could be considerable. Resolution for 2002: find out what is happening locally in measures to tackle poverty in child health, and contribute! Spencer's book will be essential advance reading.