Blog by Dr. Guddi Singh
Child poverty is finally getting some attention, thanks to a report out this month from the Royal College of Paediatricians and Child Health and the Child Poverty Action Group. Earlier this month I discussed this problem on Sky News.
Politicians, however, haven’t seemed to notice; the 4 million children living in poverty in the UK still haven’t featured in any of the debates leading up to the general election. The Lancet made the assertion that “Policy is lacking to prevent adverse health in poor UK children”. But let’s be clear. It is not that policy is lacking - after all it was policy abrogation that removed poverty reduction targets, with the Welfare Reform and Work Bill of 2015. Indeed, this bill has actively pushed more children into poverty, through introduction of the income cap and changes to tax credits. What’s lacking then is not policy, but political will. And it is important to make this distinction.
Poverty is a political problem. Poverty does not exist in a vacuum; it is neither natural nor inevitable. Poverty is created by political choices - and will only ever be dissipated by making different political choices.
It’s all a question of priorities.
The importance of socioeconomic status and the social gradient to health are well established. A series of major analyses commissioned by successive Labour governments, from Sir Douglas Black’s 1980 report on Inequalities in Health to Sir Michael Marmot’s 2008 review, Fair Society, Healthy Lives: a Strategic Review of Health Inequalities in England post-2010 all reiterate that progressive health outcomes can only be delivered through progressive economic and social policy. These reports point to the things that we as a society can do to improve public health. The fact that we live with problems like air pollution, food insecurity and a housing crisis is testament to the political choices that have been made about the economic organisation of our society. Despite the overwhelming evidence they provide, none of these reports has ever been seriously acted on, and since 2010 the policies of successive governments, particularly those linked to austerity and the withdrawal of social security, have aggravated the problems these reports aimed to alleviate. The latest research shows that in 2015 infant mortality rose for the first time in a decade. Worse still, while mortality has been rising for the poorest children since 2010, it has continued to fall for more advantaged groups. In other words, inequalities are widening. This failure has left us with a higher proportion of children in poverty than any other western European nation and persistent stark inequalities in health and well-being.
But just because the solutions might be political, it does not mean politicians are the only actors here. Civil society must also play their part - not least those of us who witness the effects of poverty on the bodies and minds of our patients everyday.
This presents doctors with an important challenge: What can we do as a profession and as professionals to act in our patients’ best interests here?
The British Association of Child and Adolescent Health (BACAPH) are working with the RCPCH in beginning to grapple with this question for paediatricians. In our national campaign to End Child Poverty we are not only making policy demands of the government, we are also beginning to flesh out what ‘doctor-action’ at many different levels in response to big societal issues might look like. Spanning from how we do our work in the clinic right up to service organization and actively bringing issues such as child poverty to national attention, we contend that doctors can – and must – think more expansively about their roles in the quest to create a better world.
Mahatma Gandhi famously said, “Be the change that you wish to see in the world”. For those of us advocating against child poverty, change must start in ourselves. And it means getting political.
This blog was adapted from a BMJ Rapid Response first published on May 22nd 2017.