All Party Parliamentary Group Health in All Policies

Child Poverty and Health – the Impact of the Welfare Reform and Work Bill 2015-2016

Introduction

We welcome the opportunity to respond to this inquiry. We have responded to those questions most relevant to our areas of experience and which impact on population health and reduce health inequalities in Scotland. We have used Scottish data to illustrate our arguments where appropriate but these are likely to be just as relevant to England.

Why we are responding

We are responding to this consultation because:

 Child poverty is common, preventable and has profound links to the quality and length of life.

 Income is a key determinant of health and health inequalities.

 Most social security issues and labour market legislation remain reserved to the UK Government.

 Priorities at a UK level have an indirect impact on Scottish Government priorities, by setting funding levels and influencing the ‘grammar’ for policy responses to social problems.

It is important to note that there are two issues at stake here: the diversion of public policy and resources away from the scale and nature of child poverty (with serious implications for the poorest 20-40% of children in the UK), and the downplaying of income as a key determinant of child health and health inequalities, with implications for the majority of children in UK society (outside the wealthiest households).

In your view, what is the relationship between child poverty and child health, including inequalities?

Child poverty has the capacity to influence child health and health inequalities in three ways:

 The direct association between childhood poverty and childhood health outcomes

 The indirect association between parental poverty and child health outcomes (mediated through parental mental health and capacity to parent effectively)

 The long-term consequences of child poverty for disadvantage in adulthood, including many key determinants of health

Direct association between childhood poverty and childhood health outcomes Poverty is bad for children’s social, emotional and mental health, their cognitive development and (to a lesser extent) their physical health1. Children’s life circumstances impact on their physical, psychological and wider development from before birth. Adverse and complex social factors experienced during pregnancy have the earliest impact on the health of the infant and their mother. There is a link between socio-economic disadvantage and health inequalities during the early years; in particular there is an increased risk of unintentional injuries, social emotional and cognitive difficulties2. In short, money matters.

Health outcomes and determinants for children and young people in Scotland are strongly patterned by income. The Strengths and Difficulties Questionnaire (SDQ) is a measure of child mental health. In 2014, Scottish children aged 4-12 in the two lowest income quintile households were six times as likely to have an abnormal SDQ score, compared to those in the highest income quintile (13% vs. 2%)3. While just 2% of children in Scotland in the highest income quintile households had bad/very bad health, this increased to 6% in the second lowest income quintile and 8% in the lowest income quintile4.

Indirect association between parental poverty and child health outcomes

The association between parental mental health and child health outcomes (especially behavioural difficulties) is well established5 6. Paternal mental health, like that of children, is heavily patterned by income. The 2008 Millennium Cohort Study found that 9.2% of mothers and 8.2% of fathers living in poverty in the UK reported having emotional problems that limiting work or study “quite a lot” compared to 3% of mothers and 2% of fathers not living in poverty7.

Long-term consequences of child poverty for disadvantage in adulthood, including many key determinants of health

As noted above, there is a clear association between childhood poverty and worse health outcomes in childhood and adolescence. The opportunity to reduce these inequalities is likely to decline as children age8. Poor mental health in childhood has a large negative impact “on the ability of affected children to work and earn as adults and on intergenerational and within-generation social mobility.”9 Adolescents with behavioural problems are more likely to leave school with no qualifications, be in a low social class in

1 Cooper K, Stewart K. Does Money affect Children’s outcomes? A Systematic Review. York: Joseph Rowntree Foundation; 2013. 2 MacDonald W, Beck S, Scott E. Briefing on child poverty. Evidence for Action, NHS Health Scotland; 2013. 3 Scottish Health Survey 2014. 4 Scottish Health Survey 2014. 5 Hobcraft JN, Kiernan KE. Predictive factors from age 3 and infancy for poor child outcomes at age 5 relating to children’s development, behaviour and health: evidence from the Millennium Cohort Study. York: University of York; 2010. 6 Marryat L, Martin C. Growing Up in Scotland: Maternal mental health and its impact on child behaviour and development. Edinburgh: Scottish Government; 2010. 7 Gregg P, Propper C, Washbrook E. Understanding the Relationship between Parental Income and Multiple Child Outcomes: a decomposition analysis. Centre for Market and Public Organisation, Working Paper No. 08/193; 2008. 8 MacDonald W, Beck S, Scott E. Briefing on child poverty. Evidence for Action, NHS Health Scotland; 2013. 9 Goodman A, Joyce R, Smith JP. The Long shadow cast by childhood physical and mental problems on adult life. PNAS 2011; published ahead of print March 28, 2011, doi:10.1073/pnas.1016970108 adulthood and (for those with severe behavioural problems) report financial difficulties in adulthood10. This has consequences for adult health inequalities.

If carried through, what will be the impact of the welfare reforms on:

Levels of child poverty in England (and inequalities)

Welfare reform and any further changes to social security are likely to have an impact on child poverty and inequalities throughout the UK, not just England.

Children’s health and wellbeing (including mental health and wellbeing)

We are concerned that removing the four child poverty targets set out in the Child Poverty Act 2010 and the UK Government’s duty to meet the targets will encourage policy-makers and the public to ignore the scale and nature of child poverty in the UK and distort policy responses to it. This is likely to reinforce existing inequalities in child health.

We welcome a focus on full employment but we are concerned that the lack of definition may allow high levels of in-work poverty (of the 3.7m children in relative poverty in the UK in 2013/14, 63% of them lived in households where at least one adult was in paid employment11), spatial and occupational inequalities in demand for labour12 and the importance of good work for workers’ health and their families13 to be ignored. Worklessness (and indeed the other measures outlined in the Bill) are not proxy or better measures of income poverty – they are related issues, but without attending to income as well the prospects for child health are not good. North American experience is that welfare reform policies focused on increasing parental employment rates without concern for earnings or household incomes either had no effect or adverse effects on children’s health. The few programmes that had a positive impact on childhood health all had an earnings supplement component.14

Impact on vulnerable groups

We are also concerned other measures in the bill, particularly increased risk of sanctions for responsible carers associated with Universal Credit, will have detrimental consequences for vulnerable groups. Lone parents and their children and families with at least one disabled member are especially at risk. Between 2004/05 and 2014/15, the number of lone parents claiming Income Support/JSA who were sanctioned doubled (from 31,000 to 60,000) in

10 Colman I, Murray J, Abbott RA, Maughan B, Kuh D, Croudace TJ, and Jones PB. Outcomes of conduct problems in adolescence: 40 year follow-up of national cohort. BMJ 2009;338:a2981. 11 HBAI 2013/14, Table 4.5db: Percentage of children in low-income groups by various family and household characteristics, United Kingdom. 12 Taulbut M, Robinson M. The Chance to Work in Britain: Matching Unemployed People to Vacancies in Good Times and Bad. Regional Studies Volume 49, Issue 12, 2015. 13 NHS Health Scotland. Inequality briefing: Good work for all. http://www.healthscotland.com/documents/26039.aspx 14 Waldfogel J. Welfare Reforms and Child Well-Being in the US and UK. London: Centre for Analysis of Social Exclusion; 2007. Britain, despite the numbers claiming benefits falling substantially15. One Parent Families Scotland have argued that both the threat and use of sanctions is already having a damaging effect on parents and children’s health and wellbeing16. The Bill proposes to increase this conditionality, with likely negative consequences for the mental health of lone parents not currently in employment17 (and for their children’s current health and future life chances, as outlined above). A sensible response would be to extend the provision of 30 hours of free childcare to include school holidays, which would increase the likelihood that lone parents are able to gain and sustain employment, and to restore flexibilities for lone parents into the benefits system (as regulations rather than guidance), as recommended by Gingerbread18. One Parent Families Scotland have also argued that to make sustainable employment a reality for lone parents “instead of focusing on punitive measures…more attention should be placed on tackling the real barriers which parents face”, such as childcare, skills, good quality employability services and flexible employment opportunities.19

Scottish Directors of Public Health & NHS Health Scotland, January 2016.

15 In 2004/05, 31,000 were sanctioned from a caseload of 823,000; In 2014/15, 60,000 were sanctioned on a caseload of 585,000. All figures are for Great Britain (Source: DWP). 16 One Parent Families Scotland. OPFS Briefing: Welfare Reform and Work Bill Report Stage. http://www.opfs.org.uk/wp-content/uploads/policy20151026a_opfs-briefing-welfare-reform-work-bill- report-stage.pdf 17 Harkness S, Skipp A. Lone mothers, work and depression. London: Nuffield Foundation; 2013. 18 http://www.parliament.uk/documents/lords-committees/Secondary-Legislation-Scrutiny- Committee/Gingerbread-submission-universal-credit-final.pdf 19 One Parent Families Scotland. OPFS Briefing: Welfare Reform and Work Bill Report Stage. http://www.opfs.org.uk/wp-content/uploads/policy20151026a_opfs-briefing-welfare-reform-work-bill- report-stage.pdf