Poverty and Child Health

Nick Spencer

• Publisher: CRC Press
• Year: 2018
• ISBN:
  9781315348070
• Edition: 2
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

The power of purchasers exposes the weaknesses of conventional thinking on the costs and benefits of priorities. Health policy analysts now have to develop rational criteria to support decisions in a process which may be inherently intuitive. This authoritative and practical text points the way towards clear choices in resource allocation and the implications of these choices on expenditure diverted among different health care programmes.

Part One

Definition and measurement

1

Defining and measuring poverty

This chapter is not intended as an exhaustive review of the long-running debate surrounding the definition and measurement of poverty. I have considered the essentials of the debate because of its importance in establishing the continued existence of poverty in developed countries and in giving a new impetus to the exploration of the effects of poverty on health. It also serves to warn the reader of some of the pitfalls inherent in defining and measuring poverty. In the brief review of approaches to measurement I have considered the profusion of measures of poverty, deprivation and socio-economic status used in government and international statistics and in health studies so as to inform subsequent chapters (Part Two) which consider the evidence linking poverty and child health and the causal debate (Part Three).

Defining poverty

‘Absolute’ and ‘relative’ poverty

There is broad acceptance that millions of people in less developed countries suffer levels of poverty which threaten their very existence. In the 19th century, Chadwick in Britain and Villerme in France documented similar desperate poverty in the burgeoning cities of the Industrial Revolution.^1,2 Such poverty can be characterised as ‘absolute’ in that those who suffer it have insufficient resources to sustain life and the health consequences are devastating (see Chapters 4 and 5).

The rise in living standards consequent upon dramatic economic expansion has all but eliminated absolute poverty in developed countries. However, substantial minorities in most developed countries have material resources insufficient to enable them to participate fully in the life of the societies to which they belong. Lack of resources imposes limits on housing, nutrition and leisure choices and they must forgo goods and services seen as ‘necessities’ by their fellow citizens.^3,4 Though not absolute in that their resources are adequate to sustain existence on a daily basis, their poverty can be described as ‘relative’; relative, that is, to the living standards enjoyed by their fellow citizens.

Relative poverty is not a universally accepted concept. It has been challenged on the grounds that it merely identifies the less well-off and that, by using the definition in an extremely wealthy society, it would be possible to argue that inability to afford a new car every year would constitute poverty.⁵

In practice, as Alcock points out, any attempt to define a poverty line must include both relative and absolute elements.⁶ It must change over time and be sensitive to ‘necessities’ of life in the specific society at the same time as establishing an absolute cut-off point below which poverty is said to exist. As early as the 1880s this was accepted by Booth, one of the early pioneers of poverty studies, who defined the very poor as those whose means were insufficient ‘according to the normal standards of life in this country’.⁷ Rowntree, in related studies of poverty in York (UK), though attempting to define an absolute subsistence level of poverty – including expenditure exclusively on minimum necessities to maintain merely physical efficiency – tacitly conceded that ‘man (and more especially English man) cannot live by bread alone’ when he included in his original measure expenditure on tea and modified his measure for the later studies to include expenditure on such items as a radio and books.^8,9

Defining poverty lines

Most developed countries use an income ‘cut-off’ point as the poverty line. The European Union’s (EU) poverty measure is below 50% of the national average income. The official poverty line in the USA uses income cut-offs which vary by family size.¹⁰ As an alternative to income cut-off points, average expenditure devoted to necessities has been proposed as a means of determining the poverty level.¹¹

In the UK, successive governments have resisted the pressure to define an official poverty line, reflecting in part a desire to minimise the extent of poverty in the UK and deflect criticism of social policy.⁶ A vigorous debate has ensued which has included a reassessment of the effects of poverty on health and a renewed interest in health inequalities.^4,12

Hidden poverty and ‘double jeopardy’

The poverty definitions considered above, based on household incomes, do not account for uneven income distribution within a household leading to poverty which is ‘invisible’, nor do they account for the ‘double jeopardy’ experienced by ethnic minority groups in which poverty is created by, or exacerbated by, discrimination, overt or covert.

Women and children are the main victims of hidden poverty.¹³ In households in which the family resources are earned and controlled by the man and women are given ‘housekeeping’ money, maldistribution has been shown to occur, leading to reduction in the food and fuel consumption of women and children within the family.¹⁴ Women separated from their partners have reported that their financial situation improved after separation despite reliance on state benefits.¹⁴

The poverty experience of women and children has been further exacerbated by restrictions in public welfare services which have been a feature of government policy in the USA and most European countries in the last few decades. Women and children are the main beneficiaries of these services and they experience their loss more acutely. These restrictions impose a further burden on women, who undertake most caring roles within the family for children and other dependants.¹⁵

The relationship between race, ethnicity, poverty and child health is considered in detail in Chapter 7, and the specific effects of double jeopardy are explored. Suffice it to say here that the poverty experience of most ethnic minority groups is greater than that of the indigenous population as a result of discrimination and, for those in poverty, discrimination and racism ensure that their passage out is blocked.^10,16

Hidden poverty and double jeopardy are not part of official definitions of poverty in developed countries. When considering the effects of poverty on child health both these factors need to be given special attention as children are likely to be disproportionately affected. In this book, wherever possible, I have drawn on evidence which addresses these important but poorly recognised aspects of the overall poverty experience of children.

The international dimensions of poverty

Though much of the evidence related to poverty and child health in this book is presented with reference to particular countries, it is important to recognise that poverty is an international phenomenon influenced by transnational as much as national economic and social policy and development.⁴ Common elements can be identified despite the diversity of experience in different countries and the multiple influences of culture and tradition which mould poverty experience in individual countries.

These common elements include material disadvantage, powerlessness and exclusion from consumption either of the basic necessities of life or the goods and services w...

Table of contents

• Cover
• Title Page
• Copyright Page
• Contents
• Foreword
• Acknowledgements
• Introduction
• Dedication Page
• Part One Definition and Measurement
• Part Two Evidence of Child Health Inequalities
• Part Three The Causal Debate
• Part Four Social and Health Policy Implications
• Appendix
• Index