Poverty and the health of children and adolescents

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Abstract
The links between poverty and child health are extensive, strong, and pervasive. By this I mean that virtually all aspects of health are worse among children living in poverty than among children from affluent families; that the difference in health between poor and well off children poses a substantial public health problem; and that children’s health varies closely with even the most subtle of socioeconomic differences. Even in a disorder such as cystic fibrosis, with an equal incidence in different social groups, survival is strongly influenced by social factors.1 This paper describes the associations between social disadvantage and various aspects of child health. It then discusses the evidence that poverty and economic factors are central to the causes of social differences in child health. Alternative explanations of the links are then considered. Finally, the implications for policy of the research evidence are outlined. The material in this paper is based on a memorandum requested by the House of Commons Health Committee as part of the evidence they collected for their inquiry into children’s health in the UK. This inquiry began in 1996 and the bulk of the memorandum is reproduced here with the permission of the committee. ### MORTALITY Infant and perinatal mortality has long been known to vary socially. Infant mortality was used to validate the Registrar General’s classification of occupations into social classes2 and is also widely accepted as an accurate indicator of a country’s economic and social development.3 Infant mortality was a key indicator in the Black report4 and the social differences persist; in 1993 infant mortality in the most affluent class (married, social class I) was 4.3/1000, whereas in the poorest class (unmarried, social class ‘other’) it was 18.5/1000.5 Overall, mortality throughout childhood and adolescence follows this social pattern; the only causes of …