1 in 4 children live in poverty in the UK and it can affect every aspect of a child’s life. Data and research can be used to help address the impact of social deprivation on the health and wellbeing of our patients and their families.
Dedicated to discussion on how we can make regions great places for all children and young people to stay healthy, develop, and thrive, this page is created by health practitioners for health practitioners, recognising health services can only ever be truly effective when coordinated with the wider determining structures within a child’s life.
Health inequalities refer to the avoidable, systematic and unfair differences in health situation between groups of people or communities. These are outlined by the World Health Organisation as “differences in health status or in the distribution of health resources between different population groups, arising from the social conditions in which people are born, grow, live, work and age”.
Child in Poverty
UNICEF defines a child in poverty as; “a child who experiences deprivation of the material, spiritual and emotional resources needed to survive, develop and thrive, left unable to enjoy rights, achieve full potential or participate as a full and equal member of society”.
Social Determinants of Health
The social determinants of health are the non-medical factors that influence health outcomes, which include the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life such as economic policies and social norms.
Healthy Life Expectancy (HLE)
This refers to a health outcome measure which denotes the years spent in good health. The healthy life expectancy measure adds a ‘quality of life’ dimension to estimates of life expectancy by dividing it into time spent in different states of health. Health status estimates are typically based on survey questions where respondents are asked to identify how their health is in general e.g. very good, good, fair, bad, or very bad.
These are used to examine the experience of individuals, families or communities in terms of the level of deprivation of the area in which they live. They are based on the Indices of Multiple Deprivation for each country and/or region, which are the official measure of relative deprivation. Decile 1 represents the most deprived 10% (or decile) of a particular region or country and Decile 10 represents the least deprived 10%.
The current state of play
We are all acutely aware of the changing scenery within the UK household. With the recent rise in the cost of living, this is no doubt going to push more children across the child poverty threshold. In England and Wales in 2020, 30% of all live births occurred in women who were born outside of the UK and 49% occurred in women who were in low-income employment or unemployed. Without the right tools and support system, there could be an ever-increasing proportion of infants born into deprivation who are at risk of experiencing poorer health outcomes.
Three devolved nations of the UK have previously reported on their HLE during the 2017-2019 time period. The proportion of life expectancy spent in poor health in those living in the most deprived areas compared to those in the least deprived (classified according to the national deprivation deciles) is shown in the maps below:
Between April 2020 and April 2021
27% of all children in the UK were living in poverty 3.9 million children or 8 in a classroom of 30
Understanding the divide
In 2014, Bywaters et al reported on a Nuffield Foundation-funded study that examined the role of deprivation in explaining differences in key children’s services interventions between and within 14 local authorities in England. The data demonstrated inequalities in rates of child welfare interventions within and between local authorities, systematically related to levels of deprivation.
In 2022, Bennett et al published a longitudinal ecological study of 147 local authorities in England and reported additional quantitative evidence of a contributory causal nature between child poverty and children’s social care involvement. In a 2021 report ‘The Economic Cost of Child Maltreatment in the UK’ by the Institute of Fiscal Studies, it was estimated that the average lifetime cost of non-fatal child maltreatment by a primary care-giver to be at £89,390 (95% uncertainty interval £44,896 to £145,508), and the largest contributors to this are costs from social care, short-term health and long-term labour market outcomes.
We cannot achieve progress without addressing inequality and each community must have the means of creating health and wealth opportunities for all. In February 2022, the UK government published the white paper on ‘Levelling up of the United Kingdom’. In this document, they set out the following agenda:
- Boost productivity, pay, jobs and living standards by growing the private sector, especially in those places where they are lagging
- Spread opportunities and improve public services, especially in those places where they are weakest
- Restore a sense of community, local pride and belonging, especially in those places where they have been lost
- Empower local leaders and communities, especially in those places lacking local agency.
The ambition for the government is to allow the UK economy to grow by incentivising the upskilling of the whole population regardless of the geographic area. They have set the timeline of 2030 to achieve their goals.
Index of multiple deprivation
Index of multiple deprivation is a relative measure of deprivation between small areas or neighbourhoods used throughout the UK. It utilises a number of different markers across seven (eight in Wales) domains to provide an overall measure of the problems experienced by a community living in a certain area.
The domains used differ slightly across the UK as the individual Governments collect and measure their data differently, therefore it cannot be used to compare between devolved nations. However, they are broadly:
- access to housing and services
- the living environment
Each area is scored in each domain and the results are added up providing data to help compare small areas as well as local authority/council areas. This can help to target policies, funding and resources to the most deprived areas.
It does have some limitations. As it uses relative data, it cannot quantitatively say how much more deprived one area is compared to another. It is not a measure of individual deprivation as there can be deprived individuals living in non-deprived areas. It is also not as effective in rural areas due to the large geographical area needed to provide the same population data.
Each Government has produced an interactive map, so you can look up areas by postcode and their related deprivation rank:
Other useful sources of data and evidence on health inequalities that are available to access online are shared below:
Information collated as part of the RCPCH State of Child Health landmark report published in 2020, looking into the health and wellbeing of children and young people and providing evidence on child health outcomes and data trends across the UK.
Social determinants that impact on a child’s health outcomes, including poverty, education, the health of their family and whether they require targeted support from social services were analysed, with a specific indicator focused on child poverty featured.
The Child Health Profiles on the Office for Health Improvement and Disparities’ ‘Fingertips’ public health data website provides a snapshot of child health in upper-tier local authority areas in England.
The indicators are part of an overview of child health in local government and CCG areas across several different themes, including the number of children in absolute low income families, homelessness, first time entrants to the youth justice system, and percentage of 5 year olds with experience of visually obvious dental decay.
The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report on health inequalities was published in April 2022. Based on NCEPOD reports over the last 15 years and data collections in progress, the report reviews data to identify themes relating to healthcare inequalities.
It identifies four areas of healthcare inequalities: protected characteristics – age and disability, socioeconomic deprivation, organisation of healthcare services and inclusion health groups. Key findings showed socioeconomic deprivation was visible in the care provided to children and young people, and highlighted hospital admissions as an opportunity to intervene in the general healthcare of vulnerable young people who may not be accessing primary care for their general health.
Commissioned by the Healthcare Quality Improvement Partnership on behalf of NHS England, this report published by the National Child Mortality Database (NCMD) in May 2021 includes analysis of 3,347 children who died in England between 1 April 2019 and 31 March 2020, and investigates the characteristics of their deaths to identify if socio-economic deprivation is associated with childhood mortality.
It finds that over a fifth of all child deaths might be avoided if children living in the most deprived areas had the same mortality risk as those living in the least deprived, with a clear association between the risk of child death and the level of deprivation for all categories of death except cancer.
Watch a presentation by NCMD Programme Lead Professor Karen Luyt introducing the report below:
An online hub created by the Health Foundation with the latest data, insights and analysis exploring how the circumstances in which people live shape their health.
Information on the platform includes analysis on international comparisons of life expectancy, life expectancy and healthy life expectancy at birth by deprivation, inequalities in age-standardised mortality rates, and a map of healthy life expectancy at birth in the UK.
An extensive online library of King’s Fund resources focussed on health inequalities and access to care for different groups in society, including in-depth analysis and expert commentary on key topics, a programme of regular educational virtual events, opinion blogs, references for further reading and useful data visualisation tools.
The King’s Fund is an independent charitable organisation working to improve health and care in England, founded in 1897 by the Prince of Wales. It is not aligned with any political or professional interests.
The Joseph Rowntree Foundation is an independent social change organisation working to solve UK poverty. Through research, policy, collaboration and practical solutions, the Foundation aims to inspire action and change that will create a prosperous UK without poverty.
Online resources include data presented from their 2022 UK Poverty report, which sets out the trends and impacts of poverty across the UK, and the latest policy briefings, news articles and reports focused on child poverty.
The Association for Young People’s Health’s new Youth Health Data website helps child health professionals find useful data about young people’s health that can be used in their day to day work.
Their health inequalities section draws together publicly available data on inequalities in health outcomes for 10-24 year olds, highlighting the extent of the problem and the need for prevention and early intervention.
Social determinants of children and young people’s health
For RCPCH Conference 2021, a breakout session on the social determinants of children and young people’s health was led by Born in Bradford (BiB) who shared their journey in tackling health inequalities in one of the most deprived cities in the UK. The BiB team were joined by a panel of child health professionals to discuss how we can all be agents for change and take a whole system approach to improving the health of the next generation.
There was science, and much more, including stories and personal reflections, insights and words of wisdom from the UK and around the world. In this section, you can explore recorded talks, vlogs, and resources all designed to ignite the conversation on social determinants of children and young people’s health. We share the challenges and successes of tackling the social determinants of health, and discuss how we can all work together to transform child health within the UK and across the world.
The BiB longitudinal birth cohort study was established in 2007 to transform the poor health outcomes facing children growing up in deprivation. BiB’s expertise in coproduction, data integration and working in complex systems is helping to create new and practical ways of building a healthier and fairer future for communities in Bradford and beyond.
These seven vodcasts, created by the BiB team and each lasting about six minutes, provides an introduction to the science of social determinants of children and young people’s health to stimulate discussion and share learning.
Dr Mathew Mathai, Consultant Paediatrician at Bradford Teaching Hospitals NHS Foundation Trust asks: ‘Is it time for a new type of paediatrician?‘
Download the slide deck below and listen to the accompanying audio commentary as you view in slideshow:
Prof Kate Pickett FRSA FFPH, Deputy Director of the Centre for Future Health and Associate Director of the Leverhulme Centre for Anthropocene Biodiversity, at the University of York discusses: ‘Unequal-ities – the importance of micro and macro- perspectives’.
Prof Mark Mon Williams, Professor of Cognitive Psychology and Academic Lead at the University of Leeds explores: ‘Why we can’t change health outcomes in isolation and we need to work with schools’.
Prof Rosie McEachan, Director of Born in Bradford, Bradford Teaching Hospitals NHS Foundation Trust and Honorary Professor at University of Bradford presents: ‘A people powered research programme: from pregnancy – through birth and childhood to transition and beyond!‘ and also explores co-production with a talk on: ‘Building a healthier, fairer future for children and communities, together’.
Download the slide decks below and listen to the accompanying audio commentaries as you view the slideshows:
Prof Neil Small, Professor of Health Research at University of Bradford and Academic Lead for BiB discusses: ‘The relationship of individuals to the whole – building alliances and sharing power’.
Prof John Wright, Director of the Bradford Institute for Health Research and Chief Investigator for BiB asks: ‘What difference does it make? From research to policy’.
Made by NHS England with the Connecting Care for Children (CC4C) team, the video below describes a system approach to integrated care for children and young people, including primary care and the community:
The CC4C film below shows a very powerful form of community engagement, using a simulation of an asthma attack. It also shows the benefits of an integrated care system that includes members of the public as equal partners:
‘Fix Freddie’: this CC4C film below encourages us to think outside the box. It describes how puppet theatre can be used to share important information with the public:
The ‘Patient Academy’: this CC4C film below describes a place that parents can play in – teaching each other; teaching professionals; and learning from professionals. It illustrates coproduction to tackle high numbers of parents bringing their young children to A&E with minor illness:
‘How to Help Your Unwell Child’: this CC4C film below shows a very powerful form of community engagement, using a simulation of an acutely unwell infant. It also shows the benefits of an integrated care system that includes members of the public as equal partners:
Parkview Olympics was an award-winning intervention that used local resources to turn weight management into a thrilling community activity, at zero cost. Watch their film here, which describes an obesity project designed and delivered by local parents.
Meet the community
- Beck AF, Anderson KL, Rich K, et al. Cooling The Hot Spots Where Child Hospitalization Rates Are High: A Neighborhood Approach To Population Health. Health Affairs 2019; 38, NO. 9: 1433–1441. DOI: 10.1377/hlthaff.2018.05496
- An ecological framework for improving child and adolescent health.
- , et al. Using a network organisational architecture to support the development of Learning Healthcare Systems.
- Fine-Goulden, M.R. Power and powerlessness in a pandemic. Pediatr Res (2021). DOI: 10.1038/s41390-021-01480-z
- , , , et al
- Klein MD, Beck AF, Henize AW, et al. Doctors and lawyers collaborating to HeLP children–outcomes from a successful partnership between professions. J Health Care Poor Underserved 2013 Aug;24(3):1063-73. DOI: 10.1353/hpu.2013.0147. PMID: 23974381
Singh, G., Owens, J., & Cribb, A. (2018). Practising ‘social paediatrics’: what do the social determinants of child health mean for professionalism and practice? Paediatrics and Child Health (United Kingdom). DOI: 10.1016/j.paed.2017.12.003
This page was created with the support of the Born in Bradford executive team and members of the QI Central Editorial Team and Wellbeing and Health Action Movement community; Dr Emma Sunderland, Dr Irnthu Premadeva, Dr Guddi Singh, Dr Helen Leveret, Dr Morven Davies and Dr Heba Abdelbari.
The Office for National Statistics published data on birth by parents’ characteristics in England and Wales in 2020, available online here.
The Office for National Statistics published data on health state life expectancies by national deprivation deciles in England between 2017 and 2019, available online here.
The Office for National Statistics published data on health state life expectancies by national deprivation deciles in Wales between 2017 and 2019 available online here.
The National Records of Scotland published data on life expectancy in Scotland between 2017 and 2019, available online here.
The Northern Ireland Department of Health published data on life expectancy in Northern Ireland between 2018 and 2020, available online here.
Bywaters, P., Brady, G., Sparks, T., Bos, E. (2014). Inequalities in child welfare intervention rates: The intersection of deprivation and identity. Child & Family Social Work, 21(4), 452–463. https://doi.org/10.1111/cfs.12161
Bennett, D.L., Schlüter, D.K., Melis, G., Bywaters, P., Alexiou, A., Barr, B., et al (2022). Child poverty and children entering care in England, 2015–20: a longitudinal ecological study at the local area level. The Lancet Public Health, 7 (6), E496-E503. https://doi.org/10.1016/S2468-2667(22)00065-2