Sunday, December 24, 2017

Poverty and the Sick Kids

A comprehensive study that examined hundreds of thousands of patient records found inequalities between children from the poorest and richest families. Across the 10 most common conditions leading to unplanned hospital visits, the rates of admission were consistently highest among children and young people from the most deprived areas. For condition after condition, the poorest fifth of young people are admitted in greater numbers than the richest fifth. In cases of tonsillitis, viral infections, abdominal pain, respiratory infections, convulsions, gastroenteritis, poisoning, chest pain – even head injuries – the poorest young people were admitted for emergency treatment at rates 40% or more higher than the richest.

One of the report’s authors, Dr Ronny Cheung, a paediatric consultant at the Evelina children’s hospital, London, says he is seeing a growing evidence of conditions not only exacerbated by poverty, but caused by it. “I’m seeing kids with rickets on a fairly regular basis in my clinic,” he says. “That is related to nutrition at the very least. We are seeing more advanced cases. It should be a Victorian illness. It shouldn’t be around to this degree any more...This is about life chances. It’s about the fact that a quarter of the children in this country live in material poverty. It’s about a lack of social mobility. It’s a cycle.”

Children from poor families are far more likely to end up in hospital A&E departments or need emergency treatment for conditions such as asthma and diabetes, according to figures revealing the consequences of poverty in Britain. Senior doctors said it showed the “devastating impact” of deprivation on child health. The most deprived young people are 58% more likely to go to A&E than the least deprived groups, with the most deprived teenagers experiencing A&E attendance rates almost 70% higher than those from the best-off families. The most deprived groups were 55% more likely to experience an unplanned hospital admission, though that gap narrowed over the last decade. School-age children from the poorest areas are two and a half times more likely to be admitted to hospital in an emergency for asthma than those in the richest areas. In 2005-06, school-age children in the most deprived areas had double the emergency admission rate for asthma compared with their least-deprived counterparts. However, by 2015-16, the gap had grown to about two and a half times. There is also evidence of alarming health inequalities persisting into adulthood. While unplanned admissions for diabetes have been stable or have decreased for younger children, analysts said there had been a “striking growth” for all 20- to 24-year-olds.

Nigel Edwards, chief executive of the Nuffield Trust, said: “Asthma and diabetes are both conditions that we should be managing outside hospital. It is an indictment of how we are looking after the most vulnerable in our society that deprived children are now more likely to experience unplanned admissions for asthma than their counterparts did 10 years ago.”

The research shows the gap has grown substantially in a decade. One of the study’s authors warned that with child poverty increasing, it is “hard to see the inequality gaps we highlight being eradicated anytime soon”. Other experts blamed cuts to school nursing and the benefits system as contributing to the divide. Experts said education, diet, environment and the pressures on families living on the breadline meant poor children often ended up in hospital when their health issues could have been headed off earlier. The report’s authors warn that the most vulnerable children are being let down by health services.

Dougal Hargreaves, Nuffield visiting researcher and of the UCL Institute of Child  Health, said: “Receiving emergency hospital treatment is often absolutely essential, and emergency care saves lives every day. But the level of variation between rich and poor, and the growing inequalities gap in unplanned admissions for asthma, is really worrying.”
Wendy Preston, head of nursing at the Royal College of Nursing, said asthma should be managed outside hospital. “Yet the worsening shortage of school nurses and health visitors means early warning signs and prevention opportunities are missed, and vulnerable children do not receive the support they need."
Professor Russell Viner, officer for health promotion for the Royal College of Paediatrics and Child Health, said that the report highlighted “the devastating impact poverty can have on child health, especially in relation to emergency admissions for asthma and diabetes. However poverty has an impact on a range of other issues such as education, housing and continuity of healthcare,” he said. “We agree with the authors of this report when they say the most vulnerable children are being let down by health services and we back their calls for policymakers to focus on narrowing the inequalities gap. They can do this by reversing cuts to universal credit which actually leave the majority of families claiming this benefit worse off, and by the restoration of national targets to reduce child poverty, backed by a national child poverty strategy.”

According to the latest government data, there were 121,360 children in temporary accommodation in England in the third quarter of 2017 – with more than 88,000 of those in London. It is the highest number in a decade. The figure in London represents a 52% growth over the last five years. In the capital alone, more than 3,000 children are living in bed and breakfasts, or hostels. Since the Conservatives came to power in 2010 the number of families with dependent children – another priority homeless group identified by councils – has increased from 22,950 to 40,130. The number of homeless households with a family member who has a physical disability has increased from 2,480 to 4,370. The number of homeless households in England identified by councils as priority cases because they contain someone who is classed as vulnerable because of their mental illness, has risen from 3,200 in 2010 to 5,470 this year.

“With homelessness soaring, it is no surprise that the number of vulnerable groups – including families with children – who are having to turn to their council for help is on the rise,” said Polly Neate, chief executive of charity Shelter. “As wages stagnate, rents continue to rise and welfare is cut, many people are struggling to keep a roof over their head. Eviction is now the number one cause of homelessness...The solution to our housing crisis must be to urgently build more affordable homes and, in the short term, end the freeze on housing benefit that is increasingly pushing people over the precipice into homelessness.”

 Research by the Joseph Rowntree Foundation earlier this month found almost 400,000 more children in the UK were living in poverty last year compared with 2012-13. It warned that decades of progress were being erased due to stagnant wages and inflation. It has called on the government to unfreeze working-age benefits and build decent, affordable homes. The Institute for Fiscal Studies estimates the number of children living in poverty is likely to rise to a record 5.2 million over the next five years. 

“Housing problems can have a major impact on child health – whether that’s increased likelihood of respiratory problems because of poor housing conditions, or mental ill-health,” said Dr Dougal Hargreaves. “In a recent survey of paediatricians, over 40% had difficulty discharging a child in the last six months because of concerns about housing or food insecurity.”

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