A/Prof Nikki Turner, School of Population Health, University of Auckland Sept 2013

1. A/Prof Nikki Turner, School of Population Health, University of Auckland Sept 2013

2. Why does childhood poverty matter? Poverty in childhood affects their whole life • affecting every health outcome • educational outcome • future jobs and income

3. Poverty leads to poor health "Income is the single most important determinant of health. There is a persistent correlation worldwide between low income and poor health.“ The National Health Committee in its report to the MOH in June 1998 “Determinants of Health in New Zealand: Action to Improve Health"

4. Poor children get sick more often The likelihood of a child being sick is 3 times higher for those in the bottom household income quintile ( Easton and Ballantyne, 2002) Hospital admission rates for children are significantly higher in low income areas (Graham, Leversha and Vogel 2001)

5. The reality?

7. Hospitalisations for Bronchiolitis by Ethnicity and NZDep Index Decile, New Zealand Infants <1 Year 2002-2006 NZ Children's Social Health Monitor 2012

8. Hospitalisation for Preventable Serious Bacterial Infections and Respiratory Diseases, Risk by ‘Deprivation’, 0-14 years, 2002-2006 Source: Craig E, et al. NZCYES: Indicator Handbook. 2007.

9. NZCYES The Health Status of Children and Young People in NZ Feb 2013,

10. Hospital Admissions for Conditions with a Social Gradient in Children Aged 0–14 Years (Excluding Neonates) by Primary Diagnosis New Zealand 2007–2011 About two –thirds are respiratory conditions NZCYES The Health Status of Children and Young People in NZ Feb 2013,

11. But why are they getting sick…..

13. “If you have five bucks left to feed the family with at the end of the week, you’ll go and get $4 worth of chips and a loaf of Rivermill bread, not fruit and vegetables.” NZ Teacher 2005

15. Juliette

16. Juliette’ s background • Had first vaccination event, none since • Mum – solo parent, 17 years old • Hard background…….. • Dad – awol, drug and alcohol problems • Home • Aunty’s house • Currently 16 in the house - smokers • Moved 4 times since birth

17. Why does she get sick? Spread of the organism Weaker immune response Reduced access to health care services

18. Jack is a 9 year old boy well know to the general practice. He has come in very many times to the GP and local A & M with a range of health issues: asthma, eczema, chest infections, skin infections, injuries. Since birth he has had TENhospital admissions: bronchiolitis (baby x2) asthma (x3), broken leg, head injury, cellulitis (x2), dental abscess

19. Jack is overweight, doing poorly at school, described by the school as having a learning difficulty. Furthermore the school are concerned because he is a playground bully. His father is in jail. He has a brother and a sister and another died as an infant. His Mum is 29 with a chronic medical condition. She has been in and out of a lot of jobs, never lasts more than a few months

20. Jack’s future…… Poor health lifelong Obesity Drug and alcohol abuse School failure, limited occupational options Criminality Broken relationships Shorter life expectancy

21. Rate (95% CIs) of initial all cause pneumonia hospitalisations, by NZDep, 2006 to 2012 Unpublished data, IMAC, University of Auckland Sept 2013

22. Rate (95% CIs) of initial all cause pneumonia hospitalisations, by ethnicity, 2006 to 2012 Unpublished data, IMAC, University of Auckland Sept 2013

24. Who is in most hardship in NZ? Adapted from: Perry B Non-income measures of material wellbeing and hardship: results from the 2008 New Zealand Living Standards Survey MSD Wellington Dec 2009. p, 22

25. Restrictions Experienced by Children, by the Deprivation Score of their Family, NZ Living Standards Survey 2008 59% of children with Benefit as source of family income experienced 4 + of these (or similar) items

26. Severe/significant hardship means • Postponing visits to the doctor and prescriptions • Colder/damper houses • Poor quality food, less meat, less fruit • Less participation in sport, music, other hobbies • Living in an area with more crime

28. This is not inevitable We have a choice as a country

29. Why has NZ has been so successful protecting older people from poverty? • Universal - everyone gets it • Simple & adequate • Does not change with work status • Does not reduce in hard times • Linked to prices and wages (indexed) • We don’t judge We made income a priority with NZ Superannuation

30. Awareness • Empathy • Practical help • Advocacy

31. The Nature of the Problem? • Low family incomes, inadequate child assistance and poorly targeted resources • Low take-up rates for many child-related benefits • Relatively low employment amongst sole parents • A poorly designed child support system • Poor quality, unaffordable, overcrowded houses • Inequitable access to many social services, including health • Poorly integrated information and service delivery systems • No plan, no authoritative child poverty measures, no targets OCC EAG Report 2012

32. NZ child poverty trends, - After housing costs incomes Bryan Perry, MSD, March 2012

33. ‘Multiple bee stings’

34. December 2012Prescription charges will increase from $3 an item to $5 an item in next week's Budget, as the Government moves to offset the cost of extra health spending in the "zero Budget". Rationale • Small increase • Shouldn’t be a problem • Low income families have other options • Disability allowance forms…..

35. URGENCY to ACT "Many things we need can wait. The child cannot. Now is the time his bones are being formed; his blood is being made; his mind is being developed. To him we cannot say tomorrow. His name is today.” Gabriela Mistral

36. Wicked problems…..messy solutions

37. Poverty Reduction Examples • Macro: • Structural economic change • Taxation • Social Security • Minimum living wage • Health • Meningococcal B vaccination campaign • Reduction in costs of health care for children (still not free) • Housing Insulation

38. 2012 targets National Health Targets National Strategy Parliamentary Enquiry NHC report PHC report NIR Priorities for Action Report 1995 Strategy Percentage fully immunised by two years of age Turner N, unpublished; using combined data from national surveys and the NIR

39. NIR data from 2009 to 2012 showing national immunisation coverage rates at 2 years of age by the NZ Deprivation Index in quintiles

40. Specific Proposals OCC EAG 2012: A Child Poverty Act • We need a plan • Measures, targets, reporting • Legally mandated • Our proposed targets are ambitious, but realistic: • to reduce overall child poverty by at least 30-40% within 10 years • to reduce those living in severe and/or persistent poverty by over 50% within 10 years

42. E akurangatira, he aha te mea nui o teneiao? Maku e kiiatu, he tamariki, he tamariki, a taatou, tamariki. Dame Anne Salmond With thanks to IMAC whanau for the children illustrations