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Student Number: 10566494

BSc (Hons) Nursing (Adult).

Module: NRS205, Promoting Public Health and Wellbeing.

Faculty of Human Sciences: Plymouth.

Module Lead: Jennie Aronsson.

Module Lecturer: Jennie Aronsson.

Submission Deadline: 1st November, 2018

Final Word Count: 3014

Urban Poverty and Health in the United Kingdom: The Impact of Poverty on Children.
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This essay will critically analyse the causes and effects of child poverty in urban areas

of the United Kingdom, focusing on Plymouth as a locality. It will identify the causes of

poverty, defining it as a major public health issue and explain the impact that it has on

children today. Using epidemiological data this essay will provide evidence at a global,

national and local level to demonstrate the impact that child poverty has on society.

Using health promotion models and incorporating the wider determinants of health, this

essay will identify the impact child poverty has on the health services; at both micro and

macro levels. It will also identify nursing interventions within this growing public health

issue, exploring primary health inequalities and the services available to families living

at the bottom of the social gradient.

The United Nations Children's Fund (UNICEF, 2017) recognises that children are

victims directly affected by poverty. UNICEF’s Sustainable Development Goals identify

that children must be a priority in the fight against poverty, with their first goal being the

elimination of poverty by 2030. Extreme poverty affects 387 million or 19.5% of the

world’s children, compared to 9.2 % of adults globally (UNICEF, 2017). In the United

Kingdom (UK) poverty is a growing public health problem. An individual is said to be

living in relative poverty if they live in a household with an income below 60% of the

median household income for that year (McGuiness, 2018). This measure looks at the

inequality between low/middle income households. An individual is said to be in

absolute poverty if their household has an income below 60% of the 2010/11 median,

which is uprated for inflation (McGuiness, 2018). By using the fixed income threshold for

2010-2011, the comparison shows how living standards in low-income households have

changed (McGuiness, 2018). Income can be measured before or after housing costs
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have been deducted (BHC or AHC). Poverty levels are higher when household incomes

are measured AHC. Families at the bottom of the income scale tend to spend a larger

portion of their income on housing compared to a household with a higher income

(McGuiness, 2018).

The Joseph Rowntree Foundation (JRF) (2017) highlights that overall, 14 million people

are living in Poverty in the UK; this equates to over one in five of the population. The

overall breakdown shows that 8 million are working age adults, 4 million are children

and 1.9 million are pensioners. Eight million of these individuals live in families where at

least one person in the household works (JRF, 2017). Poverty levels over the last 20

years, have seen dramatic reductions amongst groups that have traditionally been at

risk, these include; pensioners and single parent families (JRF, 2017). Recently the

progress against poverty has declined; poverty rates for these specific groups have

started to rise. The analysis team with the Joseph Rowntree Foundation (2017) highlight

that the main factors contributing to a decline in poverty are now under question. These

include; the reduction of state support for many families on low-incomes, this coupled

with a rise in housing costs means that poverty levels in the UK are rising (JRF, 2017).

The Department of Work and Pensions (DWP) initiated the Welfare Reform and Work

Act (2016). This restricted the number of children to whom the Child Element of the

Universal Credit applies. The Individual Child Element in Child Tax Credit has also been

limited to a maximum of two children per family (DWP, 2016). The legislation was

brought forward by the Government with the intention to restore fairness in the benefit

system between those receiving benefits and those funding the system, it aimed to

increase social mobility and encourage people to work. This meant those receiving
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benefits would have to make the same financial decisions as those supporting

themselves solely through work. This appears to have had a detrimental effect on

poverty levels, the introduction of this legislation coincides with the increase in national

poverty levels (DWP, 2016).

The Joseph Rowntree Foundation (2017) state that ‘In work’ child poverty rates are

closely linked to the number of working adults in a family and the number of hours they

work. Child poverty rates are higher in single parent families or families where only one

parent works full time; this is compared to families where both parents work. National

statistics show that children in lone parent families are more likely to have higher

poverty rates, even when the parent is working full time. In lone parent families working

full time poverty has risen from 13% in 1996/97 to 23% in 2016/17. Between 1996/97

and 2010, the child poverty rate in lone-parent families working part-time halved from

46% to 23%. It has since risen back to 38%. Poverty among single earner couples rose

from 29% in 1996/97 to 38% in 2014/15 (McGuiness, 2018). In 2016/17, 2.7 million

children were living in relative poverty BHC, 19% of these children were in relative low-

income households BHC. Based on an AHC basis, there were 4.1 million children in

relative low-income poverty, this is 100,000 more than the previous year, meaning that

30% of all children were living in relative low-income poverty AHC (McGuiness, 2018).

These are national statistics, to better observe the impact of child poverty the locality of

Plymouth will be used as an example. Plymouth is one of the largest cities in the South

West, has a population of approximately 262,700 and an economic output of £5.2 billion

(PCC, 2017b). Despite a higher than average employment rate and economic output

level; deprivation, poverty and health inequalities still exist in Plymouth.

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Plymouth City Council (PCC) describes a deprived area as a place where people are

relatively poor, have ill health or longstanding health conditions, have higher levels of

unemployment and are struggling educationally (PCC, 2017b). These inequalities occur

geographically across the city with the disadvantaged and marginalised populations

being the most affected. The number of residents that experience deprivation and

poverty due to a low household income has increased in recent years. The number of

lower super output areas (LSOAs) in the most deprived 10 percent of residents (income

domain of the index of multiple deprivation (IMD) 2015) has increased from 12 in 2010

to 19 in 2015. These LSOAs have a combined population of 29,751 residents which is

11.5 percent of the city’s population. Plymouth has also seen an increase in families

experiencing in-work poverty or caught in cycles of low pay. Plymouth’s average full-

time weekly earnings are £481.50 compared to £513.20 in the South West (2016), this

is a decrease from £483.90 in 2015. The gender pay gap in the city also persists with

men earning on average £500.80 weekly gross pay compared to women at £454.80

(2016). This is a decrease for both men and women compared to 2015 pay levels (PCC,

2017b). These inequalities could be contributing to the rising level of children living in

poverty across Plymouth, especially in lone parent families.

Poverty is not just dependent on a family's financial status, but also the outcome of

economic, environmental and social factors. These factors can damage a child's

development, limit or prevent children from being socially accepted and prevent them

from experiencing opportunities that others take for granted (PCC, 2012). Evidence

suggests that child poverty is associated with structural differences in several areas of

brain development, and this may account for the differences in academic achievements.
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Recent studies in the USA suggest that child poverty influences the development of

specific areas of the brain. These areas are critical for the development of language,

function and memory, impacting the educational prospects of the child, capping

opportunities and affecting future lifestyle choices (Wickham and Anwar, et al, 2016).

Marmot (cited in Nathanson and Hopper, 2010) states that differences in social and

economic health status reflect, and are caused by, social and economic inequalities in

society. Plymouth has 11,700 children living in poverty (10,380 are under the age of 16).

This number equates to 22.1% compared to 21.2% nationally. This number has

increased by 600 children compared to the previous 12 months. Nearly 70% of children

in poverty live in lone parent families. Also, more than 41% live in families with three or

more children (PCC, 2012; 2018) The revision of the means tested benefit cap could

have contributed to the overall percentage of families living in poverty.

Plymouth’s most deprived neighbourhoods are on the Western side of the city. The

highest rate of child poverty can be found in North Prospect where 57.6% of children

live in poverty, with 5 other areas having over 50% of children living in poverty. These

neighbourhoods are LSOAs (PCC, 2017b, 2018). The most deprived neighbourhoods in

Plymouth have been scored using the 2010 Indices of Multiple Deprivation tool:

Devonport scores highest with 60, then in descending order of Stonehouse, North

Prospect, Weston Mill, East End and Whitleigh. The deprivation score correlates with

the high levels of poverty across Plymouth, they are among some of the most deprived

in the country (PCC, 2017b). The 2010 Indices of Multiple Deprivation highlights

Plymouth as being just above the bottom 20% of local authorities for levels of

deprivation, ranking 72 out of 326. Plymouth is most deprived in the domains of income
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and employment, even though Plymouth has a higher than average employment rate

when compared to national employment statistics (PCC, 2012).

The Plymouth Health & Wellbeing Strategic Framework uses the Marmot Review, ‘Fair

Society, Healthy Lives’ (PCC, 2012; Marmot, cited in Nathanson and Hopper, 2010) to

provide evidence for effective evidence-based approaches to reduce health inequalities

in the city. The Marmot Review (2010) utilises a life course approach to improve health

and wellbeing and to reduce health inequalities, especially with regards to children

having the best start in life to reduce deprivation and poverty. Marmot (2010) states that

inequalities in health are in fact inequities in power, money and resources; these are

things that children cannot control. He suggested that power and resources should be

redistributed from those at the top of the social gradient to those at the bottom (Marmot,

cited in Nathanson and Hopper, 2010). There could be difficulties or limitations when

trying to apply Marmot’s theory in practice. Those at the top of the social gradient could

feel like it’s not their responsibility to provide for those at the bottom.

The Barton and Grant (2006) Determinants of Health and Well Being model shows that

individual decisions are affected by the wider determinants of health. Health and

wellbeing are influenced by many factors such as; community, local policy, and socio-

political factors. A family living in poverty faces health inequalities determined by social

factors and their socio-economic level. A parent's choice to partake in costly lifestyle

choices such as; smoking and drinking, plus social determinants such as education,

housing, employment and crime, indirectly affect a child's quality of life (NHS Devon,

2016). Living in poverty directly impacts any underlying biological problems, potentially

making them worse (Barton and Grant, 2006). The health map portrays the layers
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affecting an individual’s lifestyle starting with genetics, gender and age and expanding

to include community, economy and the ecosystem at a macro level (Barton and Grant,

2006). The wider determinants of the home environment, city of residence and the

natural ecosystem can impact poverty and the health status of the population

(Goodman, 2012).

Devon County Council (DCC) and NHS Devon (2016) have produced a ‘Joint Health

and Wellbeing Strategy’ based on the Barton and Grant (2006) health map, aiming to

tackle child poverty and health inequalities across Devon. For the strategy to be

effective at a local level individuals and communities need to feel supported by the

healthcare professionals and in their area (NHS Devon and DCC, 2016). Families need

to feel empowered in their care, so they can take responsibility for their own situation.

This includes broaching sensitive issues such as domestic violence and alcohol abuse,

early family interventions and support, lifestyle changes and incorporating healthy

eating and exercise (NHS Devon and DCC, 2016).

The scheme aims to develop ways to support families affected by welfare reform, to

promote financial independence and build on the strengths in the community; thus,

promoting social cohesion and support for vulnerable groups in society (NHS Devon

and DCC, 2016). Poor nutrition, smoking and substance or alcohol misuse can affect a

child’s health and quality of life before birth, having a major impact on health and birth

weight (NHS Devon and DCC, 2016). The ‘Joint Strategic Needs Assessment’ provides

informed, evidence-based priorities to challenge and resolve the identified issues. The

priorities focus on giving children the best possible start to life, with interventions from

local health services, community nursing teams and support systems to prevent
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adverse child health and developmental outcomes (NHS Devon, 2016; Wickham and

Anwar, et al, 2016). This includes nurses supporting families through pregnancy, breast

feeding, teenage health issues, low aspirations and educational underachievement.

Poverty in childhood plays a critical role in shaping the life chances of a child, having a

detrimental effect on their education and their ability to socially interact (NHS Devon and

DCC, 2016). Choosing a collaborative scheme based on the Barton and Grant (2006)

Health Model demonstrates the effectiveness of the health map at both a micro and

macro level. The scheme helps individuals identify their barriers, supporting their

choices and providing help and information. Helping them to identify and change the

wider determinants that are affecting their family's health and empowering them to make

informed decisions to change their situation. The limitations to this scheme could lie in

the accessibility of the services to families across Devon especially in rural areas where

social isolation is rife; also, voluntary participation in the scheme from the community

(NHS Devon and DCC, 2016).

When identifying health promotion models to assess the issue of child poverty,

Tannahill’s (1985, 2009) model states that health promotion is the interrelationship of

three things- health education, prevention and health protection (Tannahill, 2009). Using

the issue of child poverty to be examined by the Tannahill model, focus should be on

education and promoting health behaviour change. Public Health England (PHE, 2016)

proclaims that poverty has both social and environmental constraints with regards to

change. An individual's upbringing, environment and income can affect the level of

influence that education has on their situation (PHE, 2016). Families living in poverty

tend to be stuck in a cycle of deprivation, having access to health education and

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accessible services for parents during pregnancy, early years and throughout childhood

should make an overall difference to their child's future (Wickham and Anwar, et al,

2016).

In Plymouth an innovative program has been set up by Plymouth Community Homes

(PCC, 2017a) in collaboration with LiveWell and NHS England to ‘Make Every Contact

Count’. The Public Health Team and Community Nurses are offering residents the

opportunity to improve their health and well-being by providing lifestyle education. They

provide practical choices and support with regards to finances and health education.

The project aims to educate the whole family in the art of healthy eating and purchasing

good quality, inexpensive food on a budget (PCC, 2017a). This new initiative has

identified the link between housing and health; it supports new residents, providing them

with access to experts that can help them lead a healthier life and achieve their goals

(PCC, 2017a). This initiative correlates with Tannahill’s (2009) health model with

regards to health education, prevention and protection. The ‘New Home, New You’

initiative would be effective so long as residents participated in the scheme, allowing full

disclosure to the nursing team and providing honest information about their lifestyle

(PCC, 2017a).

The Government led nationwide ‘Healthy Start’ scheme, aims to improve the health of

low-income families, pregnant women and families receiving benefits. It provides food

vouchers, allowing poverty-stricken families to buy basic fresh and frozen produce (NHS

England, 2018). The scheme provides support from local health professionals to

pregnant women offering information and advice; whilst providing them with
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breastfeeding support, vitamin tablets and drops (NHS England, 2018) This scheme can

be linked to all three sections of the Tannahill (2009) Model, health professionals are

providing advice to expectant mothers that could prevent deprivation in early childhood.

The Healthy Start scheme is a prime example of the support available to families living

in poverty. The provisions it provides allows children to have ‘the best start in life’ which

is the main goal in preventing child poverty. The negatives of this scheme are that

families must apply and be granted the vouchers; meaning some may not qualify.

Furthermore, there have been discrepancies with the list of retailers that will accept the

vouchers, leading to a delay in receiving vital items (NHS England, 2018). Locally in

Plymouth, Barnardo’s have a city-wide Child Poverty Strategy, collaborating with

several organisations. The team consists of Speech and Language Therapists,

Midwives and the LiveWell Community Nursing team (Barnardo’s, 2018) The centre

allows people from deprived communities to drop in for health advice and support. LIDL

supermarkets also provide unsaleable or damaged food to be redistributed to the most

vulnerable families in the area, complimenting the food provided by local Foodbanks

(Barnardo’s, 2018). This initiative is available to anybody, with the most deprived

families receiving nutritional assistance. It provides nursing interventions and support to

the community; however, as with all schemes and strategies the families must be willing

to accept the help offered and follow the advice given to them by the multidisciplinary

team (Barnardo’s, 2018).

To conclude, the Barton and Grant health map illustrates that by tackling the wider

determinants of deprivation, poverty should be impacted at an individual level. Parents

need education to prevent poverty making a lasting impact on their children. Accessing
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nursing care and support within the community and taking part in local schemes will

assist identification, health education, prevention and control over the preventable

causes of child poverty. Unfortunately, inequalities in wages, benefits and housing costs

cannot be changed individually, they need to be actioned at a national level.

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Total word Count: 3014

Full Reference List.

Bernardo's Plymouth (2018) Child Poverty: Plymouth North. Available at:

http://www.barnardosplymouth.org.uk/index.php?page_id=32#1/ (Accessed: 18th

October, 2018).

Barton, H,. Grant, M (2006). A Health Map for the Local Human Habitat. J R Soc

Promot Health, 126 (6) , pp. 252-253. Available at:

https://www.ncbi.nlm.nih.gov/pubmed/17152313/ (Accessed: 8th October, 2018).

Goodman, B. (2012) Sociology and Nursing. Available at:

http://www.bennygoodman.co.uk/what-implications-do-the-differences-between-a-

social/ (Accessed: 13th October, 2018).

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McGuiness, F., Parliament. House of Commons (2018) Poverty in the UK: Statistics

(7096). London. Available at:

https://researchbriefings.files.parliament.uk/documents/SN07096/SN07096.pdf

(Accessed: 2nd October, 2018)

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Nathanson, C. and Hopper, K. (2010) 'The Marmot Review- Social Revolution by

Stealth', Social Science and Medicine, 71 (7), pp. 1237-1239. Available at: https://www-

sciencedirect-com.plymouth.idm.oclc.org/science/article/pii/S027795361000540X/

(Accessed: 5th October, 2018).

NHS Devon and Devon County Council (2016) Health and Wellbeing, Available at:

http://www.devonhealthandwellbeing.org.uk/wp-content/uploads/2014/05/Devon-Joint-

Health-and-Wellbeing-Strategy-2013-to-2016.pdf (Accessed: 18th October, 2018).

NHS England (2018) Health Matters, Available at:

https://www.healthystart.nhs.uk/contact-us/ (Accessed: 18th October, 2018).

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Plymouth City Council (2018) Data Plymouth: Local Community. Available at:

http://www.dataplymouth.co.uk/local-community (Accessed: 18th October, 2018).

Plymouth City Council (2017a) New Home, New You. Available at:

http://plymouthnewsroom.co.uk/new-home-new/ (Accessed: 14th October, 2018).

Plymouth City Council (2017b) Plymouth Report. Available at:

https://www.plymouth.gov.uk/sites/default/files/Plymouth%20Report%20October%2020

17%20FINAL.pdf/ (Accessed: 2nd October, 2018).

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Plymouth City Council (2012) Plymouth's Child Poverty Needs Assessment. Available

at: https://www.plymouth.gov.uk/sites/default/files/Child-poverty-needs-assessment

2012.pdf/ (Accessed: 2nd October, 2018).

Public Health England (2016) Health Matters: Giving Every Child the Best Start in Life.

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Tannahill, A (2009) Health Promotion: The Tannahill Model Revisited. Public Health,

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com.plymouth.idm.oclc.org/science/article/pii/S0033350609000596/ (Accessed: 10th

October, 2018).

The Department of Work and Pensions (2016). Universal Credit and Child Tax Credit:

Crown Copyright. Available at: https://www.gov.uk/government/consultations/universal-

credit-and-child-tax-credit-exceptions-to-the-2-child-limit#history/ (Accessed: 1st

October, 2018).

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The Joseph Rowntree Foundation (2017) UK Poverty, 2017. Available at:

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