Child Health and inequality the role of Citizens Advice Bureau, Nurses and Health Visitors

This is a story about two conversations.

The first was a passing chat with a Danny Dorling a few years ago – lets be clear I am not claiming that this happens very often!  We were talking about how children from low income families are more likely to die at birth or in infancy than those born in the richest areas and are are more likely to suffer chronic illness during childhood (see Child Poverty Action Group for more evidence on this)

His theory was that precisely at what should be a joyous and celebratory time – the birth of  a baby –  families on low incomes experience increased stress and pressure which should be preventable. The scenario he set out was a bit like this.

A family is just about getting by financially and then a new child arrives – not only do they have all the additional work and expense associated with a new baby but their income might be reduced if one of them has stopped or reduced working hours,  they may experience greater employment insecurity, and they may already have other pressures poor housing, indebtedness etc.

Of course they will be entitled to some financial support from the state such as maternity grants,  Child Benefit, Child Tax Credits etc however, this might take a while to play in.

So while there is support there – the combination of a new child, any existing financial stress, the complexity of the benefits system and its responsiveness can mean that  the health and wellbeing of young children in poor families is  under greater and unecessary risk for a period of time.

This view is supported by Sir Michael Marmot:

“First time pregnant mothers dependent on Income Support find their level of income particularly challenging. …pregnant women in receipt of benefits remain vulnerable, especially if they are under 25 and only receive lower age benefit rates for themselves, making it difficult to maintain a healthy standard of living” (Quote from Strategic Review of Health Inequalities Post 2010 Page 117)

Of course this is also in an atmosphere where the government is increasingly describing people on low income as underserving which may put some people off claiming what they are entitled to.

Steps to a solution

The second conversation I had was last week at the Citizens Advice annual conference. This was with the Jeremy Vanes who is the Chief Executive of Wolverhampton Citizens Advice Bureau. Jeremy told me about an initiative that they are running – funded by the Wolverhampton City Council Public Health Department.

This is basically a maternity advice hotline that aims to address precisely the issue that Danny described.

The project aims to give top priority to this group – supporting them get right to the front of the queue. The key agents are health professionals who are encouraged to use a simple pathway to support the parent – usually mother access advice and support.

Jeremy told me that the original champions were midwives – but they have now broadened this to a wider group of professionals who are more community based – School Nurses and Health Visitors and referrals to the hotline have gone up.

It is still early days so as far as I am aware the programme has not been evaluated. However, the programme feels really strong joining up a social determinants of health intervention with the delivery of NHS care. It is targeted at the most vulnerable and it comes in early and therefore has the opportunity to be genuinely preventative.

As the government gets ready to announce the 17 successful Integrated Care Pioneers shouldn’t we expect initiatives like this to be at the heart of this work?

Update

Since I published this piece Jackie Erdman has got in touch and drawn my attention to this really useful evaluation of a piece of work in Scotland. She says “We have developed an intervention in Glasgow and Clyde aimed at women and children and taking a gendered approach to child poverty. Over the last 2.5 years this has generated over £4 million in benefits and debt reduction for children and families, as well as other benefits such as help in kind.” The initial evaluation is available here: Healthier Wealthier Children Project. She says that a further evaluation is due shortly.

Do you know of any other examples of this sort of intervention?

What do you think?