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A prescription for the government: tackle child poverty to help address health inequalities A prescription for the government: tackle child poverty to help address health inequalities Camilla Kingdon neonatologist andpresident While the package of financial support delivered by the UK chancellor Rishi Sunak last week gives many families room to breathe, it won’t touch the sides of child poverty. The lifelong implications of growing up in poverty are significant, both for the individual and in costs to society. Clinicianswant to help—that’s why we work in healthcare—but there is no prescription we can ever give that will tackle child poverty. The government needs to make a choice, and that choice must be investing in childhood—the nation depends on it. For those on the lowest salaries there is no wiggle room when costs rise, particularly for essentials like basic food and fuel. And while price increases are seemingly apart of life, the scale and speedof soaring inflation compared to salaries is leaving many families financially constricted, with little room to breathe. Last Thursday the chancellor set out a £15bnpackage of support for people and families to respond to the serious rising cost of living.1 It includes £650 in the pockets of the lowest earners, many of whom have children, which is welcome news. Eye watering anecdotes have been published in recent weeks. A food bank in Cornwall is reporting that children in its area are getting food poisoning, because parents can’t afford electricity so are turning off their fridges.2 Others have said they can’t cook food, as they can’t afford the energy costs.3 It’s impacting the NHS directly, not just because of rising energy bills, but the rising backlogs in care that we are all trying to tackle. I recently heard from a colleague who was trying to sort out waiting lists for dental surgery by calling up parents to prioritise appointments. Most of the children had complex disabilities and were potentially in a lot of pain, but parent after parent said while they valued the call, they just couldn’t make the appointment, because the fares to get to the hospital were too high, or they couldn’t afford the day off work. Child poverty, the scourge of our society, needs a robust response. Estimates showapproximately four million children are living inpoverty in theUK,which is around 30% of all children. The pandemic and rising cost of living will have made this worse.4 Clinicianswill recognise all toowell that childpoverty has a lifelong impact. For example, those who treat COPD, will know that more than 50% of cases can be traced back to disease in childhood.5 Much of this relates to living in areas with poor air quality. As a neonatologist, I witness the impact of poverty regularly and how it exacerbates health inequalities. Poverty means you may not be able to visit your sick baby on the neonatal unit because you cannot afford to travel. Povertymaymean you cannot afford to take maternity leave to spend time with your sick preterm baby and establish breastfeeding. Poverty impacts eachdecision aparentmakes. Child adversity begins pre-conception, where the social determinants of health are at play. And so much is determined by chance. Over timewehave seenhow local authorities in areas of greatest deprivationhavehad the greatest budget cuts. Thismatters because that translates into less support for the families in the greatest need. As clinicians we always want to help the whole person, and their families, not just the sickness in front of you.Andwemust. But there is noprescription you can ever write that will solve all these problems, from housing, education, or welfare. Tackling child poverty is a decision that needs to be taken by our government and the government must provide real action. For those swayed by economic arguments, tackling child poverty makes sound sense. It’s an investment whichpaysdividends to the individual and thenation as health and life chances improve. David Hirsch’s work into the costs of child poverty to the UK showed that in 2008 the cost was £25bn, in 2013 it was £30bn, and in 2021, he estimates the cost of child poverty to the nation has risen to a whopping £38bn.6 According to theChildPovertyActionGroup,between 1998 and 2003 reducing child poverty was made a priority—with a comprehensive strategy and investment in children—and the number of children in poverty fell by 600 000. We can and we must do this again.7 Child poverty is predicted to rise to 5million by 2030.8 We should be doing everything in our power to combat this trend. Theveryhigh costs of childpoverty demonstrate that an investment in an effective anti-child poverty strategy is likely to pay for itself many times over. The chancellor has another spending opportunity in the autumn todomore for children and families; and in themeantime, the government’smuchanticipated white paper on Health Disparities is due. We need to see an explicit focus, with national targets, on reducing child poverty and child health inequalities, and it must be published without delay. The government must urgently put children at the heart of its policy making. The future health of the nation depends on it. Competing interests: none declared. Provenance and peer review: not commissioned, not peer reviewed.