Targeting Single Health Issues Will Not Fix Child Poverty

By Dr Nikki Turner

We will not fix poverty-related health issues with selective resourcing into single health issues alone.

Health issues arise from a range of complex environmental, social, and physical reasons.  The solutions to them are rarely linear. One assumes you treat a skin infection with an antibiotic and it gets better. But then step back think further about the skin infection, where did it come from and why did it get so bad - there will be a complex mixture of reasons.  The spread of the bug, the host response and the health-seeking response.

For example, I see a six-year-old in my general practice with a skin infection that is so severe she requires admission to hospital for intravenous antibiotics.  

Why did she get so sick?  

Firstly, the organism was transmitted easily because she lives in a crowded house and bed-shares with her sister and mother for warmth. Hygiene is not ideal and towels are shared.  Secondly, she is more likely to get sick because her immune system is not functioning as well as other six-year olds, due to poor nutrition with limited access to fresh fruit, vegetables and good quality meat, and her immune response is to living in a household that has multiple stressors. Thirdly, the child was not brought to primary care when the infection was in its early phase, because her mother was working and she was home with her grandmother who did not have access to a vehicle, who also had two younger children to manage.  

Numbers and figures do not give meaning to the real picture of why a child gets sick and repeatedly sick. I can quote figures, such as a child who is living in the most deprived area has who has a ten times higher rate of ending up in hospital with pneumonia than a child living in a more well-off environment. And yet it makes little sense without understanding the multiple factors behind poor health outcomes associated with living in poverty.

Consider a family having multiple bee stings – if I have one or two large stressors arising I usually have the resilience to respond to them, but if I am faced with multiple stressors a lot of the time it is much harder to cope. Can anyone on the outside really understand what it means to be chronically short of funding to cover essential bills, nutritious food, secure warm housing, GP visits, dental care, not to mention all the additional social needs for a growing child to be able to participate in NZ society, such as a carer at home for them after school and when sick, the cost of school attendance, uniforms, fees ... And there's little to no hope for hobbies or holidays. Financial poverty creates multiple stressors.

Apply similar thinking to rheumatic fever.

New Zealand has very high rates of rheumatic fever, an inflammatory condition that arises after an infection with a bacterial organism, called ‘group A streptococcus’.   It can lead on to lifelong disability, particularly with heart conditions. Over 90% of cases occur in Pacific and Māori children and over 90% of cases are in children in the poorest five deciles on the New Zealand poverty measure (NZDeP).  It has been shown to be linked to crowded households. This is a disease with its origins in poverty. New Zealand has made some progress on reducing the incidence of this disease as we have seen recently in Counties Manukau. School-based programmes and widespread use of antibiotics in primary care, alongside creating community awareness of the need to treat sore throats, particularly for Pacific and Māori communities, appear to have some effect.  

However throwing antibiotics at the organism may mitigate the disease, but alone will not eradicate it. A single linear solution is not going to solve a disease that is born out of economic and social hardship.  I celebrate all my health colleagues who are working hard in schools and general practice to identify and treat sore throats and I am sure it is helping, but it is one small piece of a much bigger problem that we all still seem to be in denial about.

The large solutions are harder, non-linear, expensive and sadly often unpalatable because they require much a much braver systematic response.  Throwing a few more million dollars into strengthening a health intervention alone will not solve this one, nor will it solve the other ones.  Alongside appalling rates for rheumatic fever, we also have shamefully high rates of chronic respiratory illnesses, skin infections and mental health issues. We will not make our children better with single piecemeal policies, no matter how hard everyone works on them.

 Come on New Zealand, this is our collective problem. This is not a problem for any one political party or any individual parent or family, this is OUR problem and we can improve it.

We respond incredibly well to natural disasters, stories of hardship, we donate generously to charity. New Zealand is a generous country on so many levels.  Why are we in denial about this one? Poverty to children long term is extremely damaging, socially, emotionally and physically. We have internationally-recognised poverty measures that we can apply when we chose to use them (both income and hardship measures).  We have good reports with solutions on the table. New Zealand has put a lot of policies in place such as our health care responses to rheumatic fever, free general practice visits and prescriptions for children aged under 13, new approaches to improving housing, targeted strategies for those who are seen as ‘vulnerable’. But we do not have a systematic plan.   Child poverty is complex, but it is not insolvable. It will not be solved by cherry-picking solutions, no matter how good each cherry pick is. It requires a solutions-based approach, an integrated plan, accept the measures and monitor how we are doing.  

No more cherry picking, where is the systematic plan? And how about some teeth in the plan so we don’t chicken out when our kids start costing us too much.

It’s time for some multi-party action to create legislation embedding a plan for child poverty, so we can measure, act and respond. No matter how brilliant a single targeted solution is, it will not solve our systematic failure to do better for our children.