Medicine And Books

Poverty and Child Health

BMJ 1996; 313 doi: (Published 10 August 1996) Cite this as: BMJ 1996;313:371
  1. Ian Roberts

    Nick Spencer Radcliffe, £18.50, pp 240 ISBN 1 85775 068 3

    If childhood poverty had no adverse health effects would paediatricians still write books about it? I like to think that they would. The systematic exclusion of children from full participation in society is unjust and detestable, and paediatricians as advocates for children should take action to stop it. But Nick Spencer's book Poverty and Child Health provides another compelling reason to put poverty high on the paediatric agenda—childhood poverty is a leading cause of death, disease, and disability. Poverty and Child Health is a thorough critical appraisal of the evidence for the relationship between poverty and child health, drawing on numerous sources, national, international, and historical. Whereas the government publication Variations in Health attempts to depoliticise health inequalities as if social class mortality differentials were little more than the colourful rainbow of social diversity, Spencer's book is refreshingly political. Artefactual and individualistic explanations for health inequalities are examined and quickly dismissed, as a prelude to a more detailed examination of the structural basis of inequalities in child health. Foremost among these are benefit cuts and the regressive taxation policies of successive conservative governments that have resulted in a doubling in the number of children living in poverty. The message of the book is unambiguous: the determinants of child health inequalities, in both developed and less developed countries, are social and economic, and so remedial action must also be social and economic.

    In keeping with contemporary epidemiological theory, the social causation of child health inequalities is depicted as a complex web of determinants operating at different levels. Particular attention is given to the cumulative effects of the many factors that are the day to day reality of childhood poverty. However, a drawback of the multicausal model is that some strands of the causal web can be emphasised at the expense of others, and one part of the web that deserves greater emphasis than it gets in the book is the exclusion of women from paid employment because of inadequate provision of child care.

    The penultimate chapter examines the role of the health sector in reducing health inequalities and presents a challenge to child health professionals to participate actively in the search for ways to reduce socioeconomic inequalities and the effects of poverty on the health of children. A book written by a paediatrician for child health professionals, Poverty and Child Health marks an important developmental milestone for community child health.—IAN ROBERTS, director, child health monitoring unit, institute of child health, University of London

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