Intended for healthcare professionals

Rapid response to:


Great leap backwards

BMJ 2014; 349 doi: (Published 02 December 2014) Cite this as: BMJ 2014;349:g7350

Rapid Response:

Re: Great leap backwards. Spanish children: the population group most affected by the economic crisis. Statement of the Spanish Society of Public Health (SESPAS) on child poverty and health

The current economic crisis has affected the whole European economy. Children are the most vulnerable population group in these situations. As the Taylor-Robinson et al. report has pointed out child health and wellbeing has taken “a great leap backwards” in many countries (1). The Spanish Society of Public Health (SESPAS) calls on governments and public administrations to implement urgent measures to combat the effects of child poverty on health of the current economic crisis. There are several messages about the importance of children, but there are no measures included in the agenda that prioritizes economic and social policies to ensure equal opportunities to growth and development.

According to the available scientific evidence exposure to deprivation and social inequality early in life is associated with worse health outcomes in the short, medium and long term(2). Furthermore, the earlier the exposure the more irreversible and definitive are the negative effects(3). Experiences during early childhood create the basis of language and cognitive, physical, social and emotional development for adult life(4). Early schooling has shown a positive impact on cognitive development, academic level and future possibilities of social inclusion. These associations are stronger among the most vulnerable population(5).
Since the onset of the economic crisis in 2008, the Spanish childhood population has worse living conditions and a higher risk of poverty and inequalities in material conditions. This deterioration has been more severe among children when compared to the general population or the population aged 65+. The percentage of children at risk of poverty has increased from 28.2% to 36.3% between 2008 and 2012 (6). Furthermore, Spain is one of the European countries with the highest percentage of children at risk of poverty.

The percentage of children living in households with all members unemployed has also increased from 6.5% in 2008 to 13.8% in 2012. The increase in unemployment rates the recent years (especially long-term unemployment), in precariousness of working conditions, and in difficulties to meet basic family needs (housing and food) have worsened the living conditions of the Spanish children. In Spain, income inequalities between the upper and lower quintiles of income have increased over 20% since the start of the crisis(7).

The rising price of basic foods, fuels and energy, as well as the difficulty to access credit affects with more intensity vulnerable families, like migrants or parents with limited resources. In Spain, the number of families with children attending non-governmental organizations looking for help to meet their basic needs has tripled since 2007.

In spite of the scarcity of data, there is already evidence of a worse overall poorer health and mental health in children from evicted families or families with housing problems(8).

According to previous experiences and current crises in other countries (9), those countries committed to maintaining and increasing investment in social protection of children are more likely to overcome the negative effects on health in the short and long term. By contrast, countries with policies of budget cuts in education, health, and social protection of families and children have worse health outcomes. In Spain budgets in social protection of children have declined and are among the lowest in the European Union. Investment in public policies for children in Spain was 1.4% of GDP in 2012, while it was 2.2% in the European Union in the same year (10). If the current increasing trend of social inequality and child poverty continues, the prevalence of health problems and the share of the population in poor economic and employment situation will increase in the future.

Measures proposed by SESPAS to remedy the current situation include ensuring access to early education, keeping and funding public school canteens during the whole year, suspending evictions of families with children and ensuring basic housing for all families, increasing effective public investment for the promotion of youth and parent’s employment and socially disadvantaged families, and effective universal and equal access to healthcare services for the entire population.

1 Taylor-Robinson D, Whitehead M, Barr B. Great leap backwards. The UK’s austerity programme has disproportionately affected children and people with disabilities BMJ 2014;349:g7350 doi: 10.1136/bmj.g7350
2 Pillas , Marmot M, Naicker K, Goldblatt P, Morrison J, Pikhart H. Social inequalities in early childhood health and development: a European-wide systematic review. Pediatr Res 2014;76:418-24.
3 Flores M, García-Gómez P, Zunzunegui MV. Crisis económica, pobreza e infancia. ¿Qué podemos esperar en el corto y largo plazo para los “niños y niñas de la crisis”? Informe SESPAS 2014. Gac Sanit. 2014;28(S1):132–136.
4 Irwin L, Siddiqi A, Hertzman C. Early Child Development : A Powerful Equalizer Early Child Development : A Powerful Equalizer [Internet]. Geneve: World Health Organization. Available from:
5 Dyson, A, Hertzman, C, Roberts, H, Tunstill, J, Vaghri Z. Childhood development , education and health inequalities. Londres: University College London; 2009.
6 UNICEF Office of Research. Children of the Recession: The impact of the economic crisis on child well-being in rich countries. Innocenti Report Card 12. Florence: UNICEF Office of Research; 2014. Available from:
7 Encuesta de Condiciones de vida. Instituto Nacional de Estadística. Available from:
8 Novoa AM, Ward J, Malmusi D, et al. Condicions de vida, habitatge i salut. Mostra de persones ateses per Càritas Diocesana de Barcelona. Barcelona; Càritas Diocesana de Barcelona; 2013. Available from:
9 Rajmil L, Fernandez de Sanmamed MJ, Choonara I, et al. Impact of the 2008 Economic and Financial Crisis on Child Health: A Systematic Review. Int J Environ Res Public Health 2014;11: 6528-6546
10 Cantó Sánchez O, Ayala Cañon L. Políticas públicas para reducir la pobreza infantil en España: análisis de impacto. Madrid: UNICEF Comité Español; 2014.

Competing interests: No competing interests

02 April 2015
Luis Rajmil
Senior researcher
Lucía Artazcoz (Agència de Salut Pública de Barcelona); Pilar García-Gómez (Erasmus School of Economics, Erasmus University Rotterdam); Manuel Flores (IDEGA, University of Santiago de Compostela); Ildefonso Hernández (Universidad Miguel Hernández); on behalf of SESPAS
Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS) / IMIM Institut Hospital del Mar d'Investigacions Mèdiques
Roc Boronat 81-95 2nd Floor Barcelona 08023