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Comment & Analysis

Money won't ease income poverty on its own – real support for families is needed too (26/1/17)

By Marion Macleod

The Royal College of Child Health today published a report that should concern us all. It indicates that the many policy initiatives and operational strategies intended to promote a better start for children and better outcomes through the life course are not having the effect intended. It also shows that early disadvantage too often has enduring impact.

This is bad news for the individuals, families and communities directly affected, but we should be under no delusion that it does not concern us all. The pattern of spending on health, education and social care is inextricably connected to the problems set out in the report. This affects the nature of our health provision in our communities, the priorities for spending in our schools and the level of support available for vulnerable individuals and groups in our society generally.

If we are to change the depressing picture the report presents, we need to be clear about the causes of the problems its identifies. Differences in health that are socio-economically patterned have increased significantly in recent decades. While there is an indisputably strong correlation nowadays between poverty and poor health, this was much less true several decades ago.

This is largely because health behaviours were much less socially patterned in the past than they are now – in the 1950s most mothers breast-fed, and most adults smoked, irrespective of social and educational status. What has happened in the intervening decades is that better-off, better-educated people have changed their health behaviours more quickly and to a greater extent than poorer people. 

We must acknowledge the complex interplay of factors that affect health outcomes. Poverty, particularly severe and persistent poverty, is likely in itself to affect some health and wellbeing outcomes. Not being able to afford adequate food, warmth and security will clearly undermine the chances of good health. In addition, the stress and uncertainty generated by such circumstances also compromises wellbeing, particularly in terms of emotional and psychological health.

It is critically important that we acknowledge, however, that this problem cannot be solved by money alone. Strong support for families, particularly in children’s early lives, is an essential complement to addressing income poverty. We need to ensure the highest possible quality in our public health and early learning systems if we want future reports to be less pessimistic.

Marion Macleod is Policy Manager at Children in Scotland 


Refections on the Bruce Perry seminar - 3 October 2016, Edinburgh

I really enjoyed this symposium given by Bruce Perry. I’ve read his books and heard him speak before, but the message he gives makes such a lot of sense its important to hear it again and again…and again. He has very interesting things to say about rhythm!

For me, the key message came towards the end of the morning, when Bruce explained the importance of relationships for children and of relationships within communities. He stresses that one single good enough relationship with an adult, enduring throughout a child’s life, is far more supportive than several. But he also stresses that the number of ‘lines of contact’ a child has throughout their day, with meaningful adults, really matters. Children who have fewer moments of contact don’t fare as well as those who have many.

Bruce finished by asking “how do we make the community ready to help these kids?” This is a big challenge, perhaps more than ever. With cuts in all agencies, there’s an increasing sense that we’re all withdrawing into our silos. There’s less time for inter-agency discussion and collaboration. As for actually getting out of the department and into the community - for most of us who work in community bases (ironically) this is becoming almost impossible. There’s increasing pressure to see more patients and clients sooner, to bring down waiting times. Understanding this primary commitment, it feels like there’s also an important need for us to resist the instinct to withdraw away from the community back into our departments. Under pressure, we’re in danger of forgetting lessons learned. We need to make the argument that time spent in building community relationships builds resilience in children.

Iain McClure, Child Psychiatrist.

Have you ever tried to do a jigsaw without the picture? All the pieces of the jigsaw lying in front of you , some pieces in places, others waiting to be slotted in. You know roughly what the picture will be and you just keep going. There comes a point when all of a sudden the big picture is clear and it all makes sense.

Well I had that moment as I sat and listened to Bruce Perry last week. All the pieces of the jigsaw which were in my head came together. I understand that many children I work with are unable to learn, are too stressed to take on anything new, that positive relationships made a huge difference. I know that small challenges can provoke extreme responses from stressed children. I know positive interactions are the biggest part of healing. I understand that the brain is hugely affected by stress. That the ability to reason, reflect and relate is inhibited by high levels of stress and trauma. 

The hugely powerful picture Bruce shared with us brought everything into focus and it gave clear explanations of what we know

I have shared the picture with staff and will share it further. 

Sarah Ogden, Headteacher, Pinkie St Peter's Primary School, Musselburgh.


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