More Income Is Required To Improve The Health Of Poor Children

Innes Asher

The future is what we choose to develop as well as what we choose to ignore. It is in our decisions and actions, our values and relationships, our language and mind-sets. There is no accidental future for our society.

Professor Linda Tuhiwai Smith



Many New Zealanders are concerned about child poverty and the growing inequality between the haves and the have nots. It is often difficult to grasp however how great an impact poverty has upon individual children, their families and society as a whole. With 260,000 of Aotearoa’s children (24% of all children) living below the poverty line and around 17% of all children missing out on many of their basic needs like a good bed, fresh fruit and vegetables, and basic clothing[1], the impact on these children’s quality of life and the long term consequences for our society as a whole, demands immediate attention in this year’s budget.

As a paediatrician, every day I see how New Zealand children in poverty have their health and education compromised for much of their formative years. Families living with the stress of insufficient money have to delay, cut back or eliminate essential items like food and doctors’ visits. When a child grows up in an impoverished environment, the lived experience of material hardship impacts upon their health and wellbeing both now, and in the future. This is turn affects their ability to ever escape poverty.

All the evidence shows that the longer the period on low income in childhood, the greater the harm. For example, the Dunedin Longitudinal Study that follows a cohort of babies born in 1972-3 found that children who were disadvantaged in preschool years had poorer health as adults. At 26 years they had poorer cardiovascular health, increased periodontal disease, caries and substance abuse. These adverse effects were not mitigated or reversed by moving into better socioeconomic positions in later childhood or adulthood.

The consequences of poverty are not just mental and physical ill health, but are reflected in a loss of hope, poor self-worth, loss of educational potential, lack of sport and music, and participation in the other normal things expected for New Zealand children. A lack of several or all of these factors may sap a growing child’s resilience.

Many who are concerned about child poverty believe ‘paid work is the way out of poverty’. Although 75% of children in poverty are supported by a government benefit paid to their parents, 2 out of 5 children in poverty are supported by a parent whose income comes from low paid work with a ‘top up’ from government funded Working For Families. Many in New Zealand, especially those who are affluent, don’t realise how low incomes are for some of the population. These days, paid work may be casual, poorly paid, insecure and at family-unfriendly hours and inflexible to children’s needs such as when children are sick. Parents caring for their own children are unpaid altogether. Furthermore there are not enough paid jobs for people, so unemployment is a reality.

Sometimes parents are just unable to take up paid work at certain times. For example if their livelihood is destroyed in an earthquake; if the local major employer closes down; if they suffer serious depression or disability; if one of their children has a terminal illness, is severely disabled, or has a serious chronic disease; if they leave their violent partner and their children are stressed; if they have young children. When a parent cannot work it is vital that our income safety-net is adequate for children at all times. At the moment it is not.

In the 1980s the proportion of children in poverty was about half what it is now. In the 1991 budget, the universal child benefit was abolished, and income support benefits were cut significantly, resulting in a doubling of children in poverty. Children in ‘beneficiary’ families were particularly badly affected – the proportion of children in poverty supported by a benefit rose from 25 to 75 percent and there it stays still, as the relative level of benefits has not been restored and such families do not get the full package of child-related tax credits provided for in Working for Families.

With benefit-related income so low it is no wonder parents can’t afford all the things that their children need for their wellbeing. I often see children in poverty in hospital. A typical patient would be an undernourished baby who is seriously sick and struggling to breathe with a chest infection brought on by living in an overcrowded, damp home which isn’t heated because the family can’t afford electricity. Under these conditions everyone living in the home, including the baby, is stressed. Medical attention was delayed because the car had broken down, and they couldn’t afford an ambulance. The baby will recover after several days in hospital on oxygen, but may be left with permanent damage to her lungs (bronchiectasis). With this disease she is likely to cough frequently, lack energy and miss a lot of school. She may become too sick to work, and may die as a young adult. If her parents had adequate income this baby may not have got sick, or not got so sick. The problems are worse for families whose ‘home’ is a garage or a vehicle.

Worryingly Māori and Pasifika children have twice the rates of poverty as European/Pākehā children. Hospital admissions for many diseases in children in young people are over double the rate for Māori and Pasifika children than European/Pākeha children. Data on rheumatic fever shows that from 1993 to 2009 there was a shocking increase in incidence of 79% for Māori and 73% for Pasifika children, whilst comparatively the European/Pākeha incidence fell by 71% (Milne 2012).

Many of these Maori and Pasifika children have their lifelong health and education compromised, impacting their wellbeing and productivity throughout adulthood. [2]

Unfortunately there hasn’t been any overall consistent government strategy to deal with the challenges for children living in poverty. In conjunction with poor nutrition, unhealthy housing factors individually and collectively combine to cause disease. The government’s own state-housing stock is not yet reliably healthy; and the Housing NZ waiting list for families with immediate housing need (Priority A) has more than doubled in the last 2 years.

While it is welcome that for children the cost of going to a general practitioner is reducing, the current focus on ‘paid work’ as the main cure for child poverty denies the reality of life for the many parents who do not have that choice. Income support benefits for parents should be at an adequate level for families where parents are caring for children, of any age, and unable to work, or unable to find suitable, adequately-paid work.

The 1991 budget drove lots of children into poverty. We can lift them out by improving housing and raising incomes for families on income support benefits and in low paid work. Evidence shows that parents would spend the extra money on their children, and that it would improve societal outcomes. We can ask our government to prioritise children in this way in the 2015 budget. In the words of motivational speaker Rita Davenport “Money isn’t everything… but it’s right up there with oxygen”.



[1] Ministry of Social Development (2014) Household incomes in New Zealand: Trends in indicators of inequality and hardship 1982 to 2013.

[2] Milne RJ, Lennon D, Stewart JM, Vander Hoorn S, Scuffham PA. ‘Mortality and hospitalisation costs of rheumatic fever and rheumatic heart disease in New Zealand.’ Journal of Paediatrics and Child Health 2012; 48(8):692-7

The adverse outcomes for Māori compared with Pākehā in health and wellbeing are well documented . The roots in poverty were clear in the 2013 report of the Māori Affairs Select Committee. Māori Affairs Select Committee (2013) Inquiry into the Determinants of Wellbeing for Tamariki Māori. Ka whai oranga, ka whai wahi, ka whai taumata ia tamaiti. Māori Affairs Committee.



Innes Asher
About the author

Innes Asher

Professor - University of Auckland School of Medicine
Innes Asher is the Professor of Paediatrics and a world expert on asthma and respiratory illness. Professor Asher is the Head of Paediatrics at the University of Auckland School of Medicine and an honorary consultant in Paediatric Respiratory Medicine at Auckland Hospital’s Children’s Department (Starship Hospital). Professor Asher is the health spokesperson for the Child Poverty Action Group (CPAG) and is a passionate communicator on the link between child poverty and poor health outcomes.