Working to promote Healthier, Wealthier Children in NHS Greater Glasgow and Clyde

The news comes from the Scottish Government-funded Healthier, Wealthier Children (HWC) project, operating in NHS Greater Glasgow and Clyde since October 2010, to help tackle and ultimately prevent child poverty. It was set up to ensure that health and other early years’ services had an easily accessible referral pathway to money advice/income maximisation services, to support pregnant women and families at risk of poverty.

From the beginning of the project in October 2010 up to March 2013, there were 5,003 HWC referrals to money advice services, mostly from health visitors and midwives, which resulted in financial gain of more than £4.5 million for those eligible for help and support.

So why should we be concerned about child poverty? 

Well, it affects one in five Scottish children, and in Glasgow alone, 33% of children (equivalent to 36,000) lived in poverty in 2012. Even within Glasgow, there are wide variations, with more than half of children in some neighbourhoods living in low-income households. The Understanding Glasgow indicators site provides comprehensive information on child poverty across the city.

Poverty is not only about the things you can’t afford to buy. It also causes significant health and social inequalities. We know that children living in the poorest neighbourhoods can expect to live 14 years less than those in wealthier areas and poverty also has a negative impact on physical and mental health and educational and social development. This then becomes a vicious circle, where poor physical and mental health and low educational achievement increase the risk of lower earning capacity and of continued poverty throughout the person’s life. A good description of these impacts can be found in the Joseph Rowntree Foundation review of The costs of child poverty for individuals and society and in the Fair Society, Healthy Lives: strategic review of health inequalities in England post-2010.

Women, especially those with children, are also more vulnerable to poverty for several reasons. They are more likely to work in part-time and/or low-paid jobs, and have caring responsibilities, which often limit their options for paid work, and this is a particular challenge for lone parents, most of whom are women. This is well described in the Healthier, Wealthier Children literature review.

Impact of HWC on health and wellbeing

As well as very impressive financial gains for families referred to HWC advice services, there were also other benefits, including reduced stress and worry and improved quality of life, help and advice with childcare, employment and housing issues, and help to re-negotiate payments to creditors and switch to more low-cost options for domestic energy and banking services.  

One example of this is a single mother, working full-time who was in debt as a result of borrowing money from an on-line money lender to pay off another bill. She was going without food herself, in order to feed her son and was in contact with mental health services as her situation was getting her down. The mental health worker referred her to the HWC advice service where she received help to re-negotiate debts into manageable payments. This enabled her to afford enough food for herself and her son and she reported being less worried and stressed and feeling much better.

Further details of outcomes for HWC clients are available in the phase one report Maximising Opportunities.

Contrary to current media narratives, a surprising finding from the phase one evaluation was that advice services had little or no previous experience of pregnant women and families accessing their services, and those referred within HWC were mostly unaware of their entitlements. Therefore the project identified unmet need among a large population group.

Mainstreaming HWC

It was encouraging during phase two of the project that, despite reduced resources, HWC referrals were being embedded within the routine work of health and money/welfare advice staff. The project continued to sustain impact and commitment of all the partners, but if this work is to be fully embedded and expanded further, it is important to ensure stability of funding, viewed as one of the pre-requisites to mainstreaming public health initiatives. 

What lies ahead?

With a prediction (Institute for Fiscal Studies) that the current UK Government’s austerity and welfare reform measures will drive the UK child poverty rate up to 24% by 2020, and result in an additional 50,000 children in Scotland living in poverty, the phase two HWC report recommends wider adoption of the HWC partnership model across Scotland and beyond, and the need to consider a new national fund to promote financial security and tackle poverty.

The potential benefits of replicating the HWC model across other areas with similar social welfare systems are likely to include improved health and wellbeing of vulnerable people, more socially and financially included populations, and extra money remaining in local economies. These outcomes would more than compensate for the resource implications of implementing this work. 

As a public health intervention that has made a tangible difference to people, this has been the most important and worthwhile project I’ve been involved in during my research career and I hope to see similar models of the HWC project adopted more widely in Scotland, the UK and beyond.