By Michelle Adams

This learning activity is relevant to the Nursing Council of New Zealand competencies: 1.1, 1.2, 1.4, 3.2, and 4.1.

Learning outcomes

Reading and reflecting on this article will enable you to:

  • Increase your understanding of the state of the nation with regard to child poverty
  • describe how child poverty affects children at different developmental stages
  • Reflect ways that you can participate in the eradication of child poverty in New Zealand.

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New Zealand is generally considered a great place for children/tamariki to grow up in and for many of our 1.1 million children this is true. For some families, however, there are significant challenges, such as poverty, which negatively affect all aspects of childhood.

This article explores childhood poverty – how it is measured, its sequalae, and initiatives for its management – and identifies ways that nurses can address child poverty in their practice.

Introduction

Childhood poverty is a relative term that is difficult to define. At its most basic, it means economic hardship. In 2012, The Office of the Commissioner for Children offered a more comprehensive definition:

“Children living in poverty are those who experience deprivation of material resources and income that is required for them to develop and thrive, leaving such children unable to enjoy their rights, achieve their full potential and participate as equal members of New Zealand society.” (Children’s Commissioner’s Expert Advisory Group on Solutions to Child Poverty, 2012, p. 2.)

Even the complex nature of this definition fails to address the social, cultural and religious dimensions of poverty, and as we are increasingly aware, these aspects are also critical to the health and wellbeing of children/tamariki.

Children/ who have reduced access to basic needs such as good health care, good nutrition, warm and non-crowded houses or the ability to develop a positive self-image, friendships and a sense of belonging during their formative years are unable to reach their potential in adulthood.

Living in poverty means they are more likely to be dogged with lifelong poor health. Another way to visualise the negative impact of poverty is via Maslow’s modified pyramid, which describes the basic needs for healthy childhood. Living in poverty negatively impacts all aspects of development.

Figure 1: Maslow’s Hierarchy of Needs for children (PhD in Parenting, 2010).

How is childhood poverty identified?

Just as the definition of poverty is complex, so too are the ways in which poverty is measured. There is debate about the most accurate way to measure it. The Child Poverty Action Group (CPAG) (2012) suggests that a comprehensive approach to measuring child poverty includes four elements:

  • An income measure adjusted for family structure and expressed before or after housing costs.
  • A measure of hardship based around deprivation of items and activities as a result of insufficient income and/or inadequate resources.
  • A measure of severe hardship (the extent or depth of hardship).
  • A measure of persistence (how long children have been experiencing poverty).

Whilst these measures of poverty provide data that is useful to quantify, the extent of poverty, the Child Poverty Monitor: 2018 Technical Report offers a more tangible way to understand how those statistics look in relation to some of the key aspects of childhood. Some key findings from this report are as follows:

  • Health – children living in the most disadvantaged communities are twice as likely to end up in hospital than those living in our most advantaged communities.
  • Education – the number of students from disadvantaged communities achieving Level 2 NCEA in 2017 was 68 percent, compared with 93 percent from advantaged communities.
  • Housing – 39 percent of households in the lowest income quintile spend more than 30 percent of their income on housing costs, compared with 14 percent of households in the highest income quintile.
  • Food security – one in five children live in households without access to enough food or healthy food (Duncanson et al. 2018).

It is generally agreed that the distribution of wealth and income has a direct impact on the wellbeing of our children.

During the last part of the 20th century, New Zealand introduced economic reforms, which included reducing benefits relative to income. These reforms widened social and economic inequalities.

The Ministry of Health (2014) stated that in1998 poverty levels were similar across Māori and European children/tamariki; however, by 2013, for every European child living in poverty there were two Māori children.

Closing the gap and enabling all children to thrive has been, and continues to be, the priority of many organisations, both nationally and internationally. It also recognises the principles of partnership, participation and protection that underpin the relationship between the government and Māori under the Treaty of Waitangi (Treaty of Waitangi, 1840).

Who is advocating for our children/tamariki?

New Zealand is not alone in its struggle to manage childhood poverty. A number of agencies both globally and locally are championing initiatives to address and end childhood poverty.

International agencies

As a member country of the 36-strong Organisation for Economic Cooperation and Development (OECD), it is possible to make comparisons with other countries. New Zealand’s ‘relative poverty rates for children’ are higher than the OECD average (OECD, 2018).

New Zealand is also a member of is the United Nations. In 1993 New Zealand became a signatory to the United Nations Convention on the Rights of the Child (UNCROC). In so doing, a legal commitment was made to protect the rights of children and safeguard their wellbeing. New Zealand is required to report on how it is implementing the rights of children.

There are 54 articles pertaining to children’s rights, which can be condensed as follows.

UNCROC gives children and young people up to the age of 18 the right to:

  • life, survival and development
  • the government ensuring that the best interests of the child are taken into account when making decisions about the child
  • access to education and health care
  • grow up in an environment of happiness, love and understanding
  • protection from discrimination of any sort
  • develop their personalities, abilities and talents
  • protection from sexual exploitation, abuse and economic exploitation
  • special measures to protect those who are in conflict with the law
  • an opinion, and for that opinion to be heard
  • be informed about and participate in achieving their rights
  • special measures to protect those belonging to minority groups.

National agencies

There are agencies within New Zealand that monitor child poverty. One key organisation is the Child Poverty Action Group (CPAG), which describes itself as:

“An independent, registered charity founded in 1994, which works to eliminate child poverty in New Zealand through research, education and advocacy. It works to produce evidence about the causes and effects of poverty on children and their families. It looks carefully at how government policies affect children. CPAG publishes reports, makes submissions and conducts small-scale research projects to achieve its goals. CPAG speaks out on behalf of the thousands of children in New Zealand whose meagre standard of living compromises their health, education and well-being.” (www.cpag.org)

Another key agency is the Office of the Children’s Commissioner, an independent Crown entity that has as its primary role advocacy for all New Zealand children under the age of 18 years. Judge Andrew Becroft is the current Children’s Commissioner. The Children’s Commissioner’s Act 2003 charges the office with three key functions:

  • Monitoring, assessing and reporting on services provided to children.
  • Advocating on issues that affect children and young people.
  • Raising awareness of and advancing the United Nations Convention on the Rights of the Child.

Each year the Office of the Children’s Commissioner creates a report, The Child Poverty Monitor, using a range of childhood poverty measures to reveal how children in New Zealand are faring. The Office of the Children’s Commissioner engages with a broad range of community groups to undertake research and publish position papers on matters pertaining to children.

The consequences of child poverty

Agencies such as CPAG and the Office of the Children’s Commissioner provide a wealth of ongoing evidence that describes New Zealand’s underperformance in prioritising the welfare of children/tamariki. Alongside this is an abundance of data that reflects the costs to both children and society.

The Children’s Commissioner’s Expert Advisory Group on Solutions to Child Poverty (2012) identified some of the ways in which child poverty impacts negatively on child development:

  • Parents’ ability to invest in their child’s development via provision of material resources, such as nutritious food, adequate footwear, and educational opportunities.
  • Less than ideal child-rearing practices that result from poverty-related stress experienced by parents; for example, relationship difficulties and parental mental health problems.
  • Biological embedding of socio-economic stress on sensitive biological systems; for example, the nervous, immune, endocrine and metabolic systems.

The short- and long-term cost to the physical and mental health of our children/tamariki is described through a growing number of studies. One often-cited study is the Dunedin Longitudinal Study (Melchior, Moffitt, Milne, Poulson & Caspi 2007).

In this study, 1000 children born in New Zealand during 1972/3 were assessed at various development ages. The researchers reported that children who had experienced poverty and/or maltreatment and/or social isolation in childhood were more likely to have, amongst other things, cardiovascular and dental health issues as adults.

Less overt, but equally troubling, was the discovery that correcting the socio-economic status of children did not alter the impact of the damage done in infancy and early childhood.

Denny et al. (2016) reviewed data gathered via the national youth health survey (2012) and found links between deprivation and smoking, obesity and depressive symptoms in young people. What is apparent is that the combination of poor childhood living conditions, poor health, poor educational achievement and other adverse effects continue through adolescence and contribute to poor adult health outcomes (Melchior, Moffitt, Milne, Poulson & Caspi 2007).

The consequences of child poverty for the child and society are described by Fletcher and Dywer (2008) and summarised below.

Table 1. The consequences of child poverty for children and society (Fletcher and Dywer, 2008, p.17).

Impact on the child Sequalae for society spending
Child poverty
  • Material and social hardship.
  • Increased mental and physical illness.
  • Higher incidence of non-accidental injury.
  • Social exclusion.
  • Loss of confidence and aspirations.
  • Increased spending on preventable child health problems.
  • Extra services to manage problems in schools, childbearing when young and unsupported.
Future consequences
  • Greater chance of material hardship into adulthood.
  • Poorer psychological wellbeing.
  • Consequences for own children.
  • Extra spending on long- term consequences, such as poor health and crime.
  • Extra spending on intergenerational cycle of disadvantage.

 

Addressing child poverty

A major step in addressing child poverty is acknowledging and accurately assessing the size of the problem. Clearly there is no single solution to eradicate child poverty. What is required is a multi-pronged and prolonged commitment across connected agencies. Ending child poverty must be a priority for government, regardless of who is in power.

Researchers have recognised for some time that maternal wellbeing is an essential prerequisite to healthy infants. As a society we must value and support parenthood.

The nurturing that infants receive in their first 1000 days of life (from conception up to two years of age) directly influences ongoing health into adulthood. The report 1000 Days To Get It Right For Every Child (Infometrics Ltd: Every Child Counts, 2011) draws attention to the critical nature of antenatal care, maternal wellbeing and bonding between caregivers and infants.

Adolescence is another critical time period in which the socio-economic impact of poverty may affect youth wellbeing. Denny et al. (2014) found that in schools with higher levels of school-based health services, mostly led and delivered by registered nurses, there was less depression and suicide risk. This shows the positive impact of easily accessible and acceptable health services for youth.

Significant government reforms addressing child poverty

Five key action points from a national or government level are identified below.

  1. The Child Poverty Reduction Act 2018 passed into law in December 2018, with cross-party support. It signifies the government’s intent to achieve a significant reduction in child poverty. Key requirements of the legislation are an annual report on the rates of child poverty in the budget and the creation of New Zealand’s first Child and Youth Wellbeing Strategy, which is due for release late in 2019. This strategy is expected to include a practical commitment to the Treaty of Waitangi and consultation with Māori, also how New Zealand meets its obligations to the United Nations Convention on the Rights of the Child. The current Prime Minister, the Rt Hon Jacinda Ardern, is the Minister for Child Poverty Reduction.
  2. Oranga Tamariki/The Ministry for Children has undergone significant reforms, many newly introduced in July 2019. These reforms are dedicated to supporting any child in New Zealand whose wellbeing is at significant risk of harm now or in the future. The ministry also works with young people who may have offended or are likely to offend. The Rt Hon Tracey Martin is the current Minister for Children.
  3. The Whānau Ora programme is a key cross-government programme jointly implemented by the Ministry of Health, Te Puni Kōkiri and the Ministry of Social Development. It is an approach that places families/whānau at the centre of service delivery, requiring the integration of health, education and social services, and is improving outcomes and results for New Zealand families/whānau. (www.health.govt.nz/our-work/populations/maori-health/whanau-ora-programme)
  4. The Children’s Act (2014) forms a significant part of comprehensive measures to protect and improve the wellbeing of vulnerable children and strengthen our child protection system.
  5. The Well Child/Tamariki Ora programme is a series of free health assessments and support services for children and their families from birth to five years. It includes health promotion activities and is an important gateway for parents to access primary and specialist health care, education and social services. The Royal Plunket Society New Zealand is one of the key agencies that delivers the Well Child/Tamariki Ora programme. Their goals are described in their strategy document Plunket Strategy 2016 – 2021. (www.plunket.org.nz/what-we-do/who-we-are/our-vision-and-mission)

What do children/tamariki understand about living in poverty?

In 2018 the Office of the Children’s Commissioner and Oranga Tamariki/The Ministry for Children sought the opinions of children and young people about, amongst other things, what they saw as the important things for them to live ‘a good life’.

One of the top responses was that there was enough money for basic items such as food, clothes and a good house to live in. They also highly rated being part of a loving family, having friends and living in a safe community. These basics are reflected internationally and the United Nations Convention on the Rights of the Child (1993) indicates that families and children in New Zealand should be able to expect these basics.

Understanding that the effects of poverty on children and young people will vary, depending on their development stage, is key to addressing their needs. Nurses come into contact with children and young people regardless of their area of practice and this knowledge will enable an informed approach to care. The five key developmental stages identified below are further detailed via the online link What do kids need? (www.occ.org.nz/giving2kids/what-kids-need)

Five key developmental stages:

  • Pregnancy and babies (0-2).
  • Pre-schoolers (2-4).
  • School children (5-12).
  • Teenagers (13-17).
  • Young adults (18-24).

The Office of the Children’s Commissioner (2015) suggests focus should be given to the following:

  • Very young children aged pre-birth to five years, as they have the greatest potential to improve.
  • Māori and Pacific children/tamariki, as they have the greatest inequalities,
  • Children in sole parent families, as they have the greatest need for support.
  • Children in severe and persistent poverty, as they have the greatest harm done.

What can you as a nurse do?

Around 155,000 children live in material hardship, such as lacking a warm home, their own bed or a decent pair of shoes. We all pay the costs for children who grow up in poverty.

Government has an important leadership role, but there is also a place for business, non-government service providers, local communities, families and individuals to make a difference for children in their communities.

As health professionals, it is important that we are aware of the scale of poverty in New Zealand and the reality facing many families, so that we are in the best possible position to make a difference.

Advocacy is not a passive activity but requires effort. We should view every interface with children and families as an opportunity to minimise hardship and maximise their ability to thrive and reach their full potential. The following websites provide information on ways to become involved.

Be informed – join professional groups/access information

  • New Zealand Nurses Organisation, College of Child and Youth Nurses (CCYN)
  • Child Poverty Action group (CPAG) www.cpag.org.nz
  • Office of the Commissioner for Children web page www.occ.org.nz

Be aware of charities and other ways to make a difference

  • kidscan A charity that provides school lunches, raincoats and shoes to school children.
  • giving2kids A range of options and opportunities suggested by the Office of the Children’s Commissioner in response to businesses and organisations that asked how they could play their part in reducing child poverty.

These are two well-known charities, but there are many other ways to support children living in poverty. Some examples are funded breakfast clubs and support for orthodontic treatment and sanitary products. Look within your own region for local initiatives.

Conclusion

Living in poverty negatively affects all aspects of childhood, impacting on chidren’s health and wellbeing through adolescence into adulthood.

Regardless of how poverty is measured and identified, the lived experience for children in material and social hardship can be devastating. The whole of society will be worse off if we do not value and cherish our children/tamariki.

Child poverty is a complex social problem and solutions are not straightforward or easy. Consistent, sustained and unified approaches across agencies are required to make an impact. Many excellent initiatives are making a difference and it behoves all of us to commit to being part of the solution to ending childhood poverty. Together we can make a difference.

Ahakoa he iti he pounamu / Although it is small it is precious
(Maori proverb)

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Useful websites

Key legislation

About the Author

Michelle Adams RN, BHSc, MA (Ed. Health Professional Education) is a Professional Teaching Fellow at the School of Nursing, University of Auckland. She leads child and infant/maternal health in the BN programme. Michelle is a committee member for The College of Child & Youth Nurses professional group of NZNO and is also the lead coordinator for the Advanced Paediatric Life Support (APLS) courses in New Zealand.

Peer reviewers of this article:

  • Kate ChiTar: MNurs(Hons), NP, RN
  • Nurse Practitioner I Youth School Health Services I Counties Manukau District Health Board
  • Catherine Lambe Reg Comp Nurse, MN (Hons.) Professional Nursing Adviser, New Zealand Nurses’ Organisation

References

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