Child poverty and physical health: What have we learned from the Quebec

Longitudinal Study of Child Development?

Louise Séguin, MD, MPH

Department of Social and Preventive Medicine

Université de Montréal

CPHA 2008 Annual Conference

Halifax, June 2008

The Research Team

Louise Séguin, Lise Gauvin, Maria-Victoria Zunzunegui, and Béatrice Nikiéma. Department of Social and Preventive

Medicine, Université de Montréal Groupe de recherche

interdisciplinaire en santé Centre de recherche Léa-Roback sur

les inégalités sociales de santé de Montréal

Child Poverty and Health

Links between child poverty and health are well known.

Mechanisms underlying these links are not fully understood in industrialized countries.

Poverty during early childhood might have long term consequences for later health.

Child Poverty and Adult Health

Child poverty during early childhood not only affects child health, it also jeopardizes future adult health independently of adult socioeconomic status.

Child Poverty and Adult Health

An adult who experienced early childhood poverty has a higher risk of: Early mortality (Kuh, 2002; Claussen, 2003, Galobardes, 2008)

Cardiovascular diseases (Barker, 1992; Barker, 2001)

Type 2 diabetes (Lawlor, 2002)

Cognitive development problems (Richards, 2002;

Yeung, 2002; Cheung, 2001; Guo, 2000)

Older age cognitive problems (Stern, 1994; Abbott,

1998; Kaplan, 2001)

Child Poverty and Adult Health

Research suggests that it is the combination of neonatal health problems and poverty conditions during the pre-school years that are especially predictive of adult health problems.

Poverty/SES

Poverty: Absolute or relative lack of material

resources most often measured as low income in

industrialized countries Socioeconomic status/Social status:

usually measured using a proxy or a composite index including any combination of the following variables:

Level of education, level of income, marital status, work status, place of living.

Consequences of Poverty

Poverty is not only about lack of money or insufficient income as it affects all aspects of life: Poverty determines choices of resources Being poor involves being exposed to

multiple adversities.

Child Poverty in Canada

Children are the age group most

affected by poverty in Canada.

Child poverty rates are higher in

Canada than they are in most

European countries.

10,9

7,3

6,8

6,7

3,4

2,4

14,5

27,0

16,2

13,6

13,1

3,6

0 5 10 15 20 25

USA

UK

Poland

Canada

Hungary

Germany

France

Switzerland

Belgium

Norway

Finland

Denmark

% children (0-17years) living inhouseholds withincome equal or below50% of the median

Child Poverty in Industrialized Countries – UNICEF 2007

The Quebec Longitudinal Study of Child Development (QLSCD)

Data are from the Quebec Longitudinal Study of Child Development (QLSCD), A representative birth cohort of 2120

singleton infants Recruited at 5 months old by the Institut de

la Statistique du Québec Data were collected annually at home by

interviewers Birth data came from hospital charts

Variables

Poverty was defined as having a household income (previous 12 months) below the Low-Income Cut Off (LICO) from Statistics Canada.

Computation of the LICO takes into account the number of persons in the household and the number of residents in a rural or urban area.

Child Poverty and Health in the QLSCD

In summary our data show a high percentage of children are growing

up in poverty in Quebec;

a direct link between the family’s poverty

(especially if chronic) and the child’s health

as these associations are independent of

their mother’s level of education.

Selected Results from

Birth to 4 Years Old

Duration of Poverty from Birth to 4 Years Old (QLSCD)

Never poor 65.7%

Occasional poverty (1-2 episodes) 15.8%

Chronic poverty (3-4 episodes) 18.5%

Sources of Income among Poor Families, Birth to 4 Years Old, QLSCD

5 mths 1 yr ½ 2 yrs ½ 3 yrs ½

N 2082 2015 1966 1910

Main sources of income among poor families

Employment 42.4 45.2 47.3 46.6

Self employed 6.7 5.3 5.2 8.4

Social Welfare 39.4 40.6 38.9 35.9Employment insur. 4.5 2.4 2.2 2.2Others 6.9 6.5 6.5 6.9

Chronic Poverty before 4 Years Old and Exposure to Adversity, QLSCD

Adversities

Chronic

poverty

n=264

Never

poor

n=1263

Food insecurity 14.4% 0.8%

Overcrowding (≥2 periods) 33.7% 13.4%

Single parent family 36.6% 4.9%

Dysfunctional family (higher quartile)

37.9% 21.0%

Domestic violence (since child’s birth)

10.8% 2.7%

Maternal depression 46.4% 19.7%

Unsafe neighborhood 24.6% 8.3%

Links between Poverty and Children’s Health in the QLSCD#, (cross-sectional analysis)

Low Income

5 months 2 yrs ½ 3 yrs ½

Infections NA + -

Asthma attacks NA + +

Hospitalizations + - +

Perceived health + + +

Data adjusted for relevant confounding variables including maternal education

Duration of Poverty and Health Problems at 3 Years ½, QLSCD

Duration of poverty

//Asthma attacks#

Unadjusted OR

(95% CI)N=1845

Adjusted OR

(95% CI)N=1814

Never poor

1-2 episodes

3-4 episodes (chronic)

1

1.13 (0.64-1.97)

1.62 (1.00-2.66)**

1

1.19 (0.67-2.11) 1.91 (1.13-3.24)**

Duration of poverty

//Health perception

< very good##

Never poor

1-2 episodes

3-4 episodes (chronic)

12.37 (1.62-3.48)***

2.07 (1.40-3.07)***

12.03 (1.36-3.02)***

1.55 (1.00-2.40)**Adjusted for: # Child’s sex, birth order, and maternal level of education. ## Child’s age, maternal level of education, and social support .

Obesity (around 4 years) as a Function of Duration of Poverty and Maternal BMI, QLSCD J. Rivest

0

0,5

1

1,5

2

2,5

3

3,5

4

Duration of poverty

<2525-3030+

% O

be

se

Selected Results at 6 Years Old

Percentage of Poverty at 6 Years Old, QLSCD

In 2004, 16.6% of 6 year old children from the QLSCD were living in a family with an income below the poverty level.

Duration of Poverty before 4 Years Old and Asthma Diagnosis at 6 Years Old, QLSCD

Model 1OR

(95% CI)

Model 2OR

(95% CI)

Model 3OR

(95% CI)

Never poor 1 1 1

1-2 episode(s)1.52

(1.05-2.20)1.52

(1.05-2.20)1.45

(0.99-2.12)

3-4 episodes1.57

(1.08-2.29)1.62

(1.11-2.37)1.53

(1.01-2.31)

Model 1: unadjusted;

Model 2: adjusted for child’s sex and birth rank;

Model 3: Model 2 + mother’s education and immigration status

Duration of Poverty before 4 Years Old and >3 Asthma Attacks between 5 and 6 Years Old, QLSCD

Model 1OR

(95% CI)

Model 2OR

(95% CI)

Model 3OR

(95% CI)

Never 1 1 1

1-2 episode(s)1.57

(0.62-3.97)1.54

(0.61-3.92)1.85

(0.71-4.79)

3-4 episodes(chronic poverty)

2.07(0.86-5.01)

2.08(0.86-5.06)

2.99(1.14 - 7.79)

Model 1: unadjusted;

Model 2: adjusted for child’s sex and birth rank;

Model 3: Model 2+ mother’s education and immigration status

Comparison of Cross-Sectional and Longitudinal Results at 6 Years Old, QLSCD

Cross-sectional(poor at 6 year)

Longitudinal(duration of poverty)

Maternal perception of child’s health

NS +(1-2 et 3-4 epis)

Asthma diagnosis NS + (3-4 episodes)

Asthma attacks NS + (3-4 episodes)

What We Have Learned from the QLSCD

A high proportion of young children live in poverty during their pre-school years in Québec.

Poor children are exposed to multiple adversities in their environment.

What We Have Learned from the QLSCD – A Direct Link

The links between poverty and children’s health are complex.

Poverty especially if it is chronic has a direct impact on the child’s health beyond their mother’s level of education.

Early poverty has a long term effect.

What We Have Learned from the QLSCD – Interactions and Other Results

Poverty is interacting with diverse characteristics of the child and of his/her family to influence the child’s health.

Longitudinal analysis yields different results than cross-sectional analysis.

So what?

The high level of child poverty in Canada is avoidable.

The level of child poverty in a country is the result of its family and social policies.

0

5

10

15

20

25

30

35

40

Child Poverty, Taxes and Transfers

Data from UNICEF (2000)

% Child Poverty generated by “the market”

% Child poverty after taxes and transfers

%23

3

24

36

17

20

Rate of Child Poverty: A Social and Political Choice

Conclusions

Early childhood poverty affects a child’s health and can also affect their health later on in adulthood.

Given such long term consequences, the issue is not only why we tolerate such high levels of poverty among our children but whether or not we can afford jeopardizing the health of the next generation of Canadians.