Section 3: Social inequalities

The foundation for a healthy life starts in pregnancy and extends throughout childhood. Early childhood is a critical time for development of later life outcomes, including health.

Evidence shows that positive experiences early in life are closely associated with better performance at school, better social and emotional development, improved work outcomes, higher income and better lifelong health, including longer life expectancy.

Conversely, less positive experiences early in life, particularly experiences of adversity, relate closely to many negative long-term outcomes: poverty, unemployment, homelessness, unhealthy behaviours and poor mental and physical health.

As with inequalities in the early years, inequalities experienced during school years have lifelong impacts in terms of income, quality of work and a range of other social and economic outcomes including physical and mental health.  

The End Child Poverty coalition with Loughborough University (Oct 2020) has published an analysis of new data from the government that tracks four years of child poverty across Britain before housing costs are considered (2014/15-2018/19). (End Child Poverty Coalition Loughborough University. 2020)  

The report highlights those parts of the country where children are most likely to have been swept into poverty since 2014. 

The North East of England has seen the starkest increase in the country with a 6.5 percentage points increase over the past four years alone, leaving families in the region ill equipped to cope. In Gateshead one in five children (21.4%) are living in poverty, before housing costs are considered. 

Child poverty in England is unequal with children in some communities six times more likely to be growing up in poverty than in less deprived areas. While child poverty is deteriorating across all areas of the country proportionately, those places starting off with a high rate see more additional children pulled into poverty.  

We all face emotionally challenging situations during our childhood and adolescence.

It is a normal part of growing up and this emotional distress can come from a range of experience such as moving to a new area, feeling stressed revising for exams, falling out with friends or forming and experimenting with our identities and sexualities.

That said many children and young people grow up in environments, or have experiences, that are more emotionally distressing, difficult and frequent. These environments and experiences are adverse and can have a potentially traumatic and long-lasting impact on their development, health and way of life.

Adverse childhood experiences (ACEs) are more common that we might think. Almost half of all adults living in England have experience at least one form of adversity in their childhood or adolescence 

The ten sentinel markers of adversity in the above diagram are from the original American Adverse Childhood Experiences Study (Sentinel markers of ACE's from the Adverse Childhood Experiences Study. Source Felitti V et al.) and were deliberately limited to direct harm and factors taking place within the home. 

ACEs are situations which lead to an elevated risk of children and young people experiencing damaging impacts on health, or other social outcomes, across the life course. (Tower Hamlets ACES and social injustice (opens new window)) 

In general, those children who experience ACE's are more likely to have had a parent who has also experienced ACE's. This perpetuation of disadvantage from one generation to the next contributes to societal inequalities as it places an extra burden on those children who come from disadvantaged backgrounds.

"There can be no keener revelation of a society's soul than the way it treats its children" Nelson Mandela (Nobel Peace Prize,1993) 

I always knew when he came home, the house went quiet. When I look back and people say 'you had adverse childhood experiences' I say 'that was how it was for us.'

My dad was a drinker and a workaholic. In his own way he was managing his own demons, the loss of his own father to suicide, the pressure to keep a roof over the family and food on the table and managing his mood swings. His relationship with my mum would now be termed as abusive, we never knew how it would be when he came home.

He wanted everything done in a certain way, he controlled mum's life and ours. I remember mum saying don't upset your father, go upstairs and hide, he is just tired, he loves you really. I remember when he hit me with a slipper for breaking a window and mum coming afterwards to tell me it was okay, that he still loved me, and it wasn't my fault. I remember when he shouted at mum and we tried to get in the way to protect her.

When dad left us, mum struggled to keep us together, she worked long hours and I cooked and looked after my sisters, we were survivors. At that time having no father was still shameful, but to us it was a joy.

What does all this mean:

I dropped out of sixth form and moved in with the first bloke who would have me. I ran wild, drank too much, slept around, took drugs and did things that I look back on with horror.

It means that I am afraid of confrontation, I literally feel sick if someone shouts near me or at me. I have lived with depression and fear and guilt for many years and needed the support of mental health services.

My early life shaped who I am and gave me challenges but it did not stop me finding a good husband and I have a good life. I was able to rebuild my education; have good jobs and I have used my experience to help others.

After many years I even got to know my dad as a person. His relationship with his second wife was very different. Life moves on. 

The Children's Commissioner for England report (2019) (Children's Commissioner. CHLDRN: Childhood Local Data on Risks and Needs) on the scale and types of childhood vulnerability in England, aims to help local and national government better understand, measure and respond to the risks facing children.

Last year it showed that 2.3 million children in England were growing up with significant family risk factors such as domestic violence or parental addiction issues - of whom two thirds were receiving unclear support or were not known to local services.

The most recently available data22 shows that in Gateshead there were:

• 68 children living in temporary accommodation (in Q3 2019)
• an estimated 7600 children living in households with any of the so called 'toxic trio' issues of domestic abuse, parental mental health issues and parental drug/alcohol problems (in 2019/20)
• 4297 households with children claiming Universal Credit (in November 2019)
• 3471 children with SEND but no EHC plan (in January 2019)
• 148 children receiving treatment for substance misuse (in 2018/19)

Further evidence of inequalities between north and south are highlighted in Growing Up North (2018) which notes that,

'Like young people across England, northern children benefit from the incredible love, care and resilience of families and communities, even in the most adverse of conditions. But there are messages from social workers about the realities for children and their families. Parts of northern England experience significantly higher levels of demand with 600 referrals made to social services for every 10,000 children in the North East compared to only 374 per 10,000 in the East of England.

This pressure is felt by social workers who, on average, work with more than 19 children each in the North West compared 16 children per social worker in London. And these regional variations of need and demand disguise enormous variation from neighbourhood to neighbourhood' (Growing Up North)

As we move to a more community led, locality focussed model in Gateshead we aim to put a renewed focus on early intervention with families and support at the right time.

The Children's Commissioner also stated that earlier identification of special educational needs should be a public health priority. Too many children in the North are starting school with high-levels of development issues, but fewer children are having a special educational needs diagnosis before starting school. The earlier issues are identified the more effective - and cheaper - the support needed. 

Section 4: Impacts of food and financial insecurity