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Otago University: Inaugural Child Poverty Monitor

Otago University: Inaugural Child Poverty Monitor

The Child Poverty Monitor is a collaboration between the Office of the Children’s Commissioner, the University of Otago’s NZ Child and Youth Epidemiology Service (NZCYES), and the JR McKenzie Trust. It has two parts: the Child Poverty Monitor itself, which puts a spotlight on four measures of child poverty in New Zealand; and the more detailed Technical Report, which also includes child health indicators related to poverty, as previously reported in the Children’s Social Health Monitor.

“It is essential that New Zealand has a set of standard child poverty measures” says Dr Jean Simpson, Director of the NZCYES, “so that over time we can tell whether we are making any difference in children’s lives”.

“The serious consequences of child poverty often go unrealised by society. Children living in poverty are often invisible to those of us going about our daily lives,” says Dr Simpson.

“But for those working in the health sector, child poverty is very visible. They see its consequences in the form of hospital admission for infectious and respiratory diseases and for assault, neglect and maltreatment.”

“The health statistics in the Monitor’s Technical Report are of concern” says Dr Jo Baxter, Associate Dean Māori at the University of Otago, “particularly as hospital admissions for infectious and respiratory diseases have continued to increase”.

“The disproportionate burden of ill health experienced by Māori and Pacific babies suggests we need to be working much harder to protect our most vulnerable, our babies, from the consequences of poverty in their early years.”

“The picture for hospital admissions for injuries arising from assault, neglect and maltreatment is more complex” says Dr Liz Craig, the NZCYES’ Senior Clinical Epidemiologist. “We know that children living in poverty have higher rates of hospitalisations for these types of injuries. However, in the last few years we have seen reductions in inpatient injury admissions, particularly for Māori children”.

“However the number of children assessed for assault related injuries and then discharged directly from the Emergency Department increased, up until 2011. In addition, assault deaths have remained static since 2000, with an average of 8 children each year dying as the result of an assault.”

Further details on the key findings from the Technical Report are appended below.


Appendix 1: Key Points Emerging from the Child Poverty Monitor

2013 Technical Report

Child Poverty Monitor www.childpoverty.co.nz

A copy of the full Technical Report is available at http://www.nzchildren.co.nz/

Websites will be updated on Monday 9th December at 1:30 pm

General Comments

Because of the anonymous nature of the data used, it is impossible to prove direct causal links between changes in child poverty, unemployment and the number of children reliant on benefit recipients, and changes in hospital admissions for conditions that are sensitive to children’s socioeconomic circumstances. The data does, however, provide a picture of the broader economic context in which New Zealand families are living, as well as information on a basket of health indicators which have been selected because, in the past, they have proven sensitive to the socioeconomic environments in which children live.

While some positive trends have emerged in this year’s data, the picture overall remains concerning, with improvements in hospital admissions for some conditions being offset by increases in others, and with marked ethnic inequalities remaining for all of the health indicators reviewed. The key points emerging from this year’s Technical Report are briefly outlined below.

Child Poverty Indicators

Income Based Poverty Measures

Of Concern

• In 2012, 265,000 children aged 017 years lived in poverty (using the <60% contemporary median after housing costs measure). This equated to 25% of all New Zealand children.

• During 2010 to 2012 (using the AHC 60% fixed line measure), around 30% of Māori and 30% of Pacificchildren lived in poor households, as compared to 15% of European children.

• Child poverty rates were also higher for younger children (0–6 years and 7–11 years vs.12–17 years), larger households (3+ children vs. 12 children), sole parent households (vs. two parent households) and for those in households where no adults were in paid work or where none worked full time (vs. self-employed or 1+ full time).

Material Hardship Measures

The NZ Household Economic Survey uses a short form of the Economic Living Standards Index (ELSI). In the Survey households are considered to be in hardship if they experience six or more enforced lacks from a list of 16 items.

Of Concern

• 17% of children aged 0–17 years were considered to be in material hardship in 2012, with this equating to around 180,000 children.

• As a group, children experiencing material hardship were exposed to a range of economising behaviours including cutting back on fresh fruit, vegetables and meat, not replacing worn out clothes, not having at least two pairs of shoes in good repair, having to put up with feeling cold, and postponing doctor’s visits because of cost.

Poverty Severity

One measure of poverty severity is the proportion of children living in households below the 60% income povertythreshold who are also experiencing material hardship.

Of Concern

• During 2012, 10% of children aged 0–17 years lived in households that were both income poor (<60% the income poverty threshold after adjusting for housing costs) and experiencing material hardship. This rate was nearly twice as high as for the New Zealand population as a whole.

Wider Economic Indicators

Children Reliant on Benefit Recipients

Children in families reliant on a benefit have a much higher likelihood of living in poverty and material deprivation. This means that their families are much more likely to have major difficulty keeping the house warm in winter, to live in a house with damp or mould, to postpone a doctor’s visit or to not pick up theirchildren’s prescriptions because of cost.

On a Positive Note

• In contrast to the increases seen during 2008-2010, the proportion of children aged 017 years reliant on a benefit recipient fell between June 2010 and June 2013 (from 21.6% to 20.1%).

Of Concern

• In June 2013, 214,746 children aged 017 years (20.1% or one in five of all New Zealand children) were still reliant on a benefit as the main source of their family’s income.

Unemployment Rates

On a Positive Note

• In the September quarter of 2013, the seasonally adjusted unemployment rate fell to 6.2%.

Of Concern

• Unemployment rates remain higher for Māori and Pacific people. Rates in the Sept. 2013 quarter were 15.7% for Pacific, 12.2% for Māori, 6.7% for Asian/Indian and 4.9% for European people.

• Unemployment rates also remain much higher for young people than for older age groups, with rates in the year ending Sept. 2013 being 26.1% for those aged 15–19 years and to 11.6% for those aged 20–24 years.

Child Health Indicators

The Technical Report includes a number of child health indicators which monitor conditions with a social gradient. That is, hospital admissions for these conditions are much higher for children from more socioeconomically deprived areas. These include a range of medical conditions and injuries, infant mortality and sudden unexpected death in infancy (SUDI), and hospital admissions for injuries arising from assault, neglect and maltreatment.

Hospital Admissions and Deaths from Socioeconomically Sensitive Conditions

This indicator monitors hospital admissions and deaths from a basket of medical conditions and injuries which are known to be sensitive to socioeconomic conditions. The majority of the medical conditions are infectious and respiratory diseases.

On a Positive Note

• Inpatient hospital admissions for injuries with a social gradient in children aged 0–14 years have declined in recent years (although the Technical Report does not look at changes in injury cases managed in the emergency department setting).

Of Concern

• Hospital admissions for medical conditions with a social gradient have continued to increase in the latest data (up until the end of 2012), with this trend being evident in the overall 0–14 year age group, and for infants aged 29–364 days.

• During 2008–2012, there were on average 40,050 hospital admissions for the socioeconomically sensitive medical conditions monitored, each year in children aged 0–14 years.

• Hospital admissions for socioeconomically sensitive medical conditions remain much higher for Pacific, and then Māori children, than for European/Other and Asian/Indian children. However, rates forchildren from all ethnic groups have increased in the past five years.

• The size of the social gradient for medical conditions (i.e. how many times higher rates were for those from the most socioeconomically deprived areas) varied markedly in infants aged 29 days–364 days. The excess in admission rates ranged from 1.3 times higher to 6.4 times higher, depending on the condition under review.

Sudden Unexpected Death in Infancy (SUDI)

SUDI is the new term for unexpected death in infancy. It includes infants dying from Sudden Infant Death Syndrome (SIDS or Cot Death), as well as infants listed as dying from accidental suffocation in bed, or from “unspecified” causes. The term SUDI is now used in preference to SIDS, as there appears to have been diagnostic shift in recent years, with those assigning cause of death codes using accidental suffocation in bed or unspecified codes more frequently than in the past.

On a Positive Note

• There was a fall in SUDI rates between 2009 and 2010, although it is too soon to say whether this is a one off fluctuation or the beginning of a downward trend.

Of Concern

• In New Zealand during 2006–2010, on average 64 babies each year died of SUDI, with 36 of these babies having their cause of death listed as SIDS, 26 as accidental suffocation in bed, and the remainder as other SIDS related diagnoses.

Assault Admissions and Deaths in Children

The previous Children’s Social Health Monitor (CSHM) monitored inpatient hospital admissions for injuries arising from assault, neglect or maltreatment in children 0–14 years. In the CSHM, children discharged directly from the Emergency Department (ED) were excluded, because of inconsistencies in the way ED cases were uploaded to the hospital admission dataset, and because inpatient injuries were seen as a measure of serious harm, which could be monitored consistently over time.

With Government policy increasingly focusing on the early identification of vulnerable children and with the consistency of hospital data on ED cases improving, the Technical Report, in addition to the standard indicator on children 0–14 years, includes an expanded section which looks at hospital admissions for assault, neglect or maltreatment in children aged 0–4 years, irrespective of whether they were inpatient admissions, or discharged directly from the ED.

On a Positive Note

• Inpatient hospital admissions for injuries arising from assault, neglect and maltreatment in childrenaged 0–14 years have declined since 2006–07, with rates during 2012 continuing this downward trend.

• Inpatient hospital admissions for injuries arising from assault, neglect and maltreatment in Māorichildren aged 0–14 years declined between 200809 and 2012.

Of Concern

• Assault deaths in children 0–14 years remained static during 20002010, with an average of 8 childreneach year dying as the result of assault, neglect or maltreatment.

• Both hospital admissions and deaths from assault in children remain highest in babies aged < 1 year.

• Many of the inpatient assault injuries seen, (particularly for younger children aged 0–4 years) were at the more serious end of the spectrum, and included skull and facial fractures, subdural haemorrhages (bleeding around the brain), rib fractures and fractures of the femur (thigh bone).

• It is unclear whether the decline in inpatient assault admissions in children 0–14 years reflects a real decline in injuries from serious assaults, or a change in the way these injuries are managed. This is because, during 2000–2011, the number of assault cases discharged directly from ED actually increased, although there was a small drop off in the 2012 year.

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