Matted hair on maggot-infested scalps, rotting teeth in pre-schoolers, developmental delays, damp houses and poor nutrition – some of the results of poverty on child health reported by paediatricians on the clinical front line.
Three paediatricians report on what they see in the course of their work and what they think needs to happen in the latest issue of The Specialist, the quarterly magazine from the Association of Salaried Medical Specialists (ASMS).
“The impact of poverty on some of the most vulnerable members of our society is chilling,” says ASMS Executive Director Ian Powell.
“Poverty is a challenging, complex issue to fix but as a society it’s imperative we find ways to address the underlying causes to improve the health and quality of life for people in our communities. This obviously means addressing problems with cold, damp housing, access to cheap, good food, and social supports that nurture children into capable adulthood.
“Senior doctors and other front line health professionals are dealing with the consequences of poverty on children’s health every day, and what they see and hear is distressing.”
Three paediatricians provide a glimpse into their work and outline what needs to happen on pages 21-23 of The Specialist at https://www.asms.org.nz/wp-content/uploads/2018/07/11950-The-Specialist-Issue-115-WEB.pdf. It follows a report from the Child and Youth Mortality Review Committee (CYMRC) in April that children and young people living in the most deprived areas are three times more likely to die in childhood or adolescence than those living in the least deprived areas.In the Specialist article, MidCentral DHB paediatrician Dr Jeff Brown writes:
“I see coughing and wheezing kids from damp and cold houses. I see rotting teeth when I lift the lip of pre-schoolers, if they have not already had a full dental clearance of all their carried teeth. I see matted hair on maggot-infested scalps needing general anaesthetics just to clean and shave.
“I see primary school kids growing up in food swamps whose morbid obesity, hypoventilation and metabolic syndromes used to be the domain of adult physicians. I see rheumatic fever and bronchiectasis, ‘third world’ diseases of overcrowding and poverty, filling hospital beds and clinics.
“No matter how good I am as a paediatrician, no matter how good the inpatient care in hospital can be, I am discharging three in every four kids back to cold and damp homes. Which is the main reason they ended up in hospital in the first place.”
Another paediatrician from a provincial town, writing anonymously, says:
“A child with complex medical needs has a mum who looks distracted. She is malnourished, front teeth missing. Couldn’t come to the last appointment because she was in hospital…As I walk in town I pass a thin, dishevelled, ill-looking young man in his 20s, clutching a tattered bag. I recognise him as one of the graduates from the paediatric diabetes clinic.
“I sit with the mother of a wheezy infant with high flow oxygen blasting up his nose. Of course she smoked during pregnancy, but now they smoke outside, so that’s okay, except when he stays with his grandmother at weekends because they all smoke over there.
“In health care, we try to do our best. The families we work with try to do their best too, but this can be an unending struggle. We are privileged to have the chance to help. But we are limited in what we can do.
“In a developed country like New Zealand, we can make choices – do we pursue economic growth and enable a small section of the community to accumulate wealth, or do we adopt a caring philosophy where government policy is aimed at improving the education, welfare and health of its poorest? We can’t do both – ‘trickle down’ doesn’t work.”
Dr Julian Vyas, a respiratory paediatrician in Auckland and a member of the ASMS National Executive, says the CYMRC report makes for sobering reading.
“If you set out to design a ‘perpetual engine’, you could do a lot worse than use poverty as your model. Many specific poverty-related problems will impinge on other poverty-related problems to reiterate and reinforce a cycle of systemic disadvantage.”
He points to suggestions from the Child Poverty Action Group to alleviate household poverty, as well as analysis from ASMS and the Council of Trade Unions about the level of funding needed to correct the cumulative under-funding of health.
“Solving the problems of living in poverty is to unpick a Gordian knot.”