Increased household financial strain, the Great Recession and child health—findings from the UK Millennium Cohort Study

Abstract

BackgroundThere is a growing body of evidence associating financial strain (FS) with poor health but most of this research has been cross-sectional and adult-focused. During the ‘Great Recession’ many UK households experienced increased FS. The primary aim of this study was to determine the impact of increased FS on child health.MethodsWe analysed the Millennium Cohort Study, a longitudinal study of children born in the UK between 2000 and 2002. Surveys at 7 years (T1, 2008) and 11 years (T2, 2012) spanned the ‘Great Recession’. Three measures of increased FS were defined; ‘became income poor’ (self-reported household income dropped below the ‘poverty line’ between T1 and T2); ‘developed difficulty managing’ (parental report of being ‘financially comfortable’ at T1 and finding it ‘difficult to manage’ at T2); ‘felt worse off’ (parental report of feeling financially ‘worse off’ at T2 compared with T1). Poisson regression was used to estimate risk ratios (RR), adjusted risk ratios (aRR) and 95% CIs for six child health outcomes: measured overweight/obesity, problematic behaviour as scored by parents and teachers, and parental reports of fair/poor general health, long-standing illness and bedwetting at T2 (N=13 112). In subanalyses we limited our sample to those who were above the poverty line at T2.ResultsCompared with those who were not financially strained at both time points, children in households which experienced increased FS were at an increased risk of all unhealthy outcomes examined. In most cases, these increased risks persisted after adjustment for confounding and when limiting the sample to those above the poverty line.ConclusionsFS is associated with a range of new or continued poor child health outcomes. During times of widespread economic hardship, such as the ‘Great Recession’, measures should be taken to buffer children and their families from the impact of FS, and these should not be limited to those who are income poor.

Assessing the Impact of Changes in Household Socioeconomic Status on the Health of Children and Adolescents: A Systematic Review

“…Among a U.S. cohort of female children, James-Todd et al ( 2010 ) found that downward socioeconomic mobility between birth and age seven was associated with a decline in the age at menarche. Similarly, two studies in the U.K. showed that children exposed to negative changes in household income experienced worse physical health overtime (Lai et al 2019 ; McKenna et al 2017 ), particularly compared to children exposed to improvements in household income (Lai et al 2019 ). A relationship between SES changes and asthma was also found in two articles.…”

“…Among the three studies conducted in Quebec, Canada there was no evidence that household income changes had a unique effect on child/adolescent anthropometric measures not observed among all children exposed to low-income (Côté-Lussier et al 2015 ; Kakinami et al 2014b ; Séguin et al 2007 ). In comparison, two studies in the U.K. and three Brazilian studies showed mixed evidence, with only one study in each country displaying a unique effect of changing income on child/adolescent BMI (Hackenhaar et al 2013 ; Hallal et al 2012 ; Lai et al 2019 ; McKenna et al 2017 ; Muraro et al 2016 ). The results of the eight studies in the U.S. were also contradictory, although the majority (n = 6) found that either short or long-term decreases in household income were associated with increased subsequent BMI among children and adolescents, and similarly increases in household income were associated with lower subsequent BMI-z scores or weight statuses (Balistreri and Van Hook 2011 ; Demment et al 2014 ; Jo 2018 ; Jones 2018 ; Kendzor et al 2012 ; Margerison-Zilko and Cubbin 2013 ; Min et al 2018 ; Oddo and Jones-Smith 2015 ).…”

“…Six of the included articles examined the relationship between changes in household SES and parent/guardian assessed overall child and adolescent health: two in the U.S., two in Canada (Quebec), one in the U.K., and one in Ireland. In general, these studies found that any exposure to negative changes in household SES, including income loss, financial strain, and reductions in parental employment, were associated with worse subsequent parental assessed child health, and positive changes in household SES were associated with the opposite (Chatterji et al 2013 ; Fuji 2012 ; McKenna et al 2017 ; Reinhard et al 2018 ; Séguin et al 2007 ). The exception was one paper from Quebec that found children exposed to transient poverty between 5 and 41 months were not more likely to be rated as less healthy by their mothers than never poor children (Béatrice et al 2012 ), however the other paper from Quebec found the exact opposite result among children in the exact same age range (Séguin et al 2007 ).…”

Lost Earnings and Nonmedical Expenses of Pediatric Hospitalizations

“…We conducted a face-to-face in-hospital survey as part of H2O and collected information on the child's demographic characteristics, including age (<3, 3-10, or >10 years), race (white, African American, or other), and insurer (private or public or self-pay). 2,15 Parents selfreported their own sex, marital status (single, widowed, separated, divorced, or married or living with partner), educational attainment (less than a college degree or college or more), employment status, and work flexibility. We categorized the employment variable according to the number of parents who were employed (0, 1, or 2) and whether that employment was full-or parttime.…”

Is austerity responsible for the recent change in mortality trends across high-income nations? A protocol for an observational study

“…The financial crash of 2007–2008, the resulting ‘great recession’, and the implementation of a variety of economic policy responses (including implementation of a fiscal stimulus in many countries up until around 2010, and subsequently ‘austerity’19 preceded the current change in mortality rate trends and have been suggested as the direct or indirect causes of the recent trends 1 8 20–22…”