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: Socioeconomic status/Social status: 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.

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 35.9 Employment insur. 4.5 2.4 2.2 Others 6.9 6.5

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 Hospitalizations Perceived health Data adjusted for relevant confounding variables including maternal education

Duration of Poverty and Health Problems at 3 Years ½, QLSCD //Asthma attacks# Unadjusted OR (95% CI) N=1845 Adjusted OR N=1814 Never poor 1-2 episodes 3-4 episodes (chronic) 1 1.13 (0.64-1.97) 1.62 (1.00-2.66)** 1.19 (0.67-2.11) 1.91 (1.13-3.24)** //Health perception < very good## 2.37 (1.62-3.48)*** 2.07 (1.40-3.07)*** 2.03 (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

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 1 OR (95% CI) Model 2 Model 3 Never poor 1 1-2 episode(s) 1.52 (1.05-2.20) 1.45 (0.99-2.12) 3-4 episodes 1.57 (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 1 OR (95% CI) Model 2 Model 3 Never 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 (poor at 6 year) Longitudinal (duration of poverty) Maternal perception of child’s health NS +(1-2 et 3-4 epis) Asthma diagnosis + (3-4 episodes) Asthma attacks

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.

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.