1. Workshop: Impact of Poverty and Social Exclusion..., Bratislava, Slovakia, 8-9 Sept 2008 The health of children in Norwegian low-income families Jon Ivar Elstad, NOVA, Oslo, Norway:

2. Norway: - population about 4.7 million - affluent Nordic welfare state (In 2005, GDP per capita in Purchasing Power Standards (PPS) was 80 per cent higher than average of 27 EU Member states, and higher than every EU member state except Luxembourg. Source: Eurostat) - total number of children aged 0-15 in 2005 = 800 000, about 5-6 per cent of them, ca. 45 000, living in ”poverty” (Source: Statistic Norway, register study estimating number of children who lived in families with incomes, adjusted for family composition, below 60 per cent of country median, during three consecutive years 2002-2004) - non-Western immigrant families, one- parent families, families with unemployed or sick parents, are over-represented among families with low incomes.

3. Mortality during ten years (1994-2003) among all Norwegian children aged 1-12 in 1993. All ”Poor”* ”Rich”** Number of children 645 148 45 949 207 964 Number of deaths 1994-2003 1454 120 407 Deaths in per cent 0.23% 0.26% 0.20% *”Poor” = 7 per cent ”poorest” children (living in families with less than 80 000 Norwegian Kroner in household-adjusted incomes in 1993) ** ”Rich” = 32 per cent ”richest” children (living in families with more than 160 000 Norwegian Kroner in household-adjusted incomes 1993) Source: Statistic Norway, own analyses of administrative registers of taxation and mortality

4. Childhood is a period of growth, development and identity formation which constitutes the foundation for future health Indicators for children’s health-related development: - Bodily growth (e.g., height, overweight) - Diseases, disabilities - Psychological well-being, psychosomatic symptoms - Social adjustment - Risk behaviour

5. A “balance sheet”: Why should children in Norwegian low-income families have more health disadvantages than other children? Possible factors leading to more ill health among children in low-income families: - insufficient material level of living, poor housing, poor nutrition, lack of money for necessary health services? - poorer psychosocial environments, less support from parents, insecurity and neglect, parents who do not teach children healthy habits? - marginalization and social exclusion in school, or among peers? Possible factors for not more ill health among children in low-income families: - in Norway, also low-income families have sufficient material level of living for ensuring children’s good health? - the psychosocial environments are not more unhealthy in low-income families than in higher-income families? - neighbourhoods and schools do not marginalize low-income children? - public welfare institutions and health services buffer against ill health among low-income children?

6. 3076 families with at least one child age 3-9 and incomes below 60% of median in 2000 Design of the study “Children’s level of living – the impact of family incomes”, conducted by NOVA – Norwegian Social Research, Oslo Sample of low income children Control sample 1627 families with child age 6-12 interviewed in 2003 486 families with child age 3-9, random sample of all income groups 310 families interviewed in 2003 1068 families with child age 9-15 år interviewed in 2006 235 families interviewed in 2006 Samples drawn from taxation register 2000 Personal interviews: First wave in 2003, second wave in 2006

7. 13,2% Results 1: Percentage short body height i 2006 Control sample N=235 ”Norwegian” low income children N=819 19,3% ”Non-western” low income children N=249 27,1% All estimations here and later are standardized for children’s gender and age

8. 35,7% Results 2: Medical diagnoses: percentages who reported either asthma, allergy, exzema and/or diabetes in 2006 (allergy was the most numerous reported disease) Control sample ”Norwegian” low income children 36,1% ”Non-Western” low income children 26,9%

9. 17,1% Results 3: Percentages reporting having at least one psychosomatic symptom several times per week Control sample ”Norwegian” low income children 23,5% ”Non-Western” low income children 14,2%

10. 52,3% Results 4: Percentages of the children who reported having ”very good” general health Control sample ”Norwegian” low income children 46,8% ”Non-Western” low income children 51,4%

11. 16,2% Results 5: Percentages who liked school ”not at all” or ”not much” Control sample ”Norwegian” low income children 21,5% ”Non-Western” low income children 14,5%

12. 9,1% Results 6: Percentages reporting more than 10 days of school absence because of illness last 4-5 months Control sample ”Norwegian” low income children 15,3% ”Non-Western” low income children 9,6%

13. 0,9% Results 7: Percentages age 13-15 saying they were daily smokers Control sample ”Norwegian” low income children 5,2% ”Non-Western” low income children 3,0%

14. Summary 1: Compared to control sample children, ”Non- Western” low income children had on average... - clearly lower body height, more overweight - but less reported diseases and disabilities - not worse overall self-reported health - not more psychosomatic symptoms - not more school absence because of illness - but slightly more daily smoking (age 13-15)

15. Summary 2: Compared to control sample children, ”Norwegian” low income children had on average... - lower body height, slightly more overweight - not more diseases or disabilities - slightly worse overall self-reported health - more psychosomatic symptoms, less well-being - more school absence because of illness - more daily smoking (age 13-15) Moreover: These psychosocial problems seemed to increase the longer duration of low incomes

16. Low income is a health risk for Norwegian children, but why? Low income More psychosomatic symptoms, poor school adjustment, becoming client to professional helpers, development of risky behaviours One-parent families, parent’s illness, unemployment The child experiences family stress Low material level of living Possible future outcomes: psychological and somatic health problems Marginalization, social exclusion? A suggested model partly substantiated by the data