1. 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

2. 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

3. 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.

4. 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.

5. 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)

6. 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.

7. 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.

8. 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.

9. 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.

10. Child Poverty in Industrialized Countries – UNICEF 2007

11. 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

12. 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.

13. 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.

14. Selected Results from
Birth to 4 Years Old

15. 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%

16. 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

17. 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%

18. 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

19. 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 ( )
1.62 ( )**
1.19 ( )
1.91 ( )**
//Health perception
< very good##
2.37 ( )***
2.07 ( )***
2.03 ( )***
1.55 ( )**
Adjusted for:
# Child’s sex, birth order, and maternal level of education.
## Child’s age, maternal level of education, and social support .

20. Obesity (around 4 years) as a Function of Duration of Poverty and Maternal BMI, QLSCD J. Rivest

21. Selected Results at 6 Years Old

22. 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.

23. 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
( )
1.45
( )
3-4 episodes
1.57
( )
1.62
( )
1.53
( )
Model 1: unadjusted;
Model 2: adjusted for child’s sex and birth rank;
Model 3: Model 2 + mother’s education and immigration status

24. 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
( )
1.54
( )
1.85
( )
3-4 episodes
(chronic poverty)
2.07
( )
2.08
( )
2.99
( )
Model 1: unadjusted;
Model 2: adjusted for child’s sex and birth rank;
Model 3: Model 2+ mother’s education and immigration status

25. 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

26. 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.

27. 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.

28. 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.

29. 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.

30. Rate of Child Poverty: A Social and Political Choice

31. 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.