Thread by @wheezylikesund1

@MarcusRashford - legend

Child poverty is THE most pressing issue for the NHS

Mr Rashford has had far more impact than I ever could, but here are 25 of my slides for a recent @AlderHey talk on #covid19, #lockdown and #Childpoverty in the UK

In adversity the vulnerable lose out most: everyone on Titanic hit the same iceberg, but the poorest people were most likely to drown

The public health message in the Black Plague was to flee towns for country residences - the poor cant do this so they stayed behind and got plague. Same in New Orleans - the poor, largely black population couldn't get out of a difficult situation.

Even before COVID there was inequality in our society - improvements in life expectancy had stalled and for some progress was going backwards eg women in poor areas. This is what the Marmot 2020 review showed us

And these inequalities are traced to childhood. We always thought COPD was a disease of accelerated lung decline... actually for many people it reflects adverse exposures in childhood - ie your health (in @ProfHurst's COPD clinic is programmed in @omi_narayans paeds clinic

And whatever inequality you look at, the UK map is the same: what we see in our respiratory clinics is the restricted opportunity to be healthy. The North is hit hard by inequalities in childhood

And in our @MDASAsthma clinic @AlderHey we found the children in the poorest postcodes had the worst lung function, and the highest inflammation. The same postcdes with the highest ED attendance and admission rates for asthma

If we look at food (@MarcusRashford ...legend), we see worsening inequalities in childhood obesity, depending on your postcode. BTW in a few years, most (literally most) kids will grow into obese adults

You can get your data about healthy food costs from the Daily Fail, or from the Harvard School of Public Health. Palatable healthy food is more £$ per calory. And if you are in the poorest decile, eating healthy basically takes out your whole expendable income after housing.

And people with less income - particularly those with families - are more at risk of hunger. God Bless the @TrussellTrust who have had a staggering rise in foodbank use. These are for people who literally will run out of food in 72 hours. This slide breaks my heart

And this reflects the horrendous levels of child poverty in the UK - around 30% - levels that weren't improving before COVID. In the middle of it all are children - and policy in the UK is lagging behind many countries

The austerity cuts of the last decade hit the poorest children hardest - cuts/head were higher in Northern urban areas, and places with lower life expectancy. The rising rates of child poverty were associated with an increase in infant mortality. #povertykillschildren

So when I tell kids in my clinic to be healthy, it's worrying and heartbreaking to hear these stories. The odds are stacked against children - and all these problems interplay with each other in a complex way. Real-world stories - like @MarcusRashford's letter - are so important

When @BorisJohnson was unwell, we were sold a story that COVID was a great equaliser, and we were all in this together.

It isn't.
We aren't.

We saw stark racial inequality for #covid19 in the UK and the US. We weren't told all the information from the government, and hardly any research funding (in fact 0.3% of covid research funding) has been set aside for this. We saw associations with poverty too.

And when it comes to children, again, the vulnerable are hit hardest. Lockdown is more tolerable for some kids than others ... .. and this fantastic document from @UNICEF_uk summarises the issues about lockdown

The worrying thing this time round has been how fast and hard the economic hit has been... the worst since a really cold winter in 1709 (Great Frost) - another natural disaster

After the last recession, @UNICEF did a piece of work learning about how children are the age group most vulnerable to poverty. The kinds of material losses are things like not being able to go on school trips and not having a birthday party. We often take things for granted...

And here's the important point - investing in families and the economy aren't mutually exclusive, they are mutually beneficial. If poor people stay poor the economy doesn't grow; if the economy doesn't grow, poor people stay poor. We need to keep businesses AND families afloat

Like Titanic and the plague, the vulnerable will be hit the hardest - unemployment is projected to hit the North the hardest, and certain types of jobs (especially low paid/low hours work) the most. This analysis was from the @McKinsey_MGI

When we compare the UK to Norway, the impact of the recession will be higher in the UK because our families have less financial resilience

And families with children are hit teh most - as @CPAGUK say - "There was nothing family focussed in the COVID policy response"

As always children are an afterthought

@LSEpoliticsblog tell us that austerity is not the way forward here - it will worsen inequality and have bad ecomomic side effects. And as we saw from the last austerity cuts, cuts in public sector spending will hit poorest areas the hardest.

One day I will put up some slides about what the #NHS needs to do about this - we cant stop #childpoverty (@MarcusRashford and @CPAGUK can!), but we do need to change the focus of what we do. Poverty is our biggest theat. If we won't fight for the rights of children, who will?