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Scotland, Australia, and Sweden: the Healthier, Wealthier Children journey so far…

16 Oct 2023 | James Egan

We published a series of blogs looking at how child health and social care services are developing new ways of working with financial support services to tackle child poverty in three countries: Scotland, Australia, and Sweden. This final blog in the series reflects on some common threads across the three countries and considers how strengthening the approach in Scotland could help ensure we live in a more just and equal society.

It was encouraging to see, across the three countries, a shared understanding of the need to build new and closer ways of working together to prevent the damaging effects of poverty arising at such crucial stages: during pregnancy and the first two years of a child’s life, when family income often goes down at the same time as childcare costs go up.

In the first blog that looked at Healthier, Wealthier Children (HWC), we were reminded that, over the last 13 years, midwives and health visitors in Scotland have played an active part in referring families for financial support. This has resulted in large numbers of struggling families receiving a boost to their income at this critical stage. In the second blog, Australian colleagues described how they adapted the HWC model as a transformative approach to tackling hardship. Healthier, Wealthier Families is the first Australian initiative to try and link universal healthcare and financial services in a systematic way. With a touch of pass-the-parcel, the work here in Scotland and in Australia, encouraged researchers in Sweden to undertake new research, which, if successful, could lead to a Scandinavian model being embedded within Sweden’s child health services.

Although the approaches within the three countries are at very different stages of development, the cost-of-living pressures and the COVID-19 pandemic were acknowledged challenges across all three. The Scottish Government’s child poverty delivery plan rightly recognises the impacts of the pandemic on the mental health of already struggling families, and the importance of integrating mental health support into family support services. Building on this theme, the three blogs identified how addressing money worries can help improve emotional wellbeing – a crucial stepping-stone when families are navigating their way out of poverty.

In Scotland, health and social care staff continue to have routine, non-stigmatising conversations about money worries, and the case studies gathered over the last 13 years of HWC clearly demonstrate how this type of support can dramatically reduce stress levels. This is a really important outcome for both parents and children, as the Australian blog reminds us that the proportion of parents experiencing poor mental health triples for those struggling with financial hardship. In Sweden, although the research is still ongoing, there is recognition that hardship can often be linked to feelings of shame and stigma. However, in the aftermath of the pandemic, more people are finding it difficult to make ends meet and the topic has been receiving more mainstream media coverage in Sweden, which is perhaps leading to money worries becoming less of a ‘taboo’ topic.

More long-term investment in financial support services is needed to tackle concerns about short-term funding models. This could ensure that advice services across Scotland have the capacity to provide timely support to already struggling families attending health services. In Sweden, although child health services have developed good routines for screening and referral, some financial support services have up to six-month waiting time. This makes it difficult to prioritise this type of preventative work, which is needed more than ever, particularly among families with limited income and no buffer.

A new Joseph Rowntree report estimates that 490,000 people in Scotland are living in very deep poverty, and that we are unlikely to meet the ambitious 2030 child poverty targets without much more action. The plan to tackle child poverty in Scotland contains a list of actions that includes improving the uptake of social security benefits and reducing household debts. To help tackle these worrying levels of deep poverty, returning to a point made in the first blog in this series, strengthening approaches like HWC could help reclaim some of the £19 billion UK social security benefits that remain unclaimed each year. It could also help end the poverty premium (the extra costs people living in poverty pay for essential products and services), which was estimated to cost around £242 million each year in Scotland.  

To conclude this series of blogs, on a personal note, it was rewarding to be part of the team that gathered the research evidence in the early years of HWC and to watch it become one of many building blocks that have sustained the model  over the last 13 years, and encouraged further innovation, such as the Special Needs in Pregnancy Service. Equally, in such difficult times it would be encouraging to see the other work in this series of blogs becoming early years building blocks. Leading to new, sustainable approaches that ensure children − whether living in Scotland, Sweden, Australia or elsewhere − have the best start and bright futures.

The other blogs in the series can be accessed here:

Working towards a Best Start and Bright Futures: reflections on an NHS child poverty partnership 

The power of working together: when health and financial wellbeing services join forces

With a little detour via Australia, Healthier Wealthier Families makes it to Sweden

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