Although it is only four years since the publication of the first edition of Nick Spencer's Poverty and Child Health, political responses to the problem of child health inequalities have moved on a long way. The government's commitment to abolish child poverty within the next 20 years and to develop national inequalities targets, including specific targets for children, signals a major change of direction since the book first came out in 1996.
The second edition of Poverty and Child Health brings the book up-to-date by looking at the new initiatives introduced by the Labour government to tackle child poverty and reduce health inequalities. It reviews some of the early evidence of the likely impact of these policies.
The book is divided into four sections. The first provides a useful overview of different ways of defining and measuring poverty and demonstrates a rising trend in levels of child poverty in both developed and developing countries throughout the 1980s which shows little sign of being reversed. Spencer then goes on to review evidence connecting poverty and child health, showing that, despite an overall fall in infant mortality rates, the health gap between the most and least privileged groups has remained constant and may even be increasing in some countries.
While the connection between poor child health and low socioeconomic status is now widely accepted, the causal links between the two are the subject of fierce political debate. Spencer examines the two principal arguments put forward to explain why children in lower socio-economic groups are less healthy by using a number of examples, including parental smoking and nutrition.While public policy interventions have often emphasised changing individuals' behaviour (for example, health education campaigns which stress the importance of eating nutritious foods), Spencer uses a range of evidence to show that structural factors, particularly income levels, may offer a more convincing explanation for differences in behaviour between different socio-economic groups.
Although much of Spencer's analysis focuses on the socioeconomic determinants of health, many of which are beyond the direct control of the NHS, in the final section of the book he stresses the role that the health sector can play in minimising the health consequences of poverty. Although the NHS may not control the factors which push people into poverty, it can go a long way to alleviate its effects by empowering communities to help shape local services promoting cross-sectoral partnerships, as well as through direct service provision to vulnerable groups.
Spencer provides some useful examples of successful initiatives, but also points out that more work needs to be done to evaluate interventions to reduce health inequalities.
According to the author, the intended audience for the book is child health professionals, but with its accessible style and helpful summaries at the end of each chapter, it will appeal to a wide range of policy makers, practitioners and researchers who have an interest in reducing health inequalities at both local and national level.