Politicians always agree that prevention is better than cure, just as they agree that “joined-up government” is a good thing. But how often do they act on the principle?
There is an overwhelming case for preventive policies in early childhood. Projects such as Head Start and High/Scope in the US have shown that better educational and social provision for under-fives from poor homes can boost school achievement, increase employment opportunities and even reduce criminal activity. One study calculates that for every dollar spent on such programmes, seven dollars will be saved in future costs to society.
In Britain, new research indicates that the first year of a child’s life, and the months before a child is born, may be particularly important. The Medical Research Council’s National Survey of Health and Development has recently demonstrated a clear link between low birth weight and poor cognitive ability. This effect persists into adolescence and even early adulthood. US studies also suggest a long-term link between low birth weight and chronic health conditions.
A pregnant mother’s own health and diet are crucial. Unsurprisingly, poverty is at the root of the problem: mothers on low incomes often go without food themselves so that they can buy adequate meals for the rest of the family. An American study in Indiana found that mothers who were at high risk of having low-birth-weight babies gave birth to heavier babies when they received additional financial support.
The Labour government’s target is to abolish child poverty by 2020. It intends to achieve this mainly by encouraging people to move off benefit and into work through the New Deal, the minimum wage and tax credits for working families. It has also introduced record rises in child benefit and improved the children’s allowance in income support. In addition, programmes such as Sure Start aim for more effective co-ordination of services for toddlers in deprived areas.
All this is admirable. But a second-term Labour government should go further. It should shift the focus of the child poverty strategy to babies under the age of one, including the months before birth.
As a start, child benefit should be extended to pregnant women, from their first scan at 12 weeks. The cost would be around £300m – an investment that is likely to amply repay itself in the long run. Parents also need extra support once their child is born. For one in three poor families, having a baby is the cause of poverty, through a combination of increased costs and reduced earnings. The current policy fails to recognise this adequately. Levels of child benefit and income support are higher for the parents of under-11s. But there is nothing extra for families with very young children.
Extending child benefit to pregnant women and increasing it for the under-ones could form part of a wider shift in the government’s approach to family policy. Most effort so far has focused on encouraging women to work. But the impact of mothers working while their child is under one year old is hotly contested. Some studies suggest that maternal employment at such an early stage may be bad for the child’s development. Other studies indicate that high-quality childcare during the first year of life actually leads to higher scores in later tests of cognitive and linguistic development. What is important is that mothers should be able to choose whether to stay at home or go out to work. Increasing child benefit for the under-ones would be a step towards allowing them to make such a choice.
But income is not the only thing that matters. The amount of stimulation babies get – how much they are talked and read to, played with and encouraged – can influence language development, reading ability and numeracy skills. The varying levels of stimulation and encouragement received by children from different backgrounds are already apparent by the age of 12 months.
Again, the government should go further, by extending Sure Start (which will cover only 250 areas by 2002) and bringing in GPs, midwives, pharmacists, health visitors and nursery assistants to help and advise parents. But, in many deprived communities, some stigma is attached to receiving help from the state. To get round this, the government could encourage the use of “community parents” – local people trained by health visitors to give help and advice to first-time parents who want it. They provide “book start” packs to encourage parents to read and talk to their children, advise how to cook on a low income and explain where to find good-quality services such as childcare.
These initiatives should focus on fathers as well as mothers. US studies have found that fathers who form secure attachments to their babies during the first three months of life are more likely to maintain these close ties as their child grows older. In turn, children with more secure parental attachments are less likely to be isolated and aggressive both before and during their time at school.
The results of such policies may not be seen for years to come – which is why they are hard to sell to politicians. None the less, they could make a real difference in ensuring that the most disadvantaged children in society reach their full potential in life.
Liz Kendall is the senior research fellow in health policy at the Institute for Public Policy Research. This is the tenth in a series of articles, prepared by the NS and the Fabian Society, on ideas for a second Labour term