Child poverty, food insecurity, and respiratory health during the COVID-19 pandemic

The eradication of poverty and hunger are the top sustainable development goals, adopted by UN Member States in 2015. Yet the World Food Programme estimates that, in the wake of the COVID-19 pandemic, acute food insecurity could double from 135 to 265 million people worldwide. In the absence of mitigating policies, poverty leading to food insecurity will damage the respiratory health of a generation of children.

Inequalities in lifelong respiratory health originate in childhood, when adequate nutrition is essential. The respiratory system starts to develop 3 weeks after conception, and grows until adolescence, with the lungs maturing most rapidly in size and intricacy in the first three years of life. Disruption to this development in childhood contributes considerably to the early onset of adult illnesses, such as chronic obstructive pulmonary disease (COPD). This disruption can be driven by many of the consequences of living in poverty, including malnutrition. Even in cystic fibrosis, an inherited genetic disease, health inequalities can be seen: social disadvantages can disrupt respiratory development, influencing survival in people with the condition.

Poor nutrition is intricately linked to other poverty-related risk factors for respiratory illness. Prematurity is linked to poverty and tobacco smoke exposure in pregnancy, and among preterm infants, those with poor intrauterine or postnatal growth have worse respiratory outcomes. Poor children are more likely to live in overcrowded and damp housing, less likely to be vaccinated, and more likely to catch infections that damage the respiratory system early in life. They have less access to green space for exercise and are more likely to breathe poor quality air, whether indoors or outside.

From previous economic crises, we know that children are more likely to fall into poverty and be subject to the negative consequences of poverty than any other age group. Even before the COVID-19 pandemic, increasing levels of poverty and food insecurity among the UK population was an urgent problem. Welfare cuts over the past decade have pushed many more children into poverty, with one in three children currently affected. Before 2010, charities providing food aid in the UK hardly existed. In 2019, subsequent to austerity measures eroding welfare provision, the Trussell Trust, who run 60% of UK foodbanks, distributed 1·6 million emergency food supply parcels.

Unintended consequences of the lockdown will have affected poor children the most. During the COVID-19 pandemic, many children who rely on school meals to sustain their nutrition have gone hungry. In the UK, in 2019, 1·3 million children were eligible for free school meals, and a further 1 million children (deemed ineligible for free meals) were estimated to be living in food insecurity. In the USA, rural counties have been hit hardest by restricted food access; during the COVID-19 pandemic, rates of food insecurity have doubled from 18% to 35%. Large observational studies suggest that living in food poverty increases the risk of developing childhood asthma, and in one US study, parents of children with cystic fibrosis were twice as likely as parents in the general population to be living in food insecurity. The effect of food insecurity on outcomes in children with asthma and cystic fibrosis, and other respiratory illnesses, are likely to persist for decades.

COVID-19 recovery policies must ensure that no child goes hungry. So far, this goal has been elusive. In the USA, the First Coronavirus Response Act, passed in March, provided additional funding to pre-existing food assistance programmes and enabled families to claim the cost of free school meals at grocery stores and certain online outlets. However, by mid-May, only 15% of eligible families were receiving the benefits. The UK Government has continued to fund means-tested free school meals for children attending school during lockdown. Families of children remaining at home and deprived of their usual free school meal became eligible for free food parcels or online food vouchers, redeemable at national supermarkets. Professional footballer Marcus Rashford successfully lobbied for the extension of this programme over the summer months to tackle the recurring phenomenon of so-called holiday hunger. But the Government have made it clear that the one-off scheme will end in September, when schools reopen. Meanwhile, there have been reports from organisations such as the Child Poverty Action Group of implementation challenges, causing distress and humiliation to families in need.

© 2020 Garo/Phanie/Science Photo Library

A far more efficient and sustainable solution to the problem of food insecurity, one that assures the dignity of families, is to directly address child poverty. Societal interventions to reduce child poverty are among the most cost-effective solutions, with studies in the UK and the USA showing huge cost savings across all sectors of society. In the UK, modelling has shown that adding a modest £10 per week per child to child benefit would reduce child poverty by 5%. In many countries, the idea of a universal basic income is being debated, with evidence of increased support for such policies in the UK and USA. One simple and urgent policy—increased investment in child benefit to reach every child in need—can powerfully address food insecurity and its consequences.

Access to an adequate food supply is a basic human right. Poverty denies children their right to a standard of living that allows for their overall development. On moral, ethical, and medical grounds, we must ensure that children have enough food to eat. National programmes to reduce inequalities in respiratory health will not succeed unless we address these issues.