Cathy Ashley

December 10, 2013 by Professor Paul Bywaters, Coventry University and Professor Brid Featherstone, Open University

In the last decades there has been a considerable rise in inequality in the UK. The work of epidemiologists Wilkinson and Pickett (2009) has illuminated the impact of this rise in inequality bringing an array of evidence in their book, The Spirit Level: Why More Equal Societies Always do Better, to reach conclusions that have been the subject of considerable debate and critique (for a good review see Rowlingson, 2011). Wilkinson and Pickett collected internationally comparable data on health and a range of social problems: levels of trust, mental illness (including drug and alcohol addiction), life expectancy and infant mortality, obesity, children’s educational performance, teenage births, homicides, imprisonment rates and social mobility. Their findings suggest that there is a very strong link between ill health, social problems and inequality. Differences in average income between countries are important up to a certain level of development, but differences within developed countries are key. The amount of income inequality in a country is crucial, often reflected and compounded by a range of other markers of inequality, such as access to good housing, education, employment and health services.

When it comes to children’s services policy, however, this evidence and, indeed, this way of thinking, is strangely absent. In 2013 a child in Blackpool has an 8 times greater chance of being a looked after child (LAC) in out-of-home care, than a child in Richmond Upon Thames, and similar differences are found in rates of children on child protection plans(CPP), with relative deprivation as the major causal factor (Bywaters, 2013). However, only recently have these differences in rates of children’s services interventions begun to be thought of as an issue of childhood inequality, forty years on from the emergence of health inequalities into public discourse. Child welfare inequalities have been defined as, ’unequal chances, experiences and outcomes of child welfare that are systematically associated with social advantage/disadvantage’ (Bywaters, 2013, p.4).

New research for the Nuffield Foundation1 studying over 10% of children in England has found:

• Very large inequalities. Children in the most deprived 10% (decile) of neighbourhoods have a 10 times greater chance of being on a CPP and an 11 times greater chance of being a LAC than children in the least deprived decile. In the most deprived 10% of neighbourhoods, on average, around 1 child in 90 is in out-of-home care, in the least deprived 10%, only 1 child in 1000.

• A gradient in CPP and LAC chances across society. There are children on CPPs or in out-of-home care from neighbourhoods across all levels of deprivation from the most affluent to the most deprived but each step increase in deprivation brings an increased rate of these extreme children’s services interventions. This gradient is also found for children’s health and educational attainment. Reducing inequalities (the steepness of the gradient) in children’s chances of welfare interventions could be an aim of policy and practice.


• Evidence of an ‘inverse care law’ in children’s services. In neighbourhoods with equivalent levels of deprivation, local authorities with low overall deprivation scores have higher rates of CPP and LAC than more deprived local authorities. For example, in the most deprived 10% of neighbourhoods nationally, the LAC rate in relatively affluent Herefordshire is 4.75 times greater than the LAC rate in much more disadvantaged Sandwell. This inverse relationship between the overall deprivation in a local authority (LA) and their rates of CPP and LAC interventions at each decile of deprivation holds true across all levels of deprivation albeit with variations between individual LAs.

This study needs replication and we have only briefly reported the findings here. But the pattern of inequalities reported is supported by the fact that it clearly reflects what has been found for health: large socially constructed inequalities, a gradient in life chances across society and an inverse relationship between need and access to services.

One thing needed now in children’s services policy and practice development is a debate about the significance of and explanations for these inequalities and a central and highly topical issue concerns the impact of relative poverty on parenting and child maltreatment. . As Wilkinson and Pickett note, whether people are happy with their income depends not only on its level but also on how it compares with what others around them have. However, the lack of income in an unequal society poses concrete everyday challenges for all members of families affected and these can be intensified by, as well as sometimes ameliorated by, services. The important research by Hooper et al. (2007) offers some helpful pointers for further debate and research. Their findings on the relationship between poverty and maltreatment focus on stress, with social support as a key factor in promoting resilience. These findings fit with a wider literature from a range of disciplines that points to the importance of social networks in supporting and promoting wellbeing and the reverse (see Cottam, 2011). Hooper et al (2007) found the ‘spoiled’ identities associated with poverty and other life experiences could lead to social isolation. The need for recognition and respect, often denied to people living in poverty and those who experience forms of adversity such as violence and abuse, could make children’s behavioural problems difficult to bear or manage.

‘Some life experiences made poverty more difficult to manage and poverty made all other forms of adversity more difficult to cope with’ ( p,32). Children’s actions such as running away, or wanting contact with an ex-partner could impede the capacity to protect especially when social, financial and personal resources were stretched. Finally, services could compound feelings of powerlessness especially when practical resources (such as housing) were not addressed.

Hooper et al found in discussion with professionals that poverty often slipped out of sight as they focused on drug or alcohol problems and on individual attitudes, values and priorities. ‘A limited conception of poverty, lack of resources to address it, and lack of attention to the impacts of trauma, addiction and lifelong disadvantage on the choices that people experience themselves as having may contribute to over-emphasising agency at the expense of structural inequality’ (p, 97).

Perhaps it is because ‘it is well established that the need for children’s personal social services is directly related to social disadvantage’ (Department of Health, 2000, p. 90), because social workers see so much social inequality without feeling able to have an impact on it, that they become immune to recognising its impact on people’s lives. Or perhaps the policy context in which social workers operate fails to support action to minimise and mitigate material deprivation.

This failure to recognise extreme child welfare interventions as markers of social inequalities (and which may sometimes compound social inequalities) is not helped when the Secretary of State, Michael Gove, equates social workers ‘understanding of the impact of social inequalities with robbing ‘families of a proper sense of responsibility, …. (and) abdicat(ing) their own.’ Understanding does not mean ‘explaining away’. It does not mean failing to recognise and act when children are vulnerable. It does mean focusing strategic attention on the upstream and midstream causes of damaged childhoods. And it does mean that practice downstream has to be re-imagined to break the link between deprivation and coercive state interventions in family life. As the WHO put it for health inequalities (with our additions):), ‘It does not have to be this way and it is not right that it should be like this. Where systematic differences in health (child welfare) are judged to be avoidable by reasonable action they are, quite simply, unfair…. Putting right these inequities – the huge and remediable differences in health (child welfare) between and within countries – is a matter of social justice.’


1. Bywaters, P., Brady, G, Sparks, T. and Bos, E., Deprivation and Children’s Services Outcomes; what can mapping looked after children and children on child protection plans tell us? Funded at Coventry University by the Nuffield Foundation, 2013-14.


Bywaters, P. (2013) ‘Inequalities in child welfare: towards a new policy, research and action agenda’, British Journal of Social Work, online advanced access.

Cottam, H (2011) ‘Relational Welfare’, Soundings, Summer, 48, 134-144

Department of Health (2000) The Children Act Report 1995 - 1999, London, The Stationery Office.

Hooper C-A., S. Gorin, C. Cabral and C. Dyson (2007) Living with Hardship 24/7: The diverse experiences of families in poverty in England, London, The Frank Buttle Trust

Rowlingson, K (2011) Does income inequality cause health and social problems? York, Joseph Rowntree Foundation

Wilkinson, R and Pickett, K (2009) The Spirit Level, London, Penguin