Abstract
Worldwide, the health and well-being of children and youth is strongly influenced by factors outside of health including income, education, food security, housing, employment, non-discrimination, and access to healthcare. Factors such as these are referred to as social determinants of health. This report brings together data on material hardship and poverty for Aotearoa from 1) Stats NZ, 2) the NZ Health Survey, 3) the Household Economic Survey, 4) National Minimum Dataset (NMDS), and 5) School Attendance Surveys to paint a picture of some social drivers of health among our children and young people up to the age of 18 years.
Income indicators consider the size and composition of the households in which children live and are expressed as ‘before’ and ‘after’ the costs of housing (rates, rents, etc.). In 2022/23, approximately 237,400 children (1 in every 5 children) were living in low-income households (incomes less than half of the contemporary median income) after adjustment for housing costs. There has been little change in this indicator since 2018/19.
Material hardship exists when a household is forced to go without 6 or more defined essentials in the DEP-17 index and include items such as insufficient food or clothing, postponed visits to healthcare providers, and being in arrears or borrowing money on more than one occasion. Children living in such households are at greater risk of illness and long-term impacts on their health even when adults in the household seek to shield them from the impact of household restrictions. Up until 2021, there had been a steady decline in material hardship from 18% in 2012 to 10% 2021. However, 2022/23 saw a significant rise from the previous year with 1 in 8 children (12.8%) experiencing hardship.
It is possible for a child live in a low-income household but be protected from material hardship (e.g., through accumulated savings, community support, access to less expensive housing). Conversely, it is also possible for a child living in a household with an income above the threshold to experience hardship if housing costs are high or health issues mean that the household has additional expenses, for example associated with attending health services and accessing treatment. Not surprisingly, children subject to both low income and hardship (estimated to be 77,200 children in 2022/3) live with the greatest restrictions on everyday activities.
Interventions to reduce childhood poverty continue to leave Māori and Pacific children behind. Only European children are meeting the 2023/24 target set by government to achieve 10% of children living in households with incomes less than 50% of the contemporary median before housing costs. Differences are even more pronounced for material hardship with 1 in 5 tamariki Māori and 1 in 4 Pacific children living in households forgoing essentials compared with 1 in 10 European children. These inequities have persisted over time.
Living with a disability is strongly associated with material hardship and children with a disability themselves or who live with at least one household member who has a disability, are left behind on the material hardship measure. Disabled children and children in disabled households experience material hardship at twice the rate of those without a disability.
There are multiple indicators associated with child poverty including food insecurity, lack of housing affordability and poor-quality housing, barriers to school attendance, and potentially avoidable hospitalisations. In 2022/23, 21% of all children (and 35% of tamariki Māori) aged 14 years or younger lived in households where food sometimes or often ran out and fewer than half (closer to one-third for tamariki Māori) were attending school regularly. The recent COVID-19 pandemic has served to exaggerate these differences. The levels of housing unaffordability remain high, affecting 1 in every 2 children, while the poor quality of housing continues to impact on potentially avoidable hospitalisations, especially respiratory illnesses, among very young children and tamariki Māori.
Under the Child Poverty Reduction Act of 2018, the government sets targets to reduce the number of children living in households with low income or material hardship. In June 2024, the Minister for Child Poverty Reduction set the following three-year intermediate targets such that by 2026/27, the Government aims to reduce the proportion of children in: • Low-income households on the before housing costs contemporary income measure to 12%; • Low-income households on the after-housing costs fixed-line measure to 14%; • Material hardship to 11%.
The targets for low income (before housing costs) and material hardship are less ambitious than the second intermediate targets (10% and 9%, respectively). A new measure of poverty persistence is currently being developed and reflects the proportion of children living in households experiencing poverty over several years. The Act requires reporting on persistent poverty from 2025/26 on.
Inequities in social determinants of health between Māori and non-Māori contribute to inequitable health outcomes, which is a breach of Te Tiriti o Waitangi. International commitments also require that Aotearoa provides adequate resources for every child to flourish.