Exploring the impact of family size on child health outcomes and service use

Background

The number of children in the UK living in poverty increased from 3.6 million (2010/11) to 4.3 million (2022/23). There is growing evidence of the impact of rising poverty on children health outcomes, for example worse respiratory health due to cold, damp and mould in housing and tooth decay related to food insecurity and poor quality diet. 

The increase in poverty has been more pronounced in larger families. This can be partly explained by benefit changes, including the two-child limit where benefits are not paid for 3rd and subsequent children and the benefit cap, which limits total household payments and so predominantly affects larger households. Changes in the welfare system is a high profile and topical issue of significant public health importance. 

Much of the evidence on links between welfare policies and children’s outcomes is not fit for purpose, for example there have been no new data since 2017 and current analyses do not account for key factors such as age or ethnicity of children in each household or lone versus two-parent households. More robust statistical methods are needed to study the association between household size and children’s health and social care outcomes. This will help inform public debate more accurately and contribute to evidence-based policy review and change. 

Aim

This project aims to: 

• Provide a robust evidence base for discussion of welfare reforms by studying the health and social care outcomes of children living in large households (3+ children)
• Where possible, to model the potential impact on children’s health and social care outcomes of policies that support larger families.

Data and methods 

Our specific objectives include:

• Work with parents/carers who have lived experience of these benefit restrictions and other public/practice stakeholders to co-design quantitative analysis plans, inform the literature review and guide interpretation and dissemination of findings
• Undertake a rapid review of qualitative studies to identify the impact of the two-child limit and benefit cap on the health and wellbeing of children and young people in the UK
• Investigate how selected health and social care outcomes vary by the number of children living in a household
• Replicate analyses on existing datasets to evaluate the consistency and generalisability of findings 

Public involvement

Members of the public and practice colleagues will be involved throughout the project. Several discussions have informed the proposal for this project, for example with the Wealdstone Baby Bank and the North West London Integrated Care System. 

Dissemination 

We will work closely with public and practice partners to produce accessible and fit-for-purpose resources summarising the research findings and a manifesto for change. These will be disseminated through websites, blog posts and social media.