Bringing Hope, Building Futures: Tackling child poverty delivery plan 2026-2031 – annex 12: Health Impact Assessment (HIA)

2. Evidence Review

Existing research/reports/policy expertise

The plan builds on the work that has been undertaken through the first two delivery plans and has been informed by an extensive evidence base of research and policy expertise in relation to tackling child poverty, including the focus on priority family groups and the key drivers of child poverty reduction. Since the publication of the first plan, the Scottish Government has produced annual progress reports outlining the action that has been taken and the impact towards the child poverty targets.

National child poverty data

The Scottish Government holds key statistical data for tracking progress against the four income-based targets set out in the Act to reduce child poverty in Scotland by 2030. High level data and analysis can be found at child poverty summary and child poverty analysis.

This data shows that child poverty rates in Scotland have remained broadly stable over the last decade. It is estimated that 23% of children (240,000 children each year) were living in relative poverty after housing costs in 2021-24. Before housing costs, it is estimated that 22% of children (220,000 children each year) were in relative poverty.

Detail of progress toward the interim targets can be found in the 2024-25 annual progress report. The latest data on poverty will be published on 26 March 2026, reflecting a new link to DWP administrative data, which will help to further our understanding of poverty in Scotland.

Child poverty data and analysis is also available from independent sources, including:

• The End Child Poverty Coalition produced a report in June 2025 alongside Loughborough University with estimates of child poverty after housing costs in parliamentary constituencies and local authorities.
• Joseph Rowntree Foundation’s annual report regarding poverty in Scotland includes a focus on poverty rates over time and progress towards the targets.
• Public Health Scotland host a child poverty prevention dashboard, with a range of quantitative indicators to help local areas tell the story about local child poverty and its drivers.

Evidence of what works

A Cumulative Impact Assessment and impact reports for the main policies are published alongside the plan. These documents, alongside the statutory annual progress reports published, tell us what is working in the national mission to eradicate child poverty and have informed the policy package set out in the plan.

The previous plan covering 2022-2026 contained a comprehensive evidence review on what works in tackling child poverty. Based on wide consensus across national stakeholders and supported by other international approaches, the review emphasises:

• Having clear targets supported by policies that directly impact on poverty rates
• Tackling poverty across all three drivers (income from employment, cost of living and income from social security and benefits in kind)
• Having a combination of various policies that support families most in need, and recognising that there is no single way to experience poverty, but a wide range of unique experiences.

In June 2025, the Scottish Government published an international review of approaches to tackling child poverty. This report – and the series of case studies that underpin it – explores different European countries’ choices and routes to tackling child poverty and how the Scottish Government might learn from them to improve the lives of families. The focus of this report is to:

• Draw out the key factors that have either reduced child poverty levels or kept them consistently low;
• Identify the policies that have been central to achieving those outcomes;
• Explore the extent to which national governments and/or wider factors have, in each case study, influenced these poverty-reduction outcomes; and
• Examine the feasibility of applying these approaches in a Scottish context, accounting for both historical differences and availability of policy levers.

Overall, the report found that rather than there being any single silver bullet, context matters alongside implementing a combination of policies that, taken together, deliver poverty reduction.

Much of the existing evidence in what works to tackle child poverty was reinforced by the study and has informed some areas of focus and actions contained in the plan. For example, there is a particular emphasis in the international review on social security and the importance of policies which support parents to enter and remain in the workplace, such as childcare and tailored support through active labour market policies.

Priority families

Poverty affects a wide range of families with a variety of protected characteristics. However, around 90% of all children in poverty in Scotland live within the six priority family types identified in our first delivery plan: lone parent families, minority ethnic families, families with a disabled member, families with a mother aged under 25, families with a child under one and larger families (3+ children).^[2]

It is important to note there is significant intersectionality within these groups and, whilst we will focus our efforts on those most at risk of experiencing child poverty, we will use the priority family types as lenses through which we address the key barriers experienced by different groups. For example, among children in relative poverty:

• 49% of children in lone parent families also have a disabled family member
• 50% of children in a family with a younger mother are also in a lone parent household
• 49% of children in families with three or more children are also in a family in which someone is disabled

Families with experience of multiple disadvantage are often among those deepest in poverty and experience most challenges to getting out of poverty. Most of these families are also likely to fall into at least one of our priority groups. Therefore, it is important that policies are mindful of the intersectionality, specific support needs and multiple barriers people can face.

Key drivers of poverty reduction

The first two delivery plans set out that tackling child poverty most effectively results from the inter-relationship between three key drivers of poverty reduction:

• Increasing income from employment
• Reducing cost of living
• Increasing income from social security and benefits in kind

Evidence shows that this driver approach remains relevant and appropriate. The third delivery plan will therefore build on this approach and, supported by views gathered from key stakeholders, also ensure that the plan supports children and families to thrive.

Relationship between poverty and health

Evidence shows that poverty in childhood - especially in the first 1,000 days - has profound and enduring effects on physical development, mental wellbeing and long‑term health trajectories. Addressing child poverty and prioritising good child health in the early years is therefore important for the health and wellbeing of children both now and into the future.^[3] Some key points regarding the relationship between poverty and health, and where action may be targeted to have the most positive impact, are outlined below.

The health of children begins with the health of their parents, and addressing the transgenerational transmission of health risks requires systemic action within and beyond traditional early childhood systems.^[4] Addressing health inequalities therefore requires a strong focus on the preconception period, raising awareness of the benefits of good health at conception and the risks of poor parental health for children.^[5]

Children in poverty are more like to experience food insecurity and are at increased risk of hospital admissions, malnutrition, developmental delays, anaemia, and asthma.^[6] People living in poverty can also have limited or lack of access to healthcare, which can contribute to poorer health outcomes for both parents and children throughout the life course, including ineffective management of conditions that impact unmet medical needs.

Making the system easier to navigate for families is therefore essential, which includes integrating services and decentralising care. Implementing place-based approaches – already in practice in Scotland – is key to tackling health and poverty-related challenges through locally tailored solutions.

Adults in Scotland’s most deprived areas are more likely to report experiencing higher levels of psychosocial stress and mental ill health. Poverty has been identified as the single biggest driver of poor maternal mental health, with women living in deprived areas being particularly vulnerable to perinatal mental health issues.^[7] We also know that parent and child mental health are closely linked, with each influencing the other and persistent childhood poverty negatively affecting both.

The wider social determinants of health are critical to health outcomes, with poverty itself one of these determinants. Key actions to address inequalities and improve health outcomes include: enhancing the income and financial stability of families; implementing supportive employment and social security policies; providing accessible, quality childcare, to enable return to work; supporting safe and affordable housing; strengthening digital connectivity; ensuring affordable transport; and strengthening strong social networks.^[8]

Consultation/feedback from stakeholders

The extensive and targeted engagement process outlined above gathered views from a wide range of organisations and people with lived experience of poverty. This process was crucial in understanding the impact of the plan on health outcomes, through hearing the views of Health Boards, expert organisations such as Public Health Scotland and those who the plan aims to help.

There was broad consensus across the consultation and engagement activities that the four strategic themes tested are appropriate, and there was no evidence of negative impacts on health outcomes as a result.

A number of key points were though made in relation to health which included:

Mental health impacts

Poverty related stress, anxiety and trauma

Participants repeatedly emphasised that poverty creates stress, anxiety, worry and mental overload for parents and children. This includes:

• Persistent stress from financial insecurity
• Trauma linked to experiences of instability
• Anxiety related to stigma, shame, and social comparison

Isolation, low confidence and damaged self-esteem

Children and young people described:

• Feeling isolated and excluded from peers because they cannot afford activities, clothes or school essentials
• Low self-esteem linked to being visibly poorer than others
• A strong sense of not feeling included or respected because of their household finances

Parental mental health impacts

Parents and carers described:

• Long waits for mental health support
• The mental strain of juggling caring responsibilities, finances and insecure work
• Feeling emotionally drained, ashamed, and stigmatised

Need for improved mental health support for young people

Children, young people, and parents highlighted:

• Long waiting lists for CAMHS and adult mental health services
• Limited early intervention support
• Need for integrated, relational, whole family mental health support, not siloed crisis-oriented models

Stigma as a health‑damaging factor

Stigma associated with poverty was described as:

• A major barrier to accessing benefits and supports
• A driver of stress, shame, and social withdrawal
• A source of bullying and discrimination in school settings

Physical health impacts

Housing conditions driving ill-health

Families described:

• Living in damp, mouldy or cold homes, leading to respiratory issues and poor general health
• Overcrowding causing disrupted sleep, stress, and health risks
• Temporary accommodation as especially damaging for children’s physical health (e.g., no cooking facilities, inadequate cleanliness)

Impact of poor nutrition and food insecurity

• Hunger, including attending school without food
• Lack of access to adequate nutrition due to rising food costs
• Reliance on free school meals or breakfast clubs
• Shame around food insecurity

Energy costs and inability to heat homes

High fuel costs meant:

• Families could not heat their homes consistently
• Children experienced cold indoor temperatures
• Parents had to choose between heating and eating

Barriers to healthcare access

Participants described:

• Difficulties travelling to health appointments due to transport cost and availability
• Long travel times in rural/island areas
• Financial barriers to attending regular preventive care

Impact on physical activity and healthy lifestyles

Costs associated with school trip, sports clubs and extracurricular activities prevented children from participating, reducing opportunities for healthy physical activity.

Intersections between mental and physical health

Poverty as a whole system health stressor

The engagement highlighted:

• How poor housing, poor diet, fuel poverty, and lack of transport combine with stigma, isolation, and anxiety
• These overlapping stressors create a cycle of poor physical and mental health

Particularly acute impacts in the early years

Professionals and families stressed:

• The importance of the first 1,000 days
• How early stress, trauma, poor nutrition and unstable housing have lifelong consequences for health

No specific gaps in evidence have been identified which may prevent determination of impact. The consultation process was wide-ranging and gathered views from across each of the priority groups to understand the impact of the plan with regards to health outcomes.