Promotion

70 MENTAL HEALTH PROMOTION
experience ill health outcomes (Patel 2001). The State of the World’s Children Report
(Bellamy 2005) estimated that there are one billion children worldwide living in poverty,
with some regions having a higher incidence than others. In Sub-Saharan Africa,
for example, the percentage of the population living on less than US$1 a day over
the period 1990 to 2002 was 43 percent compared to 21 percent in the rest of the
world. While there are countries and environments where virtually all children experience
poverty, in others it is commoner for a proportion of the child population to
experience it. For example, in the UK there is a strong link between poverty and
social class, with 16 percent of children between 5 and 15 years of age in the lowest
income groups with mental health problems compared with just under 6 percent in the
highest income groups (Melzer et al. 2000). The complex impact of poverty on children’s
lives and the potential impact on mental health can be suggested as illustrated in
Figure 4.2.
Education
While informal education in family and community contexts promotes mental health,
it is widely recognized that lack of participation in formal education is associated with
a whole range of poorer outcomes, including poorer mental health (Bellamy 2001).
UNICEF reported in 2005 (Bellamy 2005) that 114 million children of primary school
age are not enrolled in school. Although the figures for enrolment are now high in
most parts of the world they remain relatively low, and persistently so, in others. In
Sub-Saharan Africa, for example, the figure for the period 1998–2003 was 58 percent
compared with 80 percent worldwide (Bellamy 2004). Fall out rates are also important
since failure to complete school is associated with poorer health outcomes (Patel 2001).
There is still a gender gap for recruitment to school and for total years in primary school
with retention rates generally better for boys. In those countries where all children have
the opportunity to go to school for the full legal period there are some whose attendance
is low and there is evidence that they also experience poorer mental health
(Melzer et al. 2000).
Figure 4.2 Some relationships between child poverty and mental health