Before the spirits visit Scrooge, he is busily working when men stop by to collect charity for the poor. Scrooge dismisses their efforts and refuses to contribute to the cause, telling the men that he cannot afford to make "idle people merry." Scrooge believes that the poor deserve their situation, assuming that they refuse to work hard. He tells the men that he already pays for them to be contained in "prisons" and "workhouses," and he refuses to contribute anything more.
Tiny Tim breaks through Scrooge's cold and indifferent heart and stirs within him feelings of true empathy. In this young boy, Scrooge sees the real face of poverty, and it conflicts with the stereotypes he has previously held. This innocent and thoughtful child clearly doesn't deserve the fate of prisons or workhouses, and Scrooge's attitude is transformed by observing the way Tiny Tim interacts with his father and his family.
When Scrooge asks the spirit whether Tiny Tim will live, he learns that the little chair in which the boy sits will soon be vacant if the future remains "unaltered." Scrooge protests, begging the spirit to tell him that the child can be spared. He is disheartened to hear his previous words about the poor parroted back to him:
What then? If he be like to die, he had better do it, and decrease the surplus population.
Tiny Tim presents the humanity of poverty, and Scrooge is "overcome with...grief" to think that Tiny Tim might die because of poverty. Scrooge has direct influence over this situation as the employer of Tiny Tim's father, Bob Cratchit.
After the final visit by the spirits, Scrooge becomes a direct influence on Tiny Tim's life and health, becoming known as a "second father" to the young boy. As a result, the boy does not die, proving that Scrooge's transformation has a profound impact on the life of this innocent boy.