Child health and inequalities

• The health of today's children and young people will be one of the key factors in determining whether England is healthy and prosperous over the next 50 years.
• Many risk factors for adult disease are established in utero or in early life. Prematurity and slow intrauterine growth, as well as maternal obesity and diabetes are all linked to an increased risk of metabolic disease. 80% of overweight and obese children will become overweight or obese adults.
• Health inequalities can be defined as differences in health status or in the distribution of health determinants between different population groups. Inequalities can result from avoidable or unavoidable differences (e.g. in genetics, environment or lifestyle).
• Health inequity - where health differences are preventable and unnecessary, allowing them to persist is unjust
• Children and young people can experience different dimensions of inequalities. Children's services (especially mental health services) are often disproportionately underfunded.
• Children living in the most disadvantaged areas have a 50% higher risk of being burned, scalded or poisoned resulting in primary or secondary care attendance than those in the most advantaged areas. Emergency hospital admission rate for unintentional injuries among under-fives is 38% higher for children from the most deprived areas compared with children from the least deprived.
• Relative poverty is based on comparison with average household income; defined as 60% of the current median in the UK (can be measured before or after housing costs)
• Absolute poverty is based on level of income needed to purchase basic goods and services.
• Material deprivation is based on family's ability to afford a list of basic children's items
• Low income and material deprivation is defined as household income lower than 70% of median income together with being materially deprived.
• Poverty and child health cycle

  • poor living conditions
  • social isolation
  • compromised safety
  • lack of support system
  • bullying and discrimination
  • poor education
  • hunger
  • poor emotional wellbeing and mental health
  • poor health
• Children who have low cognitive scores at 22 months of age but who grow up in families of high socioeconomic position improve their relative scores as they approach age 10. The relative position of children with high scores at 22 months but who grow up in families of low socioeconomic position worsens as they approach age 10
• Poor nutrition can have a huge effect on population level

  • exposure to famine in early gestation was found to be associated with a 2 fold risk of obesity in adulthood
  • higher levels of triglycerides and LDL cholesterol
  • increased mortality
  • experience in utero affected long-term gene control
• Childhood experiences, both positive and negative, have a tremendous impact on future violence victimisation and perpetration, and lifelong health and opportunity. As such, early experiences are an important public health issue. much of the foundational research in this area has been referred to as Adverse Childhood Experiences. ACEs have been linked to risky health behaviours, chronic health conditions, low life potential, and early death,
• Adverse Childhood Events

  • child maltreatment
  • verbal abuse
  • physical abuse
  • sexual abuse
  • childhood household
  • parental separation
  • domestic violence
  • mental illness
  • alcohol abuse
  • drug use
  • incarceration
• Adverse childhood events lead to increased risk of:

  • high-risk drinker
  • unintended teenage pregnancy
  • smoke e-cigarettes or tobacco
  • underage sex
  • smoke cannabis
  • victim of violence
  • committed violence against someone else
  • used crack cocaine or heroin
  • been incarcerated in their lifetime
• Best Start in Life and Healthy Child Programme

  • help parents develop and sustain strong bond with children
  • support parents in keeping children healthy and safe and reaching their full potential
  • protect children from serious disease, through screening and immunisation
  • reduce childhood obesity by promoting healthy eating and physical activity
  • identify health and wellbeing issues early, so support and early interventions can be provided in timely manner
  • focus on health needs of children and young people ensuring they are school ready
• Ready for School

  • communicate their needs and have good vocabulary
  • become independent in eating, getting dressed and going to the toilet
  • take turns, sit still and listen and play
  • socialise with peers and form friendships and separate from parents
  • good physical good health, including dental
  • well nourished and within healthy weight for height range
  • protection against vaccine-preventable infectious diseases, having received all childhood immunisations
• Universal prevention considerations

  • universal in principle may not be universal in practice
  • may advantage people who are already in favourable positions, or fail to proportionately improve the outcomes of those in less favourable circumstances thereby widening the health gap
• Targeted prevention considerations

  • targeted approaches may address consequences rather than causes
  • understanding the target population requires appropriate data, gathered over time
  • determining eligibility can be problematic. There is potential for exclusion errors (under coverage) and inclusion errors (over subscription).
• How can doctors address inequalities in child health?

  • build trust and communicate clearly
  • make sure that history taking includes contextual factors
  • recognise patterns of neglect and abuse, support at-risk parents and families and make sure you know how to raise concerns
  • share information and referring in timely manner to health or social care colleagues
  • signpost to financial, housing and food support
  • learn and apply practical measures to improve accessibility to families, children and young people in more deprived groups and involve them in their healthcare
  • advocacy
• Many risk factors for adult disease can be traced back to intrauterine life and infancy
• Right from conception (and beginning preconception), poorer children generally experience poor outcomes
• The pathways and associations between socioeconomic inequalities and health inequalities are complex, and involve biopsychosocial mechanisms
• The role of healthcare is important but not sufficient to tackle inequalities, however as a doctor treating adults or children, child health inequalities will have an impact on you work