Www.bournemouth.ac.uk Inequities In Health and Well Being; The Evidence Base for Children Centres Dr Ann Hemingway June 2009

www.bournemouth.ac.uk

Inequities In Health and Well Being;The Evidence Base for Children CentresDr Ann Hemingway

June 2009

www.bournemouth.ac.uk

Inequalities in health are: “Differences in the prevalence or incidence of health problems between individual people of higher and lower socio-economic status”.

Inequities in health are these differences but articulated as being preventable, unjust and wrong.

Kunst A. & Mackenbach J. (1994) Measuring Socio-economic Inequalities in Health WHO monographWHO CSDH (2008) Commission on the social determinants of health final report WHO: Europe

www.bournemouth.ac.uk 3

The Social Determinants of Health: The Evidence (WHO 2003)

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Prof Skilledmanual

Unskilledmanual

Men

Women

3-D Column 3

1. The social gradient


2. Stress

Social and psychological circumstances can cause long term stress and early death.

Insecurity

Low Self Esteem

Social Isolation

Lack of control

Lack of supportive friendships

Continuing anxiety

Poor mental health

Feeling a failure


3. Early Life

A good start in life means supporting mothers and young children: the health impact of early development and education lasts a lifetime

Poor circumstances during pregnancy

Deficiencies in nutrition

Maternal stress/risk of smoking + misuse of drugs/alcohol

Insufficient exercise and inadequatePrenatal care


4. Poverty and Social Exclusion

Life is short where its quality is poor. By causing hardship and resentment, poverty, social exclusion and discrimination cost lives. The stress of poverty and social exclusion are particularly harmful during pregnancy, to babies, children and older people.Increases risks of divorce/separation

Increases the risk of becoming disabled

Increases the risk of becoming chronically ill

Increases the risks of developing an addiction


5. Stress in the workplace

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0.5

1

1.5

2

2.5

High Low

People who have more control over their work have better health.

Risk of suffering with CHD related to degree of control at work –high degree of control = 1 (Marmot et al 1997)


6. Unemployment

Job security increases health,

well-being and job satisfaction. Higher rates of unemployment

cause more illness and premature death.


7. Social Support

Friendship, good social relations and strong supportive networks improve health at home, at work and in the community. Those who get less social and emotional support are more likely to experience depression and a greater risk of pregnancy complications. In addition poor close relationships can lead to

worse mental and physical health.


8. Addiction

Individuals turn to alcohol, drugs and tobacco and suffer from their use, but use is influenced by the wider social setting.


9. Food

Because global market forces control food supplies, healthy food is a political issue. A good diet and sustainable food supply are central to promoting health and well being.


10. Transport

Healthy sustainable transport means less driving and more walking and cycling, backed up by better public transport. Healthy transport also encourages social interaction in the street and greater social cohesion.


How does a poor start in life compromise health in adulthood? (What are the links between childhood disadvantage and poor adult health)?

Disadvantage is the everyday context in which children live, and is largely determined by the resources available to their parents.

How does a poor start in life compromise health in adulthood?


childhood circumstanceschild circumstances adult circumstances

adult health child health

Graham H. & Power C. (2004) Childhood disadvantage and health inequalities. Child: Care, Health and Development. 30 (6) 671-678 Nov.


childhood circumstanceschild circumstances adult circumstances


educational pathways & social identities

health behaviours


childhood circumstances

child circumstances adult circumstances


developmental health


Concept of ‘Developmental Health’ Recognises That:

childhood is a period of rapid development, embracing physical, cognitive & socio-emotional development;

disadvantage constrains these key developmental processes.


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7 9 11 13 15

age in years

I & II

IV & V

Jefferis et al, 2002

Cognitive development (maths test scores) for age 7-

16 years in professional & unskilled

manual households (1958 cohort study)

mean

score


poor adult circumstances

birth starting pre/school

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poor adult health

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cognitive & educational trajectories


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poor adult health

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cognitive & educational trajectories

physical and mental health


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health behaviour

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Childhood Disadvantage & Poor Adult Health

• framework grounded in evidence from longitudinal studies.

• highlights key pathways linking childhood disadvantage to poor adult health.

• provides a tool for identifying where & how policies can contribute to improving the health prospects of poor children.


Policies To Tackle Disadvantage In:

current and rising generation of parents

material & social conditions of poor children

their developmental health (physical, emotional and cognitive) & health behaviour

their educational and social trajectories

their adult lives

their adult health


current and rising generation of parents

material & social conditions of poor children (FTC)

their developmental health (physical, emotional and cognitive) & health behaviour (Sure Start/Childrens Centres)

their educational and social trajectories (teenage pregnancy)

their adult lives (ND)

their adult health (smoking cessation)

New Policies/Interventions


The National Health Inequalities Targets

Two national health inequalities targets were announced in February 2001 (Dept of Health).

• “Starting with children under one year, by 2010 to reduce by at least 10 per cent the gap in mortality between manual groups and the population as a whole.”

• “Starting with health authorities, by 2010 to reduce by at least 10% the gap between the quintile of areas with the lowest life expectancy at birth and the population as a whole.


Tackling Health Inequalities: Status Report On The Program For Action

2005 (UK, DOH)

• A continuing widening of inequalities as measured by infant mortality and life expectancy at birth in line with the trend

• Reductions in childhood poverty and improvements in housing have occurred. Some signs of narrowing of the gap in relation to heart disease mortality and to a lesser extent cancer


UK Life Expectancy

• The latest data indicate that since the baseline (1997) the relative gap in life expectancy between England as a whole and the fifth of local authorities with the worst life expectancy has increased for men and women. For males the gap increased by nearly 2%, for females by 5%


Infant Mortality

• The infant mortality rate among the `manual` group was 19% higher than for the total population in 2003 compared with 13% higher in the baseline period beginning in 1997


Child Poverty

This is defined as when a child lives in a family where the amount of money the family has to spend is less than 60% of the national average. The Acheson Report in 1998 showed that one in three children in the UK were living in poverty.

The UK government aim to halve child poverty by 2010 and end it by 2020.

Three key strategies to achieve this are: Childrens Centres, The Childrens Fund and

Connexions (Every Child Matters).


What Children Think – Every Child Matters 2003/4

• Be as healthy as possible• Stay safe and be protected from harm and abuse• Enjoy life and learn skills to prepare for growing up• Make a contribution to society and not behave badly

or commit crimes• Having enough money did not seem to bother

children too much who thought that family and friends were more important….however the government made achieving economic well being another key area

• These five aims are at the heart of the Children Act 2004 which means that legally all agencies must make these aims top priorities for all children and young people


The Evaluation of Sure Start

The evaluation of sure start showed that once the emphasis of services was clearly focused on child well being in the most vulnerable families with most support going to the most disadvantaged children and their families they benefited from living in sure start areas. Early interventions can improve the life chances of young children living in deprived areas.

Melhuish E., Belsky J., Leyland A.H. & Barnes J. (2008) Effects of fully established Sure Start Local Programmes on 3 year old children and their families living in England: a quasi experimental observational study. Lancet, Vol 372, Issue 9650, 8 Nov, 1641-1647.


In 06/07 the National Audit Office Report on Childrens Centres Identified a number of areas for further development:

• The need to ensure that the most excluded and needy families access services from children`s centres

• The need to plan effective working partnerships with other agencies that can developed services through centres

• The sharing of resources across areas to avoid gaps and duplications

• The collection of hard and soft data on performance

• A better understanding of costs and measurable outcomes and outputs


References

Davey Smith G. et al., (2002) Health inequalities in Britain J. Epid Comm Health 56 p 434-435

Department of Health (2007) Tackling Health Inequalities: Status Report On The Program For Action, UK, DOH: London

Graham H. & Power C. (2004) Childhood disadvantage and health inequalities. Child: Care, Health and Development. 30 (6) 671-678 Nov.

Wilkinson R. & Pickett K. (2009) The Spirit Level: Why more equal societies almost always do better Allen Lane Penguin: London

WHO Marmot M. & Wilkinson R. (Eds) (2003) Social Determinants of Health: The Solid Facts, WHO: Europe.

WHO CSDH (2008) Commission on the social determinants of health final report WHO: Europe.

Woodward A. & Kawachi I. 2000 Why reduce health inequalities J. Epid Comm Health 54 p 923-929.

Documents

Www.bournemouth.ac.uk Inequities In Health and Well Being; The Evidence Base for Children Centres Dr Ann Hemingway June 2009