Health inequalities in the early years Catherine Bromley ScotCen

Research questions What is the extent and character of health inequalities in the early years? What factors, if any, correlate with the avoidance of negative early health outcomes, among families from disadvantaged backgrounds?

Defining health and inequality “…not merely the absence of disease or infirmity” (WHO) Measures spanned pregnancy to 46 months Interested in outcomes (e.g. poor health)… …and risk factors for negative outcomes (e.g. poor diet) Inequality “The unequal socio-economic patterning of outcomes which disadvantages less affluent children” Analysis focuses on area deprivation and household income

What do we already know?

Origins of Health Problems often Linked to Circumstances in Early Life 2nd Decade 3rd/4th Decade 5th/6th Decade Old Age Obesity Hypertension Depression Addictions School Failure Teen pregnancy Criminality CHD Diabetes Premature aging Memory loss Hertzman C. Early Child Development: A powerful equalizer. Cited by: Sally Haw, MRC Scottish Collaboration for Public Health Research and Policy

What does GUS add?

Inequalities in pregnancy Household income quintile

Inequalities in early childhood Household income quintile

Developmental outcomes (46 months) Household income quintile

% with a long-term condition at least once since child’s birth Household income quintile

What can we do?

Total no. of negative outcomes

Total no. of negative outcomes

What might help disadvantaged children avoid negative outcomes? Child factors Being a girl Maternal factors Not experiencing a long-term condition in child’s early years Older age at birth Having a positive attitude towards seeking help early on Household factors A highly enriched home learning environment At least one adult in full-time work Neighbourhood factors Not having low satisfaction with facilities in local area

Early risks and outcomes Social gradients generally steeper for risk factors than for outcomes Policy response clearly beyond reach of NHS alone Needs of wider family critically important Emotional, cognitive and linguistic development all show clear gradients Often more so than for illness/poor general health measures Powerful illustration of the potential – and need – for: Early identification and intervention Action to combat poverty and exclusion