In June we published our report, ‘Breaking the dependency cycle: Tackling health inequalities of vulnerable families’, which illustrates how the combined impact of unemployment, economic and social disadvantage is often passed down from parents to children, creating a negative spiral of inequalities.1 This week’s blog, by Matthew Thaxter, one of our two analysts here at the Centre, takes a deeper look into how the social determinants of health impact the health status of children.
Having been involved in the collation and analysis of the data used in our report, the correlations that we identified made me appreciate the challenges presented in breaking the dependency cycle of vulnerable families and the necessity of tackling the underlying causes of deprivation during childhood so that optimal societal and health benefits can be achieved. This blog, therefore, provides my take on the issues that struck me as the most relevant in relation to improving outcomes for children in lower socio-economic groups, with a particular focus on children living in vulnerable families, defined as families in contact with several departments of local authorities, including the child or youth welfare system.
During my analysis of the numerous data sets on health outcomes and deprivation, it became clear to me that while improving the targeting of healthcare services should not be understated, tackling the wider social determinants of health (SDOH) at all life stages is also essential if we are to improve the health and wellbeing of current and future generations of children.
In our report, we highlight that healthcare is only responsible for around 15 to 25 per cent of health outcomes, with a range of social determinants driving trends around mortality and ill-health, these include the quality of education, housing, employment, working conditions and welfare. Indeed the conditions in which people are born, grow up, live, work and grow old, account for more than 50 per cent of health outcomes; with the remainder shaped by genetic and environmental factors. Our report uncovers the impact of health inequalities throughout life – with a focus on maternity and infancy, childhood and adolescence, adulthood and working life, and elderhood. It identifies the need to tackle the SDOH and the impact of intergenerational levels of social deprivation at all life stages. Importantly, living in vulnerable families - where parents are more likely to be unemployed, poorly educated, socially marginalised and likely suffering from poor physical and mental health - accentuates the risk of poor life outcomes for those most dependent on family structures, especially children and adolescents. Moreover, children living in vulnerable families face greater direct physical challenges to their health status and health promoting behaviour with negative consequences for their educational achievements, future employment opportunities and healthy life years.
Our report uncovers the impact of health inequalities throughout life – with a focus on maternity and infancy, childhood and adolescence, adulthood and working life, and elderhood. It identifies the need to tackle the SDOH and the impact of intergenerational levels of social deprivation at all life stages. Importantly, living in vulnerable families - where parents are more likely to be unemployed, poorly educated, socially marginalised and likely suffering from poor physical and mental health - accentuates the risk of poor life outcomes for those most dependent on family structures, especially children and adolescents. Moreover, children living in vulnerable families face greater direct physical challenges to their health status and health promoting behaviour with negative consequences for their educational achievements, future employment opportunities and healthy life years.
Maternal behaviour during pregnancy has a big impact on the unborn child’s life chances, with nutrition, smoking and drinking while pregnant all associated with low birth weight, carrying numerous risks for the unborn child, including lower performance on development scores and higher risk of disease in later life. Deprivation and health inequalities have a significant impact on maternal health and behaviour. For example, in Scotland over a quarter of women in the most deprived areas acknowledge smoking during pregnancy, compared with 3.3 per cent in the least deprived areas. Educational attainment of parents is also a large determinant, with mortality in children under five reducing in line with the years of schooling that women attain, partly because education improves women’s decision-making on pre-natal care, hygiene, nutrition and immunisation. Furthermore, educational attainment of vulnerable family members is strongly correlated to childhood deprivation.
Children of vulnerable families living in stressful environments are also less likely to get access to or encouragement to be physically active and eat healthy foods, and as a result are more likely to be obese. In England, for example, 40 per cent of children in the most deprived areas are overweight, compared with just 27 per cent in the most affluent areas. These children from vulnerable families are also more likely later in life to adopt – and less likely to discontinue – risky health behaviours such as smoking, alcohol and drug abuse.
In order to compare and contrast Western European countries in their performance on various indicators of childhood deprivation, we developed a heat map, using the Organisation for Economic Co-operation and Development (OECD) Child Wellbeing dataset for age specific child wellbeing information, to visualise how our cohort countries ranked out of 23 OECD nations (see Figure 1). Our analysis demonstrates that there is a wide variation in health indicators related to childhood deprivation across Western European countries and that such maps can be used to highlight specific areas where countries are performing well and where there remains room for improvement.
Figure 1. Cohort performance on childhood deprivation (rank out of 23 OECD nations)
My involvement in this important research has led me to conclude that improving outcomes for vulnerable children can’t be addressed by interventions that are solely aimed at children, and that actions that address the needs of the entire family will have the greatest impact. In particular, that although spending on prevention and early intervention can and does make a difference, especially in the early years of life, improving maternal health and education are also particularly important, including educating parents and carers as to the importance of their children’s physical, mental and oral health status.
Our report highlights a number of good practice case examples, including preventing childhood obesity through cross sector partnerships, working together to improve educational attainment and employability and improving the mental resilience of children and adolescents. In all cases, stakeholders from service provision, policymaking, academia and the wider public have come together to address the moral and economic imperative of reducing health inequalities. I consider, therefore, that sustainable change is achievable, but only if relevant stakeholders are prepared to learn from what works elsewhere and come together to work across institutional and professional boundaries.
1 Breaking the dependency cycle – tackling health inequalities of vulnerable families, Deloitte, 2017. See also: https://www2.deloitte.com/content/dam/Deloitte/uk/Documents/life-sciences-health-care/deloitte-uk-breaking-the-dependency-cycle-final.pdf