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Inequities In Health and Well Being; The Evidence Base for Children Centres Dr Ann Hemingway June 2009
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 monograph WHO CSDH (2008) Commission on the social determinants of health final report WHO: Europe
3 The Social Determinants of Health: The Evidence (WHO 2003) 1. The social gradient
Stress Social and psychological circumstances can cause long term stress and early death. Insecuri ty Low Self Esteem Social Isolatio n Lack of control Lack of supporti ve friendshi ps Continui ng anxiety Poor mental health Feeling a failure
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 inadequate Prenatal care
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/se paration Increases the risk of becoming disabled Increases the risk of becoming chronicall y ill Increases the risks of developing an addiction
Stress in the workplace 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)
Unemployment Job security increases health, well-being and job satisfaction. Higher rates of unemployment cause more illness and premature death.
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.
Addiction Individuals turn to alcohol, drugs and tobacco and suffer from their use, but use is influenced by the wider social setting.
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.
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.
13 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?
14 childhood circumstances child circumstancesadult circumstances adult healthchild health Graham H. & Power C. (2004) Childhood disadvantage and health inequalities. Child: Care, Health and Development. 30 (6) Nov.
15 childhood circumstances child circumstancesadult circumstances adult healthchild health educational pathways & social identities health behaviours
16 childhood circumstances child circumstancesadult circumstances adult healthchild health developmental health
17 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.
18 Jefferis et al, 2002 Cognitive development (maths test scores) for age 7-16 years in professional & unskilled manual households (1958 cohort study) mean score
19 poor adult circumstances birth starting pre/school mothers background partners background leaving school poor adult health child Childhood disadvantage
20 poor adult circumstances cognitive & educational trajectories birth starting pre/school mothers background partners background leaving school poor adult health infant social trajectories Childhood disadvantage
21 poor adult circumstances cognitive & educational trajectories physical and mental health birth starting pre/school mothers background partners background health behaviour leaving school poor adult health infant social trajectories Childhood disadvantage
22 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.
23 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
24 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
25 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.
26 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
27 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%
28 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
29 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 Three key strategies to achieve this are: Childrens Centres, The Childrens Fund and Connexions (Every Child Matters).
30 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
31 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,
32 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
33 References Davey Smith G. et al., (2002) Health inequalities in Britain J. Epid Comm Health 56 p 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) 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 Why reduce health inequalities J. Epid Comm Health 54 p