The social determinants of child health

Social determinants of health have long been recognised but their importance is often overlooked. Globally social determinants are responsible for most childhood illness and death. In the UK, conditions which constitute a large part of paediatric practice are socially patterned. Social determinants exert their influence on child health through a complex inter-relationship of more distal social factors such as income and education with more proximal factors such as health behaviours.The pathways by which the social determinants exert their influence operate over time and across generations. Socially related risk and protective factors cluster in different social groups and accumulate over time. Social determinants are profoundly influenced by social and political decisions which are beyond the control of parents and individual paediatricians. Societies can protect children against the adverse effects of social disadvantage. National paediatric societies have a key role in promoting policies which protect children. This brief review summarises the impact of social determinants on children's health in the UK and considers the role of paediatricians in reducing the health inequities generated by these determinants.     

Climate change: The implications for child health in Australasia

Children are particularly vulnerable to the health effects of climate change, the biggest global health threat of the 21st century. However, the worst effects on child health can be avoided, and well‐designed climate policies can have important benefits for child health and equity. We call on child health professionals to seize opportunities to prevent climate change, improve child health and reduce inequalities, and suggest useful actions that can be taken.     

Higher-income countries and global child health

Social and economic factors, acting via communities and households, impact child health. These are the social determinants of health. An array of international forces can affect the availability of these health determinants; this is especially important in lower-income countries. Government revenue is critical to funding the public services which provide child health determinants, such as water, sanitation, healthcare, and education. Global actors play a significant role in the availability of resources to provide these services and, thus, global child health. Important global actors: upper-middle and high-income countries, multinational corporations, and international organisations (such as the International Monetary Fund and other banks), impact policies and the availability of government revenue within lower-income countries. This short review considers the potential impacts of these actors. Understanding these dynamics is essential for advocacy, and paediatricians and healthcare professionals have a critical role. Child health advocates could critically analyse the impact of global actors and use these to advocate for children's right to health.     

Child health inequities

Many of the most common causes of mortality and morbidity in childhood are socially patterned with risk increasing with increasing social disadvantage. The social determinants that underlie this distribution of risk are responsible globally for most childhood illness and death. In the UK, social inequities, inequalities that are unjust and avoidable, account for more than 30% of births before 32 weeks gestation, over 40% of activity limiting longstanding illness and between 34 to 59% of different types of mental health problems in childhood. These conditions constitute a large part of paediatric practice.Social inequities in child health arise as a result of the complex inter-relationship of more distal social factors such as income and education with more proximal factors such as health behaviours. The pathways by which the social determinants exert their influence operate over time and across generations. Socially related risk and protective factors cluster in different social groups and accumulate over time.Child health inequities are profoundly influenced by social and political decisions which are beyond the control of individual paediatricians. However, paediatricians can promote the health of disadvantaged children and possible approaches are discussed including influencing local and national government by advocacy.     

Social determinants of inequalities in child undernutrition in Bangladesh: A decomposition analysis

Socioeconomic inequalities in child undernutrition remain one of the main challenges in Bangladesh. The social determinants of health are mostly responsible for such inequalities across different population groups. However, no study has examined the relative contribution of different social determinants to the socioeconomic inequality in child undernutrition in Bangladesh. Our objective is to measure the extent of socioeconomic‐related inequalities in childhood stunting and identify the key social determinants that potentially explain these inequalities in Bangladesh. We used data for children younger than 5 years of age for this analysis from 2 rounds of Bangladesh Demographic and Health Surveys conducted in 2004 and 2014. We examined the socioeconomic inequality in stunting using the concentration curve and concentration index. We then decomposed the concentration index into the contributions of individual social determinants. We found significant inequality in stunting prevalence. The negative concentration index of stunting indicated that stunting was more concentrated among the poor than among the well‐off. Our results suggest that inequalities in stunting increased between 2004 and 2014. Household economic status, maternal and paternal education, health‐seeking behavior of the mothers, sanitation, fertility, and maternal stature were the major contributors to the disparity in stunting prevalence in Bangladesh. Equity is a critical component of sustainable development goals. Health policymakers should work together across sectors and develop strategies for effective intersectoral actions to adequately address the social determinants of equity and reduce inequalities in stunting and other health outcomes.     

The health of Canada's children. Part III: Public policy and the social determinants of children's health

The health of Canada's children does not compare well with other wealthy industrialized nations. Significant inequalities in health exist among Canadian children, and many of these inequalities are due to variations in Canadian children's life circumstances - the social determinants of health. The present article describes the social determinants of children's health and explains how the quality of these social determinants is shaped, in large part, by public policy decisions. The specific public policies that shape the quality of Canadian children's health are examined, and Canadian approaches in comparison with other wealthy developed nations are described. Policy directions that would improve the quality of the social determinants of children's health are presented and barriers to their implementation are considered.     

The social determinants of early child development: An overview

Aim: This paper offers an overview of the current state of knowledge of the critical social determinants of child development and the complex ways in which these can influence health trajectories. Methods: We conducted an overview of the research conducted by medical and social scientists in the attempt to uncover the conditions under which children reach optimal health and developmental. Results: The first years of life represent a critical period during which trajectories of health vulnerability are determined by the complex interplay between biological, genetic, and environmental conditions. Conclusions: There are fundamental principles of optimal child development that apply to all human beings, regardless of language and culture.     

Household food insecurity and child health

Food insecurity, the lack of consistent access to sufficient quality and quantity of food, affects an estimated 800 million people around the world. Although household food insecurity is generally associated with poor child nutrition and health in the USA, we know less about household food insecurity and child health in developing countries. Particularly lacking is research assessing how associations between household food insecurity and children's health outcomes may differ by child age and among children beyond age 5 years in low‐income settings. We use data from a population‐based sample of households with children ages 3–11 years (N = 431) in León, Nicaragua to consider how household food insecurity is associated with three measures of child health: illness, anaemia and low height‐for‐age. Our results provide new evidence that even mild household food insecurity is detrimental to children's health; and that child age conditions the associations between household food insecurity and child health. We find that food insecurity is especially harmful to health during early childhood, but continues to have significant associations with health into middle childhood (up to ages 7–8 years). We discuss the potential implications of these results for future child health research and policies in low‐income countries. © 2016 John Wiley & Sons Ltd     

‘Rules for radicals’: a subversive's guide to putting social paediatrics into practice

Paediatricians witness the social determinants of health in action in their clinical practice every day. By pushing hundreds of thousands of children into poverty, the global coronavirus pandemic has only made the link between social justice and health inequalities in the UK clearer and more relevant than ever. Yet paediatricians face a glaring dearth of opportunities to meaningfully engage with the issue, and lack the resources with which to learn what can be done about it. Using real-life examples from the author's own professional experience, this article demonstrates how ordinary paediatricians can apply a theoretical framework to clinical practice to move from why paediatricians ought to orient their practice towards the social determinants of health, to how. Rather than waiting for institutions to lead the way, this article provides ‘rules for radicals’ and makes a call for bottom-up, grassroots organizing around social justice and developing the knowledge and tools to fight it, including the exciting new initiatives of the ‘social tool kit’ and the ‘social incubator’.     

The health impact of social disadvantage in early childhood; the Generation R study

Inequalities in child health are of major concern to policymakers, public health specialists and clinicians. This review of studies within the context of the Generation R study illustrates that inequalities in population health, at least partly, originate in pregnancy and early childhood. The review shows inequalities with regard to the health of the pregnant mother, with regard to the growth of the fetus, with regard to birth outcomes, and with regard to health indicators in early childhood. These results are shown with regard to both biological/somatic outcomes, as well as with regard to psychosocial outcomes and healthy lifestyles. Both socioeconomic inequalities and ethnic inequalities in health are present. Although some inequalities can be explained by known determinants, research needs to be done to reach a full understanding of the pathways between social disadvantage and ill health in early childhood.     

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??Now in the child health care??developmental screening and developmental surveillance has been put in the clinics as a routine. In this article??we explain the conceptional terms which are related to the developmental screening and developmental surveillance. We also emphasize how to scientifically apply them and how to interpret the result of the developmental screening and developmental surveillance??and the important influence of the nurture environment on the child development. To the children of normal development??it is suggested to use the internet technics to collect the big data of children health. To the children of abnormal development??there is different management based on the severity degree and the pediatric resources.     

Exploring health inequalities through the lens of an ethnographic study of healthy eating provision in the early years sector

The social determinants of health are increasingly receiving international attention since the publication of the World Health Organization's Commission on the Social Determinants of Health in 2008. How different determinants affect health is much debated. Contrasting suggestions include, for example, a major link with socio‐economic inequalities, lack of social status and psychosocial stress or the extent of the welfare state. Others emphasise the need to understand the socio‐cultural contexts of specific situations. Diet‐related health is a good example of the relationship between poor health outcomes and deprivation. The aim of this paper is to explore the specific conditions and contexts that might reduce or exacerbate the provision of a healthy diet to children under 5 years in a range of nurseries supported by the Sure Start Local Programmes initiative in Liverpool. An ethnographic approach was taken to gather data from six nurseries, combining observation at the nurseries with interviews with owners and or managers (10), cooks (6), staff (12) and parents (2). The findings reveal the complex way different issues work together to support or hinder a nursery to develop a healthy eating culture and how relative inequalities, in general, are outworked. While recognising the importance of social status leading to poor health due to psychosocial stress, the findings tend to emphasise the importance of a strong welfare state and taking an early years of life‐course approach in reducing health inequalities.     

Translating research into political advocacy to improve infant and child health

Dramatic improvements have occurred in the overall health of our children driven by rigorous research translated into clinical practice. However, all is not well for too many, not only for their health but for other outcomes of their lives. These outcomes reflect poorly on how professional groups in child life and health have advocated effectively at the political level for the needs of children and for the services to support them.     

Parental perception of the use and usefulness of a parent-held child health record

Abstract This study surveyed 313 parents to investigate how frequently parents used a parent-held child health record, and whether they saw the record as useful. Since 1981, The Child, Adolescent and Family Health Service has distributed a Personal Health Record (PHR) to the parents of all children in South Australia. The PHR has provided each family with an ongoing record that has been consistently used for immunization, child health checks and child health screening. However, little is known about how parents view the PHR, its usefulness, and how frequently the record is used. Previous studies, generally conducted prior to, or shortly after, a parent-held child health record was introduced, have shown a poor understanding of the uses of the PHR on the part of parents and a low level of use by health professionals such as general practitioners. In contrast, the results of this study show high levels of understanding of the health record on the part of parents, and an increase in the use of the health record by general practitioners over the 10 years since the record was introduced. Although moderated by the age of the child, the sections of the PHR seen as most useful (and the most frequently used) by parents were immunization, growth charts, progress notes and health checks.     

From office tools to community supports: The need for infrastructure to address the social determinants of health in paediatric practice

Previous research has highlighted the importance of addressing the social determinants of health to improve child health outcomes. However, significant barriers exist that limit the paediatrician’s ability to properly address these issues. Barriers include a lack of clinical time, resources, training and education with regard to the social determinants of health; awareness of community resources; and case-management capacity. General practice recommendations to help the health care provider link patients to the community are insufficient. The objective of the current article was to present options for improving the link between the office and the community, using screening questions incorporating physician-based tools that link community resources. Simple interventions, such as routine referral to early-year centres and selected referral to public health home-visiting programs, may help to address populations with the greatest needs.     

Social policy and child health

Under the rubric of social policy and child mental health are two overlapping but conceptually different areas. The first set is the social policy questions with direct relevance to child mental health programs per se; that is, decisions about whether a given child mental health proposal merits the investment of community resources. The second category of social forces is that which has important secondary consequences for child mental health although child mental health per se may never enter the discussion; for example, policy decisions which have a major impact on family life (women's rights, tax policy, divorce law, employment policy, etc.). This paper will review the first category, the overt policy issues, before moving on to the second category, the "covert" child health debate.     

Promoting child and adolescent mental health in low and middle income countries

Children and adolescents in low and middle income countries (LAMIC) constitute 35–50% of the population. Although the population in many such countries is predominantly rural, rapid urbanisation and social change is under way, with an increase in urban poverty and unemployment, which are risk factors for poor child and adolescent mental health (CAMH). There is a vast gap between CAMH needs (as measured through burden of disease estimates) and the availability of CAMH resources. The role of CAMH promotion and prevention can thus not be overestimated. However, the evidence base for affordable and effective interventions for promotion and prevention in LAMIC is limited. In this review, we briefly review the public health importance of CAM disorders in LAMIC and the specific issues related to risk and protective factors for these disorders. We describe a number of potential strategies for CAMH promotion which focus on building capacity in children and adolescents, in parents and families, in the school and health systems, and in the wider community, including structural interventions. Building capacity in CAMH must also focus on the detection and treatment of disorders for which the evidence base is somewhat stronger, and on wider public health strategies for prevention and promotion. In particular, capacity needs to be built across the health system, with particular foci on low-cost, universally available and accessible resources, and on empowerment of families and children. We also consider the role of formal teaching and training programmes, and the role for specialists in CAMH promotion.     

Inequalities in children's health in the UK

Health outcomes for children in the United Kingdom vary depending on socioeconomic risk factors. This article explores the evidence for this association including data on child mortality, developmental progress, educational outcomes and obesity. Fair Society, Healthy Lives was a 2010 report chaired by Professor Marmot and this article describes the framework proposed in the Marmot report to understand how health inequalities occur and what policy objectives could reduce the gap between outcomes for the wealthy and the poor in British society.     

The impact of climate change on child health.

Human activity has contributed to climate change. The relationship between climate and child health has not been well investigated. This review discusses the role of climate change on child health and suggests 3 ways in which this relationship may manifest. First, environmental changes associated with anthropogenic greenhouse gases can lead to respiratory diseases, sunburn, melanoma, and immunosuppression. Second, climate change may directly cause heat stroke, drowning, gastrointestinal diseases, and psychosocial maldevelopment. Third, ecologic alterations triggered by climate change can increase rates of malnutrition, allergies and exposure to mycotoxins, vector-borne diseases (malaria, dengue, encephalitides, Lyme disease), and emerging infectious diseases. Further climate change is likely, given global industrial and political realities. Proactive and preventive physician action, research focused on the differential effects of climate change on subpopulations including children, and policy advocacy on the individual and federal levels could contain climate change and inform appropriate prevention and response.     

Methodologic challenges in developing and implementing measures of quality for child health care.

OBJECTIVE: To review the major building blocks in measurement of quality for child health care, with recommendations for future research. METHODS: We describe a framework of building blocks for quality measurement and discuss how an investigator's choices for each component are constrained by the special features of child health care. RESULTS: Methodologic challenges for children's health care include developmental change and dependency on others, fragmentary care and inadequate health care data, unusual care settings, potential for long-term consequences, proxy reporting of outcomes and patient experience, small sample sizes, and lack of evidence that links processes and outcomes of care and of methods for risk adjustment. We cite examples of child-specific measures of quality that illustrate solutions to these challenges. CONCLUSIONS: Children are different from adults, and measures of health care quality for children must differ from those for adults. We suggest future research on measures of quality directed toward overcoming the methodologic problems specific to child health care.