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Client focused response to reducing health inequalities

A strong evidence base exists in relation to health inequalities. However, the evidence base is less robust in relation to effective interventions to reduce health inequalities.

Understanding the circumstances of women's lives and how these influence and impact on their individual health behaviours, how they uptake services, and their concordance with service provision needs to be fundemental to any action services take to address health inequalities.

Key indicators for assessment of risk

It can be difficult to identify risk early, as, often, little is known about the experience and abilities of the parents, and the characteristics of the child. This is why skilful holistic assessment is critical. Useful predictors of risk include:

  • Young parenthood, which is linked to poor socio-economic and educational circumstances
  • Educational problems – parents with few or no qualifications, a history of non-attendance or learning difficulties
  • Parents who are not in education, employment or training
  • Families who are living in poverty
  • Families who are living in unsatisfactory accommodation
  • Parents with mental health problems
  • Unstable partner relationships
  • Gender-based violence
  • Parents with a history of anti-social or offending behaviour
  • Families with low social capital
  • Low self-esteem or low self-reliance
  • A history of abuse, mental illness or alcoholism in the mother’s own family
  • Smoking by the parents or partner 

Some of the indicators listed above are more difficult to identify than others. Practitioners should be skilled at establishing a trusting relationship with families and be able to build a holistic view.

Protective factors

Professionals can support the development of skills which can provide protective factors for health inequalities. Authoritative parenting combined with warmth and with an affectionate bond of attachment built between the child and the primary caregiver from infancy is an important protective factor, as are the following:

  • Parental involvement in the baby’s development and learning
  • Protective health behaviour, such as smoking cessation
  • Breastfeeding
  • Psychological resilience, including self-esteem of the mother and partner or carer

For more information, see NHS Health Scotland's evidence summary: Interventions to support parents, their infants and children in the early years (pregnancy to 6 years)