Inequalities in the early years

Avoidable differences in health that appear during pregnancy, birth or the early years often affect maternal health and the development of the child, its lifelong health, happiness and productivity in society.

A range of policies and interventions aimed at reducing such inequalities is supported by a growing evidence base.

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What are health inequalities?

Health inequalities are systematic and avoidable differences in health between population groups. These differences occur as a result of the unequal distribution of resources within populations and the associated accumulation and interaction of multiple risk factors.

For example socio-economic disadvantage impacts on a families ability to pay for goods and services, their exposure to different physical environments, employment, education and other opportunities.

Equally Well adopted the definition that health inequalities can occur through variations in exposure to risk factors that increase the likelihood of, or prolong, poor health outcomes.

The Marmot Review (external link) suggests that these inequalities are reflected best as a gradient across society rather than as a gap between two population groups.

Using evidence to address inequalities

NHS Health Scotland is committed to identifying, gathering and disseminating evidence of what works in terms of interventions to reduce inequalities and improve health.

View more information on evidence-based health improvement in NHS Health Scotland's corporate strategy, A Fairer Healthier Scotland (external link).

Health inequalities and the early years

Health inequalities appearing at pregnancy, birth and during the early years often have a significant bearing on maternal health and the subsequent development of a child, its lifelong health, happiness and productivity in society.

The circumstances children experience growing up largely reflect the resources available to their parents or carers, their family income and the environments in which they can afford to live. Early intervention is crucial as the opportunity to reduce the impact of inequalities declines as children age.

The socio-economic circumstances that children live in are strongly linked to the risk that they will experience unintentional injuries and social, emotional and cognitive difficulties during their early years of life.

In Scotland, a child’s risk of a wide range of negative health, social, emotional and cognitive outcomes and circumstances have been shown to be greater for children from less advantaged backgrounds, measured in terms of their family’s income, social class and experience of multiple deprivation (Growing up in Scotland, 2010 (external link)).

Who is at risk?

All professionals who provide care and support to parents, families and children should be aware of those children who are most at risk of health inequalities during their early years.

A recently published evidence summary by NHS Health Scotland highlights the link between socio-economic disadvantage and health inequalities during the early years (external link), in particular an increased risk of experiencing unintentional injuries and social, emotional and cognitive difficulties.

Factors linked to increased risk of social, emotional and cognitive difficulties include:

  • low socio-economic status
  • low income
  • housing
  • parental relationship
  • maternal factors including mental health and health behaviours.

Some of these factors may increase the risk of a child developing cognitive, social and emotional difficulties but they are not an absolute risk. However, maternal age, education and general health along with a family’s housing situation are reported to be the greatest risk factors for a child to experience negative outcomes.

Protective factors

Protective factors are crucial for the potential to build future resilience and reduce the impact of health inequalities.

Professionals need to begin a process that supports the development of skills that can provide protective factors to health:

  • high socio-economic status
  • high income
  • early years education/childcare
  • parental relationship: married, positive relationship at birth
  • parenting: positive parenting style
  • child factors
  • maternal factors.

Parents make a huge difference to their child’s development. A secure, loving and nurturing home environment which provides a child with a secure attachment relationship is an important protective factor for their emotional, social and cognitive development.

Addressing health inequalities in the early years

Reducing health inequalities requires both strategies to improve health and reduce the causes of inequalities. These complex problems cannot be tackled by individual organisations alone, they require input at many levels from a wide range of organisations.

In order to address health inequalities in children, the Scottish Governments polices and interventions also need to address the circumstances and inequalities experienced by their parents and wider community.

This is at the heart of the National Parenting Strategy (external link), the Early Years Framework (external link) and the Getting it Right for Every Child (GIRFEC) (external link) programme.

Tackling health inequality in the early years requires input at many levels from a wide range of organisations. This task is not within the remit of the health service or other service providers alone.

Proportionate universalism

The Marmot Review (external link) calls for a universal service, tailored to provide a gradient of support for populations with differing needs, often referred to as proportionate universalism.

An example of proportionate universalism for children 0-5 years is home visiting. This is a universal service offered to all families. However, based on the family’s situation and circumstances the level of support and referral services can be tailored and intensified.

An example of proportionate universalism for children aged 5-8 is the provision of support for learning at school. Some children may need additional support to help them learn at school.

Both the Additional Support for Learning Act and Curriculum for Excellence: Building the Curriculum 3 entitles all children to gain as much as possible from their learning environment. This includes identification of learning needs and ensuring that the support provided to children and young people should be tailored to their individual needs.

Effective interventions to reduce health inequalities

Evidence summary: Interventions to support parents, their infants and children in the early years (pregnancy to five years) (2012) (external link) shows that effective interventions to promote social, emotional and cognitive development include:

  • Pre - and postnatal home visiting for vulnerable children and their families led by suitably skilled professionals. For example Family Nurse Partnerships.
  • High quality early years childcare and education (e.g. children's centres - Sure Start).
  • Targeted specialist programmes - group-based parenting programmes effective for secondary and tertiary prevention (e.g. Triple P, Incredible Years).

Families and communities at risk of poor outcomes should be able to contribute to the solutions in order to build their assets and capacity.

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