Child health and inequalities

Question 1

Why is children’s health important?

Answer 1

The health of today’s children will determine whether England is healthy and prosperous over the next 50 years
Many risk factors for adult disease are established in utero or in early life

Question 2

Risk factors for metabolic disease

Answer 2

Prematurity
Slow intrauterine growth
Maternal obesity
Maternal diabetes

Question 3

What are health inequalities?

Answer 3

Differences in health status or in distribution of health determinants between different population groups

Question 4

What is health inequity?

Answer 4

Allowing health differences to persist when they are preventable and unnecessary is unjust

Question 5

What is intersectionality?

Answer 5

Inequalities can interact with one another

Children experience different inequalities

Question 6

How many children between 0 and 5 due from home accidents each year?

Answer 6

60

Question 7

How many children suffer serious/fatal injury on roads each day?

Answer 7

17

Question 8

How much more likely are children in disadvantaged homes to be burned/scalded/poisoned than those in most advantages areas?

Answer 8

50% more likely

Question 9

How much higher are hospital admission rates for under 5s in deprived areas than those in least deprived areas?

Answer 9

38%

Question 10

Materialist explanation for inequalities in injuries

Answer 10

Lack of safety equipment
Unsafe housing
Place

Question 11

Behavioural/cultural explanations for inequalities in injuries

Answer 11

‘Playing out’ culture

Understanding of child development

Question 12

Artefact explanation for inequalities in injuries

Answer 12

e.g. could children and young people from less deprived backgrounds be less to attend hospital for injuries

Question 13

What is relative injury?

Answer 13

Comparison with average household income; defined as 60% of current median in UK (can be measured before or after housing costs)

Question 14

What is absolute poverty?

Answer 14

Based on level of income needed to purchase basic goods and services

Question 15

What is material deprivation?

Answer 15

Based on family’s ability to afford a list of basic children’s items

Question 16

What is lower income and material deprivation?

Answer 16

A household income lower than 70% of median income together with being materially deprived

Question 17

Evidence for inequalities

Answer 17

Infant mortality rate is rising

Deprived children have poorer mental wellbeing

Question 18

Is there a correlation between cognitive scores and socioeconomic status?

Answer 18

• Low cognitive scores but who grew up in families of high socioeconomic position improve their scores as they age
• The opposite happens to those in families with low socioeconomic positions

Question 19

What happened during the Dutch Hunger winter?

Answer 19

• Exposure to famine in early gestation found to be associated with two fold risk of obesity in adulthood
• Higher levels of triglycerides and LDL cholesterol
• Increased mortality
• Experience in utero affected long-term gene control

Question 20

How has covid-19 affected children?

Answer 20

• Closed schools
• Stopped children mixing
• Stopped children seeing gradparents
• Parents reduce hours
• Financial stress of parental unemployment
• Safeguarding risks
• Increased physical abuse
• Isolation for surgery
• Vaccination programmes suspended

Question 21

Steps to reducing childhood inequalities

Answer 21

Prevent stratification
Reduce exposure to inequalities
Address those with highest vulnerability
Address different consequences of ill health

Question 22

What does the Healthy Child Programme do?

Answer 22

• Helps parents develop and sustain strong bond with children
• Supports parents in keeping family safe and allowing children to reach full potential
• Protects children from disease
• Reduces child obesity
• Identify health and well-being factors early so interventions can be implemented
• Focus on health needs of children by ensuring they are school ready

Question 23

How can you tell that a child is ready for school?

Answer 23

• Good vocabulary
• Independent in eating/dressing/using toilet
• Take turns, sit still and play
• Socialize and form friendships, separate friends from parents
• Good physical and dental health
• Well nourished
• Vaccinated

Question 24

Considerations in universal prevention

Answer 24

• Universal in principle may not be universal in practise
• May advantage people in favorable positions or fail to proportionately improve outcomes of those in less favorable circumstances, therefore widening the health gap

Question 25

Considerations in targeted prevention

Answer 25

• May address consequences rather than causes
• Understanding that target population requires appropriate data, gathered over time
• Determining eligibility can be problematic - potential for over or under subscription

Question 26

How can doctors address inequality in child health?

Answer 26

• Build trust and communicate clearly
• Make sure you address all contextual factors when taking history
• Recognize patterns of abuse
• Share information and referring in timely manner
• Signpost financial, housing and food support
• Learn and apply practical measures that can improve accessibility to families, children and young people in more deprived groups and involve them in their healthcare
• Advocacy - healthcare isn’t sufficient to tackle inequalities