Tackling child health inequalities: a longitudinal cross-cohort and cross-country analysis of contemporary data to inform policy development

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Children from less advantaged backgrounds are more likely to experience worse health than those from richer backgrounds. These 'health inequalities' (which can be seen in the UK and many other countries in the western world regardless of national wealth) are unjust and costly to the economy. Despite this, little is known about why these health differences emerge and even less is known about how to prevent them. For example, do less advantaged children experience poorer health because their parents are less able to afford the things they need to help their children stay healthy (such as nutritious foods), because they live in poorer quality housing, or because their parents experience barriers to health information or services? My programme of research seeks to address these questions by analysing information from two large studies of children, born at the turn of the 21st century, in the UK (the Millennium Cohort Study) and in Australia (the Longitudinal Study of Australian Children). The majority of evidence refers to the association between social background and health at one point in time; however, social background and health vary over time and so might the relationship between them. Social, economic, and health information has been collected on the MCS and LSAC children and their families, at several time points throughout their childhood. I will exploit this longitudinal information to describe how the health of children from different social backgrounds in these two countries varies, exploring factors which might influence these differences, such as poverty, the home environment, and parental health; and important events or transitions, such as starting primary school. I will look at a number of measures of social background, such as mother's education, occupation and family structure, because the pathways through which these characteristics influence health are likely to vary. I will also examine several aspects of physical and mental health; for example, childhood overweight, emotional and behavioural development, and unintentional injuries. The areas of health I focus on most will be based on how common they are, their social distribution, and whether they can be changed through policy. Health inequalities can also be seen in very young children; for example, infants from poorer backgrounds are more likely to be born with low birthweight or experience infections in early infancy, and these conditions are likely to lead to other poor health outcomes later on in childhood. Mothers from less advantaged backgrounds are more likely to engage in risky health behaviours which could influence the health of their child, for example they are more likely to smoke in pregnancy and less likely to breastfeed or have their child immunised. Following the mother back in time, before the child was born or even conceived, will help to understand how inequalities in child health emerge. To give an example, are women from less advantaged backgrounds more likely to experience depression before pregnancy? And if so does this make it harder for them to give up smoking during pregnancy or to persevere with breastfeeding when their child is born? I will investigate these types of questions using information from the Southampton Women's Survey, which was established at a similar time to the MCS and LSAC. The study follows approximately 12000 women who were childbearing age in 1998-2000, and of whom approximately 3000 went on to have children in the period '99-'07. Finally, I will compare and contrast inequalities in child health (and factors explaining them) in the UK and Australia. Focussing on an area of health where there are large differences found between the two countries, I will examine the role that the UK and Australian governments might play in reducing or exacerbating child health inequalities. I will make recommendations to inform policy development, and produce analytical plan to carry out a future policy evaluation.