Reducing inequalities in child health: understanding pathways, interventions and policies

减少健康不平等和改善儿童健康是英国和国际政策的目标。贫穷和社会不平等损害儿童的健康。与贫穷有关的健康状况不佳限制了儿童的潜力和发展，导致成年后健康状况和生活机会不佳。在英国，由此产生的不平等给整个社会造成的成本每年约为600亿英镑，这种不平等源于儿童时期。解决贫困儿童较差的健康问题是英国公共卫生面临的一项重大挑战。然而，要做到这一点，我们需要确定如何打破不利的社会经济条件与儿童健康状况恶化之间的联系。一项重大挑战是，虽然贫困与儿童健康之间的联系是明确的，但我们对不良社会条件与儿童健康恶化之间的复杂联系缺乏了解。研究面临的另一个挑战是，几乎不可能用随机对照试验等传统方法研究可能产生影响的全民干预措施。目的和目的本研究旨在找出导致贫困儿童健康状况较差的关键机制，并评估有可能改善这种状况的干预措施和政策的效果。我将使用一些世界上最大的当代数据集来做这个，这些数据集跟踪了英国和丹麦的孩子们的一生。其中包括英国千禧年队列研究，威尔士儿童电子队列和丹麦国家出生队列。我将量化儿童健康不平等的主要原因和后果，并评估公共卫生、福利和教育干预措施的影响，这些干预措施有可能打破贫穷与较差健康之间的联系。以儿童哮喘为例，这是儿童时期最常见的长期疾病之一，我已经证明，生活在较贫穷社会经济条件下的儿童更有可能在童年时期患有喘息。在研究可能的原因后，我发现，贫困儿童患哮喘的母亲更有可能在怀孕期间吸烟，而且母乳喂养的可能性更小。这两个原因解释了我们观察到的弱势儿童和优势儿童在哮喘方面的大部分差异。在我提出的研究中，我将运用统计方法，看看如果在全国范围内全面实施有效的增加母乳喂养的干预措施（如妇产医院的婴儿友好支持政策），英国人口中儿童哮喘的不平等会发生什么。这项研究还将显示哮喘等长期疾病对出勤率和考试成绩的影响。儿童健康状况差导致教育成绩差可能是产生卫生不平等的一个重要途径，但目前对这一点还没有很好的了解。应用和收益这项研究将直接为决策者和实践者提供信息，他们正在努力解决如何最好地打破儿童贫困与较差健康之间的联系，从而改善健康，减少整个生命过程中的健康不平等。通过将新方法应用于重要的儿童健康状况，我将更好地了解如何减少儿童健康方面的不平等。我将与决策者和从业人员合作，确保这些发现对儿童、家庭和全体人口的健康和福祉产生影响。虽然我将在利物浦承担大部分工作，但我已经召集了来自不同学科的研究人员进行国际合作，以解决这一关键的公共卫生问题，这将提供一流的研究培训。在我的研究方案中产生的信息具有巨大的潜力，可以对整个人口产生影响，减少保健不平等现象，并带来明显的总体经济效益。

RELEVANCE OF THE PROBLEMREDUCING HEALTH INEQUALITIES AND IMPROVING CHILD HEALTH ARE UK and INTERNATIONAL POLICY GOALS. Poverty and social inequality harm children's health. The poor health associated with poverty limits children's potential and development, leading to poor health and life chances in adulthood. The costs to society as a whole of the resulting inequalities, which have their origins in childhood, amount to around £60 billion per year in the UK. Tackling the poorer health of poorer children is a major challenge for public health in the UK. For this to happen, however, we need to identify how to break the link between adverse socio-economic conditions (SECs) with worse child health. One major challenge is that, while the association of poverty and children's health is clear, we lack understanding of the complex pathways linking adverse social conditions to worse child health. Another challenge for research is that it is rarely possible to study the sorts of population-wide interventions that might make a difference using conventional methods, such as randomized controlled trials.AIMS and OBJECTIVESTHIS RESEARCH AIMS TO IDENTIFY THE KEY MECHANISMS THAT LEAD TO POORER HEALTH IN POORER CHILDREN AND TO EVALUATE THE EFFECTS OF INTERVENTIONS AND POLICIES THAT HAVE THE POTENTIAL TO IMPROVE THE SITUATION. I will do this using some of the largest contemporary datasets in the world that follow-up children over the course of their lives in the UK and Denmark. These include the UK Millennium Cohort Study, the Welsh Electronic Cohort of Children, and the Danish National Birth Cohort. I will quantify the main causes and consequences of inequalities in child health and evaluate the impacts of public health, welfare and education interventions with the potential to break the link between poverty and poorer health.Taking childhood asthma, one of the most common longterm conditions in childhood, as an example, I have shown that children living in poorer socioeconomic conditions are more likely to have wheezing in childhood. Examining possible reasons, I found that the poorer children with asthma were more likely to have mothers who smoked during pregnancy and who were less likely to breast-feed. These two reasons accounted for most of the differences in asthma between disadvantaged and advantaged children that we observed. In my proposed research, I will apply statistical methods to see what would happen to inequalities in childhood asthma in the UK population if, for example, effective interventions to increase breast-feeding (such as baby friendly support policies in maternity hospitals) were fully implemented nationwide. The research will also show what effect longterm conditions like asthma have on attendance at school and exam results. Poor child health leading to poor educational performance is likely to be an important way in which health inequalities are generated, but this is not well understood currently. APPLICATIONS and BENEFITSThis research will directly inform policymakers and practitioners grappling with how best to break the link between child poverty and poorer health, and thereby improve health and reduce health inequalities across the life course. By applying new methods to important child health conditions I will develop a better understanding of HOW TO REDUCE INEQUALITIES IN CHILD HEALTH. I will work with policy makers and practitioners to make sure that the findings make a difference to the health and wellbeing of children, families and whole populations. Though I'll undertake most of the work in Liverpool, I have brought together an international collaboration of researchers from a range of disciplines to address this critical public health issue, which will provide superb research training. The information generated in my research programme has great potential for having a population-wide impact, a reduction in health inequalities and clear overall economic benefits.