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

家境较差的孩子比家境富裕的孩子更有可能健康状况较差。这些“健康不平等”(在英国和西方世界的许多其他国家都可以看到，无论国民财富如何)对经济都是不公平的，而且代价高昂。尽管如此，人们对这些健康差异产生的原因知之甚少，对如何预防更是知之甚少。例如，是因为父母买不起帮助孩子保持健康所需的东西(如营养食品)，因为他们住的住房质量较差，还是因为他们的父母在健康信息或服务方面遇到了障碍，所以处于不利地位的儿童的健康状况较差？我的研究计划试图通过分析英国(千禧年队列研究)和澳大利亚(澳大利亚儿童纵向研究)两项大型儿童研究的信息来解决这些问题。这两项研究出生于21世纪之交。大多数证据指的是社会背景和健康在某个时间点之间的联系；然而，社会背景和健康随着时间的推移而变化，它们之间的关系也可能不同。在儿童时期的几个时间点收集了关于MCS和LSAC儿童及其家庭的社会、经济和健康信息。我将利用这些纵向信息来描述这两个国家不同社会背景的儿童的健康状况是如何变化的，探索可能影响这些差异的因素，如贫困、家庭环境和父母健康；以及重要事件或过渡，如开始上小学。我将研究一些衡量社会背景的指标，如母亲的教育、职业和家庭结构，因为这些特征影响健康的途径可能会有所不同。我还将研究身心健康的几个方面；例如，儿童超重、情绪和行为发展以及意外伤害。我最关注的卫生领域将基于它们的普遍程度、它们的社会分布以及它们是否可以通过政策来改变。健康不平等现象也出现在幼儿身上；例如，来自贫困家庭的婴儿出生时体重较低或在婴儿期早期就受到感染的可能性更大，这些情况很可能导致儿童以后的其他健康状况不佳。来自不太有利背景的母亲更有可能从事可能影响孩子健康的危险健康行为，例如，她们更有可能在怀孕期间吸烟，更不可能母乳喂养或给孩子接种疫苗。在孩子出生甚至受孕之前，追踪母亲的过去将有助于理解儿童健康中的不平等现象是如何出现的。举个例子，背景较差的女性是否更有可能在怀孕前经历抑郁症？如果是这样的话，这是否会使她们在怀孕期间戒烟或在孩子出生后坚持母乳喂养变得更加困难？我将使用南安普顿妇女调查的信息来调查这些类型的问题，该调查与MCS和LSAC成立的时间相似。这项研究跟踪了1998年至2000年的大约12000名育龄妇女，其中约3,000人在‘99-’07年间生育了孩子。最后，我将比较和对比英国和澳大利亚在儿童健康方面的不平等(以及解释这些不平等的因素)。聚焦于两国之间存在巨大差异的健康领域，我将研究英国和澳大利亚政府在减少或加剧儿童健康不平等方面可能发挥的作用。我将提出建议，为政策制定提供参考，并制定分析计划，以进行未来的政策评估。

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.