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

解决健康不平等和改善儿童健康问题的相关性是英国和国际政策目标。贫困和社会不平等损害儿童的健康。与贫困相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不佳和生活机会不佳。在英国，由此产生的不平等现象给整个社会造成的损失每年约为600亿GB，其根源在于儿童时期。解决贫困儿童的健康问题是英国公共卫生面临的一大挑战。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(SECs)与儿童健康恶化之间的联系。一个重大挑战是，尽管贫穷与儿童健康之间的联系是明确的，但我们缺乏对将不利的社会条件与儿童健康恶化联系在一起的复杂途径的了解。研究的另一个挑战是，几乎不可能使用随机对照试验等传统方法来研究可能产生影响的全人群干预措施的种类。AIMS和OBJECTIVESTHIS的研究旨在确定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情况的干预措施和政策的效果。我将使用世界上一些最大的当代数据集来做这项工作，这些数据集跟踪了英国和丹麦儿童的一生。其中包括英国千年队列研究、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，以打破贫困和较差健康之间的联系的可能性。以儿童哮喘为例，儿童哮喘是儿童时期最常见的长期疾病之一，我已经表明，生活在社会经济条件较差的儿童在儿童时期更有可能出现喘息。我研究了可能的原因，发现患有哮喘的贫困儿童的母亲更有可能在怀孕期间吸烟，而不太可能母乳喂养。这两个原因解释了我们观察到的弱势儿童和弱势儿童在哮喘方面的大部分差异。在我提议的研究中，我将应用统计方法，看看如果增加母乳喂养的有效干预措施(如产科医院的婴儿友好支持政策)在全国范围内得到全面实施，英国人口中儿童哮喘的不平等将会发生什么。这项研究还将显示哮喘等长期疾病对学校出勤率和考试成绩的影响。儿童健康不佳导致教育成绩不佳很可能是造成健康不平等的一个重要方式，但目前对此还没有很好的理解。他的研究将直接为政策制定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和较差健康之间的联系，从而改善健康并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，我将更好地理解如何减少儿童健康方面的不平等。我将与政策制定者和实践者合作，确保这些发现对儿童、家庭和整个人口的健康和福祉产生影响。虽然我将承担利物浦的大部分工作，但我已经召集了来自一系列学科的研究人员的国际合作，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极大的潜力，可以对整个人口产生影响，减少健康不平等，并产生明显的整体经济效益。

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.