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

RELEVANCE OF THE PROBLEM REDUCING 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 OBJECTIVES THIS 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 BENEFITS This 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.