UNNATURAL CAUSES is inequality making us sick? HEALTH EQUITY research topics and resources to learn more
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Childhood / Early Life

Background: The conditions of our early life not only affect how sick or well we are as children, they have an impact on our life-long health and even that of future generations. Just as our income, education and neighborhood environment shape our health as adults, they have even greater consequences for children. Because children are still developing, they are especially vulnerable to deprivation and stressful environments. Children are also the least empowered to protect themselves or change their environments. Circumstances set in motion during the early stages of child development are difficult to overcome later on.

Key Factors:

Socioeconomic Status. Lower socioeconomic status in childhood has been linked repeatedly with lower educational and income levels in adulthood, which in turn predict health status. Children in poor families are about seven times as likely to be in poor or fair health as children in the highest-income families. Those whose parents have not finished high school are over six times as likely to be in poor or fair health as those whose parents are college graduates. Although children in middle-income families are better off than those in poor families, they still fare worse than those at the top.

Among other things, diet, housing conditions, educational quality, and neighborhood environment are a function of class. Nutrition in childhood, for example, affects learning, growth and development, which in turn affect educational success, job prospects and future behavioral patterns. Obese children are more likely to be obese as adults, increasing their risk for serious chronic diseases including diabetes, heart disease, and stroke. Children in disadvantaged situations are also more likely to develop health problems when they are young, further limiting their long-term prospects.

Class differences also affect the quality of care and attention that children receive, in both positive and negative ways. Children whose parents have access to the knowledge, skills, time, money or other resources to create healthy and stimulating home environments benefit in terms of cognitive, brain, physical, emotional and behavioral development. Wealth also conveys other health advantages that last well beyond childhood. For example, people who grew up in a house owned by their parents were less likely as adults to become sick when exposed to a cold virus.

From one generation to the next, healthy children are more likely to grow up to become healthy adults who have healthy children.

Maternal Health. The influence of "social determinants" on health begins even before we are born. Study after study has outlined the ways in which a woman's health, diet and stress level during pregnancy affects her newborn's life chances: everything from neurological and emotional development to the likelihood of adult obesity. Proper nutrition, prenatal care, and exercise are important, but class, racism, loving relationships and place can also affect pregnant women.

Women who have not finished high school are one and a half times as likely to give birth to a premature or low birthweight baby compared to those who have college degrees. Babies born to a college graduate are twice as likely to survive past their first birthday. Income level and neighborhood conditions also constrain access to healthy foods, quality medical care and opportunities for exercise, while having unpaid bills, job worries, dealing with lousy transportation, and worrying about crime and violence can affect stress levels during pregnancy.

Increasingly, research has shown that life-long exposure to stressful experiences even BEFORE pregnancy can increase a woman's risk of delivering a premature or low birth weight baby, which in turn elevates the child's lifelong risk of chronic health problems. In fact, many researchers hypothesize that the added stress burden of racism through the life course helps explain the persistent African-American/white mortality gap.

Neighborhood Conditions

Children who live in low-income communities are more likely to be exposed to environmental pollutants such as lead, dirty air, toxic mold and vermin - all of which can contribute to chronic ailments and poorer health, especially asthma. At the same time, these neighborhoods are less likely to have access to healthy food options, to parks and public spaces where families can exercise, gather or play, and to jobs and educational opportunities that might provide a path out of poverty.

Violence in school and on the street also exposes children to injury and accidents and triggers conflict and anxiety. Not only does growing up with crime and brutality increase a child's own propensity for destructive behavior, researchers have shown that elevated stress levels chemically interfere with the development of neural pathways - affecting not only normal developmental processes but a child's actual capacity to learn.

Policies that can help young children gain a healthy start include: (1) support for working families: earned income tax credit, paid family leave, flexible work arrangements, guaranteed quality childcare, and universal health care; (2) programs that benefit young children: universal preschool, early reading, parent education, new mother support, more equitable education spending; (3) improvement of neighborhood conditions: revitalization of neglected communities, removal and monitoring of toxic hazards, creation of more quality, affordable housing, better land use and development that limits fast food outlets, encourages grocery stores and other health-promoting local businesses, and builds wealth for poor families.

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Image Thumbnail National Scientific Council on the Developing Child E-mail to a friend

The NSCDC is a multi-disciplinary collaboration comprising leading scholars in neuroscience, early childhood development, pediatrics, and economics. Created to seize the opportunity that arose from response to the landmark report from the National Research Council and Institute of Medicine, From Neurons to Neighborhoods, the Council works to build strong, informed, bipartisan leadership in both the public and private sectors to close the gap between what we know and what we do to promote successful learning, adaptive behavior, and sound physical and mental health for all young children.

Image Thumbnail Neuroscience, Molecular Biology, and the Childhood Roots of Health Disparities: Building a New Framework for Health Promotion and Disease Prevention E-mail to a friend
SCHOLARLY ARTICLE, Journal of the American Medical Association, June 3, 2009

This paper, co-authored by Drs. Jack P. Shonkoff, W. Thomas Boyce, and Bruce S. McEwen, illustrates that the origins of many adult diseases can be traced to negative experiences early in life, so confronting the causes of adversity before and shortly after birth may be a promising way to improve adult health and reduce premature deaths.
Summary of Essential Findings (pdf)
Q&A (pdf)

Image Thumbnail Ordinary Magic: Lessons From Research On Resilience In Human Development E-mail to a friend
Canadian Education Association

Resilience is all around us. Certainly as risk levels increase, the rates of resilience fall, and there are conditions under which no child can survive or flourish. However, early risk researchers did not expect to observe so much variation or so many good  outcomes among children who experienced poverty, violence, disaster, or trauma.

This article will highlight key lessons learned from current research on resilience that may guide practices and policies aimed at promoting positive development among children exposed to high levels of risk or adversity.

Image Thumbnail Partnership for Working Families E-mail to a friend

The Partnership is an economic justice organization that works to ensure that public resources are invested in ways that are economically sound and provide a return to the community. They are working to reform development policy throughout the country so that the social and economic return on investment is tracked and reported to the public. The Partnership also seeks to secure a systematic and timely process for accomodating community input into development decisions.

Image Thumbnail Policies to Promote the Healthy Development of Infants and Preschoolers E-mail to a friend
Greg Duncan and Katherine Magnuson

What are the most important policy issues for children’s healthy development? There is clear evidence of the dangers of prenatal exposure to poor nutrition, infections and environmental neurotoxins (e.g., alcohol, lead), most of which are readily preventable with established interventions. Routine pediatric care for infants can effectively screen for and treat many important causes of early developmental delays. Recent experiments and many nonexperimental studies suggest that economic deprivation during the preschool years is harmful for children’s development. Accordingly, policy should minimize the chance that children experience severe economic hardship early in life, although it should also be mindful of the employment incentives that these policies may create.

Poverty As A Childhood Disease E-mail to a friend
Blog post by Dr. Perri Klass at the New York Times "Well" blog

"Think for a moment of poverty as a disease, thwarting growth and development, robbing children of the healthy, happy futures they might otherwise expect. In the exam room, we try to mitigate the pain and suffering that are its pernicious symptoms. But our patients’ well-being depends on more, on public health measures and prevention that lift the darkness so all children can grow toward the light."

Image Thumbnail Presentation - The Unsolved Mystery of Racial Disparities in Birth Outcomes (pdf) E-mail to a friend
PRESENTATION SLIDES from Paula Braveman, MD, MPH, Professor of Family & Community Medicine and Director of the Center on Social Disparities in Health, University of California, San Francisco

Dr. Braveman made this presentation, fully titled "The Unsolved Mystery of Racial Disparities in Birth Outcomes: Is Racism-Related Stress a Missing Part of the Puzzle?" at the NIH Summit on Health Disparities in December 2008. It provides an excellent summary of the logic and evidence that points to structural racism as a key factor in explaining the Black / white gap in infant mortality and low birth weight. Includes considerations of neighborhood, employment, social factors, the life-course model, and the "immigrant paradox."

Image Thumbnail Promoting Health Equity: A Resource to Help Communities Address Social Determinants of Health (pdf) E-mail to a friend
WORKBOOK - Centers for Disease Control and Prevention, 2008

This workbook is for community-based organizations seeking to affect the social determinants of health through community-based participatory approaches and nontraditional partnerships. Along with an introduction to the concepts of health equity, the workbook presents case studies of communities working at both small and large scales. The authors then provide guidelines for developing your own initiative, from creating partnerships to identifying your approach to assessing and maintaining your progress.

Public Health Advocacy Curriculum E-mail to a friend

Public Health Advocacy Curriculum: This ten-lesson curriculum combines classroom- and community-based activities to teach students about the upstream or root causes of health, and to encourage them to become health advocates.

Image Thumbnail Public Health Puzzle: Social Determinants of Health (pdf) E-mail to a friend
NEWSLETTER, Chronic Disease Notes & Reports, Centers for Disease Control and Prevention

This issue of cdnr is the first part of a 2-part series on eliminating health disparities. It includes articles on disparities in maternal and child health, eliminating disparities in oral health, and health disparities among Native Hawaiians and other Pacific Islanders.

Image Thumbnail Race, racism, and racial disparities in adverse birth outcomes E-mail to a friend
Clinical Obstetrics and Gynecology

The chronic stress of racism and the social inequality it engenders may be underlying social determinants of persistent racial disparities in health, including infant mortality, preterm delivery, and low birth weight. This article describes the problem of racial disparities in adverse birth outcomes; outlines the multidimensional nature of racism and the pathways by which it may adversely affect health; and discusses the implications for clinical practice.

Image Thumbnail Race, Stress, and Social Support: Addressing the Crisis in Black Infant Mortality E-mail to a friend
REPORT by Fleda Mask Jackson, from the Health Policy Institute, 2007

This background paper examines the impact of stress and stress mediators on pregnancy outcomes for African American women. The report also examines social support and other relational experiences, and makes recommedations for related changes in public policy and maternal and child health practices.

Image Thumbnail Racial and Ethnic Disparities in Birth Outcomes: A Life-Course Perspective E-mail to a friend
SCHOLARLY ARTICLE by Michael Lu, MD, Journal of Maternal Child Health, 2003

Learn more about Dr. Michael Lu’s “life-course perspective”
(Abstract only)

Image Thumbnail Reducing Racial and Social Inequalities in Health: The Need for a New Approach E-mail to a friend
SCHOLARLY ARTICLE by S. Leonard Syme, Health Affairs 2008

It is well known that people in racial and ethnic minority groups and in lower social-class positions have higher morbidity and mortality rates from virtually every disease. To effectively deal with the problem, we will need to adopt a more appropriate conceptual model that focuses on the fundamental determinants of health, we will need to understand how important this is for all Americans as a society, and we will need to better deal with the issues people care about: their children, homes, jobs, safety, education, families, retirement, and future prospects.

Abstract only. Subscription required to read full text.

Image Thumbnail Rethinking MCH: The Life Course Model as an Organizing Framework E-mail to a friend
U.S. Department of Health and Human Services, Health Resources and Services Administration

This concept paper is a first step in assisting the Health Resources and Services Administration, Maternal and Child Health Bureau explore how life course theory (LCT) might be used as a strategic planning framework, guiding the work of MCHB, its grantees, and partners over the next 5 years.   Four core life course concepts are identified – timeline, timing, environment and equity – that can be used to redirect public health practice for greater impact. The paper briefly introduces the implications of these concepts for MCHB strategic planning. Further, it proposes that in order to effectively advance a life course approach, MCHB will need to develop a strategic agenda for change, working simultaneously in three broad arenas: (1) knowledge base, (2) program and policy strategies, and (3) political will. Finally, examples provided throughout the paper highlight how a shift to a life course framework might be applied in each of these areas. 

Image Thumbnail Richmond California Struggles for Clean Air E-mail to a friend

Community activist Torm Nompraseurt leads a "toxic tour" of Richmond, California where high levels of industrial pollution are wreaking havoc on the health and wellbeing of residents.

Image Thumbnail Ron Sims: The King County Equity and Social Justice Initiative E-mail to a friend
TRANSCRIPT of a speech by Rom Sims, King County Executive, March 2008

In a speech for the CDC Health Transformation Lecture Series, Mr. Sims explains how his office has made health equity central to its work - across sectors and in partnership with communities, business, and local agencies - and makes the case for the CDC to use its considerable influence and reach to promote and support health equity nationally.

Image Thumbnail Running from Despair E-mail to a friend
NEWS ARTICLE by Joe Spring, New York Times, February 16, 2008

A positive look at how some young people living on reservations are becoming involved in cross country running. Wings of America, a team of Native American athletes from around the country that has won 20 national titles since 1988, is also an NGO that works to counter the high rates of diabetes, obesity, alcoholism, and suicidal depression on reservations.

Image Thumbnail Sick People or Sick Societies? E-mail to a friend
RADIO SHOW, CBC, "The Best of Ideas Podcast" 2008

Journalist Jill Eisen explores the importance of the social determinants of health from a Canadian perspective. The program devotes considers the importance of looking at "upstream" causes of health and presents possible policies for intervention on different levels.
Part One: S. Leonard Syme, Richard Glazier, Carol Shively, and Michael Marmot explain the concepts behind social determinants of health, present evidence for how stress contribute to "modern" diseases, and elaborate the moral and practical obligations we have to demand action.
Part Two: Dennis Raphael, Richard Glazier, and Clyde Hertzman discuss the obesity and diabetes epidemics and early childhood development. Raphael makes an interesting commentary as to why governments continuously fail to address social threats to health.

Image Thumbnail Social determinants of child health and well-being E-mail to a friend
Health Sociology Review

The notion of ‘human rights to health’ is gaining increasing recognition in research and few would disagree with this social justice principle and ideal. But it is time to think of how these rights can be guaranteed and protected in concrete terms and there is a critical need to begin cross-disciplinary dialogues between health, law, politics and health economics to map out the path to reaching this goal.

Image Thumbnail Society for Equity in Child Health E-mail to a friend

The Society for Equity in Child Health (SECH) is an interdisciplinary group of professionals committed to improving the health and well-being of children through the integration of the principles of equity, social justice, and children's rights into child health practice.

Image Thumbnail Strategic Review of Health Inequalities in England Post 2010 E-mail to a friend

Professor Sir Michael Marmot has been asked by the British government to Chair an independent Review to propose the most effective strategies for reducing health inequalities in England from 2010. This review is a response to the recommendation of the WHO Commission on Social Determinants of Health that national governments develop and implement strategies and policies suited to their particular national context aimed at improving health equity.

Image Thumbnail Take Back Your Time E-mail to a friend

Take Back Your Time is a campaign to pass The Minimum Leave Protection, Family Bonding and Personal Well-Being Act of 2007. This amendment to the Fair Labor Standards Act would guarantee that anyone who's worked at a job for a year would get three weeks of vacation. On the site, you can download a handbook and other resources for mobilizing around this goal.

Image Thumbnail Talking Early Child Development and Exploring the Consequences of Frame Choices: A FrameWorks Message Memo E-mail to a friend

This memo reports on the findings from FrameWorks’ research on how the public views early childhood issues in general and school readiness policies in specific. This work was first undertaken with the specific intent of providing a foundation for understanding how the public thinks about school readiness, what are the implications of these thinking patterns, and what alternative frames might yield better public support for the kinds of policies that child-focused organizations propose. In subsequent years, as the research base has expanded, the research question has evolved as well to test whether frames currently in use by advocates, legislators, policy experts and scientists are in fact advancing a coherent understanding of how children grow and develop, sufficient to support a movement that must persist over time, and address a range of issues that spans health, education, housing, and economic policies.

Image Thumbnail Targeting Childhood Development to Make the Nation Healthy Again E-mail to a friend
PRESENTATION by Stephen Bezruchka, MD, January 19, 2007

With characteristic humor and clear, accessible style, Dr. Bezruchka illustrates how the US falls behind less affluent countries in health indicators and argues for better policies to address early childhood development and improve national health.

The page contains a text summary of the presentation, or you can listen to the audio while following along with his slides by clicking "audio slides" under Dr. Bezruchka's photo on the right side of the page.

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