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 The biggest asthma trigger of them all? New studies indicate how poverty itself Is inflammatory E-mail to a friend
 Edith Chen, Ph.D at the Psychobiological Determinants of Health Lab at the University of British Columbia

Scientists such as Edith Chen, Ph.D, have found evidence that the very experience of poverty and the stress it induces might itself be an asthma “trigger.” Dr. Chen co-founded the Psychobiological Determinants of Health Lab at the University of British Columbia to better understand the pathways by which class gets under the skin and influences our heath.  Rather than focus on how material pollutants, like soot, disrupt our physiology Chen and her colleagues are investigating how ‘social pollutants’ – that is, toxic social environments can become embedded in our bodies and increase susceptibility to disease. 

Image Thumbnail The Biology of Disadvantage: Socioeconomic Status and Health E-mail to a friend
JOURNAL Nancy E. Adler  and Judith Stewart, eds. Annals of the New York Academy of Science

How does socioeconomic status get under the skin? This book summarizes the decade of research by the MacArthur Foundation Research Network on Socioeconomic Status and Health “exploring the pathways and mechanisms that contribute to the gradient relationship between socioeconomic status and health.”

PDFs of each article are available online.  You may also purchase a complete copy of the journal.

Image Thumbnail The Built Environment: Designing Communities to Promote Physical Activity in Children E-mail to a friend
POLICY STATEMENT from the American Academy of Pediatrics

This first-ever policy statement on health and place from the AAP argues that pediatricians working with community partners should participate in establishing communities designed for activity and health.

Image Thumbnail The Early Years Study 2: Putting Science into Action E-mail to a friend
The Council for Early Child Development

The Early Years Study by Margaret McCain and Fraser Mustard (1999) had an electrifying effect on scientists working in the area of early child development. In this second edition of the Early Years Study the authors review the scientific advances that have been made in the past eight years in developmental neuroscience, and the organizational advances that have been in the implementation of this knowledge. We are still a long way, however, from the sorts of universally accessible high quality programs that are needed. As important as it is to continue our scientific investigations, the most important challenge that we face today is to muster the political will and effort necessary to translate what we already know about early brain development into action.

Image Thumbnail The Effects of Childhood Stress on Health Across the Lifespan E-mail to a friend
REPORT from the Centers for Disease Control and Prevention

This report summarizes the research on childhood stress and its implications for adult health and well-being. Of particular interest is the stress caused by child abuse, neglect, and repeated exposure to intimate partner violence (IPV). This publication provides violence prevention practitioners with ideas about how to incorporate information on childhood stress into their work.

Image Thumbnail The Fall and Rise of US Inequities in Premature Mortality: 1960-2002. E-mail to a friend
SCHOLARLY ARTICLE by Nancy Krieger, et al., PLoS Medicine, 2008

Between 1966 and 1980, socioeconomic inequities in premature mortality and infant death shrank, absolutely and relatively, especially for US populations of color. However, starting in 1980, the relative gaps widened and the absolute gaps remained unchanged.

Image Thumbnail The Foundations of Lifelong Health E-mail to a friend
Center on the Developing Child, Harvard University

This edition of the InBrief series explains why a vital and productive society with a prosperous and sustainable future is built on a foundation of healthy child development. This video summarizes findings from The Foundations of Lifelong Health Are Built in Early Childhood, a report co-authored by the National Scientific Council on the Developing Child and the National Forum on Early Childhood Policy and Programs.

Image Thumbnail The Health of Canada's Children. Part I: Canadian Children's Health in Comparative Perspective E-mail to a friend
Dennis Raphael in the Journal of Paediatics & Child Health

This article examines the state of Canadian children's health through scores on a set of key health indicators. National and provincial infant mortality rates show little recent improvement, and in the case of low birth weight rates, a worsening trend is evident. These health indicators are strongly related to income, and studies documenting these associations are reviewed. Compared with other wealthy nations, Canada performs poorly with regard to infant mortality rates and somewhat less so for low birth weight rates. For other health indicators and measures of the quality of the social determinants of children's health (such as poverty) and children's well-being, Canada's performance suggests that there are numerous areas for improvement.

Image Thumbnail The Health of Canada's Children. Part II: Health Mechanisms and Pathways E-mail to a friend
Dennis Raphael in the Journal of Paediatrics & Child Health

This article provides models that explain how exposures to differing quality living circumstances result in health inequalities among children. Living circumstances - the social determinants of health - operate through a variety of mechanisms to shape children's health and cognitive, emotional and social development. In addition to specifying the mechanisms that mediate the relationship between living circumstances and health outcomes, the article also identifies some of the economic and political factors that shape the quality of the living circumstances to which Canadian children are exposed.

Image Thumbnail The Health of Canada's Children. Part III: Public Policy and the Social Determinants of Children's Health E-mail to a friend
Dennis Raphael in the Journal of Paediatrics & Child Health

The health of Canada’s children does not compare well with other wealthy industrialized nations. Significant inequalities in health exist among Canadian children, and many of these inequalities are due to variations in Canadian children’s life circumstances – the social determinants of health. This article describes the social determinants of children’s health and explains how the quality of these social determinants is shaped, in large part, by public policy decisions. Policy directions that would improve the quality of the social determinants of children’s health are presented and barriers to their implementation are considered.

Image Thumbnail The Health of Canada's Children. Part IV: Toward the Future E-mail to a friend
Dennis Raphael in the Journal of Paediatrics & Child Health

Canadian children’s health is influenced, in large part, by the living circumstances that they experience. These living circumstances – also known as the social determinants of health – are shaped by public policy decisions made by governmental authorities. While public policy should be focused on providing all Canadian children with the living circumstances necessary for health, it appears that Canada is far from achieving this goal. Instead, there are programs directed at Canada’s most severely disadvantaged families and children. While vital, these programs appear to achieve less than that which would be achieved if governmental action was designed to strengthen the social determinants of health for all children. Considering the governmental actions that would achieve this goal are well known – with rather little evidence of policy implementation – it is essential to understand the processes by which public policy is made. An important physician role – in addition to providing responsive health care services – is to become forceful advocates for public policy in the service of health. It is in the latter sphere that physician involvement may yield the strongest benefits for promoting children’s health.

Image Thumbnail The Relationship of Adverse Childhood Experiences to Adult Medical Disease, Psychiatric Disorders, and Sexual Behavior: Implications for Healthcare E-mail to a friend
Vincent J. Felitti, MD and Robert F. Anda, MD, MS

The focus of this chapter will be an examination of the relationship between traumatic stress in childhood and the leading causes of morbidity, mortality, and disability in the United States: cardiovascular disease, chronic lung disease, chronic liver disease, depression and other forms of mental illness, obesity, smoking, and alcohol and drug abuse.  To do this, the authors will draw on their experience with the Adverse Childhood Experiences (ACE) Study, a major American epidemiological study providing retrospective and prospective analysis in over 17,000 individuals of the effect of traumatic experiences during the first eighteen years of life on adolescent and adult medical and psychiatric disease, sexual behavior, healthcare costs, and life expectancy.4

Image Thumbnail The Work, Family, and Equity Index: How Does the United States Measure Up? E-mail to a friend
REPORT by The Project on Global Working Families, 2007

The Work, Family, and Equity Index has been developed to measure governmental performance around the world in meeting the needs of working families in general and and low- and middle-income working families in particular. The policies used to comprise the index have achieved widespread recognition based on the weight of the research evidence or consensus in global policy and international agreements.

Image Thumbnail Too Young to Die: Part 1, Life's Toll E-mail to a friend
NEWS ARTICLE, San Francisco Chronicle, October 2004

In Bayview-Hunters Point, the stress created by environmental problems, racism, poverty and crime may explain why so many babies die young. Infant mortality is twice as high here as in the rest of San Francisco.

Image Thumbnail Unraveling the Mystery of Black-White Differences in Infant Mortality E-mail to a friend
VIDEO EXCERPT, Unnatural Causes

Neonatologists James Collins and Richard David specialize in the care of infants born too soon or too small. Their research on differences in birth outcomes between African American and white American women points to a provocative idea: the cumulative stress of racism is taking a toll on African American families even before they are born.

Image Thumbnail Violence Ages Children's DNA, Shortens their Chromosomes E-mail to a friend
ARTICLE from USA Today, 2012

According to a new study in Molecular Psychiatry, violence leaves long-term scars on children's bodies, altering their DNA and causing changes that are equivalent to seven to 10 years of premature aging. Scientists measured this cellular aging by studying the ends of children's chromosomes, called telomeres.

Image Thumbnail Where We Live Matters for Our Health: The Links Between Housing and Health E-mail to a friend
REPORT by the RWJF Commission to Build a Healthier America, Oct 2008

This issue brief focuses on three important and inter-related aspects of residential housing and their links to health: the physical conditions within homes; conditions in the neighborhoods surrounding homes; and housing affordability, which not only shapes home and neighborhood conditions but also affects the overall ability of families to make healthy choices.

Image Thumbnail Why Social Determinants? E-mail to a friend
Healthcare Quarterly

There is overwhelming evidence that social factors have profound influences on health. Children are particularly sensitive to social determinants, especially in the early years. Mounting an effective response to social determinants will involve both direct social policy initiatives designed to eliminate poverty and inequality, and indirect approaches focused on disrupting pathways between social risks and poor health outcomes. To be effective, these indirect strategies will require nothing short of a transformation of existing child health systems. Parents and professionals must work together from the ground up, raising public awareness about social determinants of health and implementing cross-sector place-based initiatives designed to promote positive health in childhood.

Image Thumbnail Youth Empowerment Strategies (YES!) Anti-Violence Program in Richmond, California E-mail to a friend

Learn more about YES! - the after-school youth anti-violence program featured in "Place Matters."

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