Early childhood, defined as the period between pre-natal development and eight years of age, is widely acknowledged to be the most important period of development, in which individuals are most sensitive to environment and external influences. Research shows that during this period, the foundations are laid for physical and mental capacities and that this influences subsequent growth, health and development. This begins before birth, when the health of a baby is often affected by the health of its mother and the socio-economic status and material circumstances of its parents.
The effects of poverty and inequality on young children are often explored in terms of the health agenda, and the links between economic and health inequalities are well established. The Marmot Review in 2011 went further in stating that: ‘So close is the link between particular social and economic features of society and the distribution of health across the population, that the magnitude of health inequalities is a good marker of progress towards creating a fairer society.’
It is abundantly clear that being poor and unequal can have seriously negative consequences for overall health and well-being.
THE EFFECTS
In this context, health should not be seen as just the absence of ill-health and infirmity. The World Health Organization defines health as a state of complete physical, mental and social well-being. Although this is an idealistic interpretation, it allows us to think positively about what a state of health might look and feel like and gives us something to strive for.
A recent study from the National Children’s Bureau (NCB) took obesity, tooth decay, injuries, development and ‘school readiness’ as key outcome indicators for children in the early years. It found that:
- 9.5 per cent (over 60,000)offour- to five-year-olds are classed as obese
- 25 per cent (over 150,000) of five-year-olds are affected by tooth decay
- 48,000 (140 cases per 10,000 of the population) hospital admissionsof children under five were due to injury
- 39.6 per cent of Reception class children did not reach a good level of development.
The report concluded that all of these outcomes were negatively influenced by what it termed ‘the pervasive impact of deprivation’. For example, it is easy to see how accidents might be more likely in poor housing conditions or if the parent is stressed or suffering from depression.
Research by End Child Poverty has shown that babies of poor mothers and those from low social classes are much more likely to be born early or small and to be stillborn or die in early infancy, and that physical ill-health and disability are more common. Acute illnesses and specific chronic illnesses, such as iron deficiency anaemia and asthma, are also often associated with socio-economic status.
End Child Poverty’s findings regarding mental health are of equal concern. While maternal mental health is an obvious factor, there is, for example, a three-fold increase in boys with behavioural problems among the poorest income groups.
ECP concludes that social differences in behaviour problems emerge early in childhood and are well established by the age of three. While poor parenting and a lack of parenting skills are often cited as causal factors, the true picture is arguably much more complex. A poor diet, inadequate housing, debt, fuel poverty and a plethora of other stresses and insecurities are part of many people’s lives and contribute to these negative statistics.
The NCB report looked at regional variations to illustrate how geographical health inequalities manifest at a sub-national level. According to this report, if the North West had the same early childhood outcomes as the South East, it would have 19 per cent fewer obese four- to five-year-olds, 43 per cent fewer five-year-olds with tooth decay, 31 per cent fewer children under five admitted to hospital with injury, and 11 per cent more children achieving a good level of development by the end of Reception.
Even within regions there are significant variations. For example, the proportion of young children who are obese ranges from 5.5 per cent in Richmond upon Thames to 14.2 per cent in Barking and Dagenham, just 18 miles apart.
While poverty and deprivation are often associated with urban environments, it is reckoned that at least one third of those living in low-income households are in rural districts. The housing and homelessness charity Shelter found that children growing up in poor housing were more likely than other children of the same age to experience mental health problems, including anxiety and depression.
FUEL POVERTY AND ITS CONSEQUENCES
A recent study by Policy Exchange estimated that there were more than one million households that could not afford to heat their homes properly, even though a family member was in work. The Marmot Review considered the health impacts of living in a cold home due to fuel poverty and found:
- Children are twice as likely to suffer from respiratory problems such as asthma and bronchitis, with severity and frequency of asthma attacks up.
- Low weight gain in infants (the infants will need more calories to keep warm, but may be receiving fewer in families that ration food to pay for other essentials).
- Higher level of hospital admissions in the first three years of life.
- Slower developmental progress.
- Increase in minor illnesses (colds and flu), with existing conditions exacerbated.
- A severe impact on the mental health and well-being of children and young people.
ACCESSIBILITY OF HEALTHCARE SERVICES
The Children’s Commissioner’s Changing the Odds in the Early Yearsreport (2015) found that accessibility of healthcare services varied considerably among the parents surveyed. Many struggled to get appointments and some reported a delay of two weeks for appointments. Many of the parents in this study felt that the cost of healthy food and the lack of opportunities for active play also presented significant challenges.
The lack of early intervention services in relation to mental health and parental well-being was expressed as a concern, with support reserved for those at crisis point. Services that families reported as useful and effective were health visitors and on-site health services in children’s centres.
A 2001 mapping exercise conducted by the National Family and Parenting Institute (NFPI) concluded that specific groups of parents were less likely to access any kind of service. These included fathers, disabled parents, BME families, asylum seekers, and homeless and rural families. Physical and practical barriers included lack of knowledge about local services and not being able to access them for reasons including the cost of travel. Social barriers included a lack of trust and also cultural barriers, typified by a perceived lack of recognition of different cultural attitudes to child-rearing, and language barriers.
EARLY YEARS SERVICES
A 2016 report from the Joseph Rowntree Foundation maintains that a robust body of evidence suggests publicly funded childcare can help reduce the effects of poverty in two key ways:
High-quality early education and effective early intervention can act as protective factors for children against the negative effects of poverty, improving long-term developmental and employment outcomes.
Access to flexible and affordable childcare can reduce pressures on family income and help parents to participate in work, education or training, reducing a family’s short- and long-term poverty risks, such as health.
The authors conclude that measured against these aims, the UK childcare system currently falls short of fulfilling its potential to help reduce the effects of poverty, and children often do not have access to childcare of the standard needed to improve developmental outcomes. While the systemic problems and challenges facing the childcare sector may require political solutions, as individual service providers and practitioners we all need to do what we can.
POINTS FOR REFLECTION
Are you aware of the health issues facing families and children in your setting?
Do you offer support and information about the services and benefits that are available?
How understanding are you of the problems that parents express?
How can you help to integrate local services in your area and make them more accessible?
FURTHER READING
Butler, A and Rutter, J – Family and Childcare Trust (2016) Creating an anti-poverty childcare system. Joseph Rowntree Foundation
Marmot, M et al(2011) Fair Society, Healthy Lives: The Marmot Review
National Children’s Bureau (2015) Poor Beginnings: Health inequities among young children across England
The Children’s Commissioner (2015) Changing the Odds in the Early Years, http://bit.ly/21RXIl8
End Child Poverty: Health Consequences of Poverty for Children, https://povertymatters.wikispaces.hcpss.org/file/view/Health_consequences_of_Poverty_for_children.pdf
Mary Dickins is an early years consultant and author specialising in inclusion.
BRIDGING THE GAP
Self-regulation is now widely regarded as crucial to early learning, lifelong achievement and bridging the gap in children’s academic outcomes. Find out more about the neuroscience behind self-regulation and how play-based curricula can support children’s ability to regulate their feelings, thoughts and actions at Nursery World’s London conference ‘Self-regulation: the key to effective learning’ on 30 June.
Our keynote speaker is Clancy Blair, professor of cognitive psychology at New York University and a leading authority on self-regulation.
The conference will cover both the emotional and cognitive aspects of self-regulation and focus on how self-regulation links to the Characteristics of Effective Learning and aspects of the EYFS.
To find out more about the programme and to book a place, visit: www.selfregulation.co.uk/home
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