Growing up in Scotland: health inequalities in the early years

CHAPTER 5 CONCLUSION

The analysis in this report spanned the period from around the time of the children's birth to just before their fourth birthdays. It showed that exposure to the kinds of risks that can impact on health and development in the early years, and have been shown in other literature to have implications for decades to come, are not uniformly or randomly distributed across the population at this very early point in life. Significant inequalities exist with those in the most deprived areas, the lowest income households or routine and semi-routine households found to have worse health outcomes and higher exposures to risks for poor outcomes than their more advantaged counterparts.

While the persistence over the years of poor outcomes was quite variable, exposure to risks such as smoking and poor maternal health were somewhat more stable. This suggests that the consequences in later life associated with early exposure to such risks are likely to be evident for decades.

Across all the outcomes and risk factors explored, inequalities in exposure to risk factors were generally larger than those evident for outcomes. However, within the outcomes explored, behavioural, psychosocial and linguistic problems showed much starker inequalities than physical ones such as poor general health. This might well reflect the nature of what aspects of development are most significant at this stage in life so future patterns might potentially change.

The analysis of health inequalities in Chapter 3, and the exploration of resilience in Chapter 4, both highlighted the extent to which more disadvantaged households experience a double burden in their experience of health inequalities with children and adults within them being at greater risk of negative outcomes. The major focus on early years currently evident in Scottish Government policy making therefore needs to be alive to the fact that tackling health inequalities in children also requires action to address the health inequalities experienced by their parents and wider families.

A major recent study of resilience and health (Mitchell et al., 2009) drew a number of conclusions but one has particular resonance in the context of this research - as poverty was such a strong predictor of poor outcomes (in their study the measure was mortality), resilience was likely to have only a very small contribution to the reduction of negative outcomes. However, this is not to detract from the finding that some factors (such as the home learning environment) were shown to be associated with the avoidance of negative outcomes which suggests that some levers to mitigate the impact of disadvantage might exist.

The findings from the exploratory analysis of resilience suggest that relatively few of the potential resilience measures explored were significant once socio-economic factors were taken into consideration. Although a study such as GUS can demonstrate the sequence over time between possible explanatory factors and outcomes, it still cannot provide definitive conclusions about the direct relationship between them. There is always the possibly that some additional unmeasured factor, related to both the outcome and apparently explanatory factor, is what actually explains the association found. To truly establish cause and effect is very complex and usually requires experimental methods and the accumulation of evidence from numerous different sources. In the absence of experimental evidence, this kind of analysis therefore contributes to the wider accumulation of evidence in favour of intervening in the early years. However, it should be noted that of significant evidence about the effectiveness of interventions in the early years has already been accumulated (Hallam, 2008).

The extent of the socioeconomic inequalities identified in this piece of work, coupled with the suggestion that resilience to negative outcomes might come in the form of actions to address a wide and disparate range of factors makes it clear that that tackling health inequality requires input at many levels from a wide range of actors. This is not in the gift of the health service or other service providers alone.