Improving children’s health is key to better overall health outcomes, and should be a cornerstone of any comprehensive health care reform. Two new reports from the World Health Organization and the Campaign to End Child Poverty explore the extent to which health outcomes are determined by social conditions, including poverty, and they show that poverty in childhood has a clear effect on adult health.
The report from the World Health Organization’s Commission on the Social Determinants of Health sets out some stark facts about health inequalities today. Infant mortality rates vary widely around the world, from around 4 out of every 1,000 live births in Sweden, to over 100 in Mozambique. But disparities are strong within, as well as between, countries. Black men here in Washington, D.C. have an average life expectancy of 63: directly to our North in Montgomery County, MD, white males can expect to live for an additional 17 years.
Differences in health are no accident; they stem directly from social inequalities and the policies that create them. WHO explains, “the high burden of illness responsible for appalling premature loss of life arises in large part because of the conditions in which people are born, grow, live, work, and age. In their turn, poor and unequal living conditions are the consequence of poor social policies and programmes, unfair economic arrangements, and bad politics.”
The commission stresses the multitude of ways that poor health is linked directly to poor living conditions. For example, mortality rates are higher for workers on temporary contracts than those in permanent positions, and stress at work is associated with a 50 percent higher risk of coronary heart disease.
The Campaign to End Child Poverty report similarly charts the ways in which poverty in childhood is linked to poor health in adulthood. Growing up in poor socioeconomic conditions as a child puts adults at greater risk of coronary heart disease, stroke mortality, having a disability, and of poor mental health. And these associations were found after controlling for current social position. It is not simply growing up poor that puts you at greater risk of poverty in adulthood—a disadvantaged childhood has a direct effect on your health in later life, even if you go on to escape poverty.
The commission notes that universal health coverage is fundamental to address health inequalities. But the clear links between childhood poverty and adult health suggest that efforts to improve health outcomes need to step outside the boundaries of what is traditionally seen as health policy. The WHO suggests three areas for action: improving daily living conditions, tackling the inequitable distribution of power and resources, and measuring and understanding the problem. And they place a high priority on establishing universal early child development programs. We know that investing early is vital for tackling child poverty, but these studies show that the need for greater investment in young children’s health is particularly urgent.