Child Health Inequality in the 21st Century: Contemporary Policies and

Strategies in Tackling the Problem

Abstract: The present paper discusses the problem of health inequality
as a notorious challenge of the 21st century. The author critically analyzes the
corpus of recent policies and strategies as to this issue around the world. It
has been demonstrated that reducing inequalities in health among children
can be tackled using an integrated approach and multidisciplinary programs.
Keywords: management of health care systems, child health,
inequality, multidisciplinary policies.
According to the latest Report on Health Inequalities in the European
Union (2013), the world today is exposed to effects of the financial crisis, and
these effects are detrimental not only for the economy, they also undermine
the ability to protect peoples health and disrupt the management of health
systems [1]. The problem of child health inequalities is one of the most urgent
in the 21st century. Child health disparities are detrimental not only to the
disadvantaged children as such, but to the entire society as well, since this
social problem triggers the endless chain of generations who have not
reached their full health potential.
Health inequalities can be defined as differences in health care access
and opportunities driven by race, gender, disability, geographic location or
income. According to the World Health Organization (2015), health
inequalities are unjust differences in health status experienced by certain
population groups [2]. However, nowadays, the apparatus to describe
inequalities in health is surprisingly limited. An important factor of child health
inequality is the disparity between living standards in developed and
developing states. The World Health Organization constantly provides vivid
examples of health inequities between countries. The statistical data as to

infant under-5 mortality is striking indeed. For instance, the infant death rate
(between birth and the age of one year) is 2 per 1000 liveborns in Iceland
while in Mozambique it is 120 per 1000 live-births [3]. There are 316 deaths
per 1000 liveborns in Sierra Leone as compared to 5 deaths per 1000
liveborns in Japan and 4 deaths per 1000 liveborns in Finland [3]. The
evidence on the child health and life opportunity inequality throughout the
world is alarming indeed: in Chad, every fifth child dies before they reach the
age of 5, while in the European Region, the under-five mortality rate is 13 out
of 1000 [3]. The WHO insists that such an alarming difference in health has
no genetic or biological grounds; hence, this disparity is socially caused.
It is necessary to bear in mind that pronounced health disparities can be
easily found within developed countries as well. The report released by World
Vision in 2013, The Killer Gap: A Global Index of Health Inequality for
Children, sheds light on the problem of child health inequality throughout the
world. The report has ranked 176 countries according to the health service
gap (including access to health services, health awareness, life expectancy
and other indicators). As a result, France is at the top of the list, while Chad is
at its bottom. The USA takes the 46th place which indicates that a countrys
wealth is not a guarantee of health equality [4].
The definitions of health, suggested by the World Health Organization in
1958 combines the physical, mental, and social spheres of our life, and in
such a manner constitutes the all-embracing formula of human existence:
health is not merely the absence of disease, but a state of complete physical,
mental, spiritual and social wellbeing [qtd. in 5]. It is necessary to observe
that health status and socio-economic conditions are closely associated. That
is to say, socio-economic inequalities quite often trigger numerous health
disparities. Childrens health status largely depends to household income, and
in the process of growing-up this relationship becomes even more distinct.

The relatively worse health status of children proceeds into adulthood, as they
are most likely to have poorer work capability and opportunities, as well as
loss of wages due to increased number of sick leaves. In this context,
A.Deaton remarks that in the UK and the US, an additional inch of height
comes with 1.5 to 2 percent higher earnings [6]. That is to say, the correlation
between low income and health becomes steeper throughout the career
development. Low family income prevents children from developing their
physical and cognitive potential. As a matter of fact, children from poorer
household arrive at the threshold of adulthood with lower health status and
educational attainment [6] the latter circumstance is partly conditioned by
poor health. Thus, educational status and poor health actually endanger their
earning power in adulthood [6]. The cumulative effects of negative conditions,
such as low income, poor housing, nutrition and limited health care aggravate
the child health status in the process of growing up. In addition to discomfort
experienced in childhood, abundant evidence suggests that exposure to
inequality may have a detrimental influence on health and well-being across
the life course [7]. Thus, another important issue that needs investigation is
the life course perspective, that is, the effect of poverty and health inequality
on the entire life of a person.
Apart from its impact on physical health, lower socioeconomic status
and inequality can also affect mental health of children. V.Murali extensively
discusses the relationships between low socioeconomic status and increased
incidence of mental illness which recently has become apparent indeed. The
scholars argue that children from the poorest households are three times
more susceptible to mental disorders than children from the well-to-do families
[8]. As a matter of fact, poverty and unemployment can trigger personality
disorders, emotional disturbance, as well as inclination to alcohol and
substances misuse, and even suicide [8]. The scholars have investigated

prevalence of psychiatric disorders according to social class (classes I, II, III,

IV and V). It is necessary to observe that the prevalence of psychiatric
disorders within the lowest social class (class V) is striking indeed (depressive
disorder: 9 % in class I; 35 % in class V; phobia: 2 % in class I; 13 % in class
V; obsessive-compulsive disorder: 6 % in class I; 21 % in class V; panic
disorder: 1% in class I; 12 % in class V; functional psychosis: 4 % in class I;
17 % in class V; alcohol dependence: 33 % in class I; 73 % in class V; drug
dependence: 7 % in class I; 50 % in class V) [8].
In 2013, British Medical Association published a report as to the child
health status in the UK. As the report demonstrates, after the application of
numerous tackling policies, the situation is improving. The report extensively
discusses the current problem of child health inequality as compared to the
situation at the end of the 90s. As a matter of fact, in 1999, the United
Kingdom ranked the third in child poverty among the industrialised countries
(behind United States and Russia); it also ranked behind Germany, France,
Japan, Slovenia and Singapore in terms of early childhood deaths (the UK
took the 18th place). Moreover, the rate of infant mortality in class V (the
poorest families) was 70 percent higher than in those from social class I; the
average birth weight in families from class V was 115 grams lighter than in
those from class I and so on [9]. Thus, despite the fact that the UK is one of
the richest countries in the world, the child well-being remains quite a
problem. According to the 2013 BMA report, there are quite alarming
examples of socioeconomic and health inequalities in the UK. For instance,
the life expectancy of a boy born in Chelsea or Kensington is over 84 years,
while it is only 75 years for a boy from Islington which is actually less than five
miles away. Furthermore, the 2003 Childrens Dental Survey demonstrates
that in classes IV and V 13 percent of five year olds never undergone dentists
examination, as compared to 2 percent in classes I, II and III [9]. That is to

say, BMA aspires to reveal the inconsistencies within the NHS system and
suggests the ways to eliminate them.
There is an extended debate as to the potential of policies in addressing
health inequalities. J.Kronenfeld argues that health services (both preventive
and therapeutical) are able to improve the health status in disadvantaged
groups [5]. For instance, numerous public health nursing programmes
(Equally

Well;

Healthier,

Wealthier

Children;

The

Family

Nurse

Partnership and the like) are aimed at supporting poor families and thus
tackling child health inequality. Indeed, elimination of child health inequalities
requires multiple actions on the part of health services. It is essential to render
health services more accessible, to raise their awareness of the problems
which poor families usually face.
Meanwhile, the opposing viewpoint asserts that a much broader context
must be taken into account. For instance, the World Health Organization
advocates the intersectoral approach in overcoming the problem of health
inequalities [10]. The WHO emphasizes the necessity of reducing the
inequalities in health in a number of documents. For instance, Health-for-All
Policy for the 21st century explicitly advocates the intersectoral collaboration,
promotion of equal health care opportunities, community participation and
sustainable development. In the UK, the activity of NHS demonstrates
commitment to intersectoral plan of actions. One of its core principles is based
on the acknowledgment that good health largely depends on environmental,
economic and social factors (for instance, housing, nutrition and education).
Therefore, the NHS is committed to work with other public services to
intervene not just after but before ill health occurs [11]. The Child Poverty
Strategy, implemented by the UK government propels a sustainable
approach to reducing child health inequality with due consideration of a wide
range of factors (for instance, home environment and education) [1]. In fact,

poor health status of children can be attributed to education within the family,
since more educated people can utilize health information more effectively.
Lower socioeconomic status can also be associated with risky behaviours,
such as immoderate drinking, smoking, lack of exercise and obesity [6].
The BMA also stimulates the cross-professional approach to the
problem

of

child

health

inequality:

their

reports

are

essentially

multidisciplinary, involving experts from different spheres of activity. In recent

years, the BMA has produced a number of effective recommendations and
reports, for instance, Getting it Right for Children and Young People (2010)
report which claims that NHS needs greater integration; Growing up in
Scotland (2011); Nurturing Children, Supporting Families childcare policy
statement (2011); The Children and Young Peoples Health Outcomes
Forum (2012) and many others. Moreover, the BMA advocates the so-called
life-course approach to this problem. That is to say, child health needs to be
controlled even before conception, as well as throughout the life. It is common
knowledge that low birth weight is one of the primary causes of infant
mortality. Therefore, under-18 mothers from poor households and other
categories of disadvantaged young women need special education and
control. It is essential to provide teenagers with health education as to their
lifestyles and habits (such as harm of smoking during pregnancy). For
instance, such programmes as Governments Teenage Pregnancy Strategy
are aimed at helping teenagers to avoid early pregnancy. Since the launch of
this programme in 1999, the rate of under-18 conception has decreased from
46.6 per 1,000 live births (1998) to 40.5 per 1000 live births (2008) [9].
It is thus obvious that health inequality cannot be addressed by separate
and narrow policies. Instead, government-directed strategies that combine
economic development and active social policies are needed [12]. The
integrated approach to the problem of child health inequality should embrace

the structural changes in economies that will promote employment;

stimulation of labour demand and generation of new workplaces; distribution
of tax credits and subsidies; government investments in skills development,
education, extension services and infrastructure. In the context of
multidisciplinary approach to the problem of child health inequality, A.Deaton
emphasizes the benefits of economists participation [6]. From the economists
position, child health inequality can be eliminated through the measures and
mechanisms, related to education, parental earnings and labour force
participation, for instance, discount rates in the sphere of education [6].
Thus, child health inequality is a burning problem of the 21st century
which must be settled with urgent steps and multidisciplinary policies. In fact,
these issues demand discussion and streamlining both at national and
international levels. By means of the collaborative approach, strategies of
comparison and contrasting, the countries all over the world will be able to
find a reasonable way out of these problems. Currently, there are numerous
policy options as to the reducing health inequalities. Most initiatives do not
focus exclusively on health service, but deal with problems in education,
employment and social security as root causes of child health inequalities. In
other words, numerous social, educational, occupational, environmental and
community service measures are important factors of promoting health and
well-being of children. Thus, the policy options are by no means limited to the
measures within the health care system. Through the application of
intersectoral plan of actions, one can achieve the long-term effects on health
status of children.
References:
1. Report on Health Inequalities in the European Union. Brussels, 2013. P. 3839.

2. World Health Organization. Monitoring Inequality: An Emerging Priority for

Health Post-2015. Geneva, 2015. P. 27.
3. Marmot M. Social determinants of Health Inequalities // The Lancet. 2005.
365. P. 1104.
4. The Killer Gap: A Global Index of Health Inequality for Children. London,
2013. P. 14.
5. Kronenfeld J.J. Health Care Policy: Issues and Trends. Westport, 2002. P.
157.
6. Deaton A. What Does the Empirical Evidence Tell Us About the Injustice of
Health Inequalities? // Inequalities in Health: Concepts, Measures and Ethics.
Oxford, 2013. P. 270.
7. Emerson E. Relative Child Poverty, Income Inequality, Wealth, and Health //
The Journal of the American Medical Association. 2009. 301(4). P. 425.
8. Murali V. Poverty, Social Inequality and Mental Health // Advances in
Psychiatric Treatment. 2004. 10. P. 224.
9. British Medical Association. Growing Up in Britain: Ensuring a Healthy Future
For Our Children. London, 2013. P. 155.
10.

World Health Organization. Social Determinants of Health. Geneva,

2013. P. 12.
11.

Gordon D. Wales NHS Resource Allocation Review. Independent Report

of the Research Team. Cardiff, 2001. P. 24.

12.

Cook S. Combating Poverty & Inequality: Structural Change, Social

Policy and Politics. New York, 2011. P. 2.