Elsevier

Academic Pediatrics

Volume 21, Issue 2, March 2021, Pages 236-243
Academic Pediatrics

A Novel 3-Part Approach to Tackle the Problem of Health Inequities in Early Childhood

https://doi.org/10.1016/j.acap.2020.12.005Get rights and content

Abstract

The first 5 years of a child's life are crucial in laying the foundation for their health and developmental trajectory into adulthood. These early years are especially influenced by the surrounding environments in which children live and grow. A large international body of evidence demonstrates that children who experience disadvantage tend to fall increasingly behind over time. At the societal level, these inequities can cause substantial social burdens and significant costs across health, education, and welfare budgets. A contributing factor is that children experiencing adversity are less likely to have access to the environmental conditions that support them to thrive. Many of these factors are modifiable at the community or place level. We argue for three key—though not exhaustive—ideas that collectively could achieve more equitable outcomes for children facing disadvantage and experiencing adversity:

  • 1.

    Adopt a social determinants approach to conceptualizing disadvantage;

  • 2.

    Stack existing, evidence-based government and nongovernment service interventions/programs that operate at the local or community level; and

  • 3.

    Use data and evidence to focus improvements for more equitable and adaptive systems.

We conclude that if adopted, these 3 ideas could contribute to the ability of local communities and networks to identify and respond to factors that address early childhood inequalities.

Section snippets

Idea 1: Adopt a Social Determinants Approach to Thinking About Disadvantage

Disadvantage is multifaceted. Philosophical perspectives emphasize disadvantage as limiting opportunity and the capacity for individuals to freely lead lives they have reason to value.30 In the context of health equity, disadvantage refers to relative position in a social hierarchy determined by wealth, power, and prestige.31 In contrast to concepts of poverty that focus on those who are the most deprived (eg, of money or material possession), socially excluded, and/or vulnerable,32

Idea 2: Stack Interventions to Make a Sustained Difference

The framework is also consistent with the idea of stacking interventions across the early years of a child's life and lends itself to creating measurable, meaningful indicators across relevant factors. Despite the range of available services for children, government and communities alike often focus on importing or trialing new programs rather than improving the existing and already funded service system where a range of evidence-based interventions could be readily incorporated.36,37 While

Idea 3: Using Data-Driven, Evidence-Based System Metrics to Drive Equitable, and Adaptive Systems for Children

Utilizing data-driven, evidence-based system metrics means communities can access more precise data to assist them with decision-making and allocation of limited resource. By building on the first 2 ideas in this paper, we argue that a next logical step is to deliver metrics on measurable and modifiable factors that are known to drive disadvantage taking the social determinants and bio-ecological approach (Idea 1) and can drive stacked responses (Idea 2).

Conclusion

Robust research supports the adverse impact of disadvantage on children's health, development, and subsequent adult outcomes. The ability of policymakers, service providers, and communities to respond as a system rather than single programs or strategies remains a challenge. To move beyond good intentions and address the issues of inequity, we have suggested 3 ideas for addressing childhood inequities that have applicability across international service ecosystems.

If we 1) adopt a social

Acknowledgments

Financial statement: This work was supported by Victorian Government's Operational Infrastructure Support Program. Prof Goldfeld is supported by an Australian National Health and Medical Research Council (NHMRC) Practitioner Fellowship (APP1155290). Funding sources had no involvement in the study design, writing of the paper, or decision to submit the article for publication.

Authorship statement: Drs Molloy, Moore, West, Villanueva, and O'Connor contributed to the conceptualization of the

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    • Cited by (6)

    The authors have no conflicts of interest relevant to this article to disclose.

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