Give every child a good start in life

Yvonne Kelly International Centre for Lifecourse Studies in Society and Health (ICLS) www.ucl.ac.uk/icls @icls_info @childofourtime

CSDH conceptual framework for action on the social determinants of health

Solar O, Irwin A (2010): A Conceptual framework for action on the social determinants of health. Social Determinants of Health Discussion Paper 2 (Policy and Practice). Geneva: World Health Organization.

Socioeconomic position

Social class Gender Ethnicity

Education

Occupation

Income

Child health and

development

Behavioural – including home environment and parenting activities (reading and telling stories), family routines (sleeping and meal times, screen based media use), physical activity Material - including, housing quality, overcrowding, air pollution Psychosocial – including parent mental health, parent-child interactions, discipline strategies, parental warmth and hostility

Soc

ial a

nd p

ublic

pol

icy

incl

udin

g he

alth

, edu

catio

n,

wel

fare

, hou

sing

Structural determinants Intermediary determinants

Social determinants for child health and development

-20

-15

-10

-5

0

5

10

0 1 2 3 4 5 6 7+

Num

bero

fmon

ths

advanced

ord

elayed

Numberofriskfactors

Verbal months ahead or behind at age 7 by number of risk factors

Kelly et al, forthcoming

0

5

10

15

20

25

30

0 1 2 3 4 5 6 7+

% c

linic

ally

rele

vant

pr

oble

ms

Number of risk factors

Mother Teacher

Clinically relevant behavioural problems at age 7, by number of risk factors

Kelly et al, forthcoming

Regression coefficients for behavioural difficulties scores (mother report) by non-regular bedtimes throughout early childhood, cumulative effects

0.0

1.0

2.0

3.0

4.0

5.0

any 1 age Any 2 ages All 3 agesUnadjusted Adjusted

Kelly, Kelly, Sacker Pediatrics 2013;132:e1184-93

-2.0

-1.5

-1.0

-0.5

0.0

0.5

1.0

Non-regulartoregular Regulartonon-regular

Diffe

renceinbeh

avioural

difficul7essc

ore

Changebetweenages3and7 Changebetweenages5and7

The effects of changes in the regularity of bedtimes on behavioural difficulties scores

Kelly, Kelly, Sacker Pediatrics 2013;132:e1184-93

Longitudinal Verbal Profiles

30

35

40

45

50

55

60

65

70

3 5 7 9 11

Mea

n B

AS

scor

es

Age

Average (74.9%) High (19.5%) Low (5.6%)

Zilanawala et al, Eur J Pub Health 2016

BMI trajectories in childhood

14

16

18

20

22

24

26

28

30

32

14

16

18

20

22

24

26

28

30

32

3 5 7 9 11

BM

I

Age Overweight range Obese range T1 Stable T2 Decreasing T3 Moderate Increasing T4 High Increasing

Kelly et al Pediatrics 2016

Being read to at age 3

*** differences compared to those read stories to every day p<0.001 Kelly et al, forthcoming

80 85 90 95

100 105 110

Every day 1-6 days/week ***

Less than weekly ***

Test

sco

re

School readiness

30

35

40

45

50

55

Every day 1-6 days/week ***

Less than weekly ***

Test

sco

re

Verbal ability

0 5

10 15 20 25 30

Every day 1-6 days/week ***

Less than weekly ***

Perc

ent

Socioemotional difficulties

-1.4

-1.2

-1.0

-0.8

-0.6

-0.4

-0.2

0.0

0.2

Diffe

renceinbeh

avioural

difficul7essc

ore

Changetoreadingdaily Changetoreadingweekly

Change in frequency of being read to, ages 3 to age 5

Kelly et al, forthcoming

Longitudinal Verbal Profiles

30

35

40

45

50

55

60

65

70

3 5 7 9 11

Mea

n B

AS

scor

es

Age

Average (74.9%) High (19.5%) Low (5.6%)

Zilanawala et al, Eur J Pub Health 2016

58.7 47.1

41.6

0 10 20 30 40 50 60 70

Every day 1-6 days/week ***

Less than weekly ***

Perc

ent

Read to at age 3

54.1

37.2

0

10

20

30

40

50

60

Girls Boys

Perc

ent

Reading for pleasure most days at age 11

Kelly et al, forthcoming

42.1 30.4 26.3

0 10 20 30 40 50 60 70

Every day 1-6 days/week ***

Less than weekly ***

Perc

ent

Read to at age 3

0.6

0.8

1.0

1.2

1.4

1.6

1.8

2.0

Self esteem Happiniess Socioemotional difficulties

Odd

s R

atio

Kelly et al, forthcoming

Well being at age 11 by reading for pleasure

Income gap in the risk of socioemotional difficulties at 5 years of age

0 1 2 3 4 5 6 7 8 9

10

Richest (2.0%)

Band 2 (4.0%)

Band 3 (6.4%)

Band 4 (11.2%)

Poorest (15.9%)

Ris

k

Income

Kelly, Sacker, Del Bono, Francesconi, Marmot. Arch Dis Child 2011;96:832-7

Summary •  Early child health and development matters – now

and for the future

•  Stark socioeconomic inequalities are evident and these start early

•  Structural factors shape ‘intermediary’ environments: behavioural, material, psychosocial

•  To give every child a good start in life - action is needed on intermediate and structural influences

Bridging social and biological sciences

www.ucl.ac.uk/icls @icls_info

ICLS LIFECOURSE STUDIES IN SOCIETY AND HEALTH

@childofourtime