Inequalities of Health in Childhood - Essay Example

? Inequalities of health in childhood The unfortunate reality that life is not fair prevails in many areas of the world. This means that not everyonegets the same privileges and challenges. Sadly, one of the most affected populations includes very young children. While many privileged children eat healthy food at regular intervals, are housed in safe and secure environments, have enough clean clothes to wear and have free access to health services, more children all over the world suffer from hunger, malnutrition, disease and utter lack of health provisions. This is a common situation where health inequalities prevail. The World Health Organization (WHO) (Sorte et al, 2011) defines health as “a state of total physical, mental and social well-being, not just the absence of disease” (WHO p. 286). Unfortunately, not everyone is healthy. The Black Report (1980) identifies the issue of health inequalities starting that “ill health and mortality is related to social class but also more generally to the ‘health differences between people in more or less favourable situations with respect to income, prestige (“standing in the community”) and education” (p. 1). Apart from these factors, health inequalities are also apparent between genders, different ethnic groups and age groups, such as the elderly. In a world where fairness and justice are desired by all, how come inequalities in health still persist? Many have attempted to explain this phenomenon. The House of Commons (2009) identify some causes of health inequalities as lifestyle factors that people adopt that make them and the people around them unhealthy. Some of these are smoking, poor nutrition, lack of exercise and sleep. Other determinants of poor health are poverty, poor or lack of housing, employment and education and limited access to healthcare. The House of Commons (2009) also claim that people suffering from mental health problems or learning disabilities also have worse health than the rest of the population. Some individuals are born with congenital deficiencies which were affected by their genes and may have been affected by the health of their mothers during pregnancy with them and then other factors worsened their health after their births. Children are vulnerable to parental influences on health habits and attitudes because they are dependent on their parents. Brofenbrenner’s Ecological Model (1979) explains that the individual’s biological and personality factors, environment and the society and culture he was born into all interplay in his development. Brofenbrenner also claims that effects of interactions between the individual and his environment are two-directional or characterized by reciprocity. This means that while a child’s development is influenced and molded by his family, school and peers, he likewise influences and molds the behavior of others. This is reflective of provision of health services. A child’s health depends on his family’s health and the provisions of society. The growing child moves through five systems that inter-relate and affect his development. The microsystem is where the child has direct contact with his environment and is where he develops various behaviors such as dependence or independence and cooperation or competition. His family is part of this microsystem, and his primary providers of his basic needs. The next system is the mesosystem which links processes that take place between environments having the child as its common factor. An example is the child’s family and societal initiatives for children. The third level comprising linkages and processes taking place between two or more settings is the exosystem. This includes at least one setting that does not directly involve the child, but still influences the processes within the immediate setting of the child. The fourth system is the macrosystem which includes the customs, values and laws considered important in the child’s culture and upbringing. Lastly, the chronosystem in Brofenbrenner’s Ecological model, refers to the time that transpires as the child relates in his various environments. An example is the change that happens to the child while he grows up moving from one system to another. This ecological model implies that the interplay and quality of the various systems and environments of the child will play different roles in influencing his development. Likewise, whatever comes out of that development will affect the various environments the child belongs to (Brofenbrenner, 1979). In the document for Every Child Matters, Working Together to Safeguard Children (HM Government, 2006), neglected children were identified as those whose basic physical and/or psychological needs are failed to be met resulting in serious impairments in their health or development. Neglect may occur during pregnancy as a result of maternal substance abuse. Once a child is born, neglect may involve a parent or carer failing to provide adequate food, clothing and shelter. His safety is also at stake as the neglect endangers him to physical and emotional harm or risks. He is not supervised well of his growth and development so his access to medical care or treatment is not ensured. His basic emotional needs are not also met. For some children, instead of being cared for, they are the ones that provide care for others. Becker (2000) defines young carers as: ‘children and young people under 18 who provide or intend to provide care, assistance or support to another family member. They carry out often on a regular basis, significant or substantial caring tasks and assume a level of responsibility which would usually be associated with an adult’ (Becker, 2000, p. 378). These young carers live differently from their non-caregiving peers. They are tasked with huge responsibilities early on in life that they miss out on the regular lives expected of children their age. It is ironic that with young carers, instead of being ensured of their welfare, they are the ones who keep the people they care for safe, leaving them vulnerable to some risks to their own safety and welfare. The problem of health inequality has been addressed in several reports such as the Black Report (1980), the Acheson Report (1998) and the WHO Commission on the Social Determinants of Health (2008). The United Nations International Convention on the Rights of the Child (CRC) is dedicated to promoting children’s rights all over the world. Following on from the Universal Declaration of Human Rights, the United Nations has proclaimed that children are is entitled to special care and assistance. It recognizes that the child is entitled to a quality of life that promotes his or her well-being in order to grow up maximizing his or her potentials as an individual. It considers “that the child should be fully prepared to live an individual life in society, and brought up in the spirit of the ideals proclaimed in the Charter of the United Nations, and in particular in the spirit of peace, dignity, tolerance, freedom, equality and solidarity” (Office of the United Nations High Commissioner for Human Rights, 1989, para.7). In response to this, Section 4 of the Childcare Act of 2006 mandates local authorities to improve outcomes for all children in reducing inequalities. It was suggested that provision of early years services should be a priority and these should be delivered in integrated ways that maximize the access and benefits to young children and their families (Armstrong, 2007). Government efforts to step up health initiatives especially for poorer areas have rapidly increased over the years, targeting a great reduction in health inequalities and improvement in health outcomes. One of the policies new labour borne out of this advocacy that targeted improved health for children is Sure Start. It is a multi-agency working initiative that aims to ensure the well-being and welfare of children. Sure Start- background Sure Start is the government’s initiative to deliver programmes that ensure the best start in life for every child. Established in 1999, Sure Start brings together early education, childcare, health and family support services for families with children aged five and under. In line with the government’s drive to fight child poverty and social exclusion, Sure Start works with parents and future parents, carers and other professionals working with children to promote the physical, intellectual and social development of babies and young children so they are readied for the challenges of school (Sure Start, 2009). Sure Start also networks with other service providers from the health, social services and early education sector as well as voluntary, private and community organisations to provide the necessary services for young children and their families (HM Government, 2006). In an effort to meet children’s developmental needs, the UK government was prompted to consult children themselves, of things that matter to them most in order to be the basis of proposals for change. These key outcomes—being healthy, staying safe, enjoying and achieving, making a positive contribution and economic well-being are detailed in the Every Child Matters report and represent a considerable shift in focus for staff providing public services for children. (Baxter & Frederickson, 2005). Sure Start is one organization that shares the aim of breaking cycles of deprivation, closing achievement gaps in education between the privileged and the disadvantaged, endorsing better parenting strategies, enhancing child development, confronting poverty issues, promoting safeguarding and community cohesion and supporting healthier lifestyles and seeking opportunities for learning for all individuals (House of Commons, 2009). Sure Start Children’s Centres have been built around the country offering high quality integrated Early Years services to local communities. It is foreseen that by 2010, there will be 3,500 children’s centres available to every family so they have easy access to the high quality services and benefits that Sure Start provides (Sure Start, 2009). Sure Start offers four core services that benefit children and their families. Child + family Health Services The first one is Child and Family Health Services. Health visitors and midwives are commissioned to help families that have newborn children; they conduct home visits and provide ante-natal and post-natal services such as breastfeeding advice and support. This service takes on an educational approach to health promotion because it provides adequate information about appropriate health practices and helps families come up with informed decisions that suit their values and lifestyle. In terms policy intervention, this service is at level 1, strengthening individuals (Whitehead, 1995), specifically family members, as it empowers them with the education of practices that would benefit their children. Although it is ideal to work with families as a whole to ensure that information on health will be consistent to all members, it may also be difficult to do so because healthcare practitioners need to consider each family’s culture, values and dynamics. That is why they should also learn cultural sensitivity and culturally responsive strategies in order to be more effective in spreading the information needed by the families they serve. Childcare and Learning Another core service is provision of high quality childcare and early learning programmes. When children turn three or four years, they already have free access to part-time (10 hours a day, five days a week, 48 weeks per year) early education, as there are over 37,000 settings offering free, Government-funded early education in various sectors. Sure Start centres comply with the quality set by the Early Years Foundation Stage (EYFS) to give children the best possible start to their learning journey (Sure Start, 2009). One criticism which may be thrown here is the lack of government provision for older children. Sure Start is more concentrated on the younger ones and it is good that they want to ensure that these young children have a “sure start” to a fulfilling and healthy life, but there should be another organization that serves the older children in order to maintain the good beginnings provided by Sure Start. The level of policy intervention this core service belongs to is level 3, by improving access to essential facilities and services, targeting young children as its beneficiaries. In terms of health promotion, this core service takes on an educational approach the obvious reason of provision of high quality early childhood education to at least 30% of the most deprived areas (House of Commons, 2009). It also takes on a client-centred approach for parents as it provides daycare facilities for their young children while they are at work to enable them to concentrate on earning a living for their families. Advice and access to specialist Services A third core service is Parent Support or provision of advice on parenting, local childcare options and access to specialist services for families like speech therapy, healthy eating advice or help with managing money. Sure Start advocates very early interventions to support families and children. This includes advice on preparation for parenthood, health in pregnancy and childcare options. This aims to prevent any untoward events that may happen and to prepare for a “sure” start in children’s lives. Since it promotes multi-agency working, the same level of caring and nurturance should be adopted by all the agencies working together so as not to create feelings of alienation with some agencies. These organizations should always keep the well-being and welfare of children in mind when providing their services along with other organizations. In terms of health promotion, this core service takes on an educational as well as a societal approach because not only does it provide information to families on good health practices, but also encourages them to address other causes of ill health and empowers them to seek the best health services for their families. This core service again falls in level 1 for policy intervention, but may effects also sit in level 2, (strengthening communities) because once this provision affects more people, it strengthens the whole community and makes it more learned on issues of parenthood and child-rearing. Work and Training Finally, Sure Start offers the core service of Employment opportunities or helping people find work or training opportunities, with their connection to placement agencies such as Jobcentre Plus offices and training providers. It is hoped that parents who are targeted will not take offense in being pushed to find adequate employment because Sure Start is only looking after the welfare of their children. This is to help families have enough income to live better quality lives (House of Commons, 2009). This last core service falls under level 4 of policy intervention, encouraging macro-economic and cultural change because it aiming at a more lucrative livelihood for people, increasing their chances of a better quality of life. This core service takes on a societal approach in health promotion because it aims to modify people’s social, economic and physical conditions that may contribute to ill health. Sure Start’s core services’ aim to meet all of the Marmot Report’s (2010) six policy recommendations to reduce health inequalities, namely: 1. Give every child the best start in life 2. Enable all children, young people and adults to maximise their capabilities and have control over their lives 3. Create fair employment and good work for all 4. Ensure a healthy standard of living for all 5. Create and develop healthy and sustainable places and communities 6. Strengthen the role and impact of ill-health prevention Sure Start’s initiatives indeed help combat health inequalities especially for children so they are able to fulfill their potential. Providing high quality services to address health, education and family needs ensures young children’s optimal development. Empowering their parents to nurture and care for them and to raise them to be healthy and successful individuals not only in terms of knowledge and skills but also of character is a noble task. The House of Commons (2009) commented that children’s centres such as Sure Start are becoming models for multi-agency working that traverses professional boundaries and services targeted for very young children up to the early childhood stage and their families. This attained success of Sure Start should be emulated by other service initiatives or organizations that target other age groups. References Acheson Report (1998) Armstrong, M. (2007) Delivering health services through Sure Start Children’s Centres, Department of Health, London Bartley, M. (2004) Health Inequality: An Introduction to Theories, Concepts and Methods. Cambridge: Polity Press Baxter, J. & Frederickson, N., (2005) “Every Child Matters: Can educational psychology contribute to radical reform?” Educational Psychology in Practice,Vol 21, No. 2 Becker S. (2000). Young carers. In The Blackwell Encyclopaedia of Social Work. M Davies (ed.)Blackwell: Oxford; 378. Black Report (1980) Bronfenbrenner, U. (1979) The Ecology of Human Development. Cambridge: Harvard University Press. Childcare Act of 2006 Department for Children, Schools and Families (n.d.) The Sure Start Journey, A Summary of Evidence HM Government (2006) Working Together to Safeguard Children: A guide to inter- agency working to safeguard and promote the welfare of children. Every Child Matters Change for Children. London: TSO House of Commons Health Committee (2009) Health Inequalities. Third Report of Session 2008–09, Volume I Marmot Report (2010) Retrieved on November 3, 2011 from (http://www.ucl.ac.uk/gheg/marmotreview/FairSocietyHealthyLivesExecSummary National Evaluation of Sure Start (NESS) (2005) Early Impacts of Sure Start Local Programmes on Children and Families. Retrieved on November 3, 2011 from http://www.ness.bbk.ac.uk. Office of the United Nations High Commissioner for Human Rights, (1989) Convention on the Rights of the Child, Geneva, Switzerland. Sorte, J., Daeschel, I., & Amador, C. (2011). Nutrition, health and safety for young children. Pearson: Upper Saddle. Sure Start (2009) Information retrieved on November 4, 2011 from http://www.dcsf.gov.uk/everychildmatters/earlyyears/surestart/whatsurestartdoes/ The Early Years Foundation Stage, (2007) Effective practice: Play and Exploration © Crown Whitehead (1995) Tackling Inequalities WHO Commission on the Social Determinants of Health (2008). Read More