Dedicated to discussion on how we can make regions great places for all children and young people to stay healthy, develop, and thrive, this page is created by health practitioners for health practitioners, recognising health services can only ever be truly effective when coordinated with the wider determining structures within a child’s life.

Useful terms

Health Inequalities

Health inequalities refer to the avoidable, systematic and unfair differences in health situation between groups of people or communities. These are outlined by the World Health Organisation as “differences in health status or in the distribution of health resources between different population groups, arising from the social conditions in which people are born, grow, live, work and age”.

Child in Poverty

UNICEF defines a child in poverty as; “a child who experiences deprivation of the material, spiritual and emotional resources needed to survive, develop and thrive, left unable to enjoy rights, achieve full potential or participate as a full and equal member of society”.

Social Determinants of Health

The social determinants of health are the non-medical factors that influence health outcomes, which include the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life such as economic policies and social norms.

Healthy Life Expectancy (HLE)

This refers to a health outcome measure which denotes the years spent in good health. The healthy life expectancy measure adds a ‘quality of life’ dimension to estimates of life expectancy by dividing it into time spent in different states of health. Health status estimates are typically based on survey questions where  respondents are asked to identify how their health is in general e.g. very good, good, fair, bad, or very bad.

Deprivation Deciles

These are used to examine the experience of individuals, families or communities in terms of the level of deprivation of the area in which they live. They are based on the Indices of Multiple Deprivation for each country and/or region, which are the official measure of relative deprivation. Decile 1 represents the most deprived 10% (or decile) of a particular region or country and Decile 10 represents the least deprived 10%.

The current state of play

We are all acutely aware of the changing scenery within the UK household. With the recent rise in the cost of living, this is no doubt going to push more children across the child poverty threshold. In England and Wales in 2020, 30% of all live births occurred in women who were born outside of the UK and 49% occurred in women who were in low-income employment or unemployed. Without the right tools and support system, there could be an ever-increasing proportion of infants born into deprivation who are at risk of experiencing poorer health outcomes.

Three devolved nations of the UK have previously reported on their HLE during the 2017-2019 time period. The proportion of life expectancy spent in poor health in those living in the most deprived areas compared to those in the least deprived (classified according to the national deprivation deciles) is shown in the maps below:

Understanding the divide

In 2014, Bywaters et al reported on a Nuffield Foundation-funded study that examined the role of deprivation in explaining differences in key children’s services interventions between and within 14 local authorities in England. The data demonstrated inequalities in rates of child welfare interventions within and between local authorities, systematically related to levels of deprivation.

In 2022, Bennett et al published a longitudinal ecological study of 147 local authorities in England and reported additional quantitative evidence of a contributory causal nature between child poverty and children’s social care involvement. In a 2021 report ‘The Economic Cost of Child Maltreatment in the UK’ by the Institute of Fiscal Studies, it was estimated that the average lifetime cost of non-fatal child maltreatment by a primary care-giver to be at £89,390 (95% uncertainty interval £44,896 to £145,508), and the largest contributors to this are costs from social care, short-term health and long-term labour market outcomes.

We cannot achieve progress without addressing inequality and each community must have the means of creating health and wealth opportunities for all. In February 2022, the UK government published the white paper on ‘Levelling up of the United Kingdom’. In this document, they set out the following agenda:

1. Boost productivity, pay, jobs and living standards by growing the private sector, especially in those places where they are lagging
2. Spread opportunities and improve public services, especially in those places where they are weakest
3. Restore a sense of community, local pride and belonging, especially in those places where they have been lost
4. Empower local leaders and communities, especially in those places lacking local agency.

The ambition for the government is to allow the UK economy to grow by incentivising the upskilling of the whole population regardless of the geographic area. They have set the timeline of 2030 to achieve their goals.

Index of multiple deprivation

Index of multiple deprivation is a relative measure of deprivation between small areas or neighbourhoods used throughout the UK. It utilises a number of different markers across seven (eight in Wales) domains to provide an overall measure of the problems experienced by a community living in a certain area.

The domains used differ slightly across the UK as the individual Governments collect and measure their data differently, therefore it cannot be used to compare between devolved nations. However, they are broadly:

• • • • income
      • employment
      • health
      • education
      • crime
      • access to housing and services
      • the living environment

Each area is scored in each domain and the results are added up providing data to help compare small areas as well as local authority/council areas. This can help to target policies, funding and resources to the most deprived areas.

It does have some limitations. As it uses relative data, it cannot quantitatively say how much more deprived one area is compared to another. It is not a measure of individual deprivation as there can be deprived individuals living in non-deprived areas. It is also not as effective in rural areas due to the large geographical area needed to provide the same population data.

Each Government has produced an interactive map, so you can look up areas by postcode and their related deprivation rank:

• • • • England
      • Scotland
      • Wales 
      • Northern Ireland

Other useful sources of data and evidence on health inequalities that are available to access online are shared below:

Social determinants of children and young people’s health

For RCPCH Conference 2021, a breakout session on the social determinants of children and young people’s health was led by Born in Bradford (BiB) who shared their journey in tackling health inequalities in one of the most deprived cities in the UK. The BiB team were joined by a panel of child health professionals to discuss how we can all be agents for change and take a whole system approach to improving the health of the next generation.

There was science, and much more, including stories and personal reflections, insights and words of wisdom from the UK and around the world. In this section, you can explore recorded talks, vlogs, and resources all designed to ignite the conversation on social determinants of children and young people’s health. We share the challenges and successes of tackling the social determinants of health, and discuss how we can all work together to transform child health within the UK and across the world.

Vodcasts

The BiB longitudinal birth cohort study was established in 2007 to transform the poor health outcomes facing children growing up in deprivation. BiB’s expertise in coproduction, data integration and working in complex systems is helping to create new and practical ways of building a healthier and fairer future for communities in Bradford and beyond.

These seven vodcasts, created by the BiB team and each lasting about six minutes, provides an introduction to the science of social determinants of children and young people’s health to stimulate discussion and share learning.

Agency

Dr Mathew Mathai, Consultant Paediatrician at Bradford Teaching Hospitals NHS Foundation Trust asks: ‘Is it time for a new type of paediatrician?‘

Download the slide deck below and listen to the accompanying audio commentary as you view in slideshow:

Inequalities

Prof Kate Pickett FRSA FFPH, Deputy Director of the Centre for Future Health and Associate Director of the Leverhulme Centre for Anthropocene Biodiversity, at the University of York discusses: ‘Unequal-ities – the importance of micro and macro- perspectives’.

Complex systems

Prof Mark Mon Williams, Professor of Cognitive Psychology and Academic Lead at the University of Leeds explores: ‘Why we can’t change health outcomes in isolation and we need to work with schools’.

Co-production

Prof Rosie McEachan, Director of Born in Bradford, Bradford Teaching Hospitals NHS Foundation Trust and Honorary Professor at University of Bradford presents: ‘A people powered research programme: from pregnancy – through birth and childhood to transition and beyond!‘ and also explores co-production with a talk on: ‘Building a healthier, fairer future for children and communities, together’.

Download the slide decks below and listen to the accompanying audio commentaries as you view the slideshows:

Ecology

Prof Neil Small, Professor of Health Research at University of Bradford and Academic Lead for BiB discusses: ‘The relationship of individuals to the whole – building alliances and sharing power’.

Policy

Prof John Wright, Director of the Bradford Institute for Health Research and Chief Investigator for BiB asks: ‘What difference does it make? From research to policy’. 

Case examples

Meet the community

Further reading

• Beck AF, Anderson KL, Rich K, et al. Cooling The Hot Spots Where Child Hospitalization Rates Are High: A Neighborhood Approach To Population Health. Health Affairs 2019; 38, NO. 9: 1433–1441. DOI: 10.1377/hlthaff.2018.05496
• Bem C, Small N. An ecological framework for improving child and adolescent health. Archives of Disease in Childhood 2020;105:299-301. DOI:10.1136/archdischild-2019-317518
• Britto MT, Fuller SC, Kaplan HC, et al. Using a network organisational architecture to support the development of Learning Healthcare Systems. BMJ Quality & Safety 2018;27:937-946
• Fine-Goulden, M.R. Power and powerlessness in a pandemic. Pediatr Res (2021). DOI: 10.1038/s41390-021-01480-z
• Henize AW, Beck AF, Klein MD, et al. A Road Map to Address the Social Determinants of Health Through Community Collaboration. Pediatrics Oct 2015, 136 (4) e993-e1001; DOI: 10.1542/peds.2015-0549
• Klein MD, Beck AF, Henize AW, et al. Doctors and lawyers collaborating to HeLP children–outcomes from a successful partnership between professions. J Health Care Poor Underserved 2013 Aug;24(3):1063-73. DOI: 10.1353/hpu.2013.0147. PMID: 23974381
• Newham JJ, Forman J, Heys M, et al. Children and Young People’s Health Partnership (CYPHP) Evelina London model of care: protocol for an opportunistic cluster randomised controlled trial (cRCT) to assess child health outcomes, healthcare quality and health service use. BMJ Open 2019;9:e027301. DOI: 10.1136/bmjopen-2018-027301
• Singh, G., Owens, J., & Cribb, A. (2018). Practising ‘social paediatrics’: what do the social determinants of child health mean for professionalism and practice? Paediatrics and Child Health (United Kingdom). DOI: 10.1016/j.paed.2017.12.003
• Wright J, McEachan R, Mathai M. Why is the Born in Bradford cohort study important for child health? Archives of Disease in Childhood Published Online First: 12 March 2021. DOI: 10.1136/archdischild-2020-321231

This page was created with the support of the Born in Bradford executive team and members of the QI Central Editorial Team and Wellbeing and Health Action Movement community; Dr Emma Sunderland, Dr Irnthu Premadeva, Dr Guddi Singh, Dr Helen Leveret, Dr Morven Davies and Dr Heba Abdelbari.