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All things being unequal…

Posted in Uncategorized by saraburke on October 23, 2014

From the Medical Independent on 23 October 2014
One-in-six (more than 11,000) of all Irish three-year-olds have a long-standing health condition. These are the key findings from a new report from the Institute of Public Health in Ireland, which draws on the rich data in the Growing Up in Ireland cohort study.Growing Up in Ireland asked children’s carers about whether their child has a long-standing illness or disability, asthma (or its symptoms), eczema (or any skin allergy), sight or hearing problems that required correction. According to their primary carer, 22 per cent of three-year-olds have more than one of these conditions. There are strong gender and social class influences in the findings and interesting differences linking the child’s circumstances to each condition.

Children whose parents are ill are 100 per cent more likely to have a long-standing illness, condition or disability. Boys and those from the lowest social classes are twice as likely as girls and those in other higher social classes to have these conditions.

Children who were low birth weight babies were 70 per cent more likely to have sight problems, while those whose mothers smoked during pregnancy were 50 per cent more likely than other children to have sight problems. Both low birth weight and smoking during pregnancy are very strongly linked to social class, with much higher likelihood of both among poorer women.

Asthma and asthma conditions were much more likely in children who also had an allergy, whose primary carer is ill and in one-parent households. Both eczema and hearing problems were much more likely among boys than girls. Children with hearing problems were more likely to have parents with private health insurance coverage.

Interestingly, children with hearing problems were more likely to have parents with private health insurance coverage. Whether this reflects better diagnosis among this cohort or higher rates among better-off children is not clear. However findings from similar studies in the UK have also found higher rates of hearing problems among children from higher socio-economic groups.

Despite this anomaly of more hearing problems among better-off children, the majority of the findings link the higher prevalence of longstanding health conditions among children from lower socio-economic groups. This mirrors previous work by the Institute of Public Health.

Children from a lower socio-economic class are more likely to have a parent with an illness or disability, be in a household where no-one works and where there is just one parent. The report situates the findings in the broader policy arena, in particular Healthy Ireland — A Framework for Improved Health and Well-Being 2013-2025 and Better Outcomes, Brighter Futures — the National Policy Framework for Children and Young People.

Unfortunately, the report fails to tie its important findings to specific policy actions which might prevent such high prevalence of long-standing conditions among children. The report does not explain why some circumstances are more likely to impact for some conditions and not for others. Obviously, some characteristic such as a child’s sex cannot be ameliorated by public policy but others, such as poverty, can be.

The report says the findings “emphasise the need to increase our efforts to tackle these inequalities and to give all children a fair chance of health and wellbeing”. But what exactly does it mean by that? Should the Government pursue a more equal distribution of income and wealth and if so, how? And how exactly should public policy intervene to give all children a ‘fair chance’? Should there be an extra year or two of State funded childcare, better investment in community projects and schools in more disadvantaged areas?

The report recognises the “important part of supporting parents and families,” especially those whose primary carer has a long-standing condition, one-parent families and households with lower social class, but again fails to suggest how.
Recent data from Eurostat shows that in 2008 in Ireland, 9.3 per cent of households had difficulty making ends meet and that this nearly doubled to 17.4 per cent in 2012. Yet there is not one mention of poverty in this report.

It would be great if the Growing Up in Ireland data could be used to show trends over time. Are there more children now with long-standing conditions than there were pre-crisis? And given the richness of the data in this report and the remit of the Institute to reduce health inequalities, it would be really welcome to get some hard hitting public policy recommendations that could really contribute to better child health in Ireland.

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