Pearce, A.; (2011) Will policies in the early years reduce inequalities in health? A synthesis to inform policy. Doctoral thesis , UCL (University College London).

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Abstract

This thesis aims to examine whether government policies in the early years are likely to influence health inequalities, using information derived from a range of sources to contribute to the 'jigsaw of evidence', and focussing on two case studies featuring high on the Labour government agenda: the first a measure of health (unintentional injury) and the second a policy (childcare). Scoping reviews were used to map areas requiring further research for each case study. A review of policy documents helped set the policy context, and secondary datasets were utilised to describe prevalence, trends and inequalities. Following this some of the less researched associations identified in the scoping reviews were explored, using data from the Millennium Cohort Study (MCS). An analysis investigating whether the home environment lay on the causal pathway between socio-economic circumstances (SECs) and unintentional injuries found that controlling for a number of proxy measures for housing quality and safety equipment use did not alter the social gradient in injuries occurring in the home. A second analysis exploring a measure of main childcare use in relation to injuries found that infants (aged 9 months) from more advantaged SECs were less likely to have been unintentionally injured (anywhere) since birth if they were looked after in formal childcare (compared to those looked after only by a parent). In contrast, those from less advantaged SECs appeared to be at greater risk of injury. Informal childcare was associated with an increased risk of injury between 9 months and 3 years, overall and in less advantaged SECs. Two further analyses explored breastfeeding and overweight in relation to childcare use. Informal and formal childcare were both associated with a reduced likelihood of breastfeeding, and whilst this remained the case for informal childcare across all social groups, for formal childcare the reduced likelihood of breastfeeding was only observed in those from more advantaged groups. Children who were looked after in informal childcare appeared to be more likely to be overweight at 3 years than those only looked after by a parent, particularly if they were from more advantaged SECs. These results were then synthesised in light of current and potential policy. The analyses were conducted with observational data and using proxy measures for the home environment and main childcare use, therefore further research is required. Findings imply that improvements to the home environment may not necessarily influence inequalities in injuries (although are likely to benefit other areas of health and wellbeing). Main childcare type appeared to be associated with better health outcomes for some social groups but not for others; further research is required to ascertain how these benefits can be recognised for all groups, for example through improved training and guidance for childcare professionals. This thesis demonstrates the use of epidemiological information for contributing to the 'jigsaw of evidence', but also the complexities of considering policy impacts on health inequalities.

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