The role of socioeconomic determinants in children’s health

Abstract

After many years of being portrayed as a major achievement of the health service, child health in Portugal has recently come under scrutiny after an increase in infant deaths. Commentators have pointed to unequal access to healthcare and poorly monitored pregnancies of migrant mothers as possible causes. In this context, we revisit the socioeconomic determinants of children’s health, reflecting on how various factors such as parental income and education, immigration, ethnicity, and social policies exert their influence on child health. Socioeconomic determinants have long been recognised, but their importance is often overlooked in the field of child health. The authors discuss theoretical approaches such as the worlds of influence framework proposed by UNICEF and consider various pathways through which socioeconomic determinants shape children’s health, namely, the so-called material, psychological, behavioural, and structural pathways. The authors then move on to consider the empirical literature, drawing attention to factors such as life course, socioeconomic disadvantage, deprived neighbourhoods, poverty and income, household and family characteristics, parental education, ethnic diversity, and immigration. Finally, policy implications are considered, with the authors arguing that a multisectoral and coordinated approach, embracing both social and public health interventions, is required. Guaranteeing universal access to services that promote healthy early child development – including early childcare and education and efforts to reduce childhood poverty – is central to promoting equity. Classic public health policies, such as health surveillance and prevention programs, especially targeted at the preconception period, gestation, and childhood, are also important. In geographical areas with a strong immigrant presence, specific programs designed to facilitate integration should be available. If we are to improve child health and make sure that none are left behind, we need to focus attention on a broad range of socioeconomic determinants.