Evidence shows that a quarter of deaths under the age of one could be avoided if we had no health inequalities. While mortality has markedly decreased over the last century, reported ill health among children is rising, with particular increases in respiratory diseases and emotional problems.

“Giving every child the best start in life is crucial to reducing health inequalities across the life course. The foundations for virtually every aspect of human development – physical, intellectual and emotional – are laid in early childhood. What happens during these early years (starting in the womb) has lifelong effects on many aspects of health and well-being: from obesity, heart disease and mental health, to educational achievement and economic status.” The Marmot Review Fair Society, Healthy Lives (2010)

The phrase ‘child health inequalities’ describes this difference in positive outcomes between babies born with every chance of a healthy life, and babies whose life chances have already been damaged during their mother’s pregnancy or are altered by their parents’ socio-economic circumstances and decisions in the early years. These health inequalities stem from wider inequalities in society that influence the health of parents, families and communities: factors such as income, housing, family size, employment, age, ethnicity, education, mental health, parenting skills, access to services, and availability of social support.

The Marmot Review Fair Society, Healthy Lives (2010)

Findings from the Marmot Review (2010) showed that children from the poorest backgrounds are nearly twice as likely to have conduct problems and hyperactivity, as well as nearly half the vocabulary ability of those from the richest backgrounds. Even at 22 months old, evidence shows there are significant differences in the educational performance of children from different social groups.

Inequalities begin before birth:

“Development begins before birth when the health of a baby is crucially affected by the health and well-being of their mother... the literature on ‘foetal programming’ demonstrates that ... when human foetuses have to adapt to a limited supply of nutrients, they permanently change their structure and metabolism. These ‘programmed’ changes may be the origins of a number of diseases in later life, including coronary heart disease and the related disorders of stroke, diabetes and hypertension... maternal health, including stress, diet, drug, alcohol and tobacco use during pregnancy, has significant influence on foetal and early brain development.”  The Marmot Review Fair Society, Healthy Lives (2010)

Low birthweight

Babies born weighing less than 2.5 kg are classified as having a low birthweight, and are at increased risk of infant death, of physical and learning disabilities, cognitive delay, and future ill health including heart disease. Babies are more likely to have a low birthweight if:

  • they are poor
  • their mother is very underweight or very overweight
  • their mother is under 18 (25% more likely)
  • their mother was born in Bangladesh (twice the risk compared with UK-born mothers), Pakistan (70% more likely), India (50% more likely), East Africa or the Caribbean.

Premature birth

Babies born before 37 weeks gestation are classified as premature, and these babies are at increased risk of disabilities, low birthweight and infant death. Babies are more likely to be born prematurely if:

  • their mother is very underweight
  • their mother is  under 18
  • their mother is of Afro-Caribbean or African origin.

Exposure to smoking

Babies whose mothers smoke during pregnancy are at increased risk premature birth, low birthweight, and infant death. Mothers are more likely to smoke throughout pregnancy if:

  • they are poor (five times more likely than the most affluent)
  • they are under 20 (six times more likely than mothers over 34).

Diet during pregnancy

Inadequate diet during pregnancy is one of the main causes of low birthweight, and it can permanently alter the baby’s blood pressure and metabolism, increasing his or her long term risk of heart disease. Mothers are more likely to have an inadequate diet during pregnancy, based on foods that are cheap but lacking in essential nutrients, if:

  • they are poor
  • they are young

Inequalities continue in the early years:

Infant death

Babies are more likely to die before reaching the age of one if:

  • they are poor (infant death is twice as common for the poorest families compared with the most affluent)
  • their mother is under 18 (infant death is 60% more common for babies of young mothers)
  • their mother was  born in Pakistan or the Caribbean (infant death is twice as common for these families compared with mothers born in the UK), most of Africa or Bangladesh.


Babies who are not breastfed are at increased risk of diarrhoea and vomiting, chest and ear infections, cognitive delay, and in later life obesity and type 2 diabetes. Mothers are least likely to breastfeed if:

  • they are poor (20% less likely than the most affluent mothers)
  • they are under 20 (one-third less likely than mothers over 34)

Social and emotional skills

The early years are a key period for developing essential social and emotional skills such as empathy, trust, application and self-control. One important factor affecting the development of these skills is the mother’s mental health: postnatal depression undermines a mother’s ability to interact with her baby responsively, so that the baby is significantly less likely to form a secure attachment, and the child is more likely to have conduct and hyperactivity problems by school age. Children are much more likely have behavioural problems if they are poor, and mothers are three times more likely to suffer from postnatal depression if they are poor or under 18.

Cognitive development

Cognitive development begins before birth, and the first year of life is critical for the developing brain. By the age of three, children from the poorest backgrounds have a much smaller vocabulary than children from the most affluent backgrounds, and are less likely to be read to every day.