Evidence shows that a quarter of deaths under the age of 1 could be avoided if we had no health inequalities. While child mortality has decreased over the last century, reported ill health among children is rising, with particular increases in respiratory diseases and emotional problems.

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. Factors such as income, housing, family size, employment, age, ethnicity, education, mental health, parenting skills, access to services, and availability of social support impact the quality of children’s early years.

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. 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.

Low birthweight can occur as a result of:

• Poverty
• Underweight or very overweight mother
• Mother under 18 (25% more likely)
• Mother 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

Premature babies born before 37 weeks gestation are at increased risk of disabilities, low birthweight and infant death.

Premature birth more likely to occur when:

• Mother is very underweight
• Mother is under 18
• Mother is of Afro-Caribbean or African origin
• Baby is exposed to smoking in the womb

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 (5 times more likely than the most affluent)
• They are under 20 (6 times more likely than mothers over 34)

Diet during pregnancy

Inadequate diet during pregnancy is one of the main causes of low birthweight, and can permanently alter the baby’s blood pressure and metabolism, increasing his or her long term risk of heart disease. Foods that are cheap but lacking in essential nutrients constitute an unhealthy diet.

Inadequate diet during pregnancy factors:

• Poverty
• Young age of mother

Infant death

Factors increasing the chance of babies dying before the age of 1:

• Poverty
• Mother under 18 (infant death is 60% more common for babies of young mothers)
• 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

Breastfeeding

Babies who are not breastfed are at increased risk of diarrhoea and vomiting, chest and ear infections, cognitive delay, and obesity and type 2 diabetes in later life.

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 3, 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.