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University of Toronto Scarborough
Health Studies
Rhan- Ju Song

HLTC05: Social Determinants of Health Lecture 11 –Inequality and Childhood (Cohen et al. 2010, WHO 2008, Chapter 5, WHO 2010, Chapter 4) Tuesday, November 20, 2012  Children the most sensitive to change Inequality in Childhood  Inequalities also exist among and between children  Like adults, these inequalities broadly reflect the class, race, and gender divisions inherent in their societies (structural violence)  In some nations, these inequalities can be lessened among children o (E.g., social services provided by government protect children and ensure more universal access to health care, education, etc.)  In others, these inequalities can be intensified (widespread poverty, lack of social services, etc.) o Resources more allocated towards parents Image  Results from the UN  Child poverty is a huge concern globally o Occurs in the most developed nations o 13% of children in Canada deal with child poverty, whereas the US child poverty is 23.1% Global Under 5 Mortality in 2008 (WHO, 2011)  At the age of 5children are the most vulnerable o Lack of nutrients due to problems in feeding o Many die due to neonatal deaths Reflection of Mothers with Poverty  Survival and development of all children, male or female, is strongly related to the position of women o Often children go with mothers, but they have better SES with fathers Inequality Affects these 3 Areas 1) Growth and Development 2) Psychosocial development and living environment 3) Long-term consequences: adult morbidity/mortality Childhood Requirements  Prenatal health: maternal health, nutrition, SES  Successful, low stress, childbirth  Post-natal nutrition, health care  Infant/child/juvenile/adolescent nutrition  Access to health resources: immunizations, medicine, etc.  Family/kin social resources: care, support, education and socialization  Safe, healthy home environments: adequate shelter, hygiene, sanitation, water, protection from elements, adequate space, free from pests and pollutants/toxic materials (air, water, solids), basic amenities, play/educational resources  Community resources: schools/formal education, recreation, park land, health clinics, religious institutions, etc. Child Growth and Development (diagram)  Most significant phases: o Infancy-somatic cell development, brain growth & development  Nutritional support o Adolescent  Body goes through puberty Fine tuning of the brain development Diagram  Height and stature in terms o f growth and development Diagram  Age and high velocity among rural India, Ladino, African, and Mayans  Ladino had a normal growth pattern in terms of when it happens (more advantages)  Other groups are disadvantaged where growth occurs at later age Image  3 girls, same age, but different heights o Wealth-health gradient ranges, SES, etc. that affect the biology of their stature Dental Development and Eruption  Established patterns of dental growth  Age at death of kids based on their bones and teeth o Period of great morbidity & mortality (to age 5), malnutrition-infection o Hard tissue evidence: Enamel Hypoplasia (generalized stress)  Used for archaeological purposes  Inefficient enamel due to any stressors of nutrition or infectious diseases Developmental “Milestones” 1) Social and emotional development 2) Language and communication 3) Cognitive (learning, thinking, problem-solving) 4) Physical development and movement (motor skills) Human Brain Growth and Function  Newborn uses 87% of its resting metabolic rate (RMR) (body energy expenditure during rest) for brain growth and function  Under 5yrs: 44-85% RMR  By 5 years: 44% of RMR for brain growth/function  Adult human: 16-25% of RMR for brain function Nutrition, Poverty, and Intellectual Performance (Pollitt and Brown, 1996)  Effects of poverty and malnutrition: the Guatemalan study  Nutritional supplementation (adequate nutrition) as “social equalizer” but also important: child’s social environment esp. poverty level o How significant protein plays a role in cognitive development, resulted in higher vocabulary scores o Protein atole supplement helped equalize SES SES and Intellectual Development  Strong and persistent connection between SES (e.g., education, occupation, income) and childhood cognitive ability and achievement, as measured by IQ, achievement test scores, and functional literacy o Crowding, Lack of resources, kids don’t show up, they don’t have school Malnutrition and Intellectual Development (Brown and Pollitt, 1996)  Earlier assumptions: o Poor nutrition is primarily an issue up to 2 yrs of age (when brain = 80% adult size) o Poor nutrition up to age 2 yrs hinders normal brain development, resulting in severe, lasting damage  Current Understanding: o With improvement in diet and health after 2 yrs, brain may exhibit “catch-up” growth (damage is not irreversible) o Brain growth can continue to be compromised by under-nutrition after 2 yrs o Intellectual impairment can result from more moderate malnutrition (micronutrients)  THUS: importance of nutrition throughout childhood Diagram  Atole supplement = high protein  Fresco supplement = no protein, sugar INCAP Study  Nutritional supplementation (adequate nutrition) as “social equalizer” but also important: child’s social environment esp. poverty level o How significant protein plays a role in cognitive development, resulted in higher vocabulary scores o Protein atole supplement helped equalize SES Consequences of Infant & Childhood Malnutrition  Poor physical and mental development (intellectual and psychological development)  Poorer school performance  More susceptible to effects of infection  More severe diarrheal episodes  Higher risk of pneumonia  Lower functioning immune systems  Lower levels of iodine, iron, protein and energy  More chronic illness  Increased mortality rate Poverty, Child Health, and Behaviour  Besides growth and development, dietary quality affects: o Socialization / interaction o Behaviour o Verbalization Child Health and Social Environment The Psychosocial Environment of Childhood Poverty  Violence (family, neighbourhood, school)  Family disruption and separation (foster c
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