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Lecture 9

HLTC05 Lecture 9.doc

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Lecture 9 06/12/2012 22:50:00 Inequality and Childhood • Inequalities also exist among and between children • 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 (e.g., social services provided by gov`t 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.) ← ← UN 2012 ← ← Global Under 5 Mortality in 2008 (WHO 2011) Survival and development of all children, male or female, is strongly related ← to the position of women ← ← 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 ← •Period of great morbidity & mortality (to age 5), malnutrition- infection ← •Hard tissue evidence: Enamel Hypoplasia (generalized stress) • horizontal band across teeth occurs when children are undernourished, chronic stress affects their dental development ← ← 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 • Guatemalan study, changed the perpective of how we think of interventions, what we need to do with supplementation • SES of the parents, and social living environemtns of these kids plays a significant role of the IQ ← ← 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 ← ← Malnutrition and Intellectual Development ← Brown and Pollitt 1996 ← Earlier assumptions: ← 1.Poor nutrition is primarily an issue up to 2 yrs of age (when brain = 80% adult size) ← 2.Poor nutrition up to age 2 yrs hinders normal brain development, resulting in severe, lasting damage ← ← Malnutrition and Intellectual Development ← Current Understanding: ← 1.With improvement in diet and health after 2 yrs, brain may exhibit “catch-up” growth (damage is not irreversible) ← 2.Brain growth can continue to be compromised by undernutrition after 2 yrs ← 3.Intellectual impairment can result from more moderate malnutrition (micronutrients) THUS: importance of nutrition throughout childhood ← ← Pollitt and Brown 1996 ← 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 ← ← 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: Socialization / interaction Behaviour Verbalization ← ← Child Health and Social Environment ← ← The Psychosocial Environment of Childhood Poverty ← •Violence (family, neighbourhood, school) ← •Family disruption and separation (foster care) ← •Smaller social networks ← •Fewer organizational involvements ← •Less contact with social network members/support systems (often due to perception of lack of social support) ← •Less parental involvement in school activities, homework ← •More issues with teacher quality, poor school infrastructure, school crowding and reduced per child spending ← •Higher ratio of kids to less engaged caregivers ← •More changes in residence, childcare, schools ← ← Home Environments ← Low-income families live in homes more likely to have: ← •more people / overcrowding ← •poor air and water quality ← •more contaminants: lead, pesticides, radon ← •houses w/structura
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