Social Inequality in Population Developmental Health: An Equity and Justice Issue

Inequality and child health: dynamic population health interventions

PURPOSE OF REVIEW

Established social gradients across a wide range of child health issues including obesity, anxiety, infectious diseases, injuries, prematurity and low birth weight suggest that much illness is avoidable and there is an imperative to intervene in this whole of society issue. This review examines recent advances in understanding of the pathways to health and health inequalities and their application to interventions to improve health equity.

RECENT FINDINGS

Children's health develops over the life course in ways that are profoundly influenced by their entire developmental ecosystem including individual, family, community and system-level factors. Interventions to address child health inequalities must include action on the structural determinants of health, a greater focus on family and community health development, and attention to the acquisition of developmental capabilities. Nascent dynamic population health initiatives that address whole developmental ecosystems such as All Children Thrive, Better Start Bradford and Generation V, hold real promise for achieving child health equity.

SUMMARY

Pathways to health inequalities are driven by social and structural determinants of health. Interventions to address inequalities need to be driven less by older biomedical models, and more by prevailing ecological and complex systems models incorporating a life course health development approach.

Socioeconomic health disparities in pediatric traumatic brain injury on a national level

OBJECTIVE

Low socioeconomic status is a determinant of pediatric traumatic brain injury (TBI) incidence and severity. In this study, the authors used National (Nationwide) Inpatient Sample (NIS) data to evaluate socioeconomic and health disparities among children hospitalized after TBI.

METHODS

This retrospective study identified pediatric patients aged 0 to 19 years with ICD-9 codes for TBI in the NIS database from 2012 to 2015. Socioeconomic variables included race, sex, age, census region, and median income of the patient residential zip code. Outcomes included mechanism of injury, hospital length of stay (LOS), cost, disposition at discharge, death, and inpatient complications. Multivariate linear regressions in log scale were built for LOS and cost. Logistic regressions were built for death, disposition, and inpatient complications.

RESULTS

African American, Hispanic, and Native American patients experienced longer LOSs (β 0.06, p < 0.001; β 0.03, p = 0.03; β 0.13, p = 0.02, respectively) and increased inpatient costs (β 0.13, p < 0.001; β 0.09, p < 0.001; β 0.14, p = 0.03, respectively). Females showed increased rates of medical complications (OR 1.57, p < 0.001), LOS (β 0.025, p = 0.02), and inpatient costs (p = 0.04). Children aged 15 to 19 years were less likely to be discharged home (OR 3.99, p < 0.001), had increased mortality (OR 1.32, p = 0.03) and medical complications (OR 1.84, p < 0.001), and generated increased costs (p < 0.001).

CONCLUSIONS

The study results have demonstrated that racial minorities, females, older children, and children in lower socioeconomic groups were at increased risk of poor outcomes following TBI, including increased LOS, medical complications, mortality, inpatient costs, and worse hospital disposition. Public education and targeted funding for these groups will ensure that all children have equal opportunity for optimal clinical outcomes following TBI.

Connecting knowledge with action for health equity: a critical interpretive synthesis of promising practices

Connecting knowledge with action (KWA) for health equity involves interventions that can redistribute power and resources at local, national, and global levels. Although there is ample and compelling evidence on the nature, distribution, and impact of health inequities, advancing health equity is inhibited by policy arenas shaped by colonial legacies and neoliberal ideology. Effective progress toward health equity requires attention to evidence that can promote the kind of socio-political restructuring needed to address root causes of health inequities. In this critical interpretive synthesis, results of a recent scoping review were broadened to identify evidence-informed promising practices for KWA for health equity. Following screening procedures, 10 literature reviews and 22 research studies were included in the synthesis. Analysis involved repeated readings of these 32 articles to extract descriptive data, assess clarity and quality, and identify promising practices. Four distinct kinds of promising practices for connecting KWA for health equity were identified and included: ways of structuring systems, ways of working together, and ways of doing research and ways of doing knowledge translation. Our synthesis reveals that advancing health equity requires greater awareness, dialogue, and action that aligns with the what is known about the causes of health inequities. By critically reflecting on dominant discourses and assumptions, and mobilizing political will from a more informed and transparent democratic exercise, knowledge to action for health equity can be achieved.