Research and commentary

Socio-economic inequalities in childhood and adolescence

History shows that children from under privileged backgrounds used to be underweight but can now be obese or overweight

History shows that children from under privileged backgrounds used to be underweight but can now be obese or overweight

Bann D, Johnson W, Li L, Hardy R (2018) Socioeconomic inequalities in childhood and adolescent body-mass index, weight, and height from 1953 to 2015: an analysis of four longitudinal, observational, British birth cohort studies. Lancet Public Health. 3, e194-203.

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Aim 

To investigate and document changes in socio-economic inequalities in childhood and adolescent body-mass index, weight and height from 1953 to 2015 in Britain.

Method

The data from four British longitudinal, observational, birth cohort studies designed to be nationally representative at the time of their instigation were compared. The studies are the Medical Research Council’s (1946) National Survey of Health and Development, the National Child Development Study (1958), the British Cohort Study (1970), and the Millennium Cohort Study (2001).

Only singleton births were included for the statistical analysis and each child’s body mass index (BMI) was calculated from recorded heights and weights at seven, 11 and 15 years. Each child’s socio-economic position was based on their father’s occupational class unless no father was present in the household, when socio-economic position was based on mother’s occupational class.

Findings

A total of 56,258 singleton births were enrolled across the four cohort studies: 5,362 in 1946, 17,202 in 1958, 17,290 in 1970 and 16,404 in 2001. Children of a lower socio-economic position moved from having the lowest weight to having higher weight than those in higher socio-economic positions. Children of a lower socio-economic position were also found to be shorter in height than those in higher socio-economic positions, although the level of difference decreased over the timespan studied. Children in the 2001 cohort demonstrated socio-economic inequality in BMI across all ages, whereas this was only seen at 15 years of age in the 1970 and 1958 cohort, and not shown at any age in the 1946 cohort.

Conclusion

Longitudinal data from four British birth cohort studies covering 62 years from 1953 demonstrate a switch in socio-economic inequalities in weight, with children from lower socio-economic positions having lower weights in the 1946, 1952 and 1970 cohorts, and then higher weight in the 2001 cohort. Children from all cohorts with a lower socio-economic position were less tall than their higher socio-economically positioned peers. Socio-economic inequalities in BMI were more pronounced and from an earlier age in the 2001 cohort.

Nurses must engage with and contribute to public policy to reduce socio-economic inequalities in children’s health

This study highlights the importance of longitudinal cohort studies, which can document and demonstrate changes over time within defined populations. By combining data from the cohort studies, the authors show there was a significant change in the pattern of socio-economic inequalities in childhood and adolescent body weight and BMI during 1953-2015.

Findings from the 2001 cohort, which show children from lower socio-economic backgrounds were more likely to have higher weight than those from higher socio-economic backgrounds, are reinforced by recent prospective studies. Almost one quarter (22.6%) of children aged 4-5 years and more than one third (34.3%) aged 10-11 whose weights were measured in England as part of the National Child Measurement Programme (NHS Digital 2017) were found to be overweight or obese. In addition, 12.7% of children aged 4-5 years living in the most deprived areas were found to be obese, compared with 5.8% of children in the least deprived areas. For children aged 10-11 these figures rose to 26.3% in the most deprived areas and 11.4% in the least deprived.

Socio-economic inequalities lead to inequalities in health (Marmot et al 2010). In this case, children and young people from lower socio-economic backgrounds are more likely to have a higher body weight and BMI. Obesity increases the risk of developing serious health-related conditions, such as type 2 diabetes, coronary heart disease, stroke and some cancers, and of reducing quality of life.

The healthy, balanced diet described in Public Health England’s (2016) Eatwell Guide is, according to the Food Foundation (Scott et al 2018), unaffordable for many families, a claim that prompted the Guardian headline ‘Four million UK children too poor to have a healthy diet’ (Butler 2018).

It is imperative that health and public policies strive to reduce socio-economic inequalities by adopting the ‘health in all policies’ approach described by Webber et al (2018) to tackle the social determinants of health. The impact of social and economic inequalities on children’s health is also recognised in an All Party Parliamentary Group on Fit and Healthy Children (2018) report, which urges the government to ‘invest now’ to address them. Healthcare professionals should therefore advocate, educate and lobby for change to public policies to improve the health and well-being of all children.

 

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References


About the author

Sarah Tizzard, clinical nurse specialist for children and young people with liver disease, Paediatric Liver Centre, Variety Children’s Hospital at King’s College Hospital on behalf of the RCN’s Research in Child Health community

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