five - Inequalities in pregnancy and early years and the impact across the life course: progress and future challenges

Summary

Introduction

Pregnancy and early childhood are particularly vulnerable stages in the life course at which adverse socioeconomic circumstances have lasting effects. Inequalities at this early stage of life have been shown to impact on adult health (Hertzman et al, 2001; Jefferis et al, 2002; Spencer, 2003) but they are also themselves the result of intergenerational inequalities (Spencer, 2004; Kahn et al, 2005). For infants surviving the first year of life, the effects of adverse pregnancy outcomes track into early childhood to contribute to inequalities in early childhood health (Pharoah et al, 1994; Jefferis et al, 2002) and form the early components of pathways that lead to health inequalities in adult life (Bartley et al, 1994; Power and Hertzman, 1999; Hertzman et al, 2001).

The Acheson Inquiry (Acheson, 1998) recognised the importance of health inequalities in pregnancy and early childhood both for infants and children themselves and for future adults, stating:

We take the view that, while there are many potentially beneficial interventions to reduce inequalities in health in adults of working age and older people, many of those with the best chance of reducing future inequalities in mental and physical health relate to parents, particularly present and future mothers, and children. (p 9)

As the above quote suggests, reducing health inequalities at this critical point is vital to disrupting the intergenerational and individual life-course pathways that generate and sustain health inequalities across the life course. The New Labour government accepted the conclusions of the Acheson Inquiry and set in place policies to tackle inequalities (DH, 2003). For the first time, a UK government gave priority to reduction of health inequalities, instituting policies across government departments. The government also made improving the lives of children an explicit priority, exemplified by the Prime Minister's pledge to eliminate child poverty by 2020 (Blair, 1999).

This chapter aims to examine progress towards the goal of reducing pregnancy and early childhood inequalities since 1997 and outline future challenges. The chapter starts with a brief summary of inequalities in pregnancy and early childhood health, and inequalities in health determinants and their respective trends. We also consider the impact of the socioeconomic environment in childhood on health outcomes in later life. Policy initiatives since 1997 aimed at reducing these inequalities are outlined, along with an examination of the evidence for their effectiveness.