Developmental health - overview

1.1 Shaping life course trajectories

A central theme in Developmental Health is social equity. But what does this mean?  Is equity the same as equality? For example, if a policy provides equal education for all, is it necessarily equitable?

Try out the following interact to help you think more about equity and equality.

A multitude of factors, from the macro to the micro levels, contribute to the divergent health trajectories that children experience. A child’s health ecosystem is influenced by social, economic, cultural, and environmental factors that impact healthy development and well-being. These influences start before birth and have an impact throughout an individual’s life and across generations. Exposure to positive influences consistently and longitudinally increases the likelihood of health production, while exposure to negative influences decreases opportunities to be healthy. The timing of these exposures in life also matters—the prenatal to early childhood period is one of the most sensitive times for children to get on the right track to meet their full health potential (National Academies of Sciences, Engineering, and Medicine, 2019, preface).

Social determinants of health

We usually think of things like a nutritious diet, exercise, clean air – all the factors that make up a healthy lifestyle as well as good genes – as being the most important factors in determining our health and life expectancy. Researchers are learning more and more that other aspects of life have major impacts on health. Experiences such as stress, a lack of control over one’s life, prolonged experience of racism, being part of a gender or sexual minority, a person’s citizenship status, culture, or other forms of discrimination or inequities, can have deeply negative effects on health outcomes. On the other hand, a sense of belonging, being loved and nurtured, opportunities for language, upward social mobility (moving to a higher position in society), and access to health care and other services, can positively affect health outcomes, often quite substantially. These are all examples of “social determinants of health” that help shape life course trajectories.

Consider these examples of social determinants of health:

Negative:	Positive:
Stress Lack of control over life Prolonged racism or other discrimination Lack of resources Food insecurity Unemployment Social isolation	Sense of belonging Being loved and nurtured Opportunities for language Supportive community Social equity Educational opportunities Job security Access to health services

Can you think of others to add to the list?

Variables such as poverty, the inequitable distribution of income, unemployment, adverse working conditions, low levels of educational attainment and inadequate housing have a dramatically averse impact on health. If as a society we were to put as much effort and resources into improving these conditions – what are called the social determinants of health – as we do into various forms of bio-medicine, our collective health would improve dramatically” (Silver, MacKinnon, & Fernandez, 2015, p. 1).

In 2008, the World Health Organization (WHO), published Closing the gap in a generation, the final report of the Commission on the Social Determinants of Health, chaired by Sir Michael Marmot. Listen to Sir Michael explain why people who are planning and implementing programs for young children throughout the world should have some understanding of the social determinants of health.

In 2012, Canada joined other WHO members in pledging to take action to address health inequities.  Read about the Health Inequalities Data Tool that supports improved monitoring and reporting.  Explore the website to learn more about the indicators, especially those for infants, children, youth and young adults.  Choose an indicator (e.g., low birth weight) – what does the data indicate in Canada as a whole?  How does this indicator differ across the country (i.e. in each province and territory)?

We know social inequities in early childhood contribute to inequities in health later on, and the conditions to which children are exposed early in life literally ‘sculpt’ the developing brain. We also know children can thrive in many different kinds of environments.

In the next clip, Dr. Maureen Black, at the University of Maryland School of Medicine discusses how ECD programs can be considered an equalizer.

The developmental health perspective is a natural fit with the evidence on the social determinants of health. The social determinants of health and well-being are also the determinants of learning and behaviour. Living circumstances determine early experiences, shape early child development and set patterns for learning, behaviour, health and well-being. People with few resources often have less control over their lives than those with more. Researchers have found that a lack of control over one’s destiny is one of the key causes of chronic stress which in turn leads to negative outcomes such as higher incidents of illness.

In the next video, Dr. Marni Brownell, from the Manitoba Centre for Health Policy at the University of Manitoba, and Dr. David Butler-Jones, former Chief Public Health Officer of Canada, discuss some social factors that impact individual and population health.

Developmental health tells us that all markers of healthy development are interrelated – for individuals and on a population basis. If women are well during pregnancy, and in turn, if babies and children have their physical needs met and are loved and nurtured, and if there are educational opportunities and social equity, the health of the entire population benefits. The following clip shows the beginning of a talk by Dr. Clyde Hertzman called Equity from the Start, about the importance of early childhood as a social determinant of health.

Now read how learning, behaviour and health are affected by the quality of early human development in the section, Learning, behaviour and health, from the Early Years Study 3 (McCain et al., 2011, pp. 40 – 43).

Gradients and the gradient effect

The reading above introduces the concept of socioeconomic status (SES) gradients and explains that the relationship between SES and a variety of developmental health outcomes can be represented as a socioeconomic gradient.

The gradient effect means that there are differences at every point along a line. There are many reasons for different outcomes but in general, the gradients show clearly that the health and well-being of populations are linked to different social settings and how resources are distributed within the population. For example, the poorest mothers have the least literate children and the wealthiest mothers have the most literate children. It is also notable that for every step in between the two extremes, the relationship between maternal poverty and literacy is there. Mothers who are slightly less poor have children with a slightly higher rate of literacy and so on up the scale so that every improvement in SES has an effect on the developmental outcome.

Dr. Martin Guhn is an Assistant Professor in the School of Population and Public Health at the University of British Columbia. In the next video, he elaborates on socioeconomic gradients and discusses using the information to make policy changes to improve outcomes for individuals.

We need to pay attention to these childhood gradients because they tend to set the path of the life course trajectory. In other words, they continue into adulthood.

Try the following activity to help you review your understanding of the gradient effect. This activity depicts the relationship between language scores and parental level of education (a common SES measure) for some Latin American countries.

Note the very high results for Cuba – a resource-poor country but one which has invested heavily in children and families for decades. More information about Cuba’s ECD programs can be found on page 2.4 in this module.

Even though developmental outcomes can be linked to SES, many in the lowest levels of SES still do well in health, education and learning. Listen as Clyde Hertzman describes how supportive families and communities can create environments that foster early child development despite lower socioeconomic circumstances.

Clearly the message from gradients is complex. As you continue with this module, you will learn more about specific factors associated with SES that predict or buffer against vulnerability in children.