Socioeconomic inequalities exist for almost every health outcome. Designing interventions and policies to reduce inequalities for specific health outcomes may be less efficient, and current evidence how this should be done is scarce. Our project assumes that health inequalities across the life-course in many specific outcomes can be prevented more efficiently if every child reaches its full potential in terms of cognitive and social-emotional development. This will increase the likelihood of entering the highest possible secondary school types, and makes children least vulnerable to engagement in unhealthy behaviours at a time in life when they increasingly make their own health choices, e.g. in adolescence. Children of parents from lower socioeconomic groups are more often exposed to unfavourable family, neighbourhood, school and peers-related circumstances. To the extent that these circumstances affect cognitive and social-emotional development and school performance, socioeconomic inequalities in health develop that may be difficult to reduce at later stages in life.
Improving early child development and education is WHO’s main strategy for reducing health inequalities. Yet, there is a paucity of evidence about the mechanisms through which determinants at different levels contribute to inequalities in cognitive and social-emotional development and school performance and the impact the latter have on socioeconomic inequalities in health in later life. The reasons for this paucity of evidence include (1) child health and development are often studied as outcomes, whereas a true life-course perspective should also consider them as determinants of educational achievement, (2) few longitudinal studies cover the prenatal to adolescent period with detailed child development and environmental data, and (3) use the data with an explicit focus on equity.
Our overall aim is to improve the understanding of the complex factors and mechanisms that explain the intergenerational transmission of health inequalities. We will examine factors at multiple levels, including conditions at the family, neigbourhood, school and peers-level, which in turn are embedded in multiple societal sectors (environment, social works, education, economy, health).
Major innovations of our study include the use of “health assets” as developmental outcome at the age of 12 years, e.g. a set of education and social-emotional and cognitive development related outcomes needed to live healthily later in life, to reach the highest levels of education, to maximise the change of upward social mobility, and to prevent downward social mobility. We will also study underlying trajectories of the development of socioeconomic inequalities in child development, and investigate the underlying multilevel determinants of both health assets and underlying trajectories as key components of the intergenerational transfer of health inequalities. Finally, we investigate the role of health assets for socioeconomic inequalities at the age of 15 years.
Data for this project come from two large cohorts (the Generation R Study in Rotterdam, and the Happy Children, Happy Adolescents study). Whereas Generation R allows to study the multilevel determinants of child health inequalities from the prenatal period to 15 years of age, the HCHA study allows more detailed study of the role of these multilevel determinants in child development trajectories. Both cohort studies are already enriched with school-characteristics (e.g. the composition measures) and school performance tracking data (“CITO-scores”). We will add objectively assessed neighbourhood demographic data, geographic information system (GIS)-based physical neighbourhood characteristics and neighbourhood social characteristics from external surveys. Advanced statistical methods (e.g. causal mediation analysis, latent class growth modelling) will allow us to maximise causal inference from observational data, and to translate the study findings into policy-relevant recommendations to prevent inequalities in child developme