Almost 20 years ago, physician Dr Michael Gliksman was involved in research suggesting that socioeconomic disadvantage during childhood can have lifelong health consequences.
Since then, a variety of studies have helped unpick some of the factors involved, and he says the implications for policy are now clear:
“The evidence supports the view that income support to lift all but especially children above realistic poverty levels and well-funded public education and health programs are essential.
In the Australian context this means equal health care access, school funding based on actual student need, the NDIS, and income support sufficient to ensure no child lives in poverty.”
If health ever surfaces as a federal election issue, Croakey wonders if these issues will be at the front of the queue?
Perhaps we will even spare a thought for the future health of those 28 babies who were born in immigration detention between 3 October 2009 and 26 May 2011 (as per documents obtained under FOI by Detention Logs).
Perhaps – now here’s a wild and crazy thought – our political leaders will be asked about their commitment to implementing a Health in All Policies approach….
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Addressing the evidence on childhood deprivation and health
Michael Gliksman (@MGliksmanMDPhD) writes:
Almost two decades ago some of us at the Harvard Medical School’s Channing Laboratory, home of the Nurses Health Study, sought to examine the link between childhood deprivation and risk of later life disease.
It was known that the relative socioeconomic status of adults is a determinant of health outcomes, including cardiovascular disease (CVD).
Could childhood socioeconomic status (SES) affect later life incidence of CVD? Can adult experience mitigate the association, if any? Until our study results were in, no-one knew.
My research group found individuals who grew up in manual (as compared to non-manual) households were at increased risk of developing CVD in adulthood, independent of the individual’s own attained SES.
How do social determinants of health reach across a lifetime of potentially levelling environmental factors?
We threw every risk factor known to affect CVD risk into our multivariate analysis. Nothing made the association go away. They barely diminished it.
We had found an independent variable (or its proxy) that did not work through differences in known CVD risk factors (including blood glucose, blood pressure, smoking, or blood fats).
What were the biological mechanisms at work? We didn’t know.
Medical knowledge has progressed since then. We now know ill health is a major cause of downward occupational mobility as well as a constraint on upward social mobility.
A child from a family in the top income quartile is 10 times more likely to have received a bachelor’s degree by age 24 than one from the bottom quartile.
Manual employment is associated with increased hazardous exposures and risk of physical injury, and is more likely to be associated with a poorer psychosocial work environment.
Higher incomes are also associated with healthier behaviours and access to health resources.
It is reasonable to conclude that the association between income, education and health status is likely to be causal. We now know that early life environment affects lifetime health through epigenetics – changes in gene expression caused by mechanisms other than change in DNA sequence.
It is not clear yet whether these changes are inheritable but if they are, the adverse health effects of childhood deprivation will likely prove inheritable too.
What can we do? Where to from here?
Targeted interventions can provide benefits that can reverse partially the negative health effect of deprivation. The beneficial health and other effects of transfer funding are well-established.
The evidence supports the view that income support to lift all but especially children above realistic poverty levels and well-funded public education and health programs are essential.
In the Australian context this means equal health care access, school funding based on actual student need, the NDIS, and income support sufficient to ensure no child lives in poverty.
The mechanisms of epigenetics indicate these programs need to be sustained over generations, if we wish to make a lasting societal impact on the adverse health effects of income disparity.
The costs to society of not doing so are likely to exceed the cost of effective action, and not just in monetary terms.
Don’t believe me? Just look at the USA.
• Dr Michael Gliksman is a physician and Chair of the AMA(NSW) Professional Issues Committee. The views expressed here are his own. Follow on Twitter at: @MGliksmanMDPhD