© 1997 Faculty of Public Health Medicine of the Royal Colleges of Physicians of the United Kingdom
research-article |
The impact of social inequalities in child health on health visitors' work
Richard Reading, Consultant Community Paediatrician, Norwich Community Health Partnership NHS Trust, and Honorary Lecturer in Child Health
Christine Allen, Community Information Project Manager
Department of Community Paediatrics, Jenny Lind Department Norfolk and Norwich Hospital, Brunswick Road, Norwich NR1 3SR
Norwich Community Health Partnership NHS Trust Norwich
Address correspondence to Dr Reading
BACKGROUND: Preventive and health promotion work by health visitors ought to reduce social inequalities in child health. However, the increased health and developmental problems among disadvantaged children may constrain health visitors' ability to carry out effective preventive work. This paper measures the impact of socioeconomic inequalities in children's health on the work of health visitors and the amount of preventive work they can provide, with emphasis on ‘parenting’ programmes.
METHODS: Data collected for health visitors' profiles wereanalysed in an ecological cross-sectional study. Individualcaseloads were classified according to the proportions offamilies in social class IV or V and families headed by anunemployed person. A range of measures of young children's health and development indicated the demands on health visitors' time. Preventive work was divided into postnatal support, parenting programmes, special clinics andother preventive work.
RESULTS: All the outcome measures were poorer in the mostdisadvantaged caseloads. Odds ratios between the most andleast disadvantaged 20 per cent of caseloads were 0.6 for breast feeding at birth, and at seven months, 1.9 for postnatal depression, 3.2 for mothers under 18, 10 for lone parentfamilies, 2.6 for families needing high intervention, 4.5 for families with a smoker, 11 for domestic violence, 4.4 for parents with a chronic health problem, 2.7 for children on the child protection register and 2.8 for children with developmental problems. There was 30 per cent greater health visitortime provided in the most disadvantaged caseloads than inthe most advantaged. There was no consistent difference in the amount of preventive work carried out; in particular, parenting programmes were delivered at a similar rate in all caseloads.
CONCLUSIONS: Large differences in demands on health visitors' time exist between affluent and disadvantaged caseloads which are barely reflected in the provision of extra time topoorer caseloads. There is no consistent pattern to the delivery of preventive programmes designed to ameliorate the effects of disadvantage on children's health and development.
Keywords: community profiling, health inequalities, child health, parenting programmes
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  M. BLAIR Public health: The need for and the role of a coordinator in child health surveillance/promotion Arch. Dis. Child., January 1, 2001; 84(1): 1 - 5. [Full Text] [PDF]
|
|