Lynch & Kaplan (1997) defined children health as the extent to which children are enabled or are able to undergo development and realization of their potential, satisfy their needs, and capacity build themselves for them to successfully interact with the social, physical and biological environments. Furthermore, the health of children encompasses social, emotional, mental and physical wellbeing of children. The health disparities between populations or groups are called health inequalities (Argyle 1994). By getting to understand how economic, social and environmental conditions affect our behavior and our lifestyles, and in turn understanding how they affect our health, we can try to find out means of reducing the inequalities in health, as well as improving the well being and health of the overall population. Inequality in health care provision is a major influence on the children’s health. The paper will give a discussion on psychiatric disorders as a health issue, and further discuss on how inequality in provision may affect on the child and family wellbeing.
According to Freeman & Stansfeld (2008), economic distress has large effects on indicators of health. Various explanations have been proposed to explain the health inequalities. The explanations can be classified into four categories; theory of social or natural selection, artifacts explanations, behavioral and cultural explanations and structuralism or materialist explanations.
Great Britain (2003) pointed out that the artifacts theory gives a suggestion that both health and class are artificial variable, and the existing relationship between them itself may be an artifact. The belief is that failure to reduce the difference between them, has been due to counterbalancing by the reduction in the size of the socio-economic groups themselves.
On the other hand Duncan & Brooks-Gunn (1997) suggested that the theory of social or natural selection gives a relegation to the occupational class to the dependent variable status, and health gets the greater causal significance degree. This explanation according to Duncan & Brooks-Gunn (1997) suggested that the social class one has the lowest premature mortality rate, because it consists of most robust and strongest women and men in the society, and social class five contains the weakest people. The explanation portrays the idea that poor health is associated with low economic reward of low social worth. However, all these factors do not result in high mortality.
The structuralists and the materialist explanations put more emphasis on economic role and the socio-structural associated factors in the health distribution. Meltzer (2000) observed that it is difficult to explain the premature mortality prevalent in lower socio- economic groups to subsistence poverty. Social class and the associated characteristics that belong to that class have implications of health. Because poverty is a concept that is relative, people categorized under low economic class may be disadvantage relatively in relation to the accident or illness risk, or to the factors that does promotion of healthy lifestyle.
The behavioral or cultural explanations of the health distribution as elaborated by Gunnell et al (2013), suggested that the result of lifestyles that are in cautious is due to unequal distribution of health in modern industrial society, where in people harm their children or themselves by their consumption of refined food and harmful commodities in excess. Furthermore, they under utilize the contraception and the preventive health care.
Hollingshead & Redlich (1998) implied that there exist sub cultural lifestyles that are rooted in level of education and personal characteristics that govern behavior. The culture of poverty as viewed by Holman (1978), states that the existence of any human in any environment involves social and biological adaptation process which gives rise to structure of behavior, ideas and norms elaboration. This poverty culture with time seems to assist individuals in coping with their environments. This view as observed by Holman (1978), firmly explains poor health to the people’s behavior, and by implication makes them responsible fully for the outcomes that are outward
Inequalities in child health
According to Brown & Harris (1978), the gap between the rich and the poor continue to widen globally. Within UK, Bruce & Hoff (1994) observed that the financial gap existing between the poor and the wealth continues to widen and the health difference between the social classes are also becoming greater. Social inequality and poverty have indirect and direct effect on the physical, mental and social wellbeing of children. It is of great importance to note that inequality and poverty are linked closely. Usser et al (2000) believed that inequality in income results to psychosocial stress that leads to health deterioration and even high rate of mortality with time.
However, the relation between life expectance and income inequality diminishing is no longer accepted universally. The children in communities that are deprived, where there exist under investment in physical and social infrastructure, have poor health and leads to high mortality to the lower socio- economic class population. Crawford & Prince (1999) found out that income inequality effects also spills over into the society, thus causing frustration, stress and disruptions of the family, which leads to crime rate increase, violence and homicide.
There are several threats, deficits and obstacles to health due to poverty. It is the poor populations who often have stress when employed, are exposed to harmful and dangerous environments, depersonalizing and unrewarding work, who lack the amenities and necessities of life, and who are isolated from support and information because they do not form part of the mainstream society. According to Great Britain (1999), one of the enduring and pervasive observations in public health is the inverse relation between risk of disease and socio economic level. It is known that the group that earns the lowest income has a higher likelihood of suffering risky health behaviors negative effects compared to the less poor people. These behaviors are not taken with intentions that are harmful, but may be termed as coping behaviors that provide relief and comfort from the stressful lives. Furthermore, lower socio- economic class people are exposed to more stressors by virtue of their circumstances in life, and with great stressors vulnerability and less resources to manage them, they are victimized doubly.
Brown, Susser, Jandorf & Bromet (2000) observed that poverty is associated with numerous long term problems, like school failure, increased mortality, poor health, substance misuse and crime among the children and the young people. The relationship between mortality and occupational class is evident from 1970s survey, which portrayed that the rate of mortality among the 20 to 64 years old men was almost twice for those of class v compared to those of class I. Furthermore, it was almost thrice as high in 1990s (Great Britain 2001).
According to Kaplan et al (2011), childhood psychiatric disorders come about as a result of interplay between environmental and genetic factors. The link existing between childhood disorder and adverse experiences is complex and includes children’s reciprocal effects, because they are not passive experience recipients. Lynch & Kaplan (1997) observed that there is a large body mushrooming up relating to health and poverty indicating that disruptive factors of demographics combined with low income and poor support from outside generate life crises and stress that put children at a great risk, and may catalyze childhood psychiatric disorders.
Argyle (1994) pointed out that poorest households children are three times likely to suffer from mental problems compared to the well off households. Social disadvantage and poverty are associated strongly with deficits in educational achievements and cognitive skills of children. Moreover, in the domain of behavior, attention-deficit hyperactivity disorder and conduct disorder are linked to family poverty. Brown & Harris (1978) adds that this is phenomenal among children facing economic stress persistently. The relationship between childhood disorder and poverty appeared to be more remarkable in boys compared to girls, and also seems to be of much strength in childhood in comparison to the adolescents. Bruce & Hoff (1994) observed that childhood disorder rates vary in communities and neighborhoods. For instance, in the UK, early studies suggested that disorders risks in the areas of the inner city were twice of those in small town areas.
Usser et al (2000) found out that conduct disorder is more common in children three to four times who reside in families that are socio-economically deprived with low income, or who resides in poor neighborhoods. Crawford & Prince (1999) suggested that the mechanisms that put poor children at psychiatric disorder risk may have to do basically with increased parental rates and characteristics of family associated with psychiatric disorder of a child, rather than disadvantage in economy itself. Persistent poverty with regard to the economic advantage should be distinguished from the current poverty. Great Britain. (1999) explained that persistent poverty predicts significantly internalizing symptoms like childhood behavioral disorders. There is a likelihood of poverty imposing stress on parents and this prevents informal social control family processes, which consequently increases harsh parenting risks, and reduces emotional availability of parents to meet the needs of their children.
Brown, Susser, Jandorf & Bromet (2000) examined the position of childhood socio-economic and adulthood cognitive function, and came to a conclusion that socio- economic position that is high during childhood and greater attainment in education are both associated with adulthood cognitive function, with fathers and mothers each making a contribution to the formative cognitive development of their offspring, and cognitive ability in later life.
Great Britain (2001) pointed out that threatening, erratic and harsh discipline, weak attachments between parent and a child, and lack of supervision mediate the poverty effects and other factors on delinquency. National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (2001) observed that one of the most import predictors of childhood delinquency in Cambridge Study in Delinquent Development is poverty. Furthermore, poverty was also associated to extreme delinquency and academic failure, when early childhood behavior and maternal education were controlled.
Freeman & Stansfeld (2008) also did a study on exposition of misuse and commonly used drugs on children, and came to a conclusion that drugs appeared to be more enshrined in children under poverty.
Description of psychiatric disorder and poverty
Great Britain (2003) observed that psychiatric disorders also show a powerful correlation of social- epidemiological apart from infectious diseases. Moreover, psychiatric disorders occur mostly in poorest areas in higher rates and cluster together and in most cases disintegrate in the communities of the inner city. Duncan & Brooks-Gunn (1997) elaborated that it is not a guarantee that absence of money will result to mental illness, but it is poverty that is conceded generally to both a consequence and a determinant of poor mental health.
The low economic status relationship and elevated prevalence and incidence of mental illness has become apparently been increasing. Meltzer (2000) pointed out a study body done in new haven 1958 and a few years later a study conducted in midtown Manhattan. From the studies, it was found that there existed a direct relationship between poverty experience and emotional disturbances of high rate, as well as use of treatment facilities and modes and differential availability by different classes. Gunnell et al (2013) further observed that it is an assumption of many peoples that socio- economic class gradient in relation to disease can be given an explanation by differences in access to healthcare.
The interrelatedness and complexity of factors such as employment, health and poverty makes it interesting to examine the prevailing relationship between them. Many epidemiological studies globally have shown inverse relationship between social class and mental illness. Psychiatric disorders according to Hollingshead et al (1998) have been shown consistently to be common among the lower social class people. The mental disorders can manifest inform of psychoses, suicide, mood disorders, alcohol, personality disorder and substance abuse.
According to Holman (1978), psychoses, a psychiatric disorder is mostly prevalent in both women and men of social class V. The relationship between psychoses and poverty is complex, and two hypotheses try to explain it-the social selection and social causation theories. Social causation model explains that the greater adversity of socio economic characteristics of the living conditions of the lower social class precipitates the vulnerability of psychosis to individuals. However, the model was challenged by Bruce & Hoff (1994) in a research which showed that the distribution of schizophrenic patients in the social class did not deviate from the population in general. The excess of status of the socio economic schizophrenic people was mainly attributed to people who have drifted from the social and occupational scale prior to the psychosis onset.
Mood disorder prevalence is associated with socio- economic status. Kaplan et al (2001) pointed out researches done in 1950s and 1960s which indicated that the depression prevalence was persistently high significantly in the population’s low socio economic status compared to other levels of socio economic status. This supported the hypothesis that poverty stress may be related to depression.
Lynch & Kaplan (1997) found out a positive relationship between the mood disorder vulnerability and socio economic status, with higher vulnerability rates among lower social educational achievement level as individuals. The hypothesis of social causation suggest that stress linked with lower social position, like social adversity exposure and lack of any resources to help in coping with the difficulties, might contribute to the mood disorder development, on the other hand, the hypothesis of the social selection suggest that individuals who are genetically predisposed fail to rise or drift down such position (Argyle 1994).
Statistics from the National Inquiry Into Suicide and Homicide as observed by Brown & Harris (1978), shows that mentally ill people who committed suicide either had long term illness or were unemployed. Moreover, people who attempted suicide in comparison to the general population were associated to social categories characterized by poverty and destabilization.
On the other hand, alcohol and substance abuse and misuse is high among the social class V and the unemployed group. Usser et al (2000) found out that high mortality rates related to alcohol are high in men of manual jobs than the non-manual jobs. Social class which is linked to social structural factors such as disadvantage, poverty and social is a risk factor for mortality that are alcohol related.
According to Great Britain (1999), personality disorders traits such as antisocial personality is prevalent among lower socio economic people.
In conclusion, poverty and social inequality have adverse demonstrable effects on health. The National Health Service in UK has many responsibilities that are linked in relation to inequalities of health, which includes equity of access provision to health care which is effective. As Crawford & Prince (1999) pointed out, of the recommendations of the inquiry into heath inequalities by an independent study, was that as health impact assessment part, all policies with a likelihood of having indirect or direct effect on health should be given evaluation in terms of their health inequalities impact. Formulation of these policies should be done in a manner that gives favor to the less well off people, and consequently reduce the inequalities. This way health provision to the children will be improved to serve all children in all social classes.
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