There is growing evidence from fields as diverse as education, criminology, child health, public health and mental health that early childhood is a more critical period in the life cycle than has been previously recognised. For example, the recent Acheson report (1998) concluded that:
While remediable risk factors affecting health occur throughout the life course, childhood is a critical and vulnerable stage where poor socioeconomic circumstances have lasting effects. Follow up through life of successive samples of births has pointed to the crucial influence of early life on subsequent mental and physical health and development. The fact that the adverse outcomes, for example, mental illness, short stature, obesity, delinquency and unemployment, cover a wide range, carries an important message. It suggests that policies which reduce such early adverse influences may result in multiple benefits, not only throughout the life course of that child but to the next generation.
Socioeconomic gradients in outcomes vary between countries
In each of these areas, there are data to suggest that there are gradients in a variety of health and education outcomes across the socioeconomic spectrum. Countries with social policies that invest more in social assistance for workless and low-paid parents have lower child poverty rates, which in turn are associated with shallower gradient slopes and better mean outcomes for the whole population (UNICEF 2000; Keating and Hertzman 1999; McCain and Mustard 1999). The Scandinavian countries, for example, have lower rates of both relative and absolute child poverty at least in part because of taxes and transfers. These countries achieve higher overall literacy standards and shallower socioeconomic gradients than many other OECD countries, despite having relatively high rates of single parent families, which, in most other industrialised countries, is highly correlated with child poverty. The extent to which this outcome is a consequence of more generous parental leave provisions and high quality child care for young children is worth pondering. Mean outcomes and gradient slopes in Cuba are also much more impressive than those in many South American countries.
Poverty, inequality or both?
While there is no doubt that poverty on the scale experienced in many third world countries is a major determinant of poor health status within their populations, in industrialised countries there is considerable evidence that health is related to relative rather than absolute income.