Childhood Deprivation and Health in the United States, the United Kingdom, and France

Background/Purpose: Early childhood is a key stage for lifelong health development and that children’s early environments “get under the skin” from the earliest moments of life. As a result, the early childhood period plays a crucial role in production of health inequalities throughout life. Much of the existing body of literature addressing health inequalities from birth uses markers of socio-economic background such as parents’ education or incomes. However, these parent-based measures of socioeconomic background may not capture the same constructs that drive inequalities for young children as for adults, and these measures vary in their utility across international social policy contexts. For example, household income faces limitations in accurately describing resources available to children as it does not fully capture children’s lived experiences of disadvantage, family composition, distribution of household income among family members, and the prioritization of resources across household members. Alternatively, a growing body of interdisciplinary research has proposed using multidimensional poverty indicators such as deprivation indices as a tool for better understanding disadvantage, especially in international contexts. In this paper we examine the patterns of multidimensional deprivation across early childhood in the United States (US), the United Kingdom (UK), and France and how deprivation and its dimensions are linked to early life health.

Method: We use nationally representative child cohort data from the US, the UK, and France to construct a multidimensional measure of deprivation including the following domains: material, housing, parenting, and health behavior deprivation. We then examine the relationship between deprivation and child health as measured by asthma and wheezing (respiratory health), unintended injury, and overweight longitudinally when children are one-year old, entering preschool, and entering kindergarten. First, we carry out analyses measuring associations between each dimension of deprivation and the overall deprivation indicator with each child health outcome. We also examine associations with classic measures such as monetary poverty to assess whether the use of multi-domain deprivation measures produces different patterns of health inequalities. Second, we apply structural equation models including autoregressive paths and cross-lagged effects, allowing simultaneously estimating sets of longitudinal relationships.

Results: Our results show that the US has the highest rates of material deprivation across early childhood, followed by the UK and then France. Children who experience higher levels of deprivation are statistically more likely to experience overweight than their non-deprived counterparts in all 3 countries. However, for respiratory health, this pattern was found only in the US and UK. Finally, we found that the depth of deprivation is important for overweight and respiratory health, where more dimensions of experienced deprivation increase the likelihood of children experiencing these health consequences in early life.

Conclusion: We find that multidimensional deprivation harms children health and wellbeing early in the lifecourse, and these results are robust to the inclusion of a robust set of controls including standard measures of socioeconomic status (income and education). These findings have implications for early life policies that vary across these countries.