ESRC/NIH Health Disparities Call: Children's Health Disparities in the US and the UK: The role of the Family
Lead Research Organisation:
University of York
Department Name: Social Policy Social Work
Abstract
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Organisations
Publications
Adserà A
(2012)
Fertility Patterns of Child Migrants Age at Migration and Ancestry in Comparative Perspective
in The ANNALS of the American Academy of Political and Social Science
Holmes J
(2013)
Persistent poverty and children's development in the early years of childhood
in Policy & Politics
Jackson M
(2012)
Nativity Differences in Mothers' Health Behaviors: A Cross-National and Longitudinal Lens.
in The Annals of the American Academy of Political and Social Science
Jackson MI
(2012)
Immigrant-native differences in child health: does maternal education narrow or widen the gap?
in Child development
Kiernan K
(2011)
Fragile families in the US and UK
Kiernan K
(2011)
Poverty, family resources and children's early educational attainment: the mediating role of parenting
in British Educational Research Journal
Prady SL
(2013)
The effect of post-natal mental distress amongst Indian and Pakistani mothers living in England on children's behavioural outcomes.
in Child: care, health and development
Prady SL
(2012)
Do risk factors for post-partum smoking relapse vary according to marital status?
in Maternal and child health journal
| Description | Using data from the United States and the United Kingdom, we investigated how family structure, race/ethnicity, immigrant status and socio-economic status are associated with disparities in children's health, both independently and in combination with one another. Research on health inequalities has disproportionately relied on race/ethnicity and socioeconomic status as markers of children's environments. Prior research has also focused on the association between environments and health outcomes within a single country. This research expands on this literature by examining the role of family structure characteristics and nativity both independently and in combination with race/ethnic and socio-economic factors and by bringing a comparative lens to our understanding of children's health disparities. Examining the role of socio-economic, cultural and family factors across the U.S. and the U.K. is particularly instructive, given the similarities in the traditions of the two countries, combined with differences in their population composition and social policies, especially health care provision. Analyses are based on the UK Millennium Cohort Study (MCS), the US Fragile Families and Child Wellbeing Study (FFCWB. Here we report on a range of key findings from the research project. Research by Margot Jackson, Kathleen Kiernan and Sara McLanahan on the health of migrant mothers led to a number of important findings. Firstly, immigrant mothers exhibit healthier parenting behaviors, including less smoking and drinking and more early pre-natal care and breastfeeding than non-immigrant mothers in both the US and UK. These findings applied to mothers from both high and low socio-economic groups and they persisted across the first five years after the child's birth. The immigrant advantage is equally strong in both countries despite different welfare and healthcare policies. Secondly, the immigrant advantage in child health is not equally strong across all educational groups and is not observed for all markers of physical and mental health. It is the lower-educated families that drive immigrant differences in child health. For example, the asthma advantage among children of immigrant mothers in both the UK and US is stronger among less-educated families. Thirdly, there was a weaker socioeconomic gradient in child health among children in immigrant families around the time of birth. However, the gradient then emerges and particularly more quickly among children who experience both low socio-economic status and marital disruption. Second-generation children in more highly educated and higher-income families maintain better health as they grow older compared to their peers at lower ends of the socioeconomic distribution. All these three studies used the Millennium Cohort Study and the US Fragile Families Study to make the cross national comparison. Wendy Sigle-Rushton and Alicia Goisis examined whether, as is the case in the US, age gradients in the risk of low birth weight in the UK are steeper for Black mothers than for White mothers. In the US literature, the "weathering" hypothesis posits that because the health of (disadvantaged) African American mothers deteriorates faster than that of White and advantaged women, so that fertility postponement may not confer the same benefits for them as it apparently does for White women. By examining a population of Black women who suffer similar kinds of disadvantage but who postpone their first births and who also have strong attachment to the labour market, they found age gradients in the risk of low birth weight which look similar to those that are reported in the US literature. This suggests that the health costs of postponement are higher for Black women than for White women in the UK despite their relatively high rates of employment and their better access to health care. Wendy Sigle-Rushton and Lydia Panico examined whether gaps in the risk of child asthma by family structure differ by whether mothers were born in the UK or were first or second generation immigrants (i.e. according to mothers' nativity status). Although living with two continuously married parents appears to be advantageous within all nativity groups, the magnitude of the marriage effect appears to be smaller in the first born and second generation born group than it was in the wider population. The findings suggest that those processes thought to drive health differentials by family structure in the majority population may well have less explanatory power for minority groups in the population. Kathleen Kiernan, Sara McLanahan, John Holmes and Melanie Wright carried out a research project that compared "fragile families" (families formed by unmarried parents) in the US and UK. They showed that, in both countries, unmarried parents have lower capabilities and less stable relationships than married parents, single mothers were more disadvantaged than cohabiting mothers, and relationship instability is associated with a variety of negative outcomes for both mothers and children. A key difference between the two countries is greater instability and family complexity in the United States. In addition, while cohabiting mothers in the UK are only slightly more disadvantaged than their married counterparts, cohabiting mothers in the US are much more disadvantaged than married mothers and more closely resemble single mothers. Kathleen Kiernan and Anna Garriga paper on Parents' relationship quality, mother-child relations and children's behaviour problems used data from the Millennium Cohort Study (MCS) to investigate the extent to which parents' relationship quality affects children's behaviour problems and whether the quality of the mother-child relationship moderates this association. The results showed that parents' relationship quality was clearly related to children's externalizing problems at ages 3 and 5 years and that the quality of mother-child relations explained a substantial part of this association. However, a warm relationship with the mother did not reduce the detrimental effect of poor parental relationship problems, but maternal conflict exacerbated it. The effect of parent's relationship quality was the same for children from different ethnic and marital status backgrounds, and according to mother's education and child's gender but was stronger amongst poorer children. These findings suggest that policies that promote parents' relationship quality are likely to be beneficial for children from different family contexts, but especially for those from poor families. Reducing child poverty has been a policy of successive UK governments, but the reduction of persistent poverty has only recently been featured on the policy agenda. A paper by Kathleen Kiernan and John Holmes on "Persistent poverty and children's development in the early years of childhood" used longitudinal data on early childhood (collected in the Millennium Cohort Study) to examine the developmental contexts and outcomes for persistently poor children and to document the contexts that might promote resilience. The results showed that persistently poor children have more disadvantageous developmental contexts and worse developmental outcomes than children who live in poverty for shorter periods. However, good maternal mental health and positive parenting enhanced resilience amongst the children living in families that were persistently poor. Another study by Kathleen Kiernan and Fiona Mensah assessed the extent to which positive parenting mediated the effects of poverty and disadvantage. This was pertinent as both poverty reduction and improving parenting are high on the policy agenda which has as a core aim the improvement of child well-being. In the MCS cohort 60% of children who had never experienced poverty achieved a good level of achievement on the Foundation School Profile. By contrast, only 26% of children in persistent poverty reached this level. A decompositional analysis suggested that about 50% of the effects of child poverty and 40 per cent of family resource disadvantage may be accounted for by the quality of parenting the child has received in early childhood and the size of the effects were broadly similar across the poverty groups and level of family resources. These are not insubstantial proportions but a substantial part of the gaps still remain to be explained. It would seem that despite the best efforts of their parents, children living in poverty and relatively disadvantage circumstances still remain behind their wealthier, well-parented peers. Moreover, they also found some evidence that the effects of poverty and parenting are independent. In other words, it might be more helpful to think of there being two separate factors at play. Children's achievement can be adversely affected by poor parenting; it can also be adversely affected by poverty. This suggests that directing efforts at only poverty or parenting, to the exclusion of the other, is unlikely to result in equitable outcomes. |
| Exploitation Route | Our research showed that immigrant mothers exhibit healthier parenting behaviors, including less smoking and drinking and more early pre-natal care and breastfeeding than non-immigrant mothers. These findings applied to mothers from both high and low socio-economic groups and they persisted across the first five years after the child's birth. The immigrant advantage was equally strong in the UK and US despite different welfare and healthcare policies. This advantage is particularly pronounced amongst those of lower socio economic status but then fades amongst the second generation. Health researchers may want to investigate why this fading occurs and how the immigrant advantage might be maintained so that the health of second generation children does not deteriorate. Our research showed that there is no single magic bullet that can be applied to help children who are not faring well cognitively, emotionally and health wise. Child poverty and its effects have been a major focus of research on child well-being but our research points to the importance of other factors including parental mental health, parental relationships and parenting as having important roles to play. This has important policy implications and needs further elaboration on the complex interplay between these factors. |
| Sectors | Communities and Social Services/Policy,Education,Healthcare |
| Description | The findings on poverty and parenting have been prominent and contributed to a number of reviews and discussion around them - a notable example being the the Field Review . They also featured in a letter to the Guardian (by Kiernan) headlined "Poverty and parenting both matter." This was in response to the Prime Minister's assertion that good parenting was all that was required for positive child outcomes. Our findings on the importance of parental relationships for child outcomes has been of interest to the Innovation Unit, Institute of Health Visitors, Early Intervention Foundation, DWP, Relate and Tavistock Centre for Couple Relationships and Lambeth Council as part of its Big Lottery bid. The work on relationships has led to Kiernan joining (September 2015) the Steering Group for a DWP review on what works to enhance couple relationships and improve outcomes for children. |
| First Year Of Impact | 2010 |
| Sector | Communities and Social Services/Policy,Education,Healthcare |
| Impact Types | Societal,Policy & public services |