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According to the Healthy Child Programme, pregnancy and the first years of life are vital stages in one’s life cycle. This is the time the foundations of wellbeing and future health are laid down (Shribman and Billingham, 2010). Besides, it is the time parents need to be more receptive to learning and making changes. According to research, it is evident that the outcomes of an adult are strongly influenced by the factors that come into play during pregnancy and the first years of life (Morgan et al., 2016). Similarly, the experiences children go through in their early childhood affect their adulthood (Canny et al., 2017). For instance, a child who comes from a family with multiple risk factors such as substance abuse, domestic violence, inadequate housing or mental illness has high chances of experiencing social outcomes and poor health. He is also likely to develop behavioural problems, substance misuse and offending behaviour (Shribman and Billingham, 2010).
Likewise, during pregnancy, fetus brain undergoes rapid development. Adverse experiences such as stress and the mother’s use of drugs at the critical developmental stage negatively affect the developing brain and other sensitive organs. The effects caused may be seen at a lower scale in childhood, but manifests in later adult years in the form of diseases such as mental health disorders, obesity or cardiovascular diseases (Canny et al., 2017). As such, the wellbeing and health of the children population determine the future adult population health. This is the reason why HCP is categorically concerned with maternal health for expecting women and the babies they are carrying.
Elsewhere, Tremblay et al. (2011) note that the emotional, social and physical development of children has a significant effect on their overall growth and later on the adult they become. Investment needs to be geared toward children emotional, health, nutrition and social aspects. Likewise, Marmot (2010) states that the foundations of every aspect of human development, that is, the physical, intellectual and emotional are all laid in early childhood. Therefore, whatever happens in an individual’s life, right from the womb, has lifelong effects on his health and well-being in adulthood. Health services, as such, improve a population’s health overall.
2. Factors seen to be important for the health of very young children
Of enormous importance is the attachment of a baby to both parents. So is the impact stress can cause on a growing fetus during pregnancy (Center on the Developing Child, 2007). According to HCP, strong parent-child attachment results in a child’s better social and emotional wellbeing. Besides, healthy eating and activity lead to a reduction in obesity as the child grows (Shribman and Billingham, 2010).
Under HCP, early recognition of growth disorders and risk factors is essential for the health of very young children as the management of the conditions begin as early as possible which can also be treated soon enough and not cause deformities to the child as s/he grows. This also includes early detection and address of abnormalities, ill health and safety concerns. Emphasis is placed on breastfeeding. The programme recommends that mothers initiate and continue breastfeeding their babies to the recommended age; two years owing to the benefits the milk has on an infant. As per HealthyFamilies BC (2013) breast milk prevents many diseases and infection in infants, for instance, type 1 diabetes, allergies, coughs and colds, gastrointestinal illnesses, Sudden Infant Death Syndrome (SIDS), pneumonia, ear infections, respiratory infections and meningitis among others.
Moreover, breast milk is considered as the safest and healthiest food for a baby as it is easily digested and is composed of the vital nutrients needed by the baby for the first six months. Research has it that babies who breastfeed have good mental development, robust immune systems, better jaws and are emotionally secure as compared to those who do not breastfeed (HealthyFamilies BC, 2013). Not only is breastfeeding important to the babies, it is also beneficial to the mothers as they build strong emotional bonds with their babies, healing after baby birth hence minimizing postpartum bleeding, burning the fat accumulated during pregnancy and helps her relax from the hormone oxytocin that is usually produced when a baby suckles, giving a relaxing and calming effect (BabyCenter, 2018).
Very young children require supportive parents who can provide sensitive and attuned care at the tender age considering that both parents have a unique influence on the baby. Besides, as the brain develops, it is influenced by genetic factors, the emotional and the physical environments. Therefore, interactions with parents and caregivers affect the way the brain is wired. The early relationships provide a basis for later control of the response to stress (Shribman and Billingham, 2010).
HCP also considers tests such as newborn hearing screening and bloodspot screening services as well as vaccination and immunisation crucial to newborns and infants as it results to early detection and intervention of complications (Axford et al., 2015).
3. Role of early childhood services
Per HCP, there is a significant emphasis on parenting support. The programme particularly emphasises parenting support considering that sensitive and attuned parenting is vital in overall well-being of a child. So, as per The Children’s Plan (Department for Children, Schools and Families, 2007), the programme supports strong couple and stable positive relationships. Following a finding that fathers are at many times left out of such services, the programme ensures that fathers, both resident and non-resident, are supported and routinely involved in the family health services. For the first-time mothers and fathers, HCP supports the transition to parenthood. Essentially, research reveals that a father’s behaviour, aspirations and beliefs greatly influence the well-being and health of both the mother and the child in many ways.
HCP plays different roles to ensure the wellbeing of children. For instance, it makes sure that children receive an appropriate referral to specialist services and ensure that families are signposted to more extensive support suitable for their needs. Priority is made on vulnerable families so that their children can receive intensive interventions and coordinated support packages. Besides, the programme encourages maternity services with the recognition of what such services make to a child’s health and wellbeing as well as that of the mother. The plan is committed to its role with the notion that children health and welfare is not solely determined by what goes around in the healthcare arena, but health services have a valued part of providing services to pregnant women, babies and families having young children. In totality, they help to lay a foundation for supportive parenting and a healthy childhood environment (Canny et al., 2017).
Needs assessment. Besides identifying current needs, health services assess future risks to build and strengthen protective factors.
4. How children’s health is promoted through the Early Years Foundation Stage Curriculum
They EYFS sets standards for development, learning and caring for children between 0 to 5 years. It supports an integrated approach to early learning and care that all schools and Ofsted-registered early years providers must follow and adhere (Department of Education, 2017). Besides, delivering quality early education, all professionals are provided with principles and commitments to provide quality childcare experiences to all children.
EYFS requires that new entrants into early years workforce must have level 2 or 3 qualification and holders of emergency pediatric first aid (PFA) certificate. This ensures that they can handle accidents and emergencies before seeking medical attention. Also, the provider must train staff to enable them to identify signs of possible abuse and neglect as early as possible and initiate an appropriate and timely response.
The requirement of early years educators to child ratios at level 3 staff ensures that teachers can attend to the children adequately as they meet the children’s individual needs and interests.
The curriculum must involve physical development. This ensures that young children are provided with opportunities to be active and interactive to develop coordination, movement and control. Moreover, the educators need to help children understand the essence of physical activity as well as making healthy choices on matters of food. In so doing, they
About social and emotional development, the framework requires that teachers help children to develop a positive sense about themselves and others as they form positive relationships and promote respect. In so doing, they develop social skills, learn to manage their feelings, understand good behaviour in groups and become confident in their abilities. Confidence can also be built through play, and a mix of adult-led and child initiated activities.
The EYFS also requires that childcare providers ensure the welfare and safety of children in the form of:
Child protection: That is being alert on issues of concern in a child’s life.
Suitable person: Checking that practitioners and other people who have regular contact with children are qualified and suitable.
Safety and suitability of premises, environment and equipment: The outdoor and indoor space needs to be suitable for the age of the children.
Health: Promoting children health as the institutions implement procedures related to illness, infection, food and drink and accidents.
Axford, N. et al. (2015) Rapid Review to Update Evidence for the Healthy Child Programme 0–5: Summary. PHE publications. London: Public Health England.
BabyCenter (2018) How breastfeeding benefits you and your baby. Available at: https://www.babycenter.com/0_how-breastfeeding-benefits-you-and-your-baby_8910.bc
[Accessed 7 Dec 2018].
Canny, M. et al. (2017) The Impact of Early Childhood on Future Health. Dublin: Faculty of Public Health Medicine Royal College of Physicians of Ireland.
Center on the Developing Child (2007) A Science-Based Framework for Early Childhood Policy: Using Evidence toImprove Outcomes in Learning, Behavior and Health for Vulnerable Children. Cambridge: Havard University. Available at: www.developingchild.harvard.edu.
Department for Children, Schools and Families (2007) The Children's Plan: Building brighter futures. London: Department of Health.
Departmnent of Education (2017) Statutory framework for the early years foundation stage: Setting the standards for learning, development and care for children from birth to five. London: Department of Education.
HealthyFamilies BC (2013) Importance of Breastfeeding. Available at: https://www.healthyfamiliesbc.ca/home/articles/importance-breastfeeding
[Accessed 7 Dec 2018].
Marmot, M. (2010) Fair Society, Health Lives. The Marmot Review. Strategic Review of Health Inequalities in England post-2010. London.
Morgan, M., Rochford, S. and Sheehan, A. (2016) Adversity in Childhood- Outcomes, risk and resilience. Dublin: Centre for Effective Services.
Shribman, S. and Billingham, K. (2010) Healthy Child Programme-Pregnancy and the first 5 years. Best Practice Guidance. London: Department of Health Department for children, schools andfamilies. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/167998/Health_Child_Programme.pdf.
Tremblay, R.E., Boivin, M. and Peters, R. (2011) Importance of early childhood development. Available at: http://www.child-encyclopedia.com/importance-early-childhood-development/complete-topic
[Accessed 7 Dec 2018].
Portfolio Task 2
The Marmot Review (2010)
1. The link between health and social inequality
The media highlights images of children suffering from lack of food in various parts of the world. In, the UK, the state benefit system works towards eradicating absolute poverty. However, there are still differences in the nutritional status of children in families still living under relative poverty (Deborah and Mukherji, 2008). The fact that people in England live in different social classes means that they experience differences in health, length of life and wellbeing (Marmot et al., 2010). As such, inequalities in health arise as a result of disparities in society. People experience different conditions in terms of where they are born, live, grow, work, and the kind of people they mingle with. For that matter, there is a link between the social and economic features of a given society and the population health distribution; depicting the magnitude of health inequalities (Marmot et al., 2010). According to the Marmot Review, it is clear that matter cannot be reduced through a separate health agenda; it requires an inclusive action that cuts across the whole society.
Also known as the social gradient in health, has resulted in some health outcomes including diabetes, depression, and heart disease among others. The poor consistently gain little from health services than the better-off. The result is that their conditions go untreated. Generally, people at the bottom of the social hierarchy experience worse health than the middle class who in turn have poorer health than those at the top. The worst affected are the children from the former hierarchy. They lack vital nutrients in their diets, food, clean water and end up malnourished and with poor health. Countries with low incomes experience high levels of infant mortality (CSDH, 2008). However, this may not be the case for England which still has vast health inequalities. The health risk factors among those who live in low socioeconomic status are drugs, alcohol, low exercise levels, obesity, smoking and high blood pressure. Notably, here, the diseases that cause shortened lives are not associated with absolute poverty.
According to a study conducted by WHO Commission on Social Determinants of Health (2008), it was established that in England, on average, people living in poor neighbourhoods die seven years earlier than their counterparts living in wealthy areas (whose life expectancy is 88 years). More disturbing is the fact that poor people not only have a maximum life expectancy of 67years, but their few years of life are accompanied by disabilities (CSDH, 2008). For a long time, health inequalities have been attributed to difficulties in accessing medical care, unhealthy behaviour, and sometimes genetic makeup. Important as such factors are, the fact is that social and economic differences in health matters reflect in qualities in the society (Marmot et al., 2010). According to Marmot et al. (2010), health inequalities are matters of social justice and to tackle the social gradient in health requires that all social determinants are included in actions to create a fairer society.
2. Link between inequality and early child development in policy objective A
If every child is given the best start in life, it could reduce health inequalities across the life course. Considering that the physical, emotional and intellectual aspects; which are the foundations of human development, are laid in early childhood, whatever happens to a child starting from when it is in the womb plays a crucial role in its health and wellbeing (Marmot et al., 2010). The social gradient also affects children. Those coming from low socioeconomic backgrounds are worst hit due to poor nutrition and ultimately health as compared to their counterparts coming from affluent families. For example, if children with less than two years undergo cognitive tests and are identified to have low cognitive scores but grow up in high socioeconomic families, by the time they are ten years, they record improvement in the scores. On the contrary, if children with a relative score are brought up in low socioeconomic families, their cognitive scores worsen by the time they are ten years old. As a result, the government is committed to reducing the inequalities in early child development through initiatives such as the Health Child Programme (HCP) and Sure Start (National Children's Bureau, 2015). The efforts are geared towards reducing inequalities in the early development of emotional and physical health as well as linguistic, cognitive and social skills. HCP, in particular, is focused on quality maternity services, child care, parenting programmes and early years’ education to meet needs across the social gradient. Sure Start, on the other hand, is committed to building resilience and the well-being of children across society.
Poor communities are characterised with children not having solid education due to lack of school fees and some end up dropping out of school. Likewise, their parents’ employment which most of the times is informal or formal but with minimal wages. As such, the best they can give to their children regarding meeting needs is almost insufficient. In such cases, early years education no longer becomes a priority to economically struggling households. For that matter, policy objective A advocates for giving every child the best start in life through good quality early years education and childcare across the gradient. Statistically, there is a significant variation in the distribution of expenditure on childhood education in European countries. For instance, in the UK, using OECD 2009 data, the ratio of middle to early childhood is 1.35. The ratio of late to middle childhood is 1.09, and that of late to early childhood is 2.30. As compared to OECD, the ratios are 2.06, 1.12 and 2.30 respectively. This indicates that the proportion of resources spent on all stages of childhood have remained unchanged over the years even though needs across different regions are different. The policy recognises that investment in the early years is crucial to reducing health inequalities. From statistics, it is clear that expenditure on later childhood years is higher as compared to early childhood. This is a notion that apparently policy objective A advocates for a rebalance towards the first years considering that gaps between social groups and individuals come up early in the life course.
3. What the Marmot Review regards as the role of early childhood services in reducing inequality
According to Marmot review, early childhood services need to support families to achieve progressive improvements in early years through prioritising the pre and postnatal interventions. Programmes such as intensive home-visiting help reduce adverse outcomes in pregnancy and infancy. Attending to prenatal family needs improves the well-being and health of mothers. When mothers are healthy, it is automatic that the babies in their wombs are healthy. In the same manner, there is a high likelihood that the health of mothers is good when their socio-economic circumstances are better. Early intervention of ensuring that women have a decent level of income and other essential material supply during pregnancy is as vital as supporting them during their child’s first years. In so doing, mothers can maintain a good level of health and nutrition. Furthermore, during pregnancy and postnatally, all families need information and support. However, some need extra help. In this role, the Healthy Child Programme has been vital in supporting families both in pregnancy, at birth and health and the well-being of children up to 5 years (Shribman and Billingham, 2010). The universal programme ensures that at least there is no stigma attached and the take-up levels are high. It has proved effective at conducting an informal family assessment that besides the baby and the parents, other needs are considered and signposting for further services in case of older children (Marmot et al., 2010).
Positive attachment also needs to be emphasised as they contribute to the growth of competencies such as self-efficacy, esteem and social skills (Marmot et al., 2010). Isolation and depression which could be characterised by nursing mothers negatively affects maternal attachment capacity. Supportive interventions to such cases can alleviate the situation. Research indicates that intensive home visiting programmes in pregnancy and after, generally improve the health, well-being, and self-sufficiency among first-time parents and low-income households (Bull et al., 2004). Reviews indicate enhanced parenting skills, improvement in maternal mental health, child development and a reduction in behavioural problems (Bull et al., 2004).
The services should advocate for parental leave for the first one year since that is the time parent-child relationships build. Research suggests that such relationships that are sensitive and responsive initiate strong cognitive skills in the young ones which are precursors for enhanced work skills and social competence later in school and life (National Scientific Council on Developing Child, 2004). The leave should be paid, and early years key workers can step in to provide advice and skills to support parents on child development and helping them forge a positive relationship with their children. In the case of additional needs, they can facilitate access to appropriate specialists. Sure Start Children Centers have been effective in providing outreach support. Still, they have not fully reached families who could benefit the most.
The services also need to provide good quality early years education and childcare at proportionate levels across the gradient. They should involve outreach to include children from disadvantaged families. Importantly, education and child care should meet quality standards and provide from evaluated models.
The services should be geared towards identifying children with special needs and disabilities at an early stage as well as support the families thereof. Additional visits should be made based on the needs assessment results. Further, the services should be keen at increasing the involvement of fathers, providing information and guidance on breastfeeding, nutrition, hygiene and safety (Marmot et al., 2010). Marmot review also suggests that early childhood services should be keen at encouraging smoking cessation, speech and language therapy among other specialists support.
Bull, J., McCormick, G., Swann, C. and Mulvihill, C. (2004) Ante and post-natal home visiting programmes. A review. London.
CSDH (2008) Closing the gap in a generation: Health equity through action on the socail determinants ofhealth. Geneva: WHO.
Deborah, A. and Mukherji, P. (2008) Food and Health in Early Childhood: A Holistic Approach. London: Sage Publications. Available at: Food_and_Health_in_Early_Childhood_A_Holistic_Appr._----__4_Health_Inequalities_.pdf.
Marmot, M. et al. (2010) Fair Society, Healthy Lives: The Marmot Review. Startegic Review of Health Inequalities in England post-2010. London: Department of Health.
National Scientific Council on Developing Child (2004) Young people develop in an environment of relationships. London.
Ntaional Children's Bureau (2015) Poor Beginnings: Health inequalities among young children across England. Lambeth: National Children's Bureau.
OECD (2009) Social expenditure database and OECD education dtabase in doing better for children. Departmental report. OECD.
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