Going upstream: Social inequality and children's health

Abstract

This study explores the impact of income inequality on the health of children. We examine the direct effects of income inequality and the mediating effects of income inequality via poverty concentration at local levels. We use a multilevel study design incorporating individual level data from the 1988 Child Health Supplement to the National Health Interview Survey supplemented with aggregate data from the 1990 Census of Population STF3A economic/ demographic files. Measures of income inequality are constructed at the county level and poverty concentration at the county and neighbourhood level. Multiple indicators are used to examine child health including physiologic, functional status, and psychological measures and behavior and school problems. The association between income inequality and child health was examined using logistic regression models. Direct effects of income inequality were observed for school suspension and indirect effects for chronic conditions, learning disabilities, emotional and behavior problems, school suspension, health status and seeing a counsellor/psychiatrist. To assess whether income inequality works through challenging the integrity of local economic institutions, we also examine whether inequality and poverty concentration at the neighbourhood level or the larger administrative unit influence children's access to health insurance. Income inequality was found to exert both a direct and an indirect effect on children's health insurance status. These findings specifically provide evidence of the effects of income inequality on children's health, and more generally demonstrate that higher level contextual factors need to be incorporated into research in order to enhance our understanding of the determinants of children's health.