Abstract
This study examines how structural determinants influence intermediary factors of child health inequities and how they operate through the communities where children live. In particular, we explore individual, family and community level characteristics associated with a composite indicator that quantitatively measures intermediary determinants of early childhood health in Colombia. We use data from the 2010 Colombian Demographic and Health Survey (DHS). Adopting the conceptual framework of the Commission on Social Determinants of Health (CSDH), three dimensions related to child health are represented in the index: behavioural factors, psychosocial factors and health system. In order to generate the weight of the variables and take into account the discrete nature of the data, principal component analysis (PCA) using polychoric correlations are employed in the index construction. Weighted multilevel models are used to examine community effects. The results show that the effect of household’s SES is attenuated when community characteristics are included, indicating the importance that the level of community development may have in mediating individual and family characteristics. The findings indicate that there is a significant variance in intermediary determinants of child health between-community, especially for those determinants linked to the health system, even after controlling for individual, family and community characteristics. These results likely reflect that whilst the community context can exert a greater influence on intermediary factors linked directly to health, in the case of psychosocial factors and the parent’s behaviours, the family context can be more important. This underlines the importance of distinguishing between community and family intervention programmes.
Highlights
There is vast evidence of the association between the place where children live and their health (Marmot, Friel, Bell, Houweling, & Taylor, 2008)
The index of intermediary determinants of early childhood health (IDECHI) by Colombian departments is illustrated by Figure 2
The map shows that departments that relatively perform better in most of the specific determinants of early childhood health are located in the centre of the country
Summary
There is vast evidence of the association between the place where children live and their health (Marmot, Friel, Bell, Houweling, & Taylor, 2008). It is clear that life chances may be very different whether a child is born in Sweden or in an African country. These differences in life chances persist between social groups. Socioeconomic characteristics Mother's education level no education (Reference) primary secondary higher Mother's occupation not working (Reference) professional, technical, manager clerical, sales, services, skilled manual agricultural, unskilled manual. Mother's autonomy Partner's education level no education (Reference) primary secondary higher no partner Socioeconomic status very poor (Reference) poor medium rich very rich Place of residence rural (Reference) urban. Community characteristics Mean years of mother's education Mean level of SES index Proportion of women currently working Children exposure to community nurseries programme Mean level of female autonomy index.
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