Social Gradients and Child Health

Abstract

The purpose of this article is to review what is known about the relationship between social gradients and health in children. The paper starts with a brief history of the relationship between social circumstances and health and makes the distinction between the relationship of poverty on health and the relationship between social gradients on health. Providing a summary of recent evidence on this latter relationship in various countries and in various population subgroups, the article shows that although there are social gradients in health, the magnitude of the effect varies from place to place and across different health conditions. Explanations for these differences and for demonstrated interactions between influences in different populations are sought in the possible mechanisms by which social gradients in child health affect adult health, and the pathways through which such effects might take place. The article concludes that the existence of social gradients is a societal phenomenon and that the evidence indicates that universal social programs rather than targeted social welfare has the highest likelihood of overcoming these gradients. Universal primary care-oriented health systems and their impact in reducing social gradients in health is provided as an example. An agenda for research to better understand the genesis of social gradients in health forms the final section of the article.