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Socio-economic inequalities in healthy child development: the evidence grows
  1. James R Dunn
  1. Correspondence to Dr James Dunn, Department of Health, Ageing and Society, McMaster University, KTH 226, 1280 Main St. West, Hamilton, ON L8S 4M4, Canada; jim.dunn{at}

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For those of us interested in socio-economic inequalities in healthy child development, this issue of the Journal of Epidemiology & Community Health should strongly reinforce concerns we may have. As has been shown previously, there are large and avoidable inequalities in a wide range of healthy child development markers beginning at conception. In addition, it is well known that although not deterministic, conditions in early childhood cast a long shadow into later life, strongly shaping future trajectories of lifelong health, well-being and competence.1 What is striking is that for any given condition or deficit, as large as the inequalities are early in life, the differences tend only to widen as children grow and develop. Even in the more affluent countries of the world, these inequalities are large and represent the origin of a great deal of avoidable morbidity and mortality.

The group of papers in this issue represent various aspects of this issue. First, there are a variety of outcomes featured, including emotional and behavioural disorders,2 obesity,3 intellectual and developmental disabilities4 suicide5 6 and stillbirth,7 and also represent different approaches to understanding the lifecourse effects of early child development. Hertzman and Wiens1 identify three approaches to understanding how early life conditions can affect outcomes later in life: latent effects, pathways effects, and cumulative effects, and each of these approaches is covered herein. Heine Strand, et al3 show that both high and low body weight in adolescence and early adulthood are related to higher adult mortality, likely representing a cumulative effect. Bevin Cohen et al,8 show low flu vaccination coverage for Hispanic children in the borough of Manhattan in New York City. In an ironic twist to the pathway effect, children who had a history of respiratory problems, like asthma, were more likely to be vaccinated. Finally, representing the latency approach to understanding how early life conditions affect health, Niederkrotenthaler, et al5 show that individuals whose parents had psychiatric disorders or who had attempted or completed suicide were at greater risk of suicide attempts and completions themselves.

As was emphasised by the WHO' Commission on the Social Determinants of Health,9 investments in early childhood have the potential to make an enormous difference reducing health inequalities across the globe, but even within affluent countries.10 The editorial team at JECH applauds the authors published in this issue and everyone in the research community that is attempting to add to the evidence base to make that happen. Moreover, we encourage authors to send us their work on interventions aimed at reducing inequalities in healthy child development, in order to continue making progress in redressing this important public health problem.



  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.