Article Text

other Versions

Download PDFPDF
Understanding child disadvantage from a social determinants perspective
  1. Sharon Goldfeld1,2,
  2. Meredith O’Connor1,2,
  3. Dan Cloney1,3,
  4. Sarah Gray1,
  5. Gerry Redmond4,
  6. Hannah Badland5,
  7. Katrina Williams2,6,7,
  8. Fiona Mensah2,8,
  9. Sue Woolfenden1,9,10,
  10. Amanda Kvalsvig1,
  11. Anita T Kochanoff11
  1. 1Centre for Community Child Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Victoria, Australia
  2. 2Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
  3. 3Centre for Education Policy and Practice, Australian Council for Educational Research, Melbourne, Victoria, Australia
  4. 4College of Business, Government and Law, Flinders University, Adelaide, South Australia, Australia
  5. 5Centre for Urban Research, RMIT University, Melbourne, Victoria, Australia
  6. 6Developmental Medicine, The Royal Children’s Hospital, Parkville, Victoria, Australia
  7. 7Department of Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
  8. 8Clinical Epidemiology and Biostatistics Unit, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
  9. 9Department of Community Child Health, Sydney Children’s Hospital Network, Sydney, New South Wales, Australia
  10. 10Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia
  11. 11Research and Policy Centre, Brotherhood of Saint Laurence, Melbourne, Victoria, Australia
  1. Correspondence to Prof Sharon Goldfeld, Centre for Community Child Health, Royal Children’s Hospital, Parkville, Victoria 3052, Australia; sharon.goldfeld{at}


Background Child health and developmental inequities exist in all countries. Comprehensive and robust concepts of disadvantage are fundamental to growing an evidence base that can reveal the extent of inequities in childhood, and identify modifiable leverage points for change. We conceptualise and test a multidimensional framework of child disadvantage aligned to a social determinants and bioecological perspective.

Methods The Longitudinal Study of Australian Children is a nationally representative sample of two cohorts of Australian children, including the birth cohort of 5107 infants, which commenced in May 2004. The analysis focused on disadvantage indicators collected at age 4–5 years. Confirmatory factor analysis was used to test a theoretically informed model of disadvantage. Concurrent validity was examined through associations with academic performance at 8–9 years.

Results The model comprising four latent factors of sociodemographic (10 indicators), geographical environments (three indicators), health conditions (three indicators) and risk factors (14 indicators) was found to provide a better fit for the data than alternative models. Each factor was associated with academic performance, providing evidence of concurrent validity.

Conclusion The study provides a theoretically informed and empirically tested framework for operationalising relative child disadvantage. Understanding and addressing inequities will be facilitated by capturing the complexity of children’s experiences of disadvantage across the multiple environments in which their development unfolds.

  • health inequalities
  • measurement
  • child health

Statistics from


  • Contributors SG contributed to and oversaw the planning and reporting of the work described in this article. MO’C, DC and SG contributed to the planning, conduct and reporting of the work described in this article and wrote the first draft of the manuscript. DC conducted the data analysis. GR, HB, KW, FM, SW, AK and ATK contributed to the planning and reporting of the work described in this article.

  • Funding This research is funded by Australian Research Council Discovery Grant DP160101735, and is supported by the Victorian Government’s Operational Infrastructure Support Program. SG is supported by Australian National Health and Medical Research Council (NHMRC) Career Development Fellowship 1082922, and FM is supported by NHMRC Career Development Fellowship 1111160.

  • Competing interests None declared.

  • Ethics approval The LSAC methodology was approved by the Australian Institute of Family Studies Human Research Ethics Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.