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Background
There is growing recognition of the importance of childhood experience
for adult health and health behaviours. However, little is known
about how health inequalities impact on, are recognised by, and
are acted upon by children and their families in the course of their
everyday lives. Even less is known about how children themselves
make sense of and recreate the health cultures in which they grow
up.
It has only been recently recognised that children play an active
part in shaping their own worlds, within the constraints of the
adult environments that they must negotiate. While children can
be viewed as a distinct social group, their experiences of health
and inequality will be diverse, as will their understanding and
negotiations of such differences. With regard to health and lifestyles,
we are still in the early stages of understanding children's own
perspectives, the interactive socialisation processes taking place
and the extent to which children exercise agency over health-relevant
issues.
Aims and Objectives
The project's overall aim is to investigate children's everyday
experiences of health variations from their own perspectives and
to examine the socio-economic and cultural contexts of their health-relevant
lifestyles.
Within this overall aim, there are five specific objectives:
- to compare
the health-relevant lifestyles, perceptions and experiences of
boys and girls, aged 10-12, living in different socio-economic
environments and the cultural processes which mediate these;
- to examine
children's negotiation of autonomy and control in relation to
health and health-relevant behaviours;
- to explore
children's own accounts and experiences of inequalities and the
way in which they may impact on their everyday lives;
- to examine
further the household context by interviewing the child's main
parent/carer;
- to document
the resources in the areas in which the children live through
community profiling.
Study Design
The study is primarily qualitative in approach, involving serial,
in-depth interviews with a total of 40 children, aged 10-12, from
two areas with contrasting socio-economic profiles. These will focus
on children's understandings and experiences of health, health lifestyles
and health inequalities. A range of child-appropriate techniques
will be used. Prior to interviewing the children, a community profile
will be carried out in each area, documenting resources and facilities
relevant to children's health lifestyles. Following the completion
of the first round of interviews, ethnographic work will be carried
out in the two areas, observing where children meet and play and
the resources which they access. Additionally single, in-depth interviews
will be conducted with a parent/carer in each participating household.
Policy Implications
Promoting the welfare of children and reducing health inequalities
are central aims of government social policy. The government is
seeking to meet these aims by developing 'joined up' policies, at
both national and local level, which take account of the lives of
children, parents and the communities in which they live. The project's
focus on children's perspectives on health and incapacity feeds
directly into these policy aims. Its findings should therefore provide
a useful basis on which to develop child-relevant policy and practice
in the fields of public health and family support.
Project Summary
There is widespread acknowledgement of the impact of socio-economic
inequalities on health outcomes at every stage of the lifecourse,
including childhood. Recent legislation emphasises that children's
voices should be listened to and acted upon by adults who make decisions
concerning their lives. However, qualitative data are still lacking
on how inequalities relevant to a range of health outcomes are experienced
and acted upon by children and their families on a daily basis.
This qualitative
study examined children's everyday experience of inequalities and
the production of health variations. 35 children aged 9-12 years,
living in two contrasting areas of Edinburgh, one relatively advantaged
and one relatively disadvantaged, were interviewed. A range of child-appropriate
research techniques was developed, which acknowledged that children
are social actors in their own right. In a second round of interviews
with the children, health issues and ideas about health and health
inequalities were addressed more directly and interviews were conducted
with their parents. The interviews were informed by a community
profiling exercise and by observational work involving over 100
children undertaken in school and community settings (e.g. youth
clubs, after-school clubs).
Key findings
- Children
were articulate about inequalities, both material (e.g. possessions,
resources, poverty and affluence) and social (e.g. control over
their lives, care and love, acceptance by peers). They located
their experience of these inequalities as much in social relationships
as in material resources, often describing them in terms of fairness
and unfairness.
- Whilst children
from the two contrasting areas often described quite different
lives and personal opportunities, both groups tended to challenge
the idea that their lives were overly affected by inequalities
in income, emphasising the importance of good parents who cared
for children well, having friends and not being bullied.
- Relationships
with both peers and adult authority figures were very important
in how children made sense of inequality, for example with respect
to bullying by peers and experiences of unfair treatment by adults.
- Interviews
with children and parents in the poorer households suggested that
gifts and transactions from wider kin were softening material
disadvantages for children. In the more affluent households, this
type of exchange was described in terms of additional items, treats
or savings rather than, for example, ensuring a holiday or a particular
leisure pursuit. However, families with scarce resources and networks,
such as those experiencing unemployment, also attempted to mitigate
the effects of financial inequality on their children.
- Inequalities
in access to health-supporting resources, like sports and clubs,
were evident, with children in the more affluent area reporting
a greater number of organised activities. However, this did not
necessarily mean differences in active lifestyles. The more affluent
children described being driven to many activities whilst those
who were less affluent reported more spontaneous outdoor sport,
play and walking.
- Parents in
both areas spoke of the tensions between ensuring children's safety
and promoting their independence; but those in the more affluent
area described a more adult-regimented existence for their children,
allowing fewer opportunities for children's independent negotiation
of their out-of-school social and physical environments.
- As with adults,
children drew on both abstract and experientially-based knowledge
to discuss health inequalities but often did not link the two.
Their abstract knowledge about inequalities and health was often
expressed in terms of experience very distant from their own,
such as talking about poverty in Africa or, occasionally, to observations
or guesses about homeless people or those living in one of the
stereotypically poor areas of their city.
- Children
in both areas spoke about individually-based health promotion
messages, particularly around smoking, diet, exercise and dental
health. However, most avoided linking causes and effects of ill
health and health inequalities. They offered both structurally
and individually-based explanations, drew on discourses of blame
and personal responsibility, and often stated that it was inappropriate
to generalise.
- Methodologically,
the project contributed to the development of child-appropriate
techniques, such photographs of different areas taken by children,
and vignettes. One vignette focused on earning pocket money through
a job, in order further to examine issues around money and resources
at the child, parent and household levels. Another vignette revolved
around sport as a way of raising issues around fairness and gender
issues, again encouraging children to talk from experience about
the relationship between inequalities and health.
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