Health inequalities: new concerns about the children of single mothers.

Abstract

Objectives--To show that the exclusion from conventional class based analyses of child mortality of children whose parents are classified as "unoccupied" produces a misleading picture of health inequalities.

Design--Reanalysis of data published in the childhood supplement of the registrar general's decennial supplement on occupational mortality in England and Wales, which compares numerator data for registrations of deaths in children over the age of 1 but below their 16th birthday in 1979, 1980, 1982, and 1983 with data about children aged 1-15 who were enumerated at the 1981 census.

Results--Parents who are classified as "unoccupied" largely consist of economically inactive single mothers. Their children are estimated to represent 89% of the 614 000 aged 1-15 classified as "unoccupied" in the childhood supplement. They have the worst mortality record of all social groups--an age specific death rate of 68.8/100 000 a year, 42% worse than in social class V (48.4/100 000) and worse than that of social class I (22.8) by a factor of 3. At older ages (10-15 years) these children have a relative risk of death of 4.14 relative to classes I and II; the risk is 2.58 in children 0-4 and 2.56 in those 5-9. Relative risks of child mortality in social classes I and II in comparison to classes IV and V suggests a progressive shallowing from 2.08 at ages 1-4 to 1.37 at ages 10-15. When unoccupied parents were combined with classes IV and V and compared with classes I and II, however, inequalities seemed to be pervasive throughout childhood; the relative risks were 2.21 for those aged 1-4 and 1.98 for those aged 10-15.

Conclusion--Children classified as unoccupied are almost certainly living in poverty as well as experiencing relatively high risks of mortality. Class based analyses which exclude them therefore produce a misleading picture of inequalities in child health. The implications for health policy are profound. Strategies to promote the nation's health should acknowledge the importance of material and social deprivation more explicitly.

Introduction

One of the main criticisms of The Health of the Nation is that it fails to pay serious attention to health inequalities. The white paper acknowledges "variations in health status between different socioeconomic groups" and recognises the "complex interplay ... of factors" which impact on health.[1] But it emphasises the significance of differences in relation to individual risk behaviour rather than the poverty and disadvantage of the most vulnerable sections of the community.

One of the reasons why the government seems able to sidestep a real assault on health inequalities is its belief that many observed differences in health status cannot "be fully accounted for by ... factors such as socioeconomic groupings."[1] Further research, therefore, is required "to elucidate the reasons for these differences."[1] We aimed to respond to this challenge by showing how significant social …