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Improving the life chances of children in deprived areas

by Guest Author on 9 May 2019

The communities and neighbourhoods we grow up in have a lifelong influence on the illnesses we get and how long we live. Professor John Wright, of Bradford Institute for Health Research, is one of eight UK Prevention Research Partnership (UKPRP) grant winners investigating wider factors, beyond the control of the individual, that impact our health. He tells us how he plans to improve the health and wellbeing of children in some of the most deprived areas across the UK.

Health is about much more than avoiding disease and living long lives – it’s about feeling well in mind and body, feeling safe, being part of a community and having things to look forward to.

The homes we live in, the design of our roads and high streets, the availability and quality of parks and green spaces and of recreational opportunities – these all have a bearing on our health and wellbeing. As do the types of shops and businesses that we’re exposed to, pollution levels and opportunities to mix with others.

For children living in deprived areas, a whole raft of environmental, economic and social factors combine to stack the odds of a long, healthy life against them. Sadly, prevention research has so far only helped to make the already healthy much healthier, while struggling to reach the less advantaged.

Improving the odds

Attempts to change individual behaviours, such as unhealthy eating, drinking, smoking and lack of exercise, have met with important but limited success. For example, increased awareness of links between childhood obesity and ill health – and the importance of exercise and healthy diet – will only have limited success if we don’t tackle broader issues.

These broader issues might include the many fast food outlets that children may walk past, the lack of access to high quality play and recreational facilities, streets that are not safe for children to walk or cycle to school, poor quality of school food, and, for some, insufficient income to buy healthy food.

One of the ‘Born in Bradford’ study families.

Thanks to the UK PRP £6.6m investment, we’ll look to draw focus towards the life chances of children in two predominantly deprived UK areas: Bradford in Yorkshire and London’s Tower Hamlets.

We’ll be using insights from the Born in Bradford study – one of the largest studies of its kind in the world – which tracks the lives of over 30,000 Bradfordians to find out what influences health and wellbeing. It’s thanks to the people taking part in this study, including 13,500 children born between 2007-2010, that we’ll have a much clearer picture of what action can be taken to make sure our communities, health systems and services can support a healthy childhood.

Focus on childhood

We believe the prevention of physical and mental ill-health will come from the cumulative effect of multiple, system-wide interventions. And we want to test this with a focus on early life, as it is such a critical period. Effective interventions at this stage can have a huge impact on people’s lives and health as they grow older.

We’ve brought together experts, local community and authority representatives to establish priority areas of research for improving child health across three key themes: Healthy Places, Healthy Learning and Healthy Livelihoods.

Improving lives

Two members of the ‘Born in Bradford’ study.

For the Healthy Places work programme, we’ll map local community assets, such as community centres, after-school groups and specific local government policies and initiatives, to help us understand how best to improve them. We also want to improve the quality of green spaces.

For the Healthy Learning theme, we’ll be working to develop local ‘Evidence Active Networks’ of preschool, school and community learning venues. These networks will help develop and evaluate a wide range of approaches to improve child health.

And for the Healthy Livelihoods theme, we’ll be looking at issues such as improving access to welfare advice services, ensuring a minimum basic income for school leavers, and helping local communities to become better involved in decisions about the best ways of spending local authority budgets.

Acting early

A key to our project is that we’ll be developing a strong data ‘tapestry’ that will bring together existing information with the results of our work. This will help us to better measure, and understand, the success of our initiatives.

We’ve called this emphasis on early life interventions, together with our highly collaborative approach, the “ActEarly City Collaboratory”. Our life course approach will allow us to measure outcomes not just after five years, but in 10 and 20 years.

At the start of the 22nd century, our ActEarly children will be in their seventies and eighties. We hope that what we do in our UKPRP programme will shape their lives, their health and the fairness of the cities in which they live.

The ActEarly City Collaboratory model.


This is a good article and great to see that some research is being carried out to improve the life chances of children.

One thing that is missing for me is the huge role that parenting plays in the long term mental and physical health of children. 40% of children (whether from deprived areas or not, but perhaps more likely in deprived areas), do not have their emotional and development needs met through lack of good parenting:
These children are likely to grow up feeling less secure and more anxious, which can contribute to both mental and physical ill health as a child and in later life. These children are more likely to have behavioral issues, look elsewhere for support in the form of gangs and to commit crime. They are more likely to go on to be poor parents themselves thus further perpetuating the situation. There is a huge need for mandatory parenting classes including
follow up to ensure all children receive the best start in life. This should be coupled with supporting parents who have often been poorly parented themselves and have their own problems. This would have a massive impact on not only outcomes for children, but for society as a whole, less
desire for children to want to be part of a ‘gang’, decreasing crime rates, fewer children going into the care system and less demand on the NHS by children growing up into calmer, more secure adults. Those children will go on to be better parents themselves, thus decreasing the amount of such education required for future generations. Any money spent on such initiatives would pay back many fold by there being less demand across a broad range of public services.

Is this something that will be explored?

author avatar by Jenny on 09-May-2019 10:25

Replying to Jenny

Thank you Jenny for your positive comments and helpful suggestions. Parenting is so important in promoting a stable and caring environment for our children. We have implemented and evaluated a number of different parenting programmes (HAPPY, HENRY, Incredible years) in the past and we will build on this experience.

One aspect that is different in this programme is the recognition that the focus on individual behaviour change (such as blaming parents for not dealing with childhood obesity) can fail to address the more upstream determinants of health and well-being – for example early education and care opportunities, welfare, housing etc. Attendance at parenting programmes can also be biased to more educated parents, and so potentially widen inequalities. So we are keen to test a more systems approach to promoting health as well as recognising the importance of parenting support. Professor Tracey Bywater from the University of York will be our academic lead for parenting programmes.

All the best,
John Wright
Director, Bradford Institute for Health Research

author avatar by Isabel Harding on 10-May-2019 14:45

Replying to Isabel Harding

Thank you for your reply. It is good to know a number of parenting programmes have been evaluated and there will be someone who will lead on this aspect. In terms of attendance on such programmes, if this were a legal requirement (as it is for children to attend school) then all children would benefit equally no matter their background or education level of their parents.

author avatar by Jenny on 14-May-2019 10:23

This is an impressive and ambitious programme, I am interested to know how you plan to identify the effects of any specific programme (or indeed the whole systems-wide package) on the development and wellbeing of children? For instance, what analytic approaches might you apply to your proposed “tapestry of data” to identify /demonstrate any causal links (or associations) between intervention and outcomes? I am not being critical here, just genuinely interested (as a fellow academic) to know.

author avatar by Colin Greaves on 08-Sep-2019 11:55

Replying to Colin Greaves

Hi Colin,

For all interventions, combinations of interventions, and systems we will be interested in (a) understanding processes of implementation including adaptation, (b) effectiveness and (c) economic impact. We will estimate both average and distributional effects, harnessing our consented cohort and routine linked datasets to follow up our children’s longer-term health and wellbeing outcomes.

Single intervention evaluations: We will use a variety of methods, depending on context, with a preference for quasi-experimental methods (e.g., propensity score matching, regression discontinuity designs, difference-in-differences) where possible. Qualitative data collection will give insights into how interventions achieved (or not) their effects, paying particular attention to contextual factors, and to identify any unexpected impacts.

Evaluating combinations of interventions: We will treat ‘groups of conditions’, (combinations of interventions that may interact to produce effects through ‘conjunctural causation’) as cases and use qualitative comparative analysis (QCA) as our approach. This algebraic technique will be used to test the extent to which different components of the configuration of the interventions, and their context, seem necessary or sufficient to produce outcomes. It will allow us to examine pathways to both positive and negative (unintended) outcomes across our complex system. Definition of cases can be based on both quantitative and qualitative data, the configurations of which are analysed as either ‘crisp set’ (where data are clearly binary) or ‘fuzzy set’ (allowing for calibration to a scale where they are not). A research fellow at York is already applying QCA techniques within BiB.

Whole, complex system analyses: We will co-develop complex systems maps, and/or complex networks of systems, related to each of our research themes or related to producing outcomes in, for example, early childhood, school age children or young adults, or systems related to particular stakeholder spheres of influence, e.g., Local Authorities. Systems will be developed and described through iterative concept mapping, expert input (via Delphi surveys) and then simulated (and refined) via agent-based and/or system dynamic models. Empirical data will then be used to explore the credibility of, and to improve, the system models. We will draw on the expertise of co-investigators Cummins, Kandt and our Complex Systems Advisory Group (led by our new Co-I Garnett).

Life course simulations, policy and economic modelling: We will simulate long-term policy effects, public costs and inequality impacts of interventions, sets of interventions or systems for our Collaboratory sites and nationally, building on co-investigator Cookson’s prototype microsimulation methods. Simulation methods will explore long-term impact of interventions on NCDs, using relationships between early life predictors and later disease.

Meta-evaluation of the ActEarly Collaboratory: We will adopt a realist context-mechanism -outcome perspective. This will involve multiple components including QCA, a complex systems analysis of the whole Collaboratory, social network analysis of collaborators, qualitative interviews, and tracking of processes, outputs and impact on policymaking.

All the best,

John Wright
Director, Bradford Institute for Health Research

author avatar by petra kiviniemi on 20-Nov-2019 14:57

Are you considering the effects of pets in the family, and in communities? This is an interesting, often overlooked area of research. Children raised with pets enjoy better health – fewer allergies and lower incidence of infections. They also tend to have higher empathy and better social skills. City youth bonded to dogs were found less likely to join gangs, or be reported to police, take drugs or excess alcohol; they had more traditional values, more respect for parents and better academic achievement. For adults, pet ownership has significant health benefits. Of special note is the cardioprotective effect: large scale longitudinal studies find pet owners have a 30% reduction in heart attack and stroke and a much better chance of long term recovery following CVA. The role of pets in social support for people of all ages is also very important. Pets are also a major contributor to social capital, influencing community health. Therefore the presence or absence of of pets in communities and in families, and the quality of these relationships, should be recorded when studying family and community health. Dr Elizabeth Ormerod, Chair of The Society for Companion Animal Studies (SCAS)and VP The International Association of Human-Animal Interaction Organisations (IAHAIO)

author avatar by Dr Elizabeth Ormerod on 19-Jan-2021 07:16

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