Inequalities in Children

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Inequalities in Childrens Educational Outcomes
Using Administrative Data to Gain a
Population-Based Perspective on Health

• Marni Brownell, Noralou Roos, Randy Fransoo,
  Leslie Roos, Anne Guèvremont,
• Leonard MacWilliam, Lauren Yallop,
• Ben Levin Beth Edwards

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Questions to be Addressed

• 1. Why focus on educational outcomes when
  studying population health?
• 2. What are administrative databases?
• 3. What do administrative databases tell us about
  child outcomes that is different from other data
  sources?

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1. Why focus on educational outcomes when
studying population health?

• First, what is health?
• WHO originally defined it as
• A state of complete physical, mental and
  social well-being and not merely the absence of
  disease or infirmity. (1948)
• In 1986 the WHO stated that at every level of
  planning health promotion should emphasize a
  social, economic and ecological, rather than a
  purely physical and mental perspective on
  health. (3)

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• Research on the social determinants of health
  much more to health than health care
• Examples
• Marmot et al. (1991) - Whitehall study of British
  Civil Servants (6)
• Evans et al. (1994) Why Are Some People Healthy
  and Others Not? (2)
• Hertzman et al. (2002) Child development as a
  determinant of later health outcomes (4)

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• Education levels strongly related to health
  outcomes
• Education outcomes have inter-generational
  effects
• Education levels may be more readily changed by
  policy initiatives than other components of
  socioeconomic status (SES)

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2. What are administrative databases?

• Data originally collected to provide and manage
  services
• extremely useful for research
• Linkages made across data sets using anonymized
  identifiers make cross-service and longitudinal
  research possible
• Manitoba Centre for Health Policy model for
  linked administrative databases

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Manitoba Population Health Research Data
Repository
-standards tests -high school marks -graduation -r
etention
- Birth weight, gestation - Injuries - Chronic
diseases (asthma, diabetes)
-income assistance -in care
Healthy Child Program Data
-diagnosis
-marital status
-residence
-family size

• Meds
• dosage

Census Data at area level
National surveys
Key health databases start in 1970
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3. What do administrative databases tell us
about child outcomes that is different from other
data sources?

• Combined with information from a research
  registry they provide a population-based
  perspective that might not be available otherwise
• We can combine information to examine underlying
  causes of inequalities in child health
• - Area level socioeconomic status
• - Age of mother
• - Birth weight
• - Apgar scores
• - Educational Outcomes
• The following slides will demonstrate how
  educational outcomes vary with socioeconomic
  status

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SES Groups, Winnipeg 2001 Census
Neighbourhood Socioeconomic Status
Assessed by High school education, Unemployment
rate, Single parent families, Female singe parent
families, Female labour force participation
10
Grade 12 (S4) Performance by SES Group Language
Arts Standards Test 2001/02
Pass/Fail rates of test writers
17/18 year olds who should have written
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Recovery What happens to the retained students
in 2 yrs after 01/02? (Percent Graduated)
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High School Completion by SES Mothers Age
Grade 9 (S1) students in 1997/98 What happens in
next 5 years?
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Grade 3 Performance by SES and Mothers
Age(Language Arts Standards Test 1998/99)
Pass/Fail Rate of Test Writers
Eight year olds who should have written
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Healthiness of Children at Birth(1984) by
Winnipeg SES Group
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Infant Hospitalization Rate First Year of Life
(Children Born 1998/99-2000/01)
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Percent Winnipeg Children Enrolled in Reading
Recovery Program, Grade One, 2001
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Child Care Spaces for 0 to 12 year olds, by
Winnipeg Neighbourhoods, 2001 (per 1000 children)
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What can be done?

• Enriched early childhood environments
• Quality child care, especially for kids in low
  SES families
• Research shows that quality ECD helps all, but
  makes largest difference for those at highest
  risk
• Enhanced programs in school years (e.g. early
  literacy programs)
• Engage with health authorities, community groups,
  and parents to make programs aimed at enhancing
  childhood development universal and needs-based
• Appreciate the short and long term health
  implications of educational outcomes.

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Conclusions

• Differences in outcomes across SES may be
  dramatically underestimated without a
  population-based approach
• Disadvantaged groups are at very high risk for
  poor outcomes
• Not all disadvantaged children do poorly
• Of the total number of kids with poor academic
  outcomes, the majority are not in the most
  disadvantaged groups
• But low SES kids are much less likely to recover
  from a setback

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Final Thoughts
This research has centered on school achievement,
but the focus of policies aimed at changing the
trajectories of disadvantaged children should not
be limited to the school system. Our analyses
and work by others (e.g. Hertzman et al. 2002)(4)
reveal that, while the vast majority of children
at every socioeconomic level show remarkable
similarities at birth, inequalities in
achievement are evident early in childhood, prior
to school entry. Children who are already behind
their peers when they begin school will likely
fall further behind engaging them in the
educational process may be difficult. This makes
it imperative for governments to provide
effective early childhood programs (starting in
the first few years of life) to improve the
experiences of children at risk, and to improve
the physical, mental and social well-being of all
children.