GCPH on the Holyrood baby: building resilience through policy

Valerie McNeice - credit GCPH

Early childhood is a crucial period for Kirsty, as it is for all children. There is a strong evidence base that shows our development – physical, intellectual and emotional – is based on what happens to us up to and including this period of our lives. Consequently, the experiences Kirsty has in her early years will be important for her development now and for her health and wellbeing throughout the course of her life. 

A number of complex and interrelated factors affect early experiences. Kirsty’s life is being influenced by her family and parenting environment, by her learning environment, by her neighbourhood environment, and by the social and economic circumstances she and her family live in.

Because Kirsty and her mum, Caley, live in one of Scotland’s most deprived areas, on her first birthday Kirsty will already be experiencing the lived realities of inequality.

What does this mean? Put simply, compared with a mum living in an affluent area, it is likely that Caley will find it more difficult to provide and maintain the optimal circumstances for Kirsty to flourish in, despite her ambition and efforts to do so. Therefore, the role our services and policies play in creating the best possible circumstances are vital.

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Evidence shows that child poverty impacts a child’s health, educational attainment, future prospects and health in adulthood (even where individuals experience improved economic circumstances in later life).

The number of children living in poverty in Scotland is thought to be growing and low-income households, especially those with children, are falling further behind those on middle incomes. Minimising the unintended impacts of poverty resulting from welfare reform on children and young people will play an important part in the health and wealth of Kirsty. 

Living in one of Scotland’s most deprived areas, Kirsty may well be living in poverty. Even if Caley is in work, this will not necessarily guard against the effects of poverty unless she can find secure, meaningful and adequately paid work that provides the material and psychological foundations for leading a health-enhancing life.

Employers paying the Living Wage (£8.25 per hour, compared with the minimum wage of £7.20) and the introduction of a universal basic income could help to boost Caley’s income and recognise the value to society of her unpaid work as a mother of a young child. 

Caley’s ability to go out to work, however, may be determined by the availability of affordable, flexible, high-quality childcare for Kirsty. The GCPH is exploring this issue currently as the evaluation partner in the ‘Childcare and Nurture, Glasgow East’ project (CHANGE), which is seeking to provide a new model of childcare through engagement with local families.

Thinking about Kirsty’s family, evidence shows that the quality of the relationship between a parent or carer and a child in their early years has profound and enduring impacts. The family structure (e.g. a supportive partner or other family members for Caley to rely on) and the attachment between Kirsty and Caley are defining factors. 

Caley’s own health, wellbeing and experiences throughout her life will continue to exert an influence on her mental and physical health. Support with parenting skills is important and there may be parenting and family support programmes or interventions on offer locally for Caley. When combined with other types of support on the basis of need, this offer will be more effective in promoting a nurturing family environment. 

An example is supporting parents to address difficult or specific life circumstances such as advice with debt, employment, childcare, finance, or housing, as in the Healthier, Wealthier Children project which sought to maximise family incomes. 

The provision of emotional support to parents with adverse childhood experiences to prevent such experiences being repeated, providing opportunities for parents to expand their social networks and develop peer support, and support for parenting and child development through education services are other great examples. 

At one year old Kirsty may already be on her feet and running around. Her neighbourhood environment is becoming increasingly important. Evidence shows that the safety of neighbourhoods impacts on how active children and young people are in their local area, influencing their mental and physical health. Implementing 20mph zones reduces the risks presented by traffic, leading to more walking, cycling and less pollution. 

Is there usable greenspace locally for Kirsty and Caley to access? These spaces can help to increase connections between people within communities too. There is good evidence that there are increasing levels of loneliness and social isolation in our society which contribute to adverse health outcomes regardless of an individual’s background. 

Opportunities and support for social participation to enable people to access, develop, expand and exploit their social networks is much needed. If such opportunities are long term, inclusive and accessible, all the better for supporting parents like Caley. 

There are many other factors in Kirsty’s neighbourhood environment that are already impacting on her health and wellbeing, such as the local availability of healthy nutritious food and of leisure activities for young children that are affordable to Caley. 

Is there enough housing in the social rented sector in Kirsty’s local area, or affordable private rented accommodation of good quality? 

Given the opportunity, Kirsty will be beginning to play with other children. Caley and Kirsty’s friendships will also affect their health and wellbeing.

Research shows that people from different cultures can exert a positive influence on health-related behaviours in their new resident communities and that having a diverse social network, including people who hold both similar and different experiences, can be advantageous when communities undergo change. It can also support access to employment opportunities. 

It is increasingly recognised that health and care services can positively engage with people to develop a person’s knowledge, skills and confidence to manage their own care and that this approach can also reduce the burden of preventable disease and alleviate demand. If public services have a greater focus on community-led and person-centred approaches, they will be better positioned to assist Caley and Kirsty in tackling the challenges they face in sustainable and effective ways.

This will be important for Kirsty, and her resilience, as she grows. GCPH work looking at resilience for health and wellbeing showed that being resilient is not only about what is within us as individuals – it is not simply an ability to cope through mental toughness.

Resilience is also dependent on our relationships with others – what is between us – as well as our ability to influence wider decisions that will have implications for our lives – what is beyond us. Services that build relationships with families to help them take an active part, rather than being viewed as passive recipients, will help to empower Caley now and set expectations for Kirsty about her ability to take control of her own life. 

We know that prioritising action that focuses on the early years and on families with children works to tackle inequalities in health. Kirsty is lucky to live in a country that recognises the importance of the early years. 

Caley and Kirsty will see their health visitor very soon for Kirsty’s 13-15 month developmental and wellbeing review. This visit is intended to provide an opportunity to support Kirsty with detection of any medical and developmental issues but also, much more broadly, where additional family support may be required.

A health visiting service that facilitates relationship building with the family can help to ensure that families’ needs are appropriately assessed and responded to in a person-centred and supportive way. 

The provision of early learning and childcare services will influence Kirsty’s learning environment over the remainder of her pre-school years. A service that aims to reduce inequalities in young lives and close the gap in differences in educational attainment will help Kirsty to have a positive experience of the education system. Taking into consideration the role of the families and communities in which children are growing up will be important.

Policy and practice intended to take specific account of the needs and desires of parents and the home learning environment with sensitivity to the specific culture, values and strengths of local communities are required, ensuring that early learning and childcare are rooted in a high quality experience for children.

The recent establishment of integrated health and social care partnerships includes children’s community services. In light of our ageing population, continued scrutiny of the proportion of resources allocated to early years services and the balance between primary prevention (e.g. parenting and family support for families like Caley and Kirsty) and treatment health and care services will need to be carefully managed. 

A recent GCPH publication brings together all of our learning related to ‘health and the early years, children and young people’ from over a decade of GCPH research. This reiterates the point that improving health and addressing inequalities is complex, with action and interventions required across the range of influences on health. 

Specifically, the work raises five key points which have been discussed in more detail above which are vitally important to Caley and Kirsty as they celebrate her first birthday together:
Firstly, emotional attachments and relationships in the early years of a child’s life are fundamental. 

The need to feel safe is critical to avoid damaging long-lasting impacts for children into adulthood. 

A lack of attachment and stressful experiences impact negatively on physical and emotional development, with potentially life-long consequences. However, there is also significant capacity for healing through changing circumstances, nurturing approaches, and supporting resilience through family support, nurseries and schools, communities and services. 

Understanding and responding to differences in personal circumstances is important for services. 

Children and young people should be meaningfully involved in decisions affecting their lives. 

Action across all of these areas will support a better, fairer and healthier Scotland to grow up in – not just for children like Kirsty who live in Scotland’s most deprived neighbourhoods, but for all children and families. 

Valerie McNeice is Senior Public Health Research Specialist, Glasgow Centre for Population Health (GCPH)