Subscribe
Share
Share
Embed
Podcast series from the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Anna Pearce:
Hello and welcome to the latest episode of 15 Minutes on Health Inequalities. I'm Anna Pearce from the MRC/CSO Social and Public Health Sciences Unit at the University of Glasgow. And we're bringing this podcast to you today as part of European Public Health Week, which this year has the overall tag line, 'Health is a political choice'. Each day has a different topic focus. And today's is, 'Health through the life course: Breaking down silos'. So with that in mind, myself and two colleagues...
Vittal Katikireddi:
Vittal Katikireddi
Anna Pearce:
and
Phil Broadbent:
Phil Broadbent
Anna Pearce:
both also from the University of Glasgow, are going to be discussing some of our recent work examining inequalities in childhood overweight and obesity. So, Vittal let's kick off by discussing a paper that the three of us co authored, looking at trends in childhood overweight in England. What was the motivation behind this study?
Vittal Katikireddi:
So there's a lot of policy interest in trying to reduce childhood obesity. We know that childhood obesity can really influence future health in adulthood, but also immediate health during childhood as well. But also we know that the social conditions that people experience and people's social characteristics is likely to shape childhood obesity as well. There are likely to be quite large health inequalities in childhood obesity. But the typical way of monitoring inequalities in childhood obesity is to rely on quite limited measures of inequalities. Often, we rely on area based deprivation measures rather than necessarily trying to assess inequalities more holistically. For example, thinking about things like household structure, whether people are in a coupled parent versus a lone parent household. Or also think about things like ethnicity and other measures of socioeconomic position. We're really interested in trying to understand how inequalities in childhood obesity were evolving over time. And are there certain groups where things aren't improving as much as we might hope?
Anna Pearce:
So Phil, I think you were doing most of the analysis in the background. Do you want to say a bit more about the datasets?
Phil Broadbent:
Yeah, so as Vittal mentioned, we were interested in looking at some particular aspects of social and economic circumstances. And the key dataset that we were using to look at that was the Health Survey for England. And that gave us data over a 25 year period, between 1995-2019, along with the key outcomes that we were looking at, which were the proportion of children living with overweight and obesity, it gave us information about these different social and economic circumstances. For instance, we looked at parental educational attainment and that data was available between 1997-2014. All of those elements weren't available throughout the whole study period, but we were able to pull out some of that really useful information. What we were trying to do was to compare this against routinely collected data. The problem with something like the Health Survey for England, as much as it gives us this really rich information on different lenses of social and economic circumstances, is that the sample site tends to be a bit smaller. So we're less confident in the results that we get from it. So we wanted to compare it against a bigger data set. And to do that we used the National Child Measurement Program and that was able to provide us comparable data, between 2006-2019. Again, looking at obesity and overweight and trying to get at whether we were seeing the same patterns reflected in terms of social and economic circumstances. In total, we were able to look at data from over 50,000 children aged between 2 and 16 years old from the Health Survey, from the Health Survey for England, and compare this against the National Child Measurement Program.
Vittal Katikireddi:
One of the things that we tried to do in terms of measuring health inequalities was use a measure that didn't just look at the most and least disadvantaged, but actually try to measure health inequalities across the whole gradient. For example, we often see if we look at socioeconomic measures, that people with the least resources have the worst health outcomes and people with the most resources have the best health outcomes. But actually people in between those two extremes often also experience disadvantage in terms of their health. We used an approach that's based on basically drawing a line of best fit or a regression line to try and capture a summary measure of inequality - called the relative index of inequality. By assessing that, it gave us a way of looking at inequalities in quite a standardised way, using all the information available, but also allowing us to compare trends over time in a way that wouldn't be affected by changes in the size of the different groups. For example, over the last few decades, the numbers of people with a degree have really increased. If you just compare people who have a degree to those who don't, you might get changes in the measures of health inequalities just because of that change in the proportion of people who have degrees. Phil, do you want to maybe explain what we found with that?
Phil Broadbent:
Yeah, the overall information that we were getting using this relative index of inequality was the inequalities in overweight and obesity by different groups have widened over the study period that we were interested in. Specifically, we looked at deprivation and we used the index of multiple deprivation. We found that the relative index inequality increased from 1.2 to 2 between 2001-2019. And really what this is telling us is that throughout that time period, increasingly children who were living in the more challenging economic circumstances were more likely to be living with overweight and obesity compared to their more advantaged peers. Similarly, we saw the same pattern among children with regard to parental educational attainment. Where comparing children who lived in households that had a degree-educated adult against children who lived in a household that had an adult who didn't have a degree level education, we found that the relative index of inequality again increased throughout the study period. We see this widening gap based on different lenses, if you like, of social and economic circumstances.
Anna Pearce:
What I thought was really striking and that we've also seen in data in Scotland as well is just if you only look at the overall prevalence of childhood overweight and obesity actually doesn't look like it's changed very much over time. It's disguising that widening of inequalities that you've just described.
Phil Broadbent:
Yeah, exactly that. Just as you say, although broadly the proportion of children living with overweight and obesity seems relatively static, that masks what's going on if you look more closely at the data, which is that the burden of overweight and obesity is increasingly following on those living in the most challenging social and economic circumstances. Whereas it remains relatively static, the proportion remains relatively static amongst more advantaged peers, those living in more disadvantaged circumstances, and that's not just deprivation, but educational status also household structure as Vittal mentioned and ethnicity, we see widening inequalities amongst all of those different lenses of inequality.
Vittal Katikireddi:
The other thing that was quite striking is that actually the results are quite similar when we compared the deprivation results from the analyses of the much larger datasets that are routinely collected as part of surveillance and the surveys for deprivation, which gives us a bit more confidence that the patterns we see for other aspects of socioeconomic circumstances and ethnicity and so forth, are likely to reflect genuine findings rather than just being a consequence of data quality issues, for example. That was quite an important issue given that over time we are aware that a lot of health surveys are experiencing reducing response levels. Anna, I believe you've done a recent report on inequalities and overweight as well using a different data set. Could you tell us a bit more about that report?
Anna Pearce:
Yeah, this was a report which was funded by Obesity Action in Scotland and was published earlier this year. We were looking at inequalities in childhood overweight and obesity using a different type of dataset this time, so a cohort called 'Growing up in Scotland'. This has followed up children at different points throughout childhood. And using that data, we could look at trajectories of overweight and obesity throughout childhood. And it also has very rich socioeconomic information as well. So we could look at inequalities. Unfortunately, we weren't able to look at ethnicity because it was quite underpowered in that dataset. But we found some really interesting stuff which I think can add to the findings that we've already been discussing. Following them up over time we found that children who experience overweight or obesity early in childhood don't necessarily go on to experience that throughout the whole of their child and adolescent years. For example, 37% of children who experienced obesity at age 4 were not experiencing obesity at age 14. However, there was a sizable portion of children who were experiencing childhood obesity right throughout childhood, between 4 and age 14, around 15%. And there were really large inequalities in that persistent measure of obesity. These varied according to various different socioeconomic measures that we looked at, but we found really big inequalities related to food insecurity in particular. Children whose mothers were reporting having experienced food insecurity in the very early years were 4 times as likely to experience persistent obesity compared to children who were not experiencing food insecurity. And this was after accounting for a range of other possible confounders and socioeconomic measures like maternal education, lone parenthood, and area deprivation.
Phil Broadbent:
I think it's really interesting that you're seeing the same patterns repeated across different studies and looking at different measures of inequality. Again and again, we see that children living in more challenging socioeconomic circumstances are more likely than more advantage peers to be living with this burden of overweight and obesity. I think a couple of reflections that I had about this work and about the 'Growing up in Scotland' work are we're looking specifically at one health outcome here, we're looking at overweight and obesity. But it's likely that if we were to look at other health outcomes or other health conditions, we'd see the same patterning. I guess it's heartening that living with overweight and obesity in childhood doesn't necessarily mean that that's going to be the case in adult life. But it's likely that a portion of children will suffer and live with health conditions as a result of this right across their life course. The impact of this across the life course is something of real interest. I guess what it led me to think about was how can we develop interventions that specifically address the challenges and the barriers faced by those living in the most challenging circumstances. I don't know if you Anna or Vittal have any thoughts about that?
Vittal Katikireddi:
Yeah, I think that's right. A real difficulty is that we often have quite global ambitions in terms of policy. The UK government and Scottish government have had a target to roughly half the levels of childhood obesity by 2030. But actually what we're seeing is that although not only has there been a lack of progress, actually childhood obesity is getting more and more socially patterned. The existing approaches are probably reaching some people - those most advantaged in society, but aren't really helping the whole of society. Increasingly, what we probably need to be doing is thinking about how do we actually ensure we're addressing childhood obesity for everyone, not just the most advantaged in society. That does require quite a different approach. It probably does mean we need to think more about how we support people's lives, address underlying causes of health inequalities. Thinking about the social circumstances, improving people's lives to try and actually make it easier to follow a healthy diet and reduce levels of childhood obesity.
Anna Pearce:
Yeah, I agree with that. And that leads me nicely to the point I'd like to finish with and that's about food insecurity. We found this really strong association in the 'Growing up in Scotland' cohort. And we know that food insecurity has increased dramatically since those children were growing up. More than 1 in 5 children in the UK now living in food insecurity. And so that would seem like an obvious place where we need to target some action. But how about we finish on a more positive note with a look to the future?Phil, you've got exciting plans ahead. Do you want to tell us a bit more?
Phil Broadbent:
Yeah, so we're very much looking forward to August. And I'll be starting my PhD fellowship, where I'm going to be exploring the impact of poverty, poverty, and childhood on health outcomes across the life board. So specifically, I'm really interested to see if there are key periods of exposure during childhood by being exposed to poverty is particularly harmful. And then using techniques that have been used in the Social and Public Health Sciences Unit before, such as microsimulation modeling, where we ask 'What If...?' questions. What if we were to introduce a policy to try to prevent people falling into poverty at these points? And what impact would that have, not just on health outcomes in the immediate term, but right across the life course? So yeah, really looking forward to that.
Anna Pearce:
Really important work. Yeah, we look forward to seeing how that comes along. I think that's us at time. Thank you everyone for listening. Thanks to you, both, Phil, and Vittal for taking the time to talk about your research today. Our listeners can find details of the publications that we've been talking about today in the podcast notes. We hope to see you next time.