Ziba Vaghri

Addressing social determinants of health inequities: what can the state and civil society do?

In this Health Policy article, we selected and reviewed evidence synthesised by nine knowledge networks established by WHO to support the Commission on the Social Determinants of Health. We have indicated the part that national governments and civil society can play in reducing health inequity. Government action can take three forms: (1) as provider or guarantor of human rights and essential services; (2) as facilitator of policy frameworks that provide the basis for equitable health improvement; and (3) as gatherer and monitor of data about their populations in ways that generate health information about mortality and morbidity and data about health equity. We use examples from the knowledge networks to illustrate some of the options governments have in fulfilling this role. Civil society takes many forms: here, we have used examples of community groups and social movements. Governments and civil society can have important positive roles in addressing health inequity if political will exists.

Priorities for research on equity and health: towards an equity-focused health research agenda.

Piroska Östlin and colleagues argue that a paradigm shift is needed to keep the focus on health equity within the social determinants of health research agenda.

Bucking the inequality gradient through early child development

A good start in life is the key to reducing health and social inequalities in society. Clyde Hertzman and colleagues argue that governments in rich and poor countries should be investing more in programmes to support early child development

Hair cortisol reflects socio-economic factors and hair zinc in preschoolers

This study examined the relationship between childrens hair cortisol and socioeconomic status of the family, as measured by parental education and income. Low family socioeconomic status has traditionally been considered a long-term environmental stressor. Measurement of hair cortisol provides an integrated index of cumulative stress exposure across an extended period of time. The present study is the first to examine the relationship between hair cortisol and parental education as well as parental income in a representative sample of preschoolers. Data on hair cortisol, family income, and parental education were collected for a representative sample of 339 children (Mean age=4.6 years; SD=.5 years) from across 23 neighbourhoods of the city of Vancouver, Canada. As maternal education was shown previously to be associated with hair zinc level, hair zinc measurements were included as well in order to explore potential relationships between hair zinc and hair cortisol. The relationship between hair cortisol and parental education was examined using hierarchical regression, with hair zinc, gender, age, and single parenthood included as covariates. Maternal and paternal education both were correlated significantly with hair cortisol (r=-0.18; p=.001). The relationship remained statistically significant even after controlling for all demographic covariates as well as for hair zinc and after taking the neighbourhood-level clustering of the data into account. Parental income, on the other hand, was not related significantly to childrens hair cortisol. This study provides evidence that lower maternal and paternal education are associated with higher hair cortisol levels. As hair cortisol provides an integrated index of cortisol exposure over an extended time period, these findings suggest a possibly stable influence of SES on the function of the hypothalamic-pituitary-adrenal (HPA) axis. Cumulative exposure to cortisol during early childhood may be greater in children from low socio-economic backgrounds, possibly through increased exposure to environmental stressors.

CRC General Comment 7 Indicators Framework: A Tool for Monitoring the Implementation of Child Rights in Early Childhood

United Nations Convention on the Rights of the Child (CRC) has universal recognition as the main human rights treaty providing international standards and a yardstick for fulfillment of childrens rights. The Convention stipulates a monitoring system for countries that signed up to it. This system places international legal obligation on countries to write periodic reports to the Committee on the Rights of the Child (UNCRC) as the monitoring body of the Convention. The monitoring Committee on the Rights of the Child as a part of the Convention (Articles 42–45 of the CRC) also issues general comments to guide governments in better understanding, implementing, and monitoring the implementation of the Convention in their countries. Therefore, it provides a basis for developing child rights indicators. Its General Comment on implementing child rights in early childhood provides an excellent basis for developing early childhood indicators based on human rights. The manual and the framework developed is a tool to address concerns to better realize young childrens rights through better data collection, analysis, monitoring, and reporting through provision of a structured guide to help governments to fulfill their obligation for state reporting and most importantly towards the youngest members and rights holders of their societies.