Total Environment Assessment Model for Early Child Development

Spheres of
Influence:
The Family
of nations in terms of the steepness of their
gradients appears not to be random. That is,
although they have been poorly studied to
date, there seem to be systematic differences
in institutional arrangements between those
societies in which the ses gradients in health
and development are steep, versus those in
which they are shallow.
Another way to state this is that since
there is no necessary, or predictable, level of
health or development associated with any
given position on the socioeconomic spectrum
(as described in the fourth point, above);
as such, health and development at any given
socioeconomic position is highly dependent
on the extent to which different societies tie
ses to one’s ability to procure health-promoting
resources and, conversely, the extent to
which ses serves as a sorting mechanism for
‘exposures’ that are harmful to health. It can
be argued that societies which are nurturant
for children (and adults) are those whose
institutions work to break these ties. In other
words, in some societies, factors fundamental
to health and development are provided as
rights of citizenship, rather than according to
socioeconomic privilege.
ses gradients suggest the
fundamental influence of societal
determinants of health
There is also another line of reasoning that
supports the thesis that societal factors are
fundamental to the expression of socioeconomic
inequalities (gradients) in health and
development. That is, that if socioeconomic
inequalities are critical for health, then so
too are the societal conditions that create
the inequalities themselves. The extent of
socioeconomic stratification that exists in
society is not innate. Rather, it is strongly
influenced by actions and inactions taken
by societies that, cumulated over time,
become embedded in institutions. Most of the
evidence in this regard arises from research
on resource-rich nations. The notion is
powerfully illustrated by contrasting poverty
rates in these nations before and after taxes
and transfers are accounted for. Data from
the Luxembourg Income Study demonstrates
that, based on market income (i.e. prior to
taxes and transfers), at 31%, poverty rates 9 in
the United States were up to 5-6% lower than
in several oecd nations, including France
and Sweden, and on par with others such
as Australia, Canada, Spain, and Germany.
However, after taxes and transfers, the United
States had the highest poverty rate among the
oecd nations at 18%, between 6% and11%
higher than all other oecd nations with the
exception of Australia which has a post tax
and transfer poverty rate of 16% [100].
The difference in poverty rates is even
more marked with respect to children. Prior to
transfers, poverty rates across oecd nations
for lone parents are consistently high, with a
range of 32% in Italy, to a whopping 80% in
the Netherlands. However, after redistributive
measures were applied by governments,
the rate for lone mothers was reduced to
approximately 10% in many oecd nations,
with a low of 4% in Germany. By contrast, the
poverty rate for lone mothers in the United
States remains at 60% [101]. In epidemiological
speak, the function of societal policies can
be thought of as necessarily causally prior to
the effects of ses on health outcomes.
The roles of institutional arrangements
in reducing socioeconomic inequality, and
undoing the link between socioeconomic
conditions and health status are difficult
to separate, since they may function in a
reciprocal manner. That is, reductions in
income inequality provide public support for
increases in systems that distribute resources
in an egalitarian manner, and the egalitarian
distribution of resources in turn may reduce
levels of socioeconomic inequality [102].
From the perspective of creating societies that
support ecd, an imperative of future research
is to understand which institutional features
promote socioeconomic equalities in ecd and
which detract from it. The following chapters
discuss the main societal institutions that to
play a major role in this process, and highlight
the available evidence to date.
9 Poverty was measured using a relative standard of 40% of
median income, and 50% of median income (Smeeding and
Ross, 1999).
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