Social inequality in health starts early in life
Children of parents with low education face poorer health on a wide range of measures – even when it comes to basic prevention such as childhood vaccinations, a new report shows.
Social inequality in health begins early. In fact, already before birth.
This is shown in a recent report from the National Institute of Public Health in Denmark, commissioned by the Danish Health Authority. The report, Social Inequality in Health and Disease, documents that children of parents with a short education are at a disadvantage compared to children of parents with a long education – both in terms of disease risk and poor mental health. And the differences are not minor.
According to the report, a clear social disparity is already evident at birth. The rate of stillbirths is twice as high among mothers with a short education (6 out of 1,000) compared to mothers with a long education (3 out of 1,000). Children of parents with a short education are also more often born prematurely, with low birth weight, and are breastfed for a shorter duration.
Vaccines don’t reach all children equally
One of the most striking disparities is in childhood vaccination rates.
Children of parents with lower levels of education are less likely to be fully vaccinated.
In 2021, only 64 percent of girls from families with a short education completed the HPV vaccination programme. In comparison, 85 percent of girls with at least one parent with a long education received the full course. When the HPV vaccine programme in 2019 was extended to include boys, the same pattern emerged: 69 percent of boys with parents with a long education were fully vaccinated by 2021, compared to just 45 percent of boys with parents with a short education.
A similar gap appears with the standard childhood vaccines. Among families with a lower education, 85 percent of children are vaccinated against measles, mumps and rubella, whereas the figure is 96 percent in families with higher education.
“It’s obviously concerning that vaccines are not distributed equally among children,” says Assistant Professor Thora Majlund Kjærulff, one of the researchers behind the report.
“If children are not vaccinated, their risk of developing diseases later in life increases – for instance, cervical cancer, which the HPV vaccine helps prevent.”
She points out that childhood is a crucial period for shaping future health:
“It’s highly problematic that we see such clear disparities this early in life. We know that inequality in childhood can carry over into adolescence and adulthood.”
Oral health and weight
Vaccination is just one area where social background plays a role. Oral health also shows a significant divide. By the age of 15, 72 percent of children with parents with a long education have no cavities. Among children from families with a short education, the figure drops to just 47 percent.
Overweight is another area with considerable differences. Among children of parents with low socioeconomic position, 17 percent of girls and 19 percent of boys are overweight or obese. Among children of parents with high socioeconomic position, the figures are 8 percent and 11 percent, respectively.
Girls feel lonelier
The report also reveals how social inequality affects children’s well-being – particularly among girls.
There is a clear correlation between parental socioeconomic position and feelings of loneliness among girls: the lower the social group, the more girls report feeling lonely often or very often. There is also a disparity in life satisfaction and self-efficacy – that is, the belief in one’s ability to achieve goals.
Among boys, the picture is more mixed. The same clear patterns are not observed in loneliness or life satisfaction.
A complex picture
According to Thora Majlund Kjærulff, social inequality among children is partly rooted in the complexity of the healthcare system, living conditions, and the resources parents have.
“If you’re a parent juggling many challenges – such as your own illness, unemployment, or financial stress – preventive care can easily be pushed down the priority list. The healthcare system can be difficult to navigate, and it can be difficult to how to book a vaccination appointment,” she explains.
She stresses that there are already efforts in place to support vulnerable families – for example, through public health nurses – but more resources are needed.
“It’s important to identify vulnerable families early and provide them with the right kind of support. We need more targeted assistance to reach those who need it the most.”
The report also documents widespread inequality in health among the adult population across nearly all examined areas, including mental health, chronic diseases, accidents, health behaviors, work environment, and access to healthcare.
Contact: Assistant Professor Thora Majlund Kjærulff, Tel.: +45 6550 7761, Email: thok@sdu.dk, National Institute of Public Health, University of Southern Denmark