How Do Family and Neighbourhood Characteristics Contribute to Raising Healthy Children?
Vol. 11, No. 3 September 2004
Both families and neighbourhoods have a measurable impact on children’s health. Families who are poor or poorly educated and neighbourhoods where many of these families live produce children with more health problems.
What Is this Research Project about?
While we know that the early years have a lifelong impact, we are less certain about which characteristics of children, families, and their neighbourhoods contribute to healthy development. In this project, we compared individual, family, and neighbourhood characteristics for children from birth up to age eight and related these characteristics to children’s health outcomes.
For this study, we analysed longitudinal data from federal, provincial, and local sources on whole populations, i.e., all children born in Saskatoon and Regina between 1992 and 1995.
We measured the stability of the children’s family income from birth until they were eight years old. We then compared income stability with the children’s health during this eight-year period and made further comparisons on a neighbourhood level.
To assess family income stability, we considered whether families had received income support from the government (and for how long). We measured stability over the eight years and not just income support at a point in time, as has been common in previous studies.
We also created a categorical variable for family income stability that included four alternatives—no support, short-term support (one to two years), intermittent support (received in stops and starts over the eight years), and long-term support (three or more years of consecutive support).
To measure health status, we looked at birth outcomes: low birth weight (less than 2,500 grams), small for gestational age (newborns below the tenth percentile for gestational age), and pre-term birth (before 37 weeks). We also considered health outcomes, i.e., number of physician visits and number and length of hospitalizations.
Finally, as we had neighbourhood level data, we investigated a spatial variation of childhood outcomes by geographically mapping research results.
Research Questions and Key Findings
a. How does family economic stability affect children’s health?
To answer this, we asked several questions.
Do children born into poor families have more health problems at birth?
Yes. Children born into poor families were more likely to be born pre-term or underweight. For example, in Regina, we found that children born in poor families were almost twice as likely to have a low birth weight or to be born pre-term than other children. (“Poor” was defined as below Statistics Canada’s Low Income Cut-off (LICO)).
Are children in families receiving income assistance visiting doctors and being hospitalized more often than other children?
Yes. Children in economically unstable families visited the doctor more and were hospitalized more than other children. For example, in Saskatoon, children in families receiving short-term income assistance were one-and-a-half times more likely to be hospitalized than children in families with no income assistance.
b. What family and neighbourhood characteristics are important in children’s health?
We found parents who were single, poor, Registered Indians, first-time mothers, or mothers who had previously had a stillborn baby were more likely to have a pre-term or underweight baby.
Neighbourhoods with more single-parent families, more poor families, and more poorly educated parents (defined as those who had left school before completing grade 9) were more likely to have pre-term or underweight children.
In addition, these children visited the doctor more and were hospitalized more than other children. We also found that these children were more likely to be males, younger children, Registered Indians, parented by single parents, and/or poor.
c. Is children’s health affected more by the family’s income or by the neighbourhoods they live in?
The answer to this question varied depending on the health outcome measured. For pre-term births, family income appeared to matter more than neighbourhood. Pre-term children were more likely to be born in a poor family than to be born in a certain kind of neighbourhood.
However, for other health outcomes, neighbourhoods appeared to matter more than family income. In Saskatoon, we found that children born in poor families had 6% more visits to the doctor than children from the general population. In contrast, children living in poor neighbourhoods had 10% more doctor visits than children from the general population.
We also found patterns at the neighbourhood level. Neighbourhoods with more single-parent families had more low-birth weight babies. In Regina, these neighbourhoods tended to cluster at the northern edge of the city. In Saskatoon, they are west of the river, in the central area, and further west. Maps with this data overlaid on neighbourhoods are available for use by policy and program planners.
Further Comments on Findings
We have consistently found in this and our other studies that children have more health problems when they grow up in poor neighbourhoods where there are more poorly educated adults, where people move frequently, and where single parenting is common.
In Saskatoon, almost twice as many underweight children were born into families that had received income assistance for five or more years (30%) than in families with no assistance (17%).
We have found that at all economic levels, very pre-term children (those born before 34 weeks) visited the doctor more in their first year of life. However, by their second birthday, children in wealthier families had reduced their number of doctor visits, catching up to other children, while children in poor families continued to lag behind, visiting the doctor more frequently.
What Are the Public Policy and Practice Implications of Our Results?
Policy-makers, program planners, and others working with children and families can use our results in a number of ways, including
- identifying and supporting vulnerable families and neighbourhoods;
- assessing the impact of long-term vs. short-term family income assistance on children;
- choosing between geographically targeted or diffused intervention programs;
- deciding on the scale of interventions (family, local area, regional/provincial) for specific problems;
- promoting local economic development and stability.