Russo Tânia, Pereira João
NOVA National School of Public Health (ENSP), NOVA University Lisbon, Lisbon, Portugal.
Department of Paediatrics, Hospital Fernando Fonseca, Unidade Local de Saúde Amadora/Sintra, Amadora, Portugal.
Port J Public Health. 2025 Mar 24:1-9. doi: 10.1159/000545167.
After many years of being portrayed as a major achievement of the health service, child health in Portugal has recently come under scrutiny after an increase in infant deaths. Commentators have pointed to unequal access to healthcare and poorly monitored pregnancies of migrant mothers as possible causes. In this context, we revisit the socioeconomic determinants of children's health, reflecting on how various factors such as parental income and education, immigration, ethnicity, and social policies exert their influence on child health. Socioeconomic determinants have long been recognised, but their importance is often overlooked in the field of child health. The authors discuss theoretical approaches such as the worlds of influence framework proposed by UNICEF and consider various pathways through which socioeconomic determinants shape children's health, namely, the so-called material, psychological, behavioural, and structural pathways. The authors then move on to consider the empirical literature, drawing attention to factors such as life course, socioeconomic disadvantage, deprived neighbourhoods, poverty and income, household and family characteristics, parental education, ethnic diversity, and immigration. Finally, policy implications are considered, with the authors arguing that a multisectoral and coordinated approach, embracing both social and public health interventions, is required. Guaranteeing universal access to services that promote healthy early child development - including early childcare and education and efforts to reduce childhood poverty - is central to promoting equity. Classic public health policies, such as health surveillance and prevention programs, especially targeted at the preconception period, gestation, and childhood, are also important. In geographical areas with a strong immigrant presence, specific programs designed to facilitate integration should be available. If we are to improve child health and make sure that none are left behind, we need to focus attention on a broad range of socioeconomic determinants.
多年来，葡萄牙的儿童健康状况一直被视为医疗服务的一项重大成就。然而，近期婴儿死亡人数增加后，葡萄牙的儿童健康状况受到了审视。评论员指出，获得医疗保健的机会不平等以及对移民母亲的孕期监测不力可能是导致这一情况的原因。在此背景下，我们重新审视儿童健康的社会经济决定因素，思考诸如父母收入和教育、移民、种族以及社会政策等各种因素如何对儿童健康产生影响。社会经济决定因素早已得到认可，但其重要性在儿童健康领域常常被忽视。作者讨论了诸如联合国儿童基金会提出的影响世界框架等理论方法，并考虑了社会经济决定因素塑造儿童健康的各种途径，即所谓的物质、心理、行为和结构途径。作者接着考虑实证文献，提请注意诸如生命历程、社会经济劣势、贫困社区、贫困与收入、家庭和家庭特征、父母教育、种族多样性以及移民等因素。最后，考虑了政策影响，作者认为需要采取一种多部门协调的方法，包括社会和公共卫生干预措施。确保普遍获得促进儿童早期健康发展的服务——包括早期儿童保育和教育以及减少儿童贫困的努力——对于促进公平至关重要。经典的公共卫生政策，如健康监测和预防计划，特别是针对孕前时期、孕期和儿童期的计划，也很重要。在移民人口众多的地理区域，应提供旨在促进融合的特定计划。如果我们要改善儿童健康状况并确保不让任何一个孩子掉队，就需要关注广泛的社会经济决定因素。
