Reading R, Allen C
Department of Community Paediatrics, Jenny Lind Department, Norfolk.
J Public Health Med. 1997 Dec;19(4):424-30. doi: 10.1093/oxfordjournals.pubmed.a024672.
Preventive and health promotion work by health visitors ought to reduce social inequalities in child health. However, the increased health and developmental problems among disadvantaged children may constrain health visitors' ability to carry out effective preventive work. This paper measures the impact of socioeconomic inequalities in children's health on the work of health visitors and the amount of preventive work they can provide, with emphasis on 'parenting' programmes.
Data collected for health visitors' profiles were analysed in an ecological cross-sectional study. Individual caseloads were classified according to the proportions of families in social class IV or V and families headed by an unemployed person. A range of measures of young children's health and development indicated the demands on health visitors' time. Preventive work was divided into post-natal support, parenting programmes, special clinics and other preventive work.
All the outcome measures were poorer in the most disadvantaged caseloads. Odds ratios between the most and least disadvantaged 20 per cent of caseloads were 0.6 for breast feeding at birth, and at seven months, 1.9 for post-natal depression, 3.2 for mothers under 18, 10 for lone parent families, 2.6 for families needing high intervention, 4.5 for families with a smoker, 11 for domestic violence, 4.4 for parents with a chronic health problem, 2.7 for children on the child protection register and 2.8 for children with developmental problems. There was 30 per cent greater health visitor time provided in the most disadvantaged caseloads than in the most advantaged. There was no consistent difference in the amount of preventive work carried out; in particular, parenting programmes were delivered at a similar rate in all caseloads.
Large differences in demands on health visitors' time exist between affluent and disadvantaged caseloads which are barely reflected in the provision of extra time to poorer caseloads. There is no consistent pattern to the delivery of preventive programmes designed to ameliorate the effects of disadvantage on children's health and development.
健康访视员开展的预防和健康促进工作应减少儿童健康方面的社会不平等现象。然而，弱势儿童中日益增多的健康和发育问题可能会限制健康访视员开展有效预防工作的能力。本文衡量了儿童健康方面的社会经济不平等对健康访视员工作的影响以及他们能够提供的预防工作的数量，重点关注“育儿”项目。
在一项生态横断面研究中分析了为健康访视员概况收集的数据。根据社会等级IV或V类家庭以及由失业者当家的家庭的比例对个人工作量进行分类。一系列幼儿健康和发育指标表明了对健康访视员时间的需求。预防工作分为产后支持、育儿项目、专科门诊和其他预防工作。
在最弱势的工作量中，所有结果指标都更差。最弱势和最不弱势的20%工作量之间的比值比，出生时母乳喂养为0.6，七个月时为1.9，产后抑郁为1.9，18岁以下母亲为3.2，单亲家庭为10，需要高强度干预的家庭为2.6，有吸烟者的家庭为4.5，有家庭暴力的家庭为11，有慢性健康问题的父母为4.4，列入儿童保护登记册的儿童为2.7，有发育问题的儿童为2.8。最弱势工作量中健康访视员提供的时间比最优势工作量多30%。开展的预防工作数量没有一致的差异；特别是，育儿项目在所有工作量中的实施率相似。
富裕和弱势工作量对健康访视员时间的需求存在很大差异，而向较贫困工作量提供额外时间的情况几乎没有体现出来。旨在减轻弱势对儿童健康和发育影响的预防项目的实施没有一致的模式。
