- Email: [email protected]
Early childhood socialization and social gradients in adult health: A commentary on Singh-Manoux and Marmot's “Role of socialization in explaining social inequalities in health” (60: 9, 2005, 2129–2133)
ARTICLE IN PRESS
Social Science & Medicine 61 (2005) 2272–2276 www.elsevier.com/locate/socscimed
Discussion
Early childhood socialization and social gradients in adult health: A commentary on Singh-Manoux and Marmot’s ‘‘Role of socialization in explaining social inequalities in health’’ (60: 9, 2005, 2129–2133) Garth E. Kendalla,b,, Jianghong Lia a
Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, PO Box 855, West Perth, WA, Australia, 6872 b School of Nursing and Midwifery, Curtin University of Technology, GPO Box U1987, Perth, WA, Australia Available online 19 September 2005
Introduction We applaud Archana Singh-Manoux and Michael Marmot’s (2005) recent paper ‘‘Role of socialization in explaining social inequalities in health’’ because it seeks to bring together neo-materialist/structural and psychosocial explanations for social inequalities in health and it highlights the critical role that early socialization and thus early child development plays in creating and maintaining these inequalities. We disagree, however, that the relationship between social class and behaviour, emotion, and cognition is an emerging theme in the psychological literature. We would like to draw readers’ attention to a body of theoretical and empirical work that has focused on the role of socialization in explaining social inequalities in child development for quite some time. This literature provides insights into the causes of social inequalities in adult health. Furthermore, our response aims to extend the work of Singh-Manoux and Marmot and contribute to a greater understanding of the link between early childhood socialization and social gradients in health.
Corresponding author.
E-mail addresses: [email protected] (G.E. Kendall), [email protected] (J. Li).
The relationship between social class and behaviour, emotion, and cognition in the psychological literature In the 1970s Bronfenbrenner (1995) first argued that children’s development may be understood only in context of the family, the school, the community, and the broader economic, political and cultural environment. Bronfenbrenner’s ‘‘ecological’’ theory has influenced generations of psychologists and it has spawned a great deal of interest in the social determinants of child development. Most recently this theory has been extended to highlight the continuous reciprocal interaction that takes place between person and environment, a ‘‘bioecological’’ theory that incorporates genetic, biological, psychological, social, economic, political, and cultural influences on human development (Cicchetti & Cohen, 1995). Jeanne Brooks-Gunn is a follower of Bronfenbrenner who has built up an extensive research program focusing on the role of family and neighbourhood contexts in determining child health and development (BrooksGunn, 1995). Brooks-Gunn and her colleagues have sought to identify ‘‘proximal’’ processes within the family and the community that mediate between socioeconomic factors and health, developmental, and educational outcomes. Key elements of this approach have been the attention given to development through
0277-9536/$ - see front matter r 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.socscimed.2005.08.034
ARTICLE IN PRESS G.E. Kendall, J. Li / Social Science & Medicine 61 (2005) 2272–2276
the early childhood years and the attention given to effective early intervention. In 1995 Brooks-Gunn, Brown, Duncan, and Anderson Moore proposed a conceptual framework based on familial and extrafamilial resources to integrate the research conducted in the field by scholars from macro perspectives (e.g., economists, sociologists, and demographers) and those from micro perspectives (e.g., developmental and clinical psychologists and paediatricians). Brooks-Gunn adapted the concepts of human capital and social capital (Becker, 1993; Coleman, 1988; Haveman & Wolfe, 1994) to develop a family and community resource framework. This resource framework departs from Coleman (1988) and Haveman and Wolfe (1994) in making more explicit the links with disciplines that focus on familial and extrafamilial processes, e.g., systems theory, ecological theory, and psychological-resource or social support theory (Brooks-Gunn, Brown, Duncan, & Anderson Moore, 1995). In broad terms, four categories of resources in the family are thought to be critical for parenting and early socialization: income, time, human capital (parents’ levels of formal schooling, together with special skills, training, and other characteristics), and psychological capital (mental health of the parents, the quality of their relationship, the psychological importance to them of factors such as education and work, and beliefs about the parental role in childrearing). Community resources include a variety of contexts—child care settings, schools, peer groups, community groups, and wider social contexts (Brooks-Gunn, 1995). Brooks-Gunn also focuses on the issue of decision-making, the choices parents face about allocating limited resources that is crucial for Haveman and Wolfe (1994). ‘‘Of interest is how parental decisions about allocation of resources within the family are made, how constraints on resources limit options, how perceptions about the importance of resources might influence parental behaviour, and how parental resources influence child outcomes’’ (Brooks-Gunn, 1995, p. 471). The family and community resource framework has made a unique and important contribution to research about social class and child development. It is innovative, in that it provides a means of studying in greater detail the psychological and social processes within the family and community that mediate between socioeconomic circumstances and health and developmental outcomes. The conceptual framework has taken research in this area of developmental health beyond the relatively unsophisticated measures of education, occupation, and income typically utilized in social epidemiology to capture the effect of socioeconomic factors. Also, it is a more detailed and clearly specified resource theory than that proposed by Lynch and Kaplan (2000) to guide research in the field of social epidemiology.
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The body of empirical work surrounding the conceptual framework provides ample evidence of a strong relationship between parental attitudes, beliefs, and values operationalized as the allocation of resources within the family, and child behaviour, emotion, and cognition measured by validated screening instruments such as the child behaviour checklist (Achenbach & McConaughy, 1997) and the Peabody Picture Vocabulary Test (Dunn & Dunn, 1981). Characteristics of the family have included parents’ attitudes and knowledge of childrearing, parenting behaviour (e.g., involved, supportive, and parenting style), parental mental health (e.g., stress, coping, and presence of disorder), and maternal social support. The results of numerous studies demonstrate a strong social gradient in childrens’ social, emotional, behavioural, language, and cognitive development and their academic achievement. (see BrooksGunn, Berlin, Leventhal, & Fuligni, 2000; Brooks-Gunn et al., 1995 for reviews). The decisions parents make about the allocation of financial and other resources to their children clearly differ by social class. The children of high-status parents have a distinct advantage because they are socialized into families with greater emphasis on childhood learning, and other favourable cultural attributes. As Becker and Tomes (1986) have said, ‘‘both biology and culture are transmitted from parents to children, one encoded in DNA and the other in the family’s culture’’ (1986, p. S4).
Key areas that link social structure to health Singh-Manoux and Marmot have rightfully identified health behaviours, psychological vulnerability, social participation and future time perspective as four key areas that link social structure and environment to health. We would like to add two important areas that have not been addressed by the paper. Biological vulnerability or biological embedding Hertzman (1999) argues that in wealthy societies the social, economic, and psychosocial (SEP) conditions of early childhood are a powerful determinant of health and well-being across the life cycle and that the social gradient in adult health has its origins in early childhood. The process, whereby the experience of SEP conditions in early childhood impacts on health and well-being across the life course, Hertzman calls ‘‘biological embedding’’. Hertzman and his colleagues at the Canadian Institute for Advanced Research clearly agree with Marmot and Wilkinson (1999) that psychoneuro-endocrine-immune pathways may be key links between socioeconomic circumstances and health and they also acknowledge the possible role of intrauterine growth restriction in the development of diabetes and
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cardiovascular disease. The Canadian researchers add yet another mechanism to those already mentioned, that of ‘‘neural sculpting’’. Cynader and Frost (1999) explain how the process of neural sculpting by the physical and social environment of early childhood may result in socioeconomic differences in cognitive abilities and strategies. As the organism develops from a single cell into a large volume of tissue through the process of cell division, migration within the embryo, and differentiation, there is a parallel process of elimination, or sculpting away in the developing brain. It is now well known that over onethird of neurons in the cerebral cortex are eliminated in the first 3 years of postnatal life and in addition to a major expansion in synaptic connections that occurs there is also a massive elimination of synapses, connections, and even entire pathways (Cynader & Frost, 1999). An appreciation of hypothesized biological mechanisms is critical for research that focuses on SEP circumstances because, to be successful, the conceptual framework that is utilized to identify causal processes in psychological and social domains must be compatible with current biological evidence. The process of neural sculpting provides a credible biological link between early childhood socialization, the development of behaviour, emotion, and cognition, and life-long health and well-being. Because parental attitudes, beliefs, and values (family culture) largely determine the physical and social environments of infants and young children, the experience of socialization is likely to become biologically as well as culturally embedded. Consequently, to some extent at least, disorders of development become embedded within families and communities.
Parental aspirations for status attainment in offspring Singh-Manoux and Marmot have identified future time perspective (FTP) as a key area of socialization that links social structure to health. It is important to acknowledge that FTP emerges in childhood, largely because of parents’ aspirations for status attainment in their children. The sociological literature suggests that parents’ aspirations for social status attainment are critical in determining children’s attitudes and behaviours regarding adult roles, such as marriage, parenthood, and employment (Acock, Barker, & Bengston, 1982; Axinn & Thornton, 1993; Haveman & Wolfe, 1994; Smith, 1983; Starrels, 1992). Furthermore, parents with high socioeconomic status (SES) serve as positive role models for their children who grow up to see that this status is achievable and rewarding. As children aspire to achieve, they come to see the long-term consequences of their present actions.
Social patterning in teenage pregnancy with regard to termination or childbirth is a prime example. Research in Australia demonstrates that parental SES is a strong predictor of the outcome of teenage pregnancy. Adolescents from low-SES backgrounds have a much higher rate of childbirth (van de Klis, Wsetenberg, Chan, Dekker, & Keane, 2002; Westenberg, van der Klis, Chan, Dekker, & Keane, 2002), while some studies show no association between parental SES and adolescent sexual risk behaviours (e.g., number of sex partners and consistency of condom use) (Miller, Kotchick, & Forehand, 1999). Early childbearing and parenthood leads to a truncation of educational achievement (Hobcraft et al., 1999; Hoffman, 1999; Maynard, 1997), which in turn will limit future employment and income opportunities. This pregnancy outcome is incompatible with middle and upper class aspirations for high-status attainment. Many teenagers seeking pregnancy termination come from relatively high-SES backgrounds and these young women report a lack of readiness for parenthood, the inability to financially support a child, and their aspirations for establishing a career first, as reasons for making this choice (Adelson, Frommer, & Weisberg, 1995). Conversely, those teenagers who chose to continue with their pregnancy, who come from lowSES backgrounds, tend not to aspire to educational and career achievement, because these options are not available or they view early motherhood as a normative and meaningful life experience (Frost & Oslak, 1999; Merrick, 1995). Thus, it is the familial and broader sociocultural environments of childhood that largely determine FTP. There is evidence to suggest that individuals who are able to delay gratification and those who value future goals are more likely to use a range of cognitive and behavioural regulatory strategies to achieve these goals (McInerney, 2004). This has important implications for interventions aimed at the amelioration of social inequalities in health because social conditions that determine the development of the FTP or lack of it may be more amenable to change and thus more responsive to interventions than the FTP itself. The fact that most individual-focused intervention efforts to reduce behavioural risk factors (e.g., unhealthy life styles) have been spectacularly unsuccessful, especially in lower SES groups, is good evidence to support this position (Emmons, 2000). The period of the life most critical and amenable to change Singh-Manoux and Marmot propose that further research is required to determine the period of the life course most amenable to changes in the social and behavioral trajectory (2005, p. 2130). It is already clear to us that early childhood is the most critical period and the most amenable to intervention. Extensive evidence
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supports the assertion that social class impacts strongly on behavioural, emotional, and cognitive development in childhood (McCain & Mustard, 1999; Keating & Hertzman, 1999; Shonkoff & Phillips, 2000; Willms, 2002). Early development from conception to 6 years of age establishes the foundation for learning, behaviour and health throughout the life-course. Growing evidence from the social epidemiological literature shows that childhood social circumstances (typically father’s occupational class) are an important determinant of adult morbidity and mortality (Davey Smith, Gunnell, & Ben Shlomo, 2001). Thus, investment in early human development as a whole can be expected to have a major long-term impact on population health and wellbeing. It is important to understand the mechanisms that link social structure to health. Socialization is one such mechanism, as the authors have explained in the paper. However, it is equally important not to lose sight of the fundamental reasons for social inequalities in health, which require change in the social structures that impact on the early socialization process. We believe that interventions must address these fundamental causes at both national and global levels. There is evidence that countries with a high level of relative income equality, greater social mobility across generations, more comprehensive state-supported childcare, and more extensive community child health services, as found in Sweden (Hogstedt, Lundgren, Moberg, Pettersson, & Agren, 2004; Li & Singelmann, 1999; Rosenfeld & Kalleberg, 1991), have better population health outcomes. These outcomes include high life expectancy, low infant mortality, and less pronounced social gradients in health and early educational achievement (Case, Griffin, & Kelly, 1999; Ross, 2004; Vagero & Lundberg, 1989). As Marmot (2005: p. 1103) has observed, Sweden’s new strategy for public health policy is ‘‘to create social conditions that will ensure good health for the entire population’’ and one of the key policy domains pertaining to social determinants of health addresses conditions in childhood and adolescence (Hogstedt et al., 2004). There is also evidence from developing countries that interventions aimed at improving childhood conditions have a significant impact on population health (Attanasio & Vera-Hernandez, 2004; Marmot, 2005). Both broad policies that aim to improve social and economic conditions in early childhood through family support and parental leave, and specific interventions that target children, the family, school, and the community, will be effective in reducing social inequalities in health. These interventions aim to provide a supportive infrastructure for early development, to allow all children the opportunity to reach their full adult potential.
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Acknowledgements GK and JL are both supported by an Australian National Health and Medical Research Council Capacity Building Grant. The authors would like to acknowledge Stephen Zubrick and Fiona Stanley for their contributions and Karina Aiberti for her assistance with the literature search.
References Achenbach, T. M., & McConaughy, S. H. (1997). Empirically based assessment of child and adolescent psychopathology: Practical applications. Thousand Oaks: SAGE Publications. Acock, A. C., Barker, C., & Bengston, V. L. (1982). Mother’s employment and parent-youth similarity. Journal of Marriage and the Family, 44, 441–455. Adelson, P., Frommer, M. S., & Weisberg, E. (1995). A survey of women seeking termination of pregnancy in New South Wales. Medical Journal of Australia, 163, 419–422. Archana Singh-Manoux, & Michael Marmot (2005). Social Science and Medicine, 60, 2129–2133. Attanasio, O., & Vera-Hernandez, M. (2004). Medium and long run effects of programme in rural Colombia, IFS working papers EWP04/06. London: Institute for Fiscal Studies. Axinn, W. G., & Thornton, A. (1993). Mothers, children, and cohabitation: The intergenerational effects of attitudes and behavior. American Journal of Sociology, 58, 233–246. Becker, G. S. (1993). Human capital: A theoretical and empirical analysis with special reference to education (3rd ed). Chicago: The University of Chicago Press. Becker, G. S., & Tomes, N. (1986). Human capital and the rise and fall of families. Journal of Labour Economics, 4(3), S1–S39. Bronfenbrenner, U. (1995). Developmental ecology through space and time: A future perspective. In P. Moen, G. H. Elder, & K. Luscher (Eds.), Examining lives in context: Perspectives on the ecology of human development (pp. 599–647). Washington, DC: American Psychological Association. Brooks-Gunn, J. (1995). Children in families in communities: Risk and intervention in the Bronfenbrenner tradition. In P. Moen, G. H. Elder, & K. Luscher (Eds.), Examining lives in context: Perspectives on the ecology of human development (pp. 467–519). Washington, DC: American Psychological Association. Brooks-Gunn, J., Berlin, L. J., Leventhal, T., & Fuligni, A. S. (2000). Depending on the kindness of strangers: Current national data initiatives and developmental research. Child Development, 71(1), 257–268. Brooks-Gunn, J., Brown, B., Duncan, G. J., & Anderson Moore, K. (1995). Child development in the context of family and community resources: An agenda for national data collections. Washington, DC: The National Academy of Sciences. Case, R., Griffin, S., & Kelly, W. M. (1999). Socioeconomic gradients in mathematical ability and their responsiveness to intervention during early childhood. In D. Keating, & C.
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Hertzman (Eds.), Developmental health and the wealth of nations (pp. 125–149). New York: The Guilford press. Cicchetti, D., & Cohen, D. J. (1995). Perspectives on developmental psychopathology. In D. Cicchetti, & D. J. Cohen (Eds.), Developmental psychopathology: Theory and methods, Vol. 1 (pp. 3–20). New York: Wiley. Coleman, J. S. (1988). Social capital in the creation of human capital. American Journal of Sociology, 94(Supplement), S95–S120. Cynader, M. S., & Frost, B. J. (1999). Mechanisms of brain development: Neuronal sculpting by the physical and social environment. In D. P. Keating, & C. Hertzman (Eds.), Developmental health and the wealth of nations: Social, biological, and educational dynamics (pp. 153–184). New York: The Guilford Press. Davey Smith, G., Gunnell, D., & Ben Shlomo, Y. (2001). Lifecourse approaches to socio-economic differentials in causespecific adult mortality. In D. Leon, & G. Walt (Eds.), Poverty, inequality and health (pp. 88–124). Oxford, England: Oxford University Press. Dunn, L., & Dunn, L. (1981). Peabody picture vocabulary test— Revised—manual. Circle Pines: American Guidance Service. Emmons, K. M. (2000). Health behaviors in a social context. In Lisa F. Berkman, & Ichiro Kawachi (Eds.), Social Epidemiology (pp. 242–266). New York: Oxford University Press. Frost, J. J., & Oslak, S. (1999). Teenagers’ pregnancy intentions and decisions: A study of young women in California choosing to give birth, Alan Guttmacher Institute, New York, Report no.2. Haveman, R., & Wolfe, B. (1994). Succeeding generations: On the effects of investments in children. New York: Russell Sage Foundation. Hertzman, C. (1999). Population health and human development. In D. P. Keating, & C. Hertzman (Eds.), Developmental health and the wealth of nations: Social, biological, and educational dynamics (pp. 21–40). New York: The Guilford Press. Hobcraft, J., et al. (1999). Childhood poverty, early motherhood and adult social exclusion, Centre for Analysis of Social Exclusion, London School of Economics, London, Report no.: CASE/28. Hoffman, S. (1999). Teenage Childbearing is not that bad after ally Or is it? A review of the new literature. Family Planning Perspectives, 30(5), 236–243. Hogstedt, H., Lundgren, B., Moberg, H., Pettersson, B., & Agren, G. (2004). The Swedish public health policy and the National Institute of Public health. Scandinavian Journal of Public Health, 32(Suppl 64), 1–64. Keating, D. P., & Hertzman, C. (Eds.). (1999). Developmental health and the wealth of nations: Social, biological, and educational dynamics. New York: The Guilford Press. Li, J., & Singelmann, J. (1999). Social mobility among men: A comparison of neo-Marxian and Weberian class models. European Sociological Review, 15, 1–13.
Lynch, J., & Kaplan, G. (2000). Socioeconomic position. In L. F. Berkman, & I. Kawachi (Eds.), Social epidemiology (pp. 13–35). New York: Oxford University Press. Marmot, M. (2005). Social determinants of health inequalities. The Lancet, 365, 1099–1104. Marmot, M., & Wilkinson, R. G. (Eds.). (1999). Social determinants of health. Oxford: Oxford university Press. Maynard, R. (1997). Kids having kids. Washington, DC: The Urban Institute Press. McCain, M., & Mustard, J. F. (1999). Early years study: Reversing the brain drain. Online (www.childsec.gov.on.ca). McInerney, D. M. (2004). A discussion of future time perspective. Educational Psychology Review, 16(2), 141–151. Merrick, E. N. (1995). Adolescent childbearing as career ‘‘choice’’: Perspective from an ecological context. Journal of Counseling and Development, 73, 288–295. Miller, K. S., Kotchick, B. A., & Forehand, R. (1999). Adolescent sexual behavior in two ethnic minority samples: The role of family variables. Journal of Marriage and the Family, 61, 85–98. Ross, N. (2004). What have we learned studying income inequality and population health? Canadian Institute for Health Information, Ottawa, Ontario. Rosenfeld, R. A., & Kalleberg, A. L. (1991). Gender inequality in the labour-market: A cross-national perspective. Acta Sociologica, 34, 207–225. Shonkoff, J. P., & Phillips, D. A. (Eds.). (2000). From neurons to neighbourhoods: The science of early childhood development. Washington DC: National Academy Press. Smith, T. E. (1983). Parental influence: A review of the evidence of influence and theoretical model of the parental influence process. In C. K. Alan (Ed.), Research in Sociology of Education and Socialization, Vol. 4 (pp. 13–45). Greenwich, CT: JAI. Starrels, M. E. (1992). Attitude similarity between mothers and children regarding maternal employment. Journal of Marriage and the Family, 54, 91–103. Vagero, D., & Lundberg, O. (1989). Health inequalities in Britain and Sweden. Lancet, ii, 35–36. van de Klis, K. A., Wsetenberg, L., Chan, A., Dekker, G., & Keane, R. J. (2002). Teenage pregnancy: Trends, characteristics and outcomes in South Australia and Australia. Australian and New Zealand Journal of Public Health, 26(2), 125–131. Westenberg, L., van der Klis, K. A., Chan, A., Dekker, G., & Keane, R. J. (2002). Aboriginal teenage pregnancies compared with non-Aboriginal in South Australia 1995–1999. Australian and New Zealand Journal of Obstetrics and Gynaecology, 42(2), 187–192. Willms, J. D. (Ed.). (2002). Vulnerable children: Findings from Canada’s National Longitudinal Survey of Children and Youth. Edmonton: The University of Alberta Press.
Social Science & Medicine 61 (2005) 2272–2276 www.elsevier.com/locate/socscimed
Discussion
Early childhood socialization and social gradients in adult health: A commentary on Singh-Manoux and Marmot’s ‘‘Role of socialization in explaining social inequalities in health’’ (60: 9, 2005, 2129–2133) Garth E. Kendalla,b,, Jianghong Lia a
Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, PO Box 855, West Perth, WA, Australia, 6872 b School of Nursing and Midwifery, Curtin University of Technology, GPO Box U1987, Perth, WA, Australia Available online 19 September 2005
Introduction We applaud Archana Singh-Manoux and Michael Marmot’s (2005) recent paper ‘‘Role of socialization in explaining social inequalities in health’’ because it seeks to bring together neo-materialist/structural and psychosocial explanations for social inequalities in health and it highlights the critical role that early socialization and thus early child development plays in creating and maintaining these inequalities. We disagree, however, that the relationship between social class and behaviour, emotion, and cognition is an emerging theme in the psychological literature. We would like to draw readers’ attention to a body of theoretical and empirical work that has focused on the role of socialization in explaining social inequalities in child development for quite some time. This literature provides insights into the causes of social inequalities in adult health. Furthermore, our response aims to extend the work of Singh-Manoux and Marmot and contribute to a greater understanding of the link between early childhood socialization and social gradients in health.
Corresponding author.
E-mail addresses: [email protected] (G.E. Kendall), [email protected] (J. Li).
The relationship between social class and behaviour, emotion, and cognition in the psychological literature In the 1970s Bronfenbrenner (1995) first argued that children’s development may be understood only in context of the family, the school, the community, and the broader economic, political and cultural environment. Bronfenbrenner’s ‘‘ecological’’ theory has influenced generations of psychologists and it has spawned a great deal of interest in the social determinants of child development. Most recently this theory has been extended to highlight the continuous reciprocal interaction that takes place between person and environment, a ‘‘bioecological’’ theory that incorporates genetic, biological, psychological, social, economic, political, and cultural influences on human development (Cicchetti & Cohen, 1995). Jeanne Brooks-Gunn is a follower of Bronfenbrenner who has built up an extensive research program focusing on the role of family and neighbourhood contexts in determining child health and development (BrooksGunn, 1995). Brooks-Gunn and her colleagues have sought to identify ‘‘proximal’’ processes within the family and the community that mediate between socioeconomic factors and health, developmental, and educational outcomes. Key elements of this approach have been the attention given to development through
0277-9536/$ - see front matter r 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.socscimed.2005.08.034
ARTICLE IN PRESS G.E. Kendall, J. Li / Social Science & Medicine 61 (2005) 2272–2276
the early childhood years and the attention given to effective early intervention. In 1995 Brooks-Gunn, Brown, Duncan, and Anderson Moore proposed a conceptual framework based on familial and extrafamilial resources to integrate the research conducted in the field by scholars from macro perspectives (e.g., economists, sociologists, and demographers) and those from micro perspectives (e.g., developmental and clinical psychologists and paediatricians). Brooks-Gunn adapted the concepts of human capital and social capital (Becker, 1993; Coleman, 1988; Haveman & Wolfe, 1994) to develop a family and community resource framework. This resource framework departs from Coleman (1988) and Haveman and Wolfe (1994) in making more explicit the links with disciplines that focus on familial and extrafamilial processes, e.g., systems theory, ecological theory, and psychological-resource or social support theory (Brooks-Gunn, Brown, Duncan, & Anderson Moore, 1995). In broad terms, four categories of resources in the family are thought to be critical for parenting and early socialization: income, time, human capital (parents’ levels of formal schooling, together with special skills, training, and other characteristics), and psychological capital (mental health of the parents, the quality of their relationship, the psychological importance to them of factors such as education and work, and beliefs about the parental role in childrearing). Community resources include a variety of contexts—child care settings, schools, peer groups, community groups, and wider social contexts (Brooks-Gunn, 1995). Brooks-Gunn also focuses on the issue of decision-making, the choices parents face about allocating limited resources that is crucial for Haveman and Wolfe (1994). ‘‘Of interest is how parental decisions about allocation of resources within the family are made, how constraints on resources limit options, how perceptions about the importance of resources might influence parental behaviour, and how parental resources influence child outcomes’’ (Brooks-Gunn, 1995, p. 471). The family and community resource framework has made a unique and important contribution to research about social class and child development. It is innovative, in that it provides a means of studying in greater detail the psychological and social processes within the family and community that mediate between socioeconomic circumstances and health and developmental outcomes. The conceptual framework has taken research in this area of developmental health beyond the relatively unsophisticated measures of education, occupation, and income typically utilized in social epidemiology to capture the effect of socioeconomic factors. Also, it is a more detailed and clearly specified resource theory than that proposed by Lynch and Kaplan (2000) to guide research in the field of social epidemiology.
2273
The body of empirical work surrounding the conceptual framework provides ample evidence of a strong relationship between parental attitudes, beliefs, and values operationalized as the allocation of resources within the family, and child behaviour, emotion, and cognition measured by validated screening instruments such as the child behaviour checklist (Achenbach & McConaughy, 1997) and the Peabody Picture Vocabulary Test (Dunn & Dunn, 1981). Characteristics of the family have included parents’ attitudes and knowledge of childrearing, parenting behaviour (e.g., involved, supportive, and parenting style), parental mental health (e.g., stress, coping, and presence of disorder), and maternal social support. The results of numerous studies demonstrate a strong social gradient in childrens’ social, emotional, behavioural, language, and cognitive development and their academic achievement. (see BrooksGunn, Berlin, Leventhal, & Fuligni, 2000; Brooks-Gunn et al., 1995 for reviews). The decisions parents make about the allocation of financial and other resources to their children clearly differ by social class. The children of high-status parents have a distinct advantage because they are socialized into families with greater emphasis on childhood learning, and other favourable cultural attributes. As Becker and Tomes (1986) have said, ‘‘both biology and culture are transmitted from parents to children, one encoded in DNA and the other in the family’s culture’’ (1986, p. S4).
Key areas that link social structure to health Singh-Manoux and Marmot have rightfully identified health behaviours, psychological vulnerability, social participation and future time perspective as four key areas that link social structure and environment to health. We would like to add two important areas that have not been addressed by the paper. Biological vulnerability or biological embedding Hertzman (1999) argues that in wealthy societies the social, economic, and psychosocial (SEP) conditions of early childhood are a powerful determinant of health and well-being across the life cycle and that the social gradient in adult health has its origins in early childhood. The process, whereby the experience of SEP conditions in early childhood impacts on health and well-being across the life course, Hertzman calls ‘‘biological embedding’’. Hertzman and his colleagues at the Canadian Institute for Advanced Research clearly agree with Marmot and Wilkinson (1999) that psychoneuro-endocrine-immune pathways may be key links between socioeconomic circumstances and health and they also acknowledge the possible role of intrauterine growth restriction in the development of diabetes and
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G.E. Kendall, J. Li / Social Science & Medicine 61 (2005) 2272–2276
cardiovascular disease. The Canadian researchers add yet another mechanism to those already mentioned, that of ‘‘neural sculpting’’. Cynader and Frost (1999) explain how the process of neural sculpting by the physical and social environment of early childhood may result in socioeconomic differences in cognitive abilities and strategies. As the organism develops from a single cell into a large volume of tissue through the process of cell division, migration within the embryo, and differentiation, there is a parallel process of elimination, or sculpting away in the developing brain. It is now well known that over onethird of neurons in the cerebral cortex are eliminated in the first 3 years of postnatal life and in addition to a major expansion in synaptic connections that occurs there is also a massive elimination of synapses, connections, and even entire pathways (Cynader & Frost, 1999). An appreciation of hypothesized biological mechanisms is critical for research that focuses on SEP circumstances because, to be successful, the conceptual framework that is utilized to identify causal processes in psychological and social domains must be compatible with current biological evidence. The process of neural sculpting provides a credible biological link between early childhood socialization, the development of behaviour, emotion, and cognition, and life-long health and well-being. Because parental attitudes, beliefs, and values (family culture) largely determine the physical and social environments of infants and young children, the experience of socialization is likely to become biologically as well as culturally embedded. Consequently, to some extent at least, disorders of development become embedded within families and communities.
Parental aspirations for status attainment in offspring Singh-Manoux and Marmot have identified future time perspective (FTP) as a key area of socialization that links social structure to health. It is important to acknowledge that FTP emerges in childhood, largely because of parents’ aspirations for status attainment in their children. The sociological literature suggests that parents’ aspirations for social status attainment are critical in determining children’s attitudes and behaviours regarding adult roles, such as marriage, parenthood, and employment (Acock, Barker, & Bengston, 1982; Axinn & Thornton, 1993; Haveman & Wolfe, 1994; Smith, 1983; Starrels, 1992). Furthermore, parents with high socioeconomic status (SES) serve as positive role models for their children who grow up to see that this status is achievable and rewarding. As children aspire to achieve, they come to see the long-term consequences of their present actions.
Social patterning in teenage pregnancy with regard to termination or childbirth is a prime example. Research in Australia demonstrates that parental SES is a strong predictor of the outcome of teenage pregnancy. Adolescents from low-SES backgrounds have a much higher rate of childbirth (van de Klis, Wsetenberg, Chan, Dekker, & Keane, 2002; Westenberg, van der Klis, Chan, Dekker, & Keane, 2002), while some studies show no association between parental SES and adolescent sexual risk behaviours (e.g., number of sex partners and consistency of condom use) (Miller, Kotchick, & Forehand, 1999). Early childbearing and parenthood leads to a truncation of educational achievement (Hobcraft et al., 1999; Hoffman, 1999; Maynard, 1997), which in turn will limit future employment and income opportunities. This pregnancy outcome is incompatible with middle and upper class aspirations for high-status attainment. Many teenagers seeking pregnancy termination come from relatively high-SES backgrounds and these young women report a lack of readiness for parenthood, the inability to financially support a child, and their aspirations for establishing a career first, as reasons for making this choice (Adelson, Frommer, & Weisberg, 1995). Conversely, those teenagers who chose to continue with their pregnancy, who come from lowSES backgrounds, tend not to aspire to educational and career achievement, because these options are not available or they view early motherhood as a normative and meaningful life experience (Frost & Oslak, 1999; Merrick, 1995). Thus, it is the familial and broader sociocultural environments of childhood that largely determine FTP. There is evidence to suggest that individuals who are able to delay gratification and those who value future goals are more likely to use a range of cognitive and behavioural regulatory strategies to achieve these goals (McInerney, 2004). This has important implications for interventions aimed at the amelioration of social inequalities in health because social conditions that determine the development of the FTP or lack of it may be more amenable to change and thus more responsive to interventions than the FTP itself. The fact that most individual-focused intervention efforts to reduce behavioural risk factors (e.g., unhealthy life styles) have been spectacularly unsuccessful, especially in lower SES groups, is good evidence to support this position (Emmons, 2000). The period of the life most critical and amenable to change Singh-Manoux and Marmot propose that further research is required to determine the period of the life course most amenable to changes in the social and behavioral trajectory (2005, p. 2130). It is already clear to us that early childhood is the most critical period and the most amenable to intervention. Extensive evidence
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supports the assertion that social class impacts strongly on behavioural, emotional, and cognitive development in childhood (McCain & Mustard, 1999; Keating & Hertzman, 1999; Shonkoff & Phillips, 2000; Willms, 2002). Early development from conception to 6 years of age establishes the foundation for learning, behaviour and health throughout the life-course. Growing evidence from the social epidemiological literature shows that childhood social circumstances (typically father’s occupational class) are an important determinant of adult morbidity and mortality (Davey Smith, Gunnell, & Ben Shlomo, 2001). Thus, investment in early human development as a whole can be expected to have a major long-term impact on population health and wellbeing. It is important to understand the mechanisms that link social structure to health. Socialization is one such mechanism, as the authors have explained in the paper. However, it is equally important not to lose sight of the fundamental reasons for social inequalities in health, which require change in the social structures that impact on the early socialization process. We believe that interventions must address these fundamental causes at both national and global levels. There is evidence that countries with a high level of relative income equality, greater social mobility across generations, more comprehensive state-supported childcare, and more extensive community child health services, as found in Sweden (Hogstedt, Lundgren, Moberg, Pettersson, & Agren, 2004; Li & Singelmann, 1999; Rosenfeld & Kalleberg, 1991), have better population health outcomes. These outcomes include high life expectancy, low infant mortality, and less pronounced social gradients in health and early educational achievement (Case, Griffin, & Kelly, 1999; Ross, 2004; Vagero & Lundberg, 1989). As Marmot (2005: p. 1103) has observed, Sweden’s new strategy for public health policy is ‘‘to create social conditions that will ensure good health for the entire population’’ and one of the key policy domains pertaining to social determinants of health addresses conditions in childhood and adolescence (Hogstedt et al., 2004). There is also evidence from developing countries that interventions aimed at improving childhood conditions have a significant impact on population health (Attanasio & Vera-Hernandez, 2004; Marmot, 2005). Both broad policies that aim to improve social and economic conditions in early childhood through family support and parental leave, and specific interventions that target children, the family, school, and the community, will be effective in reducing social inequalities in health. These interventions aim to provide a supportive infrastructure for early development, to allow all children the opportunity to reach their full adult potential.
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Acknowledgements GK and JL are both supported by an Australian National Health and Medical Research Council Capacity Building Grant. The authors would like to acknowledge Stephen Zubrick and Fiona Stanley for their contributions and Karina Aiberti for her assistance with the literature search.
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