Second Opinion: Why good health depends on social class, not social justice

Unlike many Irish babies born on the same day, Prince George is practically guaranteed good health for the rest of his life. Not because he is a Prince with royal genes but because his parents can control virtually all the determinants of his future health.

In Ireland and the UK these are, in order of priority, education, nutrition, environment, income, social supports and availability of health services. Educational attainment is a powerful determinant of health for adults and children.

For over 50 years international and Irish studies have linked the number of years spent in school and qualifications obtained, to heart disease, cancer and chronic health problems. Prince George’s parents are both educated to third level. Birth weight is another important determinant and, at 8lbs 6oz, his is ideal.

The best start
From day one the Prince will have the best food, breast milk to start, followed by, when being weaned, freshly cooked, mashed vegetables and as much fruit as he likes. No nasty fast or processed foods or unnecessary follow-on milk for him.

He will have the right kind of clothes and shoes for each season: warm woollens and well-fitted leather shoes for colder months, and light cottons and sandals during the summer. Hoodies and cheap synthetic track suits will not be part of his wardrobe.

He will play in and be surrounded by beautiful environments and be housed in comfortable, spacious, mortgage-free homes. His family and social supports have already kicked in.

He will never have to deal with criminality in his neighbourhood nor fear for his safety. Social exclusion, income, poverty and unemployment will not be his problems. He is guaranteed the best health services available without having to queue for months for treatment.

Prince George’s health potential is identical to that of any Irish baby born to well-educated, better-off parents because they can also control the determinants of their child’s health.

Contrast this with the health potential of babies born in Ireland to parents who are unable to control those determinants. Children whose parents are poorly educated and unemployed will have health problems.

The latest findings from the Growing Up in Ireland study show that a child's life in the early years is crucial. "It leaves an indelible mark, affecting the risk of obesity, level of educational development and psychological wellbeing."

The World Health Organization report – Closing the Gap in a Generation – shows conclusively that huge differences in health between and within countries are matters of social justice. "Social injustice is killing people on a large scale."

In fact, children from lower socio-economic groups are practically guaranteed to reach 50 years of age with one or more chronic health conditions, such as obesity, diabetes or heart disease.

Children from poor backgrounds are more likely to be under or overweight when born because their mothers smoked or ate poor quality food during pregnancy. Most will not be breastfed, missing out on the best start in life.

Only a quarter of women in lower socio-economic groups even attempt breastfeeding compared with two-thirds of their better-off counterparts. A report from the Food Safety Authority of Ireland shows that, when being weaned, many infants in poor families "receive high-fat, high-sugar . . . foods more frequently than fruit and vegetables".

No control
Parents in low-income groups have no control over the quality of their child's education and have to take what they can get, even if going to school won't do much good. More than 9,000 children leave school every year without doing their Leaving Cert and those from lower socio-economic groups are three times more likely to drop out than children from professional backgrounds.

Negative interaction with teachers and school climate are the main causes of early school leaving, a major cause of health inequalities.

I don’t grudge Prince George or any other baby’s good fortune to be born to parents who can control the determinants of their health. Good luck to them. I just wish those in lower socio-economic groups got a fairer deal.

Decades of poorly thought-out social welfare policies have resulted in huge numbers of jobless households where adults and children have chronic health problems.

Having well-educated parents is not an absolute guarantee of good health in children. Accidents and rare childhood diseases, such as cancer, can happen to anyone. However, unless children from higher socio-economic groups are singularly unlucky, or poor children get very, very lucky, such as meeting interested teachers, good health will continue to depend on social class, not social justice.

drjackyjones@gmail.com