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This is the second in a Series of four papers about optimising child and adolescent health and development
IntroductionMassive inequalities in the distribution of wealth, both between and within countries, are a key challenge to sustainable development.1 Despite progress in the alleviation of poverty in most parts of the world over the past three decades, wealth inequalities still exist, and several low-income countries have seen the incomes of the bottom 40% stagnating, or even decreasing.2,3 In a time trend analysis of 83 countries, the global average Gini index—weighted by national population size—increased from 36·7 in 2000 to 40·8 in 2015. This finding indicates that the average person was living in a country where inequality was on the rise.4
Addressing inequality is at the core of the Sustainable Development Goals5 target of leaving no one behind.6 Economic inequality is not only important per se, but it is also a major driver of health status, as is emphasised by initiatives aimed at tackling the social determinants of health.7 In addition to how the poorest communities are at increased risk of illness and malnutrition, inequality affects the health of entire populations. Social gradients in health are ubiquitous, with stepwise increases in illness and mortality down the socioeconomic spectrum.8
There is ample literature on the effect of poverty during the life course in high-income societies. Birth cohort analyses, from countries such as the UK, New Zealand, USA, and Norway, point to the lifelong effects of material and psychosocial exposures on health and human capital.9 By contrast, the literature from low-income and middle-income countries (LMICs) on such topics is scarce. Nevertheless, many (if not most) children currently living in LMICs experience suboptimal nurturing care,10,11 an innovative concept that encompasses child health, nutrition, learning, relationships, security, and safety. These five components of nurturing care are largely determined by poverty; a “cause of the causes”12 of poor health and development. Exposure to adversity in early life,9,13 for which poverty is a proxy measure, is postulated to be a major driver of adequate nurturing care and of its consequences on human capital.
Key messages
- • Data from low-income and middle-income countries (LMICs) substantiate the negative effects of early-life poverty on...