What is SES deprivation?
Dimensional Model of Adversity and Psychopathology (DMAP),
one of the recent models that study how dimensions of adversity experiences
influence developmental processes and outcomes, defines deprivation as the
absence of expected social or cognitive stimulation (1). The Index of Multiple
Deprivation (IMD) is the official measure of relative deprivation in England. IMD
follows an established methodological framework and defines relative
deprivation by encompassing a wide range of an individual’s living conditions. People,
for example, if they lack the financial resources to meet their needs, are
considered to be living in poverty. However, if they lack all resources,
not just income, they are regarded as deprived (2).
The UK’s ministry of housing, communities & local
government examines seven distinct domains of deprivation to measure the level
of deprivation in neighbourhoods (figure 1)(2):
- Income
- Employment
- Health
Deprivation and Disability
- Education,
Skills and Training
- Crime
- Barriers
to Housing and Services
- Living
Environment
How does SES deprivation affect
child development?
There is a well-documented association between early-life
adversity (ELA) and a host of adverse outcomes for children. For example, children
exposed to ELA show an increased risk of poor cognitive, socioemotional and
physical health outcomes. In addition, deprivation has a unique influence on brain
development (1).
Children often suffer from disadvantages during their
lives, from educational achievement to employment prospects, if they grow up in
a more deprived area. Their physical and mental well-being is also affected.
Inequalities exist despite the downward trend in recent years for children not
ready for school and young people not in education, employment or training
(NEET) (3).
Abel et al. (2016) examined children at school entry
age (4/5 years old) for executive function (EF) to predict their school
readiness and their academic competence at a later stage. Availability of
learning materials in the home for infants/toddlers is essential for their
cognitive development and influences their school readiness (4). Both Abel et al. (2016) and Vogel et
al. (2021) have shown in their studies that there was a strong association
between early-life SES and EF abilities; higher deprivation led to poorer EF
outcomes (1,4).
In addition, Abel et al. (2016) demonstrated in their study
that low-SES may increase the risk of deprivation and threat in childhood.
Deprivation and threat, which accounts for SES-related cognitive ability
retardations, are highly related, but their experiences are distinct. A threat
is exposure to threatening or harmful experiences or stimulation (4). Although there is
limited knowledge of how deprivation and threat together and independently
influence child development within the low-SES context, a few studies
specifically examined dimensions of deprivation and threat in the context of
early life poverty (1).
DMAP uses experimental and theoretical observations of
neurodevelopment to assume that deprivation influences the development of the
association cortex, which is the area associated with higher-order cognitive
abilities. This conceptualisation of deprivation comes from neuroscience
literature that suggests that synaptic trimming in the prefrontal cortex and social
and cognitive stimulation levels are associated. Reduced levels of these
stimulations result in decreased dendritic branching and reduced synaptic
density on dendritic spines. Synaptic density and dendritic branching help the
brain connect and communicate information; however, the brain may be preparing
for less complexity in the environment with their reduction. Consequently, this
adaptation may impact the development of higher-order cognitive abilities such
as cognitive control and EF (1).
No shortage of literature shows the link between early life
deprivation and increased risk of reduced executive function (EF) abilities.
Nevertheless, the bulk of the study has focused on children in Romanian
orphanages adopted internationally after spending varying times in the orphanage.
In a study sample of 2.5- to 4-years-old-post-institutionalized children have
been found to have significantly reduced EF abilities compared to their
non-institutionalised counterparts. Similarly, studies that use the Family
Stress and Family Investment models and the DMAP models consistently found an association
between social and cognitive deprivations and cognitive outcomes. A significant
amount of work shows the association of early life social and cognitive
deprivation with increased risk for reduced EF abilities and related aspects of
cognition throughout childhood (1).
How does SES deprivation
contribute to child mortality?
Infant mortality is a sensitive indicator of the effect of
social determinants of health. Therefore, deprivation, particularly the kind
that leads to infant/child death, should be avoidable in a wealthy society (5).
In the UK, infant mortality, predominantly among families
in more deprived areas, has risen over the last four years, probably due to increased
child poverty. Out of 23 Western European countries, the UK ranked 22 in 2019
for under five years old child mortality (5).
One way to eliminated infant and child deaths is to assess
its relationship with deprivation. For example, the National Child Mortality Database
(NCMD) 2019 report shows that for each decile of deprivation, the mortality
risk is approximately 10% higher on average, going from lowest to most
deprived; that is double the rate of the least deprived. Therefore, 23% of
child death is avoidable if the child mortality rate in the most deprived half
of the population is reducing to equal to that of the least deprived half (5).
NCMD report believes deprivation has a causal effect on
child mortality; the more significant the deprivation, the higher the mortality
rate. Intervention can drastically reduce child mortality through social
justice by avoiding those inequalities that are judged to be avoidable by
reasonable means. In the words of Professor Sir Michael Marmot, UCL Institute
of Health Equity, “In a rich society, deprivation should be avoidable –
particularly of the kind that leads to deaths of infants and children”(5).
Conclusion
Early life poverty or low-SES increases the risk of a high
level of deprivation in children and exposes them to stressful or threatening
input. Consequently, deprivation negatively affects the executive function
abilities of children as well as their socioemotional and physical growth. In
addition, deprivation may lead to infant/child mortality, which is currently in
an upward trend in England. In a wealthy society, to experience this level of
deprivation that leads to child mortality is unacceptable. For that reason,
avoidable deprivation should be reduced or eliminated by tackling inequality in
socioeconomic status.
Figure 1: The seven domains of deprivation that create the Index of Multiple Deprivation (IMD2019). From <https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/835115/IoD2019_Statistical_Release.pdf>
References
(1)
Vogel SC, Perry RE, Brandes-Aitken A, Braren S, Blair C. Deprivation and threat
as developmental mediators in the relation between early life socioeconomic
status and executive functioning outcomes in early childhood. Developmental
cognitive neuroscience. 2021; 47 100907. Available from: doi:
10.1016/j.dcn.2020.100907 Available from: http://dx.doi.org/10.1016/j.dcn.2020.100907
.
(2)
Ministry of Housing, Communities & Local Government. The English Indices
of Deprivation 2019 (IoD2019) - Statistical Release. 2019.
(3)
Public Health England. Research and analysis
Chapter 6: social determinants of health. Available from: https://www.gov.uk/government/publications/health-profile-for-england/chapter-6-social-determinants-of-health
[Accessed 21 Jun 2021].
(4)
Abel GA, Barclay ME, Payne RA. Adjusted indices of multiple deprivation to
enable comparisons within and between constituent countries of the UK including
an illustration using mortality rates. BMJ open. 2016; 6 (11): e012750.
Available from: doi: 10.1136/bmjopen-2016-012750 Available from: http://dx.doi.org/10.1136/bmjopen-2016-012750
.
(5)
David Odd, Sylvia Stoianova, Vicky Sleap, Tom Williams, Nick Cook, Louisa
McGeehan, Alison Garnham, Stephanie Davern, Rachel Rimmer, Judith Gault,
Jennifer J Kurinczuk, Ingrid Wolfe, Karen Luyt. Child Mortality and Social
Deprivation National Child Mortality Database Programme Thematic Report. 2021.
