About

The Emergence of Health Gaps in Early Life: A Dynamic Analysis of Three National Birth Cohorts Project aims to advance our understanding of health inequalities in France, the United Kingdom and the United States. Evidence suggests that inequalities in health begin from the starting gate and that children’s early environments “get under the skin” from the earliest moments of life. Early childhood is therefore crucial to our understanding of the production of health inequalities in later life. Compared to other national settings, there is less data and empirical research about the dynamics of health inequalities in the early years for France, yet preliminary results suggest stark health gaps from birth, comparable to those documented in other developed countries. The lack of nuanced, longitudinal data and empirical research on early health inequities in France is at odds with a renewed policy focus on anti-poverty measures, with a strong emphasis on early living conditions and childhood education.

A body of research, mostly coming from the economics literature, has put forward multi-domain deprivation as a tool to better understand childhood disadvantage, rather than classic measures such as income poverty. Also, national contexts and policy environments may have a strong effect in moderating the relationship between early experience of deprivation and child health, leading to different dynamics of inequalities in early health. However, most studies in this field focus on single national contexts or cross-sectional comparisons. Today, recently maturing birth cohort studies across developed countries can provide a unique opportunity to assess this variation across national settings using fine, longitudinal data on deprivation which allows describing when and how early health inequities begin across countries.

In this project, we propose to conceptually and methodologically bring together the economics literature on the measurement of childhood deprivation on the one hand, with the epidemiological literature on health inequalities on the other hand. Applying a longitudinal framework, we propose to make use of interdisciplinary, nationally-representative data to characterize children’s multi-domain deprivation and explore how it links to dynamics of early health. To do so, we use a unique new data source, the Etude Longitudinal Française depuis l’Enfance (Elfe) a birth cohort following over 18,000 children born in continental France in 2011. After a nuanced description of the French setting, we compare Elfe to two national birth cohorts from the US and UK to examine whether different policy environments and social institutions produce different patterns of inequities across countries.

A particular innovation of this project is the use of a life-course, multi-domain framework to study early childhood deprivation and how it correlates to early health. Using longitudinal data and methods, we explore how dynamics of early childhood deprivation are associated with dynamics of early health. The focus on multiple domains of deprivation allows exploring which dimensions of deprivation matter most for early health; this is a critical step to move from describing to understanding health inequalities.

Our key research questions are:

• What are the patterns of multi-domain deprivation across early childhood in France?

• How do different domains of deprivation link to early health? Do these associations vary according to child age? Does the cumulation of deprivation (across time, across dimensions of deprivation) matter for early health?

• To what extent do these patterns of early health inequities in France compare to those observed in other developed countries? We compare the French experience to two other national contexts, the UK and the US.