Health Inequalities during the First 1000 days in EU and Nordic countries

Aileen Robertson

    Publikation: Konferencebidrag uden forlag/tidsskriftAbstraktForskningpeer review


    Health Inequalities in the First 1000 days – EU and Nordic countries,
    Iceland University, December 2016
    Aileen Robertson, Global Nutrition and Health, Metropolitan University College.

    A healthy start to life is the key to reducing health inequalities across EU and Nordic countries, and important for future generations. There is evidence that health inequalities, according to level of maternal education, exists in Nordic countries at several stages during the first 1000 days of life.
    High levels of obesity in reproductive age women in EU and Nordic countries result in high risk of excess weight gain during pregnancy. This in turn results in either small (SGA) or large for gestational age (LGA) newborns with significant negative correlation between them. In addition, women with low levels of education breastfeed less and practice more inappropriate infant feeding practices compared with mothers with high levels of education. During the separate stages of the first 1000 days the risk factors accumulate, compound and perpetuate the high risk of both childhood obesity and ill-health.
    An overview of key epidemiological data indicates the extent of disparities during the separate stages during the first 1000 days of life. This includes: high prevalence of obesity in reproductive age women with low levels of education; evidence that these obese women tend to gain excessive weight during pregnancy and, in addition, have a high incidence of either small-for-gestational age (SGA) or large-for-gestational age (LGA) newborns; furthermore, the prevalence of both breast-feeding rates and correct infant feeding practices is lower in mothers with low levels of education.
    Opportunities to reduce the social gradient in health inequalities in Nordic countries by intervening during the first 1000 days are discussed. One overarching recommendation is that a more joined-up and “coordinated approach” is needed within maternal and young child health and care services. Improved coordination would simultaneously decrease risk of childhood obesity, improve maternal health and reduce disparities among the most disadvantaged. A “coordinated approach” is conceptualised as a life cycle where if obese women become pregnant they are likely to gain excessive weight during pregnancy and retain it after giving birth. Women with low socioeconomic status tend to have more children and thus are exposed to the impact of repeated pregnancies. Women, who are obese and/or gain excessive weight during pregnancy, are likely to deliver either a SGA or LGA newborn who is predisposed to childhood obesity. In addition, feeding of the newborn is likely to pose problems as obese women are predisposed to difficulties with breastfeeding which leads to formula feeding regimen. Formula feeding along with too early introduction of foods is associated with childhood obesity.

    This sequence of events set the infant on course, especially girl infants, to become obese before they themselves become pregnant and so increase the risk of transfer of obesity to the next generation. Evidence shows how difficult it is to optimise gestational weight gain in obese mothers and thus it is crucial to prevent obesity before conception. In addition, women, to lose their excess retained weight after giving birth, need skilled support to enable them to breastfeed exclusively for 6 months. Moreover, it is key for parents to learn about “anticipatory feeding” methods and to know when, what and how much safe, nutritious foods to feed their infant.

    A more “joined up” health sector requires much better integration and communication between maternal and infant health care providers, along with welfare and young childcare services. In order to reduce inequalities, Nordic governments must aim for a continuum of care from preconception through maternity, birth, post-delivery, infancy, and into early childhood and take the social determinants of health into account. The boundaries have to be broken down between healthcare and non-health sectors and across home and community settings. Traditional professional “silos” have also to be broken down and coordinated to reduce the inequalities in childhood obesity in order to reap the health gains and economic benefits.
    Central governments can initiate joined-up approaches through creating joint priorities and building social safety-nets for the most disadvantaged. This includes honouring pledges concerning the Convention of Rights of Child and other UN Resolutions, including the length of paid maternity leave and clamp down on exploitative tactics of infant food companies.
    New evidence will be presented including:
    • high prevalence of obesity in reproductive age women where 1 out of 7 women in EU, with low levels of education, are obese;
    • strong correlation between SGA prevalence and EU Member States’ gender equality index;
    • significant differences between low breastfeeding rates and maternal education;
    • infant feeding practices often do not reflect the guidelines where the enjoyment of vegetables depends on young taste buds being repeatedly exposed to the taste of vegetables.

    Without the best nutritional start in life, infants are set on a trajectory where unhealthy exposures accumulate, compound and perpetuate the high risk of childhood obesity, ill-health and inequalities.
    Publikationsdato25 okt. 2016
    StatusUdgivet - 25 okt. 2016


    • Sundhed, ernæring og livskvalitet