Reducing Inequalities in early childhood – lessons from A Better Start

Ava Berry, Policy and Research Officer at the National Children’s Bureau, considers work to counteract the negative impacts of inequalities on young lives.

Where you are born and who your parents are can help predict a number of outcomes in pregnancy, childhood and beyond.

Inequalities in pregnancy and the early years have a significant impact on the human experience, and this is more pronounced in societies with the biggest gaps between the wealthy and the poor (UNICEF, 2015). Structural inequalities, including those linked to ethnicity, disability, gender, socioeconomic status, and access to health and early education services, all contribute to the likelihood of experiencing adverse outcomes.

The five ABS partnerships are established in areas of increased need, based on data on deprivation and child and maternal health outcomes. Therefore, families living in ABS areas are more likely to experience the effects of inequality in comparison to the general population.

Fair Society, Healthy Lives (The Marmot Review) (2010) identified a direct link between living in areas of higher deprivation and reduced life expectancy. The follow up report (Health Equity in England, 2020) highlighted how life expectancy had stalled for the first time, and people living in poor areas spent longer in poor health than the previous report found. These changes can both be attributed to societal inequalities (Institute of Health Equity, 2020). There is a strong moral case for intervening now to reduce inequalities in society and ensure the next generation can live long and healthy lives regardless of the circumstances they were born into.

In reality, family lives are often impacted by more than one source of inequality. Kymberlé Crenshaw first coined the term “intersectionality” to describe the combined impact of the inequality faced by women from Black communities in the USA who experienced the intertwined discrimination of being both Black and a woman. Today, the term is used to describe the combined impact of various structural inequalities on individuals and groups.

Inequality is experienced in different ways by individuals and communities; however, engaging an intersectional lens provides a framework for considering how these combined inequalities can impact on individuals across the life course.

There is a clear commitment across the ABS partnerships to supporting families who are affected by different and multiple forms of disadvantage. A variety of evidence is embedded throughout the work of ABS, at programme, partnership and service level, and while there have been challenges along the way, there have also been many opportunities for learning as partnerships have developed their approaches. Common lessons are summarised below.

Early intervention and universal services

It is evident that providing early intervention and universal services for pregnant people and families is a crucial avenue to target the negative impacts of inequality.

Across the ABS partnerships a range of innovative approaches are being offered which aim to provide support at the right time; this helps to reduce the need for more intensive interventions further down the line, when it can be more difficult to resolve issues. The independent review of children’s social care recommended the establishment of family help teams in local neighbourhoods, and learning from the ABS partnerships contributes to the evidence base for the need to provide early intervention in communities.

Services led by the communities they serve

The ABS partnerships are integrating the voices of parents and carers into the development and delivery of services. Parents and carers have had a say in what services are offered to families, based on what they need. This ensures service providers reflect the communities they serve, which can help families from minority communities feel safe and included. ABS partnerships recognise the importance of positive relationships between the workforce and families, and they prioritise continuity. This includes innovative work such as parent mentors and outreach.

Awareness of systemic racism and an anti-racist approach

The ABS partnerships have a strong awareness of the impact of systemic racism on family life, and are committed to addressing its impact. Minority ethnic groups are over-represented in areas of high deprivation and ABS partnerships have put clear approaches in place, including ensuring materials are accessible (in a variety of languages), increasing representation among practitioners, and developing new approaches to identifying risk in pregnancy.

Effective data and information sharing across multi-agency teams

Collecting data about the demographics of families within local communities provides an important avenue for understanding local need and ensuring the necessary services are commissioned. ABS partnerships collaborate with a variety of multiagency teams and have developed innovative ways of sharing data which enables services to be better targeted and delivered. If it goes ahead, the development of a Single Unique Identifier for children will help to streamline this approach further, and again, learning from ABS will be critical.

About A Better Start

A Better Start is a ten-year (2015-2025), £215 million programme set-up by The National Lottery Community Fund, the largest funder of community activity in the UK.

Five A Better Start partnerships based in Blackpool, Bradford, Lambeth, Nottingham and Southend are supporting families to give their babies and very young children the best possible start in life. Working with local parents, the A Better Start partnerships are developing and testing ways to improve their children’s diet and nutrition, social and emotional development, and speech, language and communication.

The work of the programme is grounded in scientific evidence and research. A Better Start is place-based and enabling systems change. It aims to improve the way that organisations work together and with families to shift attitudes and spending towards preventing problems that can start in early life. It is one of five major programmes set up by The National Lottery Community Fund to test and learn from new approaches to designing services which aim to make people’s lives healthier and happier

The National Children’s Bureau is coordinating an ambitious programme of shared learning for A Better Start, disseminating the partnerships’ experiences in creating innovative services far and wide, so that others working in early childhood development or place-based systems change can benefit.

Sign-up to join our mailing list