Background Studies of adults show that adverse childhood experiences (ACEs) are associated with health and social problems and are more common among people living in deprived areas. However, there is limited information about the geographical pattern of contemporary ACEs. Methods We used data from the police, social services, schools and vital statistics in England to calculate population rates of events that represent childhood adversity. We constructed an ‘ACE Index’ that summarizes the relative frequency of ACEs at local authority level, informed by the methods of the Index of Multiple Deprivation. We explored associations between the ACE Index and local characteristics in cross-sectional ecological analysis. Results The ACE Index was strongly associated with the proportion of children that live in income-deprived households (child poverty). In addition, the ACE Index was independently associated with higher population density and was higher in certain regions, particularly the north-east. Conclusions The association between ACEs and child poverty provides evidence of a process in which deprivation increases the risk of adverse experiences in childhood. The ACE Index can inform allocation of resources for prevention and mitigation of ACEs.

Abstract:This paper aims to understand the pathways through which financial vulnerability affects children's social, emotional and behavioural (SEB) wellbeing and whether that impact is directly experienced or, as hypothesised, indirectly through their mothers' emotional wellbeing. It uses data from Growing Up in Scotland -a longitudinal birth cohort study of 5,217 children born in 2004-5. The results show that maternal emotional distress is strongly associated with financial vulnerability, more so than with income, and that child SEB wellbeing is negatively associated with financial vulnerability and maternal emotional distress, with two-thirds of the effect of financial vulnerability being experienced indirectly through maternal emotional distress. While the qualitative evidence shows that financial vulnerability adversely affects older children directly, through the comparisons they make to their reference group, the quantitative finding is that young children are also negatively affected but predominantly via the effect of financial vulnerability on their mothers' emotional distress.

While widespread lip service is given in the UK to the social determinants of health (SDoH), there are few published comparisons of how the UK's devolved jurisdictions ‘stack up’, in terms of implementing SDoH-based policies and programmes, to improve health equity over the life-course. Based on recent SDoH publications, seven key societal-level investments are suggested, across the life-course, for increasing health equity by socioeconomic position (SEP). We present hard-to-find comparable analyses of routinely collected data to gauge the relative extent to which these investments have been pursued and achieved expected goals in Scotland, as compared with England and Wales, in recent decades. Despite Scotland's longstanding explicit goal of reducing health inequalities, it has recently been doing slightly better than England and Wales on only one broad indicator of health-equity-related investments: childhood poverty. However, on the following indicators of other ‘best investments for health equity’, Scotland has not achieved demonstrably more equitable outcomes by SEP than the rest of the UK: infant mortality and teenage pregnancy rates; early childhood education implementation; standardised educational attainment after primary/secondary school; health care system access and performance; protection of the population from potentially hazardous patterns of food, drink and gambling use; unemployment. Although Scotland did not choose independence on September 18th, 2014, it could still (under the planned increased devolution of powers from Westminster) choose to increase investments in the underperforming categories of interventions for health equity listed above. However, such discussion is largely absent from the current post-referendum debate. Without further significant investments in such policies and programmes, Scotland is unlikely to achieve the ‘healthier, fairer society’ referred to in the current Scottish Government's official aspirations for the nation.

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The diets of young children in Scotland deteriorated between the ages of 2 and 5 years across the entire socioeconomic spectrum. Additionally, deterioration in subjective income predicted less healthy diets for children.