Are child welfare services unintentionally exacerbating health inequalities?

The social determinants of health act across the lifecourse to create unequal chances of long and healthy lives. The top priorities for action to reduce health inequalities in England are to give every child the best start in life and enable all children (and) young people to maximise their capabilities and have control over their lives (Marmot 2010). This means flattening the gradient in life chances by tackling the extent and impact of social inequalities. Child welfare services internationally focus on children in extreme circumstances, whose current and future physical and mental health is threatened by the disadvantaged social conditions in which they live and by adverse events. However, evidence from England suggests that child welfare services may be unintentionally exacerbating inequalities. Unlike for health inequalities, deprivation has been taken for granted as the inevitable cause of damaged childhoods, while poor quality out-of-home care services and the stigma of safeguarding interventions often lead to poor childhood outcomes. If child welfare services are not to be implicated in making health inequalities worse, policy, practice and research must acknowledge child welfare as a site of inequity, learning theoretical, research, policy and practice lessons from the field of inequalities in health.