Now that I am pregnant and expecting my fourth baby, I have started to reflect upon the circumstances that this child will experience once it is born, especially compared to other babies born in different places in the world. Chapter 12 discusses the global context of health and highlights children dying from malnutrition (see page 252), as well as a range of other issues such as trade and the promotion of formula milk that have an impact upon the life chances of new babies. More than that, many inequalities exist within the UK meaning that children are exposed to a range of health challenges from before birth, some more so than others. Recent research shows that children born in the UK do not lead privileged lives as is commonly assumed but rather that the UK ranks poorly on child health indicators (see the Growing Up in Britain report, available at http://bma.org.uk/working-for-change/improving-and-protecting-health/child-health/growing-up-in-the-uk). Researching health (see chapter 3, investigating health) is of course important, and a long term study called Born in Bradford began in 2007 to add to the evidence base about life chances from birth until adulthood (see http://www.borninbradford.nhs.uk/). Bradford experiences high levels of deprivation and poverty therefore will make an important contribution to the evidence base about determinants (see http://news.bbc.co.uk/1/hi/uk/6754153.stm).
Contemporary Health Studies outlines the main determinants of health in part 3 of the book, telling the reader about the many influences that we all have upon our health and wellbeing. Beginning at chapter 8 at the start of life itself foetal development and programming are discussed. So from the very beginning of life, our health is influenced by a range of factors which many of us will not necessarily consider. What I now eat is influencing the health of my unborn child with research showing that a lack of iodine affects cognitive development (see http://www.independent.co.uk/life-style/health-and-families/health-news/mothers-diets-may-harm-iqs-in-twothirds-of-babies-8626229.html) and that diet in pregnancy can affect DNA and levels of obesity in later years (see http://www.bbc.co.uk/news/health-13119545). Smoking in pregnancy is also detrimental to the health of unborn babies, and there are significant area differences in the UK in terms of smoking rates during pregnancy, with more women smoking whilst pregnant in northern England, the area where I live (see http://www.bbc.co.uk/news/health-17056866). Drinking alcohol in pregnancy has also been researched in terms of the impact that it can have on unborn babies, with foetal alcohol syndrome being an extremely negative outcome (see pages 178 and 179). Moderate alcohol consumption has been reported as not being an issue for the health of unborn babies (see http://www.bbc.co.uk/news/health-18506174) however the latest NHS guidance given to pregnant women is not to consume any alcohol at all especially in the first trimester (see http://www.nhs.uk/chq/Pages/2270.aspx?CategoryID=54#close).
The availability of health care is important too in terms of maternal health, including routine monitoring, health advice, screening and the provision of safe childbirth. During 2009 in the midst of a swine flu outbreak, pregnant women in the UK were prioritised in terms of being vaccinated (see http://news.bbc.co.uk/1/hi/health/8199629.stm) as a mechanism to protect both their health and the health of their unborn babies. Providing quality medical care is an issue that is often debated in relation to the NHS as a service, with recent news reports focusing upon hospital failings in general terms (see http://www.bbc.co.uk/news/health-23315869) More specifically in relation to maternal and child health, media reports in the UK have focused upon the shortage of trained midwives available (see http://www.bbc.co.uk/news/uk-politics-22113693), which remains a challenge for policy-makers. Whilst Chapter 4 of the book discusses the medicalization of childbirth as an area in which sociologists offer criticism of the medical profession, evidence from other contexts demonstrates the importance of medical care for pregnant women. Indeed, the importance of this is enshrined within global policy goals and statements, for example the Millennium Development Goals (see chapter 12 and http://www.un.org/millenniumgoals/).
However, as this blog has demonstrated before the level of the global is considered there are many other local and national influences that determine health. In childhood the communities into which we are born and raised are important (see chapter 9). The physical environment that we occupy also affects our health (see chapter 10). Therefore, I am already mindful that my new baby will be born into a deprived community environment as this is where I live but that on a more positive note that he/she will not have concerns about accessing safe or clean water, will have adequate sanitation, access to a safe, secure and healthy home and health care services for monitoring, immunization and of course emergency medical care if the need arises. As my baby grows and develops the policy context into which they arrive (see chapter 11) will enable access to primary and secondary education, which is also important in terms of health however this is just the starting point. This new life will also experience policy changes that influence health, wellbeing and life-chances through a range of sectors as well as a broad array of other influences such as employment, welfare state provision, globalization and all of the other determinants outlined in part 3 of the book.