“Te first child is often a shocking experience in lots of ways, as well as rewarding – the sleep deprivation, the all-consuming demands and responsibility of infant care. “It's reassuring, then, to know people who are actually having or have had the same experience. But that then knocks out all of their social network who are child- less. Tat's maybe why, having made some new friends through antenatal services can be quite important, and if that's not happened and you don't have any other friends who have had children, then you're already in trouble, lacking social support. “Most of us know our own mother has had children because we are our mother's child. Becoming a parent sometimes result in a big shift in how we see our relationship with our own parents and particularly our mother. It becomes renewed.” With Caley’s normal timetable and routine disrupted by a very young
baby, Jamieson suggests her relationship with the surrounding community will also play a factor. With evidence suggesting trust in neighbours can be low in areas of deprivation, this might make life more difficult for Caley. “If you don’t trust your neighbours and know about local trouble you have
reason to be more vigilant, fearful and protective on behalf of your child.” Everyday hazards like air pollution will also be more prevalent, she says. Caley will be up at different times of night, like every parent, but Jamie- son points out she is unlikely to have a car or feel safe enough to go out for a walk with her baby at night.
“Babies learn their place in society by how their parents are treated.”
And as Kirsty grows, access to green space and playparks will be important, she says, as well as public libraries. Dr Mullin says Govan’s green spaces have been well
maintained and improved child development in the area. “It sounds like a bit of a silly thing, but urban plan- ning is really important to the debate. You need usable, safe community spaces. Community education projects. Social investment, but you have to have the vision to actually do that,” she says.
Community health hubs like the one in Govan have taken an asset-based approach to health improvement,
empowering the community to be part of it. Elsewhere in Scotland, how- ever, there may not be such a sense of agency. Scotland’s Children and Young People Commissioner (SCCYP), Tam
Baillie, works to ensure children understand their right to be heard, but as a newborn, how can Kirsty’s voice be heard? Dr Beth Cross of the University of the West of Scotland wrote a report on engagement with babies for the SCCYP and found the approaches in the community health hubs have made a difference through a culture of listening. Tey have even branched out to other community empower- ment activities, she points out, citing the success of community radio in Rutherglen, and ‘books for babies’ in Craigmillar. “Tey have a baby book of the year award and they don’t use experts to shortlist. Tey are the experts. In fact, that award is now named after a local grandmother, rather than Sainsbury’s or something,” she says.
Voices Dr Anne Mullin, 'Deep end' GP, Glasgow Kirsty needs a fair start
▏ GPs who work in the deep end have a story to tell about children like Kirsty who are born into socio-economically disadvantaged communities. That story basically confirms what we inherently know, that unequal health that begins in childhood has long-term consequences that will adversely affect the entire life of Kirsty’s health, education and eco- nomic potential.
The contribution that GPs make to ame-
liorate the impact of inequalities in early years is found in the localised knowledge that GPs gain about families. Understand- ing Kirsty’s family dynamic is the basis for continuity of holistic care during the times that children like her become vulnerable. GPs will tell you that children can dem- onstrate resilience to the challenges of
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www.holyrood.com 23 May 2016
experiencing socio-economic deprivation and while ultimately it is the wider family that is important to all children, having supportive friends, being loved uncondi- tionally by at least one primary caregiver, living in networked communities, growing up in adequate housing, having uncondi- tional access to early years education and good quality home learning and universal healthcare all contribute to a good start in life. Unfortunately, GPs will also tell you
the story of children who are ‘born to fail’. If children experience extreme material hardship,
food and housing insecurity
and grow up in a household where there are additional stress factors, for example, parental mental health, addiction and dis- ability issues, low parental employment
and educational status, their future is not assured. Persistent health and social problems that are never ade- quately addressed hinder their access to networked resources and reduce their life chances.
The challenge to Scottish government within the current financial climate is to progress with its extensive early years policies and ambitious stretch targets; to narrow the gap that exists between the majority and the minority; and diminish the inequity of service provision. The GPs working at the deep end would like to posi- tively contribute to that agenda to help all of Scotland’s Kirsties. ⌞
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