Equity and Child Health: Addressing Health Inequalities and Improving Child Health Through a Public Health Approach
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“Leaving no one behind”, as the United Nations’ Sustainable Development Goals promise, is a goal most of us support, especially when children are concerned. However, the road towards this goal is more challenging than the slogan suggests. In this thesis, I try to understand whether and how empowerment in public health interventions can provide a double gain in low- and middle-income countries: improving child health and health equity. More specifically, I explore four questions: what interventions work, how empowerment can work for child health, how empowerment has been actually translated into public health interventions, and what their effects have been on child health and health equity. Starting from a global perspective, this thesis then goes into the details of a promising type of social protection program for health equity, through a case study of Lesotho’ Child Grants Program. To tackle the complex ways through which, in a given program, empowerment can lead to a healthier, fairer start in life, I combine qualitative, quantitative and mixed methods. The body of evidence on the effects of various interventions on child health and equity is growing, thanks to a more diverse and transparent definition of health equity in research and programs. This thesis finds that some preventive interventions targeting disadvantaged children can deliver on the double promise of child health and equity. However, the way they can do so is complex. Building solid, global evidence on this will require further research. Secondly, I find that economic empowerment components targeting children and their households show more promises than broader, more structural empowerment efforts. However, testing the effect of empowerment in a given program is hampered by the challenges of translating a complex idea (like empowerment) into practical tasks and activities. This thesis makes two main contributions to health equity research and practice. The first is to the field of health equity research. I follow a comprehensive definition of health equity that goes beyond the exclusive focus on the most-disadvantaged groups. This approach clarifies the effects and the mechanisms of action of interventions not only on health equity but also on child health in the wider community. The second contribution of this thesis is to the field of social protection. Examination of the Child Grants Program provides a concrete case study of how empowerment strategies and child health equity are integrated into a specific program. Besides its contribution to research, this thesis is a plea for open discussions in program planning and implementation about what lies behind broad development promises like empowerment and “Leaving no one behind”.