At the Human Early Learning Partnership, we have built on the concept of proportionate universality, introduced by Sir Michael Marmot and applied this to child development in B.C. to suggest a strategy for moving toward greater equity in the early years and flattening of the child development gradient – improving outcomes for all children.
Traditionally, improvements in child development have been suggested within a conceptual framework that sets universal solutions – those that are available to all children and families irrespective of their socio-economic status (SES) level - against targeted solutions – those that are focused on the lowest SES range (special at-risk populations) and in specific low-income geographic areas. An assessment of each suggests that neither, on its own, will be sufficient in flattening substantially the social gradient for health. Experience with existing Canadian policy platforms such as health and education, which are universal and incorporate some element of targeting to reach vulnerable populations, is instructive.
A universal approach has the potential to improve things for children in all SES ranges. But in practice, children in higher SES ranges tend to benefit more than those in lower SES ranges. This is because lower SES families are more likely to face obstacles to accessing services – these might be physical, cultural, or social (see sidebar). Using a universal approach without addressing barriers to access, one that provides the same service to all, can actually steepen the gradient, and create greater differences in child outcomes between SES ranges.
Targeting programs toward children who are most vulnerable has the potential to reach children in the greatest need. But targeting also has substantial challenges. First, targeted solutions can reach the most vulnerable children in low SES ranges in a more intensive way, and so possibly improve outcomes for these children. However, as the largest number of vulnerable children is in the middle class, the majority of vulnerable children are missed. Second, targeting programs in itself does not eliminate barriers to access – barriers such as the stigma associated with some programs continue to affect families. Targeting alone then, does not flatten the social gradient overall and improve child outcomes across the whole population.
Key to reducing vulnerability in the early years is a universal platform of supports and services available to all children. This platform needs to be accompanies by additional targeted services for highly vulnerable children and children in low SES ranges or geographical areas. Key also, is the elimination, as far as possible, of barriers to access.