Inequalities in child health up to five years: a supradistrict audit

Reducing inequalities is a key national priority. This paper describes a unique retrospective multidisciplinary audit that was carried out across the Greater Manchester area. The aim of the audit was to identify the extent to which local health and local authority services were implementing evidence-based interventions to reduce health inequalities in children aged below five, using both qualitative and quantitative approaches. Health visitor and midwifery records were audited against service provision around seven standards--reducing postnatal depression, promoting breastfeeding, social and emotional support for parents, improving the health of looked-after children, improving nutrition in children and women of childbearing age, provision of day care and pre-school education, and reducing smoking in pregnancy and the postnatal period. The results suggest that recommendations for reducing inequalities were not implemented across all geographic areas, services or populations consistently, particularly in relation to smoking cessation, the management of postnatal depression and the promotion of breastfeeding initiation and continuation. It is recommended that, with the widening gap in health outcomes between both ends of the socioeconomic spectrum, local services should be targeted for those most in need.