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Introduction     • Bronfenbrenner’s Ecological Model
Determinants of Chronic Conditions and Special Health Care Needs Among Children
Determinants of Health

Introduction to Developmental Health

Developmental Health has been defined as the physical and mental health, well-being, coping and competence of human beings (Keating, 1999) and is the combination of health and developmental outcomes. Many different factors can positively or negatively affect developmental health. If we want to impact a child's development and ultimate life trajectory, we must understand the key risk and protective factors that strongly influence children's future health and well-being.

Some of the factors influencing children's developmental health include income, education, health, culture, parenting, neighbourhood, and social status. It is a challenge to present this complex web of factors which influence child development, as most of them are interrelated. For example, income is a powerful indicator which can impact education level, access to health and child care services, choice of neighbourhood, stress level, transportation, and social status.

Child development is cumulative in nature. A nurturing and stimulating environment will promote learning skills that in turn allow the child's curiosity and creativity to blossom and may even "open future possibilities in spite of biological interventions" (Shanker, 2008) . On the other hand, adopting a "wait and see" approach when a child is showing some atypical or delayed development in one domain, can negatively impact many areas of development over time (OCFP, 2005).

Over the years, a number of different models have emerged which attempt to explain the interaction of factors that influence child development. To date, Bronfenbrenner’s ecological system of human development (1979) is the most widely used models in both public health and child developement. This system evolved to represent the interconnectedness of biological and social environments.

Bronfenbrenner’s Ecological Model
In his original model, Bronfenbrenner (1979) outlines four different levels that interact with one another: the microsystem, the mesosystem, the exosystem, and the macrosystem. A visual representation of his model is shown in Figure 1. Bronfenbrenner’s (1979) definition of each system provides further clarification.
Microsystem - “a pattern of activities, roles, and interpersonal relations experienced by the developing person in a given setting with particular physical and material characteristics” (p. 22). Sample settings can include the home, school, and child care centre. Tudge et al. (2000) note that there is “a tendency to focus on development within a single microsystem – on development within the family, or at school, or with the peer group” (p. 2).
Mesosystem - “the interrelations among two or more settings in which the developing person actively participates (such as: for a child, the relations among home, school, and neighborhood peer group; for an adult, among family, work, and social life)” (p. 25)
Exosystem - “one or more settings that do not involve the developing person as an active participant, but in which events occur that affect, or are affected by, what happens in the setting containing the developing person. Examples of an exosystem … might include the parent’s place of work, a school class attended by an older sibling, the parents’ network of friends …” (p. 25)
Macrosystem - “consistencies … at the level of the subculture or the culture as a whole, along with any belief systems or ideology underlying such consistencies” (p. 26). Some examples provided include the differences in playgrounds, schools or coffee shops in different counties.
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Determinants of Chronic Conditions and Special Health Care Needs Among Children

A similar type of model, often used in the context of social pediatrics, shows the determinants of chronic conditions and special health care needs among children (see Figure 2). As in Bronfenbrenner’s model, each level is nested within another system, and incorporates factors affecting the child, family, community, and society. A common feature of both models is that the child is found at the core, and remains the central focus. In this model (see Newacheck et al., 2008), a wide range of determinants are outlined. They are essentially based on the Determinants of Health (Health Canada, 2001; WHO, 2003). These physical and social factors affect a person’s health and well-being, but have an even more significant impact on a child’s trajectory of development.


Determinants of Health

In recent years, there has been a shift from looking at the health of individuals, to looking at the health of populations (Ford-Jones, Williams, & Bertrand, 2008; Hertzman & Irwin, 2007) and how their health is determined. Children are in need of support through parenting and supportive communities and therefore most affected by the determinants of health. The first six years of life set “a base for learning, behaviour and health over the life cycle” (McCain & Mustard, 1999, p. 2). Furthermore, it has now been well established that both nature (e.g., genes) and nurture (e.g., environment) interact and influence developmental outcomes throughout life (Ford-Jones, Williams, & Bertrand, 2008; Mustard, 2008; National Collaborating Centre for Determinants of Health, 2008a).

  • The key determinants of health identified by Health Canada (2001) are:
    1. Income and social status
    2. Employment
    3. Education
    4. Social environments
    5. Physical environments
    6. Healthy child development
    7. Personal health practices and coping skills
    8. Health services
    9. Social support networks
    10. Biology and genetic endowment
    11. Gender
    12. Culture