INTRODUCTION

Health inequalities are systemic, avoidable, and unfair differences in health outcomes across populations (McCartney et al., 2019). These disparities pose a serious threat to both public health and healthcare systems. While socioeconomic deprivation is often the most visible driver, inequalities also arise from other social factors such as disability, race, sexual orientation, and religion. These dimensions frequently overlap, compounding disadvantage and deepening their impact on health.

Inequalities often emerge early in life and persist into childhood and adulthood. Children who grow up in low-income families face a substantially higher risk of chronic illness and developmental challenges than their wealthier peers (Currie & Rossin-Slater, 2014). Such disadvantages shape health trajectories over the long term, as consistently documented across diverse populations. Addressing these gaps is therefore critical not only to improve individual outcomes but also to reduce the wider social and financial burdens they create.

This review focuses on three major determinants of childhood health inequality: socioeconomic status, geographical disparities, and educational attainment. It also examines how the COVID-19 pandemic has intensified these vulnerabilities, further marginalizing disadvantaged populations. By synthesizing evidence across these domains, the review underscores the urgent need for coordinated, long-term strategies to promote equity in child health. An overview of the key determinants and outcomes of child health inequalities is presented in Figure 1.

THE EFFECT OF HEALTH INEQUALITY ON OVERALL CHILDREN’S HEALTH

Health inequalities have a significant impact on children's physical and mental health outcomes. This section explores these effects by examining current research that highlights disparities and their implications for children's overall health.

Physical Health

Disparities in children's physical health are especially concerning because they frequently reflect broader environmental and social inequalities. These differences may lead to long-term health problems that compromise children’s development, growth, and overall quality of life throughout their entire lifespan. A national cross-sectional study in China demonstrated that children from lower socioeconomic backgrounds had reduced access to cancer care services, which was linked to higher incidence rates of pediatric cancer (Ni et al., 2022). This finding suggests that disparities in healthcare access contribute significantly to poorer physical health outcomes among disadvantaged children. In addition, an analysis of health, nutrition, and well-being among Afro-descendant children across ten Latin American and Caribbean countries concluded that consistent gaps persist between Afro-descendants and non-Afro-descendants (Costa et al., 2022). These differences were especially evident in indicators such as nutritional status and overall health, highlighting the urgent need for targeted interventions to address these inequities.

Stunting, a widely recognized indicator of poor physical health, also varied significantly across socioeconomic determinants, particularly among under-five children in Tanzania (Musheiguza et al., 2021). The study found that children from socioeconomically disadvantaged households experienced a much higher prevalence of stunting compared to their more advantaged peers. Another example involves children and young people with type 1 diabetes. Research shows that minority ethnic communities consistently report higher HbA1c values than white children, and this gap has been increasing over the last six years, reflecting a worsening trend in health inequalities (Ng & Evans, 2021). Lastly, differences in physical activity provide further evidence of inequality: a study examining activity levels among children and youth in Scotland found clear disparities by socioeconomic status, reinforcing that disadvantage has a direct influence on physical health behaviors and outcomes (Bardid et al., 2022). Collectively, these studies underscore the persistent and multifaceted ways in which socioeconomic and social factors drive disparities in children’s physical health. To provide an integrated overview, Table 1 summarizes key studies on both physical and mental health inequalities in children, highlighting their design and major findings across diverse contexts.

Mental Health

Disparities in children's mental health are equally concerning since they can have a significant impact on social development, academic success, and general well-being. Evidence from Germany, for instance, shows that children living in socioeconomically disadvantaged areas with fewer opportunities for social and recreational activities are more likely to experience mental health problems, with these inequalities persisting through adolescence (Stahlmann et al., 2022). Such findings highlight how disadvantage becomes embedded in daily life, reinforcing disparities over time.

Patterns of healthcare use also reveal inequality. In Scotland, an analysis of prescribing and referral data found that children from deprived communities were more likely to be given psychiatric medication and referred to specialist services compared with peers from more affluent backgrounds (Ball et al., 2023). Although these differences partly reflect greater need, they also raise concerns about whether disadvantaged children are receiving the right type of support at the right time, or whether they are encountering systems that intervene only after problems have escalated. European evidence further illustrates these inequalities. Research shows that socioeconomic disadvantage has long been associated with higher risks of psychological difficulties in children and adolescents, and that these gaps have widened in recent years (Melchior, 2021).

Together, this evidence demonstrates how social inequalities shape children’s mental health in multiple ways: by increasing the likelihood of emotional and behavioral problems, by producing unequal patterns of service use, and by sustaining long-term disparities in well-being. Tackling these divides requires improvements in clinical care, along with sustained action on the underlying social and economic determinants that drive them. As noted in Table 1, these disparities span both physical and mental health outcomes, underscoring their broad and systemic impact.

THE COVID-19 PANDEMIC AND HEALTH INEQUALITIES IN CHILDREN

The COVID-19 pandemic has magnified vulnerabilities and deepened health inequalities worldwide, affecting both the physical and mental health of children (Rebouças et al., 2021; Marmot, 2021).

Physical Health

Evidence from multiple regions shows that the pandemic amplified the effects of socioeconomic disadvantage. In Japan, infant mortality and adolescent suicide rose among low-income families, while wealthier households were less affected (Takeuchi et al., 2024). Similar patterns were observed in Canada, where gaps in children’s diet and physical activity widened during school closures (Maximova et al., 2023). European studies also report that disadvantaged children faced greater barriers to maintaining healthy behaviors and accessing healthcare throughout the crisis (Geweniger et al., 2022; Lorthe et al., 2023).

Mental Health

The pandemic also widened inequalities in mental health outcomes. In the UK, longitudinal data revealed that children aged 5–8 experienced worsening mental health during this period, despite some disparities narrowing (Miall et al., 2023). In Europe, socioeconomic inequalities also deepened in developmental outcomes, with disadvantaged children showing higher risks of overweight and language delays (Weyers et al., 2023). In Spain, families with limited education and financial resources reported poorer housing conditions during lockdowns, compounding children’s difficulties across physical, emotional, and social domains (Sancho et al., 2021).

Taken together, global evidence shows that the pandemic did not create disparities but acted as an amplifier, revealing and worsening inequities in healthcare, nutrition, and education. Children in disadvantaged households were not only more exposed to risks but also had fewer protective resources. Thus, the pandemic highlighted the fragility of existing support systems. Table 2 summarizes the key studies that illustrate how the pandemic exacerbated inequalities in children’s health across different regions. The next section examines structural determinants—socioeconomic status, geography, and education—that shape outcomes both during and beyond the pandemic.

FACTORS THAT INFLUENCE CHILDREN’S HEALTH INEQUALITIES

Health inequalities stem from long-standing socioeconomic, geographic, and educational disparities that have shaped child health outcomes for decades (McCartney et al., 2019). Addressing such structural determinants is essential for developing durable strategies to reduce disparities in child health outcomes. Key studies underpinning these conclusions, including study designs and succinct findings, are summarized in Table 3.

Socioeconomic status

Socioeconomic status is one of the most powerful forces shaping child health, influencing everything from daily living conditions to access to medical care (Gautam et al., 2023). Families with fewer resources often struggle with overlapping disadvantages, including poor housing, financial stress, and limited access to healthcare. These cumulative pressures make children especially vulnerable to poorer outcomes. Evidence from Bangladesh illustrates this clearly. Children in low-income households were far less likely to be fully vaccinated, with barriers linked to parental education and employment (Srivastava et al., 2022). Preventive care that should be universal becomes a privilege tied to wealth.

The same pattern emerges in other settings. For example, in Brazil, mothers from socioeconomically disadvantaged families were more likely to hold negative views of their children’s oral health, reflecting how poverty shapes not only health outcomes but also parental perceptions and expectations (Karam et al., 2023). Beyond individual households, broader family dynamics such as parental mental health, conflict, and parenting practices can reinforce inequalities across generations (Blume et al., 2021). These findings illustrate a cycle: disadvantage influences parental attitudes, which in turn feed back into children’s well-being.

Further studies show how access to treatment also follows these gradients. In Ethiopia, children from rural or less educated families were less likely to be hospitalized for pneumonia (Shibre et al., 2021). This underscores how educational and geographic barriers compound vulnerability. Meanwhile, in urban environments, the absence of safe parks or sports facilities has been linked to higher rates of mental health problems in children, showing how structural deprivation translates directly into daily stressors (Rittsteiger et al., 2021). Health inequalities are not just about medical care but about the environments in which children grow and interact.

Geographical location

Geographical location often intersects with socioeconomic factors to influence children’s health outcomes. For instance, evidence from Nigeria shows how location magnifies disadvantage. According to the study, children in rural and underserved regions face significantly higher risks of mortality before age five, reflecting both limited health infrastructure and persistent poverty (Okoli et al., 2022). In China, disparities are also evident between urban, rural, and migrant populations. Using data from the Chinese Education Panel Survey, Wang et al. (2019) found that rural and migrant children had poorer health outcomes, measured by lower height-for-age scores, compared to urban children. Importantly, the father’s level of education moderated these disparities, suggesting that geographic disadvantage is compounded by intergenerational educational inequalities.

Moreover, regional disparities are also evident in Latin America. A study in Peru found that children’s access to dental services varied widely across natural regions, with rural and low-income communities facing the most barriers (Aravena et al., 2021). Evidence from Australia highlights another layer of inequity since children from disadvantaged or geographically remote households not only had higher rates of oral disease but also relied more heavily on acute dental services rather than preventive care (Haag et al., 2021).

These findings underscore that health inequalities are not evenly distributed but are closely tied to geography. Whether through rural–urban divides, regional disparities in infrastructure, or the compounded effects of remoteness and poverty, place fundamentally shapes children’s health outcomes and reinforces broader social inequalities.

Education

Education is another fundamental determinant of child health, influencing outcomes through health literacy, resource accessibility, and the capacity to adopt healthier lifestyles. Its impact is not only immediate but also intergenerational. It shapes both children’s present well-being and their long-term opportunities (Viner et al., 2012).

Evidence from the United States shows that maternal education strongly predicts children’s health and educational attainment. Mothers with more years of schooling were significantly more likely to raise healthier children, highlighting how disparities in parental education perpetuate inequalities across generations (Behrman & Rosenzweig, 2002). This finding underscores the role of parental education in setting the foundation for children’s health trajectories from birth onward.

At the global level, comparative analyses across OECD countries demonstrate that higher levels of educational attainment are consistently associated with improved health indicators, including lower prevalence of chronic illness and better mental health. Conversely, lower levels of education are linked to poorer outcomes and broader health disparities (Raghupathi & Raghupathi, 2020). These cross-national patterns show that education functions as a protective factor, buffering children against the risks posed by socioeconomic and geographic disadvantage.

Taken together, the evidence emphasizes that improving access to equitable, high-quality education is not simply a matter of social policy but a public health imperative. Strengthening educational opportunities, particularly for disadvantaged families, is central to breaking cycles of inequality and ensuring healthier futures for all children.

Additional factors

Beyond socioeconomic, geographic, and educational determinants, children’s health is also shaped by intersecting influences such as gender, poverty, and systemic barriers in healthcare. Long-term international evidence shows that health inequalities among adolescents have not diminished but persisted across decades, pointing to deeply embedded structural disadvantages (Elgar et al., 2015).

Gender inequities are especially significant. A Lancet Global Health analysis found that gender inequalities in health and well-being emerge during early childhood and persist through adolescence, particularly in low- and middle-income countries (Kennedy et al., 2020). Similarly, Daghagh Yazd (2023) demonstrated that higher levels of gender inequality within societies are correlated with poorer health outcomes among children, underscoring how systemic discrimination reinforces disparities.

These inequities are also compounded by broader social determinants. A systematic review revealed that factors such as poverty, parental education, and limited healthcare access increase children’s vulnerability to adverse outcomes, including maltreatment and chronic illness (Hunter & Flores, 2021). Further evidence shows that children with special healthcare needs are disproportionately affected by poverty and structural barriers. This emphasizes how overlapping disadvantages can magnify inequality (Van Cleave et al., 2022).

Inequalities are further reinforced by the ways health systems respond to crises. During the COVID-19 pandemic, for example, school closures and disruptions in essential services disproportionately harmed children from disadvantaged households, illustrating how systemic barriers intersect with social disadvantage to amplify disparities (Viner et al., 2020).

These findings show that child health inequalities cannot be understood through a single lens. Gender, poverty, healthcare access, and systematic responses all interact to create complex disparities that require long-term, multisectoral interventions.

APPROACHES TO TARGET HEALTH INEQUALITIES IN CHILDREN

Reducing health inequalities in children is a complex challenge that requires urgent cooperation among hospitals, schools, and governments. There are still major obstacles in successfully implementing policies targeting these health inequalities (Brewster et al., 2024; Hammami et al., 2022). This emphasizes the necessity of strong regulations and ongoing initiatives in this public health issue. We can integrate various research to highlight the improvements made so far and the existing challenges in tackling these disparities (Holding et al., 2021). Key study designs and findings for policy, hospital, and school approaches are summarized in Table 4.

Government Intervention

The effective development of various government interventions plays a crucial role in solving health inequalities among children (Ball et al., 2023; Holding et al., 2021). However, there are still notable challenges that need to be targeted. English national policy approaches to health inequalities often suffer from significant absences and narrow framings of inequality (Griffin et al., 2022). Although policies do exist, this review suggests that they may not be inclusive or extensive enough, indicating the need for more detailed and comprehensive policy frameworks.

Regional averages can obscure important health inequalities between countries, and national estimates may hide even greater disparities between subgroups (Sanhueza et al., 2021). It is extremely important to have precise data and focused treatments to successfully address particular vulnerabilities within populations (Holding et al., 2021).

On the other hand, there have been significant reductions in disparities for most nutritional indicators among Brazilian preschool children from 2006 to 2019, except for an increase in childhood anemia in the North region (Cardoso et al., 2023). This suggests that although improvement is possible, it is frequently uneven and that more attention may be needed in certain areas than others. Together, these results demonstrate the complexity of governmental actions and the requirement for ongoing policy review and modification.

Hospital-Based Interventions

Hospitals also play a critical role in addressing health inequalities, but face substantial challenges. For instance, hospital staff in England consider resolving health inequities as a shared but unclear responsibility (Brewster et al., 2024). Leaders across England’s integrated care systems similarly report conceptual, cultural, capacity, and resource barriers, indicating that better alignment of policy, processes, and resources is required for hospital-based interventions to be effective (Alderwick et al., 2024).

Children's hospitals serve as effective sites for public health interventions, particularly those with committed staff and comprehensive methods (Brennan et al., 2024). Hospitals can make an important contribution to reducing health inequalities among children if they are given the right resources and organized initiatives (Brewster et al., 2024).

Despite improvements in the reduction of infectious diseases, they persist as a significant risk to children's health in low- and middle-income countries (LMICs), especially for disadvantaged groups, according to Besnier et al. (2019). Thus, hospitals are responsible for putting in continuous efforts in the prevention and treatment of infectious diseases, particularly in environments with limited resources. Although hospitals have the ability to address health inequalities, they require consistent funding and targeted strategies to do so effectively (Brennan et al., 2024; Besnier et al., 2019).

School-Based Interventions

Schools are effective platforms for narrowing health gaps when interventions target diet and mental well-being together. A Norwegian school-meal trial found that providing a free, healthy lunch for one school year increased children’s intake of nutritious foods, with larger gains among lower-SES pupils (Vik et al., 2019). Broader policy evidence points the same way: systematic reviews of universal free school meals (UFSM) report higher meal participation and signals of improved health/behavioral outcomes, though effects on some endpoints remain mixed—underscoring the need for rigorous implementation and evaluation (Cohen et al., 2021; Spill et al., 2024).

By reducing loneliness, providing nutritious food, and offering opportunities for social engagement, school holiday interventions also reduce socioeconomic disparities in mental health and well-being (Morgan et al., 2019). Schools can be highly beneficial in reducing the negative effects that socioeconomic deprivation has on children's psychological well-being.

Scaling school-based programs consistently runs into funding, implementation, and administrative hurdles. Reviews of school mental-health and nutrition initiatives note gaps in implementation capacity, evaluation frameworks, and long-term financing. These are barriers that can blunt impact even when interventions are promising (Heinrich et al., 2023; O’Byrne et al., 2024). Although school-based interventions show potential, their successful growth and sustainability require careful design and strong support (Vik et al., 2019).

Reducing child health inequalities ultimately requires coordinated action across policy, hospitals, and schools. On the provider side, children’s hospitals worldwide are mobilizing but highlight the need for clearer frameworks and resources to address inequities effectively (Brennan et al., 2024). School systems, for their part, can reduce nutritional and psychosocial risks when programs are properly funded and delivered at scale (Cohen et al., 2021; Spill et al., 2024)

CONCLUSION

Health inequalities in childhood are patterned by social, economic, and environmental conditions, and they emerge early, compound over time, and span both physical and mental health. Across settings, we identified consistent gradients by socioeconomic position, geography, and education, with disadvantaged children facing lower access to preventive care, higher exposure to adverse environments, and more barriers to timely treatment (see Table 3). The COVID-19 pandemic did not create these gaps but amplified them, exposing how fragile protections can be for families with the fewest resources.

Closing these gaps requires action on two fronts. First, address the conditions that create risk: fairer social and educational systems, and targeted, place-based investment where need is greatest. Second, improve the services children encounter: earlier access pathways, clear equity mandates, and sustained resources in hospitals and schools. The strongest levers we reviewed align with these goals—more inclusive policies, hospital initiatives with explicit accountability for inequalities, and school programmes that combine nutrition with psychosocial support and are built for scale, quality, and reach (see Table 4).

In conclusion, progress requires disciplined implementation and continuous learning. Disaggregated monitoring reveals who benefits and who does not. A genuine partnership with communities ensures cultural and contextual fit. Finally, evaluation must track outcomes and equity, not one without the other. Reducing child health inequalities is not a single intervention but a coordinated, long-term project. With sustained policy commitment, accountable health systems, and strong school–community partnerships, we should guarantee that every child, regardless of their social or economic circumstances, has the chance to develop their full potential by addressing these disparities effectively.

Take home messages

Addressing childhood health inequalities is crucial for achieving Sustainable Development Goal 3 (Good Health and Well-Being). These disparities, driven by socioeconomic status, geographical location, and educational access, impact both physical and mental health. The COVID-19 pandemic worsened existing inequalities, disproportionately affecting children in marginalized communities. Targeted policy interventions—including expanding healthcare access, improving health literacy, and integrating social support services—are necessary to bridge these gaps. Governments, hospitals, and educational institutions must collaborate to develop sustainable solutions that ensure equitable health outcomes for all children.

NOTES

Funding

No financial support was provided for research conduct and/or preparation of the article.

Conflict of interests

This work was supported by the Yonsei Fellowship, funded by Lee Youn Jae (JIS). This project was undertaken within the framework of a research internship organized by the Severance Underwood Meta-research Center during the 2024 Yonsei International Summer School (Research Mentor: JAE IL SHIN).

Data Availability

The data supporting the findings of this review are based on previously published studies and publicly available data, as detailed in the references section.

Figure 1.

Conceptual Framework of Health Inequalities in Children.

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