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Research in relation to equity: extending the agenda.

An appreciation of the role of social and emotional well-being in determining health outcomes is important in advancing the equity agenda.(1) These aspects of health are adversely affected by inequity. They also are important as potential causal factors. Low levels of emotional and social well-being among the rich may be important in perpetuating health and social inequity. In the past, most research on inequity has focused on the negative end of the continuum of emotional and social health (eg, child abuse, conduct disorder, mental illness, drug and alcohol abuse) and concentrated on the problems of the poor, not the rich. The prevalence of emotional and social well-being has not been well studied. At the other end of the spectrum, emotional and behavioral problems now are the most important cause of disability in childhood,(2) affecting between 10% and 20% of children.(3) In between these 2 extremes, some children are socially competent, are liked by their peers, are resilient in the face of problems, know their own minds, are kind to others, and are able to handle conflict in a way that leads to resolution. Others are prone to aggression and deceit, are ostracized by their peer group, and create conflict and distress. These children may have very low self-esteem. They often are manifestly unhappy and anxious and certainly make others unhappy and anxious. This group may not meet the Diagnostic and Statistical Manual of Mental Disorders-defined criteria for emotional and behavioral problems; teachers therefore may be more aware of them and their impact on others than physicians. As a result, teachers and educational psychologists have been at the forefront of developing interventions to help this group.