International research has demonstrated links between residential mobility in childhood, and adverse health, social, educational, and physiological outcomes in children. Aotearoa New Zealand (hereafter Aotearoa) is a highly mobile population, with particularly high levels of residential mobility among young people. This is correlated with structural and societal factors such as housing tenure, income, maternal education, and ethnicity. Because high levels of residential mobility are associated with both poorer health outcomes and markers of socioeconomic disadvantage (that are in themselves associated with poorer health outcomes and disproportionately experienced by tamariki Māori and Pacific children in Aotearoa), it is possible that residential mobility may be exacerbating existing child health inequities.One pathway through which this may occur is via unmet healthcare needs. Some international evidence suggests that children experiencing high levels of residential mobility are less likely to receive routine childhood immunisations. In Aotearoa, residential mobility has been associated with incomplete B4 School checks (a key general practitioner visit assessing children's health and development prior to primary school entry), although it is unclear the extent to which these findings may have been influenced by other sociodemographic factors that are also associated with barriers to accessing healthcare. Furthermore, there is little research evidence on whether and how the specific timing and frequency of residential mobility across early childhood influences both unmet healthcare needs and child health outcomes.
This study therefore sets out to answer four primary research questions:
- What are children’s experiences of residential mobility across early childhood?
- Which factors are associated with different types of residential mobility patterns?
- Are patterns of residential mobility associated with children’s unmet health care needs?
- Are these patterns of residential mobility associated with children’s health at 8 years, and does unmet need explain part of this association?
Using longitudinal data from Growing Up in New Zealand, over 5,000 children were followed from antenatal (data collected in 2009/10) through to when they were 8-years old (2018) to examine experiences of residential mobility across early childhood (through to 54-months) and how these may influence unmet healthcare need and child health outcomes (at 54-months and 8-years).
Social sequence analysis was applied to examine patterns of residential mobility across early childhood by grouping together children with similar residential mobility experiences. Multinomial regressions were used to explore whether sociodemographic factors, such as maternal education attainment, household income, and family structure, were associated with children’s residential mobility trajectories. A further set of regression models examined whether residential mobility trajectories were associated with children’s unmet healthcare need and their health. At each study wave information on the number of residential moves since the prior wave was collected. Children not moving house between waves were categorised as ‘stability.’ One move was considered ‘low mobility,’ two moves were classed as ‘high mobility’, while three or more moves were considered ‘very high mobility.’
The research found that 12 percent of children experienced a transition from relative stability in the earliest years to high or very high residential mobility. Experiences of higher residential mobility were found to be associated with unmet healthcare needs. This negative association was strongest for children experiencing a transition to very high residential mobility, where children had moved three or more times between data collection waves.
The research did not find strong associations between early childhood residential mobility trajectories and child health. Any associations were either attenuated once socioeconomic characteristics were controlled for, or if the association remained it was weaker than the association between socioeconomic characteristics and child health.
Overall, the research confirms previous findings that many young children in Aotearoa are not residentially stable. Findings also indicate that stable housing has benefits for children's access to healthcare and, to a lesser extent, child health. Researchers recommend that policies should ensure that all children have access to stable housing. In addition, public health interventions and healthcare delivery should recognise that residential mobility may disrupt children's access to healthcare.