Comparative social costs of six early years disadvantages: a birth cohort microsimulation study

BACKGROUND: Policymakers lack comparative information about the social costs of specific early disadvantages. We compared six policy-relevant childhood (0-5 years) disadvantages and their diverse social costs over 17 years for the UK and Bradford (a multi-ethnic district of about 550 000 in the northeast of England with high levels of deprivation). METHODS: Using a microsimulation model, we compared the harms to well-being (proxied by parent-reported emotional problems), health and educational attainment and government spending (such as inpatient NHS costs) up to age 17 of the following: having a teenage mother, preterm birth, low birthweight-for-gestational-age, low height-for-age-and-sex (age 5), disability (age 5) and cognitive delay (age 5). We modelled a UK birth cohort born in 2000 and a Bradford cohort born in 2019 based on local prevalence data, uprated to 2023 prices and discounted at 3.5%. RESULTS: Disability imposed the highest per-child cost, with a well-being loss of 7.2 WELLBYs (CI 6.1 to 8.2; monetised value £89 k) and public cost £64 k (CI £37 k-£91 k) per child by age 17. Cognitive delay had a smaller per-child loss of 3.8 WELLBYs (3.2-4.5), but the largest population-level loss was in both the UK and Bradford at 728K WELLBYs (600 K-856K; monetised value £9,044 m) and £5,588 m (£1,872-£9,303) public cost per cohort of 679 000 children born in the UK. Monetised well-being loss is almost always higher than public cost and sometimes more than twice as high. CONCLUSIONS: Cognitive delay at 5 years of age imposed larger total social costs than the other early disadvantages. For an individual child, however, well-being loss was most affected by disability or having a teenage mother.